The effect of pain on gait in older people: A systematic review and meta-analysis

Multi-site pain is common in people aged 60 years and over and is associated with a high risk of falls. To prevent and treat pain-related disabilities, it is crucial to identify the mechanisms underlying these associations. There is some evidence that pain leads to changes in walking, such as slower gait speed and shorter walking distance, which impair mobility and may increase the risk of falls. This review evaluated evidence on the relationship between pain and gait characteristics in older people. A comprehensive search on PubMed and Embase included observational studies and clinical trials assessing objective measures of walking, such as gait speed, cadence, stride length, and double-limb support time, in older people with and without pain. Of the 1218 studies screened, thirteen met the inclusion criteria from the primary search. An additional study was identified through the secondary search, resulting in fourteen studies included in this systematic review and meta-analysis. None of these studies investigated the relationship between fear of pain and gait characteristics in older people. Results showed that older people with pain had slower gait speed than those without pain, with a small effect size (Hedge's g = -0.30, 95% CI = -0.41 to -0.19, p < 0.0001). There were no statistically significant differences in cadence, stride length, and double-limb support time. These findings suggest that pain impacts walking speed in older people, highlighting the importance of addressing this association to manage mobility deficits and fall risk. PERSPECTIVE: This systematic review and meta-analysis show that pain is associated with reduced gait speed in older people. Recognising and addressing the impact of pain on walking may be important for preventing mobility-related disorders and falls in this population.