Una E Makris1, Tracy M Paul2, Nicole E Holt3, Nancy K Latham4, Pengsheng Ni5, Alan Jette6, Suzanne G Leveille7, Jonathan F Bean8. 1. Department of Internal Medicine, UT Southwestern Medical Center and Dallas VAMC, 5323 Harry Hines Blvd, Dallas, TX 75390-9169(∗). Electronic address: una.makris@utsouthwestern.edu. 2. Case Western Reserve University School of Medicine, Cleveland, OH(†). 3. Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA(‡). 4. Health Policy and Management, Boston University, Boston, MA(§). 5. Health Policy and Management, Boston University, Boston, MA(¶). 6. Health Policy and Management, Boston University, Boston, MA(#). 7. College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA(‖). 8. Department of Physical Medicine and Rehabilitation, New England GRECC, VA Boston Healthcare System; Department of PM&R, Harvard Medical School; Spaulding Rehabilitation Hospital, Boston, MA(∗∗).
Abstract
BACKGROUND: For older adults with mobility problems, one focus of rehabilitation is treating the underlying neuromuscular impairment(s) that lead to functional decline and disability. Knowing which neuromuscular impairments contribute to basic mobility tasks among older adults with back pain will fill an important knowledge gap and is a critical step towards developing mechanistically based rehabilitative interventions. OBJECTIVE: To evaluate the relationship of neuromuscular impairments with performance of mobility tasks among older adults with and without back pain. DESIGN: Cross-sectional analysis of baseline data from the Boston Rehabilitative Impairment Study of the Elderly. SETTING: Primary care-based population. PATIENTS: Participants (N = 430) were older primary care patients who completed assessments of neuromuscular impairments and mobility tasks. METHODS: Back pain was assessed by the use of an established comorbidity questionnaire. Neuromuscular impairments included trunk extensor muscle endurance, kyphosis, leg strength, leg strength asymmetry, leg speed, mean reaction time, leg coordination, and knee and ankle range of motion. MAIN OUTCOME MEASUREMENTS: Mobility tasks included gait speed, standing balance, chair stand, and patient-reported functional status. Analysis of covariance was used to generate adjusted means for neuromuscular impairments that differed significantly by back pain status. Separate multivariable regression models evaluated the association between neuromuscular impairments and mobility based on back pain status after we adjusted for sociodemographic factors and physiologic impairments. RESULTS: Participants had an average age of 77 years, 68% were female, and 31% reported back pain. Trunk extensor muscle endurance, leg strength, and rapid leg coordination were significantly lower among those with back pain compared to those without (P < .01, P = .01, P = .04, respectively). Patterns of neuromuscular impairments that were associated with mobility tasks differed according to back pain status. CONCLUSIONS: The neuromuscular impairment profiles associated with mobility function among older adults with back pain vary compared with older adults without back pain.
BACKGROUND: For older adults with mobility problems, one focus of rehabilitation is treating the underlying neuromuscular impairment(s) that lead to functional decline and disability. Knowing which neuromuscular impairments contribute to basic mobility tasks among older adults with back pain will fill an important knowledge gap and is a critical step towards developing mechanistically based rehabilitative interventions. OBJECTIVE: To evaluate the relationship of neuromuscular impairments with performance of mobility tasks among older adults with and without back pain. DESIGN: Cross-sectional analysis of baseline data from the Boston Rehabilitative Impairment Study of the Elderly. SETTING: Primary care-based population. PATIENTS: Participants (N = 430) were older primary care patients who completed assessments of neuromuscular impairments and mobility tasks. METHODS:Back pain was assessed by the use of an established comorbidity questionnaire. Neuromuscular impairments included trunk extensor muscle endurance, kyphosis, leg strength, leg strength asymmetry, leg speed, mean reaction time, leg coordination, and knee and ankle range of motion. MAIN OUTCOME MEASUREMENTS: Mobility tasks included gait speed, standing balance, chair stand, and patient-reported functional status. Analysis of covariance was used to generate adjusted means for neuromuscular impairments that differed significantly by back pain status. Separate multivariable regression models evaluated the association between neuromuscular impairments and mobility based on back pain status after we adjusted for sociodemographic factors and physiologic impairments. RESULTS:Participants had an average age of 77 years, 68% were female, and 31% reported back pain. Trunk extensor muscle endurance, leg strength, and rapid leg coordination were significantly lower among those with back pain compared to those without (P < .01, P = .01, P = .04, respectively). Patterns of neuromuscular impairments that were associated with mobility tasks differed according to back pain status. CONCLUSIONS: The neuromuscular impairment profiles associated with mobility function among older adults with back pain vary compared with older adults without back pain.
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