IDENTIFICATION OF POSTURAL CONTROL SYSTEM IMPAIRMENTS IN OLDER ADULTS WITH CHRONIC NECK PAIN

Abstract

Chronic neck pain (CNP) can affect postural control among older adults. Gait performance, in terms of gait speed and symmetry, is an indicator of dynamic postural control. The Balance Evaluation Systems Test (BESTest) is used to assess the systems of postural control. This study aims to determine which gait variables were more sensitive to dynamic postural control among older adults with CNP and assessed that BESTest could identify postural control impairments in CNP and item difficulty by Rasch analysis. This cross-sectional study recruited 30 young adults (YOUNG), aged 20-40 years, and 80 older adults, aged 60 years or older [without neck pain (OLD) = 60, with chronic neck pain (CNP) = 20]. Questionnaires were used to collect demographic data, neck pain intensity, self-rated neck pain and disability, and balance confidence. The 10-Meter Walk test was used to assess gait performance with three different conditions: no head movement (NM), horizontal head movement (HM), and vertical head movement (VM). BESTest was used to assess postural control. The Inertial Measurement Unit was used to capture and analyze gait parameters. The CNP group reported moderate pain and zero to mild disability in daily activities. Balance confidence was moderately correlated with gait speed (r=0.62) and moderately inversely correlated with gait asymmetry during HM and VM (-0.56 and -0.69, respectively). The CNP group showed slower gait speed during HM and VM (p<0.05), lower stride length and cadence. The gait asymmetry index in the CNP group was higher than the OLD group in VM (p<0.05). Thus, gait speed with a head movement was more sensitive. Compared to the YOUNG group, the BESTest score was lower in the OLD group, the CNP group had the lowest score, in biomechanical constraints, transitions-anticipatory postural adjustment and reactive postural response (p< 0.05). The BESTest was the most accurate of the three was 48.5 of 51 for older adults whose daily life were affected by neck problems with a high AUC (0.79), sensitivity (72%), and specificity (69%). The Timed Up and Go was the most difficult BESTest item for all groups, while 14 items had more difficulty for the CNP group. BESTest can identify postural control impairments in older adults affected by CNP and help clinicians consider management to prevent falls in CNP.

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