A cognitive dual task affects gait variability in patients suffering from chronic low back pain

Chronic pain and gait variability in a dual-task situation are both associated with higher risk of falling. Executive functions regulate (dual-task) gait variability. A possible cause explaining why chronic pain increases risk of falling in an everyday dual-task situation might be that pain interferes with executive functions and results in a diminished dual-task capability with performance decrements on the secondary task. The main goal of this experiment was to evaluate the specific effects of a cognitive dual task on gait variability in chronic low back pain (CLBP) patients. Twelve healthy participants and twelve patients suffering from CLBP were included. The subjects were asked to perform a cognitive single task, a walking single task and a motor-cognitive dual task. Stride variability of trunk movements was calculated. A two-way ANOVA was performed to compare single-task walking with dual-task walking and the single cognitive task performance with the motor-cognitive dual-task performance. We did not find any differences in both of the single-task performances between groups. However, regarding single-task walking and dual-task walking, we observed an interaction effect indicating that low back pain patients show significantly higher gait variability in the dual-task condition as compared to controls. Our data suggest that chronic pain reduces motor-cognitive dual-task performance capability. We postulate that the detrimental effects are caused by central mechanisms where pain interferes with executive functions which, in turn, might contribute to increased risk of falling.