Hirase Tatsuya, Okubo Yoshiro, Menant Jasmine, Lord Stephen R, Sturnieks Daina L
Department of Physical Therapy Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia.
Age Ageing. 2020 Oct 23;49(6):982-988. doi: 10.1093/ageing/afaa070.
pain is associated with increased postural sway and falls in older adults. However, the impact of pain on reactive balance induced by postural perturbations and how this might predispose older adults to falls is not known.
to investigate whether any pain, back/neck pain and lower limb pain are associated with poor reactive balance and prospective fall outcomes in older adults.
12-month prospective cohort study.
community.
242 community-dwelling older adults aged 70+ years.
participants completed a questionnaire on the presence of pain and underwent force-controlled waist-pull postural perturbations while standing. Force thresholds for stepping, step initiation time, step velocity and step length were quantified. Falls were monitored with monthly falls calendars for 12-months.
participants with lower limb pain had significantly lower force thresholds for stepping. Those with any pain or pain in the back/neck had longer step initiation time, slower step velocity and shorter step length. The three pain measures (any pain, back/neck pain, lower limb pain) were significantly associated with multiple falls when adjusted for age, sex, body mass index, use of polypharmacy, strength and walking speed. In mediation analyses, there was a significant indirect effect of reactive balance for the relationship between back/neck pain and falls with fractures.
older people with pain have impaired reactive balance and an increased risk of falls. Reactive balance partially mediated the association between pain and fall-related fractures. Further research is required to confirm the findings of this study.
疼痛与老年人姿势摇摆增加及跌倒有关。然而，疼痛对姿势扰动引起的反应性平衡的影响以及这如何使老年人易发生跌倒尚不清楚。
研究任何疼痛、背部/颈部疼痛和下肢疼痛是否与老年人反应性平衡差和未来跌倒结局有关。
12个月的前瞻性队列研究。
社区。
242名年龄在70岁及以上的社区居住老年人。
参与者完成一份关于疼痛存在情况的问卷，并在站立时接受力控制的腰部牵拉姿势扰动。对迈步的力阈值、迈步起始时间、步速和步长进行量化。通过每月的跌倒日历监测12个月的跌倒情况。
下肢疼痛的参与者迈步的力阈值显著更低。有任何疼痛或背部/颈部疼痛的参与者迈步起始时间更长、步速更慢且步长更短。在对年龄、性别、体重指数、多种药物使用、力量和步行速度进行调整后，这三种疼痛指标（任何疼痛、背部/颈部疼痛、下肢疼痛）与多次跌倒显著相关。在中介分析中，反应性平衡对背部/颈部疼痛与跌倒伴骨折之间的关系有显著的间接影响。
有疼痛的老年人反应性平衡受损，跌倒风险增加。反应性平衡部分介导了疼痛与跌倒相关骨折之间的关联。需要进一步研究来证实本研究的结果。
