Review Article| Volume 21, ISSUE 5, P597-603.e8, May 2020

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Pain Is Associated With Poor Balance in Community-Dwelling Older Adults: A Systematic Review and Meta-analysis

  • Tatsuya Hirase
    Address correspondence to Tatsuya Hirase, PhD, PT, Department of Physical Therapy Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8520, Japan.
    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
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  • Yoshiro Okubo
    Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia

    Faculty of Medicine, University of New South Wales, Sydney, Australia
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  • Daina L. Sturnieks
    Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia

    Faculty of Medicine, University of New South Wales, Sydney, Australia
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  • Stephen R. Lord
    Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia

    Faculty of Medicine, University of New South Wales, Sydney, Australia
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      Pain is a risk factor for falls in older adults, but the mechanisms are not well understood, limiting our ability to implement effective preventive strategies. The aim of this study was to systematically review and synthesize the literature that has examined the impact of pain on static, dynamic, multicomponent, and reactive balance in community-dwelling older adults.


      Systematic review and meta-analysis.

      Setting and Participants

      Studies from inception to March 2019 were identified from electronic databases (MEDLINE, EMBASE, PsycINFO, CINAHL), contact with the primary authors, and reference lists of included articles.


      Cross-sectional and case-control studies that compared objective balance measures between older (minimum age 60 years) adults with and without pain were included.


      Thirty-nine eligible studies (n = 17,626) were identified. All balance modalities (static, dynamic, multicomponent, and reactive) were significantly poorer in participants with pain compared to those without pain. Subgroup analyses revealed that chronic pain (pain persisting ≥3 months) impaired balance more than pain of unspecified duration. The effects of pain at specific sites (neck, lower back, hip, knee, and foot) on balance were not significantly different.

      Conclusions and Implications

      Pain is associated with poor static, dynamic, multicomponent, and reactive balance in community-dwelling older adults. Pain in the neck, lower back, hip, knee, and foot all contribute to poor balance, and this is even more pronounced for chronic pain. Comprehensive balance and pain characteristic assessments may reveal mechanisms underlying the contribution of pain to instability and increased fall risk in older people.


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