Department of Physical Therapy, University of Pittsburgh, Pennsylvania.
Department of Physical Therapy, University of Delaware, Newark.
J Geriatr Phys Ther. 2019 Oct/Dec;42(4):E97-E104. doi: 10.1519/JPT.0000000000000212.
Chronic low back pain with radiculopathy (CLBPR) is common among older adults and can lead to walking difficulty. Energy cost of walking strongly predicts changes in walking speed, which is predictive of mortality in older adults. The purposes of this study were to examine (1) the impact of pain provocation on the energy cost of walking and (2) the relationship between pain intensity and change in energy cost of walking.
Older adults (60-85 years) with (n = 20) and without (n = 20) CLBPR were matched on age, sex, and diabetes presence/absence. Energy cost of walking was measured with a portable metabolic gas analyzer, as participants walked for 20 minutes or less. Energy cost and pain measurements occurred during early and late stages of walking. Percent change in energy cost was calculated. Participants were grouped by their pain response during walking: increased pain (n = 13); consistent pain (n = 7); no pain, matched to individuals with increased pain (n = 13); and no pain, matched to individuals with consistent pain (n = 7). We examined the within-groups change in energy cost for all groups, as well as the relationship between late-stage pain intensity and percent change of energy cost for individuals whose pain increased.
Within the increased pain group, energy cost of walking significantly increased from early to late stages (median change = 0.003 mL/kg/m, P = .006), and late-stage pain intensity explained 41.2% (p = 0.040) of the variance in percent change. Since pain appears to be linked to energy cost, effective pain management with walking may be an important factor in preventing mobility decline.
Among older adults with CLBPR, pain provocation drives increases in the energy cost of walking. Because high energy cost of walking is predictive of mobility decline, clinicians may focus on effective pain management strategies during walking, which may potentially decrease the risk of mobility decline.
伴有根性病变的慢性下腰痛（CLBPR）在老年人中很常见，可导致行走困难。行走的能量消耗强烈预测行走速度的变化，而行走速度的变化可预测老年人的死亡率。本研究的目的是：（1）检查疼痛诱发对行走能量消耗的影响；（2）疼痛强度与行走能量消耗变化之间的关系。
将（n = 20）伴有和不伴有（n = 20）CLBPR 的老年人按年龄、性别和糖尿病存在/缺失进行匹配。使用便携式代谢气体分析仪测量行走 20 分钟或更短时间内的行走能量消耗。在行走的早期和晚期进行能量消耗和疼痛测量。计算能量消耗的百分比变化。根据参与者在行走过程中的疼痛反应对其进行分组：疼痛增加（n = 13）；疼痛持续（n = 7）；无疼痛，与疼痛增加的个体相匹配（n = 13）；无疼痛，与疼痛持续的个体相匹配（n = 7）。我们检查了所有组内能量消耗的变化，以及疼痛增加个体的晚期疼痛强度与能量消耗百分比变化之间的关系。
在疼痛增加组中，行走的能量消耗从早期到晚期显著增加（中位数变化= 0.003 mL/kg/m，P =.006），晚期疼痛强度解释了能量消耗百分比变化的 41.2%（p = 0.040）。由于疼痛似乎与能量消耗有关，因此通过行走进行有效的疼痛管理可能是预防活动能力下降的重要因素。
在伴有 CLBPR 的老年人中，疼痛诱发会增加行走的能量消耗。由于高能量消耗与活动能力下降有关，因此临床医生可能会在行走期间专注于有效的疼痛管理策略，这可能潜在地降低活动能力下降的风险。
