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      Pain Intensity and Functional Outcomes for Activities of Daily Living, Gait and Balance in Older Adults Accessing Outpatient Rehabilitation Services: A Retrospective Study

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          Abstract

          Purpose

          Older adults are referred for outpatient physical therapy to improve their functional capacities. The goal of the present study was to determine if pain had an influence on functional outcomes in older adults who took part in an outpatient physical rehabilitation program.

          Patients and Methods

          A retrospective study was performed on the medical records of patients aged 65 and over referred for outpatient physical therapy to improve physical functioning (n=178). Pain intensity (11-point numeric pain scale) and results from functional outcome measures (Timed Up and Go [TUG], Berg Balance Scale [BBS], 10-meter walk test, 6-minute walk test and Functional Autonomy Measuring System [SMAF]) were extracted at initial (T1) and final (T2) consultations. Paired t-tests were performed to determine if there were differences in functional outcome measures between T1 and T2 in all the patients. Patients were stratified to those with pain (PAIN, n=136) and those without pain (NO PAIN, n=42). Differences in functional outcome measures between T1 and T2 (delta scores) were compared between groups with independent t-tests with Welch corrections for unequal variances. Pearson correlation coefficients between initial pain intensity and changes in functional outcome measures (T2-T1) were also performed. Correcting for multiple comparisons, a p-value of p≤0.01 was considered as statistically significant.

          Results

          The TUG, BBS, 10-meter walk test, 6-minute walk test all demonstrated improvement between T1 and T2 (all p<0.01). There was no difference between groups for delta scores for TUG (p=0.14), BBS (p=0.03), 10-meter walk test (p=0.54), 6-minute walk test (p=0.94) and SMAF (p=0.23). Pearson correlation coefficients were weak between initial pain intensity and changes in functional outcome scores between T1 and T2 (r= −0.16 to 0.15, all p-values >0.10).

          Conclusion

          These results suggest that pain is not an impediment to functional improvements in older individuals who participated in an outpatient physical rehabilitation program.

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          Most cited references 53

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          Clinical and laboratory measures of postural balance in an elderly population.

          The objective of this cross-sectional study was to compare scores on the Balance Scale with laboratory measures of postural sway and other clinical measures of balance and mobility. Thirty-one elderly subjects were assessed on the clinical measures and the laboratory tests of postural sway while standing still and in response to pseudorandom movements of the platform. The average correlation between the Balance Scale and the spontaneous sway measures was -.55. It was slightly lower (r = -.38) for the same parameters measured during the pseudorandom tests. There were high correlations between the Balance Scale and the Balance Sub-Scale developed by Tinetti (r = .91), Barthel Mobility sub-scale (r = .67), and timed "Up and Go" (r = -.76). The Balance Scale was the most efficient measure (effect size > 1) to statistically discriminate between subjects according to their use of each type of mobility aide (walker, cane, no aids). These data contribute to existing information on the performance of the Balance Scale and supports the validity of the Balance Scale in this geriatric population.
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            Systems neuroplasticity in the aging brain: recruiting additional neural resources for successful motor performance in elderly persons.

             Sofie Heuninckx,  Nicole Wenderoth,  Stephan Swinnen (corresponding) (2008)
            Functional imaging studies have shown that seniors exhibit more elaborate brain activation than younger controls while performing motor tasks. Here, we investigated whether this age-related overactivation reflects compensation or dedifferentiation mechanisms. "Compensation" refers to additional activation that counteracts age-related decline of brain function and supports successful performance, whereas "dedifferentiation" reflects age-related difficulties in recruiting specialized neural mechanisms and is not relevant to task performance. To test these predictions, performance on a complex interlimb coordination task was correlated with brain activation. Findings revealed that coordination resulted in activation of classical motor coordination regions, but also higher-level sensorimotor regions, and frontal regions in the elderly. Interestingly, a positive correlation between activation level in these latter regions and motor performance was observed in the elderly. This performance enhancing additional recruitment is consistent with the compensation hypothesis and characterizes neuroplasticity at the systems level in the aging brain.
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              • Article: not found

              Predicting the probability for falls in community-dwelling older adults.

              The objective of this retrospective case-control study was to develop a model for predicting the likelihood of falls among community-dwelling older adults. Forty-four community-dwelling adults (> or = 65 years of age) with and without a history of falls participated. Subjects completed a health status questionnaire and underwent a clinical evaluation of balance and mobility function. Variables that differed between fallers and nonfallers were identified, using t tests and cross tabulation with chi-square tests. A forward stepwise regression analysis was carried out to identify a combination of variables that effectively predicted fall status. Five variables were found to be associated with fall history. These variables were analyzed using logistic regression. The final model combined the score on the Berg Balance Scale with a self-reported history of imbalance to predict fall risk. Sensitivity was 91%, and specificity was 82%. A simple predictive model based on two risk factors can be used by physical therapists to quantify fall risk in community-dwelling older adults. Identification of patients with a high fall risk can lead to an appropriate referral into a fall prevention program. In addition, fall risk can be used to calculate change resulting from intervention.
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                JPR
                jpainres
                Journal of Pain Research
                Dove
                1178-7090
                07 August 2020
                2020
                : 13
                : 2013-2021
                Affiliations
                [1 ]School of Rehabilitation, Faculty of Medicine, Université de Montréal , Montreal, Quebec, Canada
                [2 ]Research Center on Aging, Centre intégré universitaire de santé et de services sociaux de l’Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l’Estrie - CHUS) , Sherbrooke, Quebec, Canada
                [3 ]School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke , Sherbrooke, Quebec, Canada
                Author notes
                Correspondence: G Leonard Email guillaume.leonard2@usherbrooke.ca
                Article
                256700
                10.2147/JPR.S256700
                7423354
                © 2020 Pelletier et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Tables: 5, References: 68, Pages: 9
                Categories
                Original Research

                Anesthesiology & Pain management

                older adults, disability, physical therapy, pain, function

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