Objective: Determine the influence of pain on balance confidence, functional lower limb strength and prospective falls in a cohort of newly diagnosed Parkinson’s disease (PD).

Background: Pain is reported by up to 85% of people with PD^,1. People with PD experience twice as many falls as the general older population.² Pain is related to an increased falls risk in older adults³ and is associated with poorer balance.^4, However, the relation between pain and falls has not been extensively investigated in PD.

Method: A recently diagnosed PD cohort were recruited to ICICLE-Gait, a nested study within Incidence of Cognitive Impairment in Cohorts with Longitudinal Evaluation-PD (ICICLE-PD). Information about pain was collected at baseline assessment using the Non-motor Symptom Questionnaire. Prospective falls data were collected via monthly falls diaries with telephone follow-up. The five-times sit-to-stand was used for functional lower limb strength and the activities-specific balance confidence scale (ABC). Relative risk (RR) was calculated for the presence of pain and a fall in the subsequent 18 months. A repeated measures ANOVA was used to test the interaction of within- (assessment) and between-group (pain reported) scores after controlling for age.

Results: After exclusions, 119 PD participants completed the baseline assessment. 54 participants experienced at least one fall in the 18 months follow up. There was no significant increased risk of falls for people who experience pain at baseline (RR=1.10, CI: 0.7-1.6, p=0.64). Participants who experienced pain at baseline had poorer balance confidence(main effect for pain, p=.035) and demonstrated a greater reduction of balance confidence over 18 months (interaction effect:, p=0.037). A significant assessment by pain interaction (p=0.049) indicated that the sit-to-stand duration increased more for people who experienced pain at baseline.

Conclusion: Self-reported balance confidence may deteriorate more quickly in people with PD who experience pain early in the disease.

References: 1.Silverdale, M. A., Kobylecki, C., Kass-Iliyya, L., Martinez-Martin, P., Lawton, M., Cotterill, S.,& UK Parkinson’s Pain Study Collaboration. (2018). A detailed clinical study of pain in 1957 participants with early/moderate Parkinson’s disease. Parkinsonism & related disorders, 56, 27-32. 2.Canning, C. G., Paul, S. S., & Nieuwboer, A. (2014). Prevention of falls in Parkinson’s disease: a review of fall risk factors and the role of physical interventions. Neurodegenerative disease management, 4(3), 203-221. 3.Stubbs, B., Binnekade, T., Eggermont, L., Sepehry, A. A., Patchay, S., & Schofield, P. (2014). Pain and the risk for falls in community-dwelling older adults: systematic review and meta-analysis. Archives of physical medicine and rehabilitation, 95(1), 175-187. 4.Hirase, T., Okubo, Y., Sturnieks, D. L., & Lord, S. R. (2020). Pain is associated with poor balance in community-dwelling older adults: a systematic review and meta-analysis. Journal of the American Medical Directors Association, 21(5), 597-603.

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