Pain and fractures are independently related to lower walking speed and grip strength: Results from the population study “Good Ageing in Skåne”

Figures & data

Flow chart showing inclusion and dropout of study participants.

Table 1.  Comparison of mean age, sex, number and time since last fracture, marital status, education, walking aid, health variables, MMSE, medication and intensity, frequency, duration, location and relief of pain, between fractured in pain, fractured with no or mild pain and controls without pain or with mild pain

	Fractured in pain n = 71	Fractured without pain n = 53	Controls without pain n = 165	P-value
Age (SD), years	82 (8.4)	83 (8.1)	82 (8.4)	0.8
Male/female, % (number)	25 (18) / 75 (53)	21 (11) / 79 (42)	32 (53) / 68 (112)	0.2
Number of fractures (SD)^a	1.7 (1.0)	1.6 (0.8)	–	0.9
Years since last fracture (SD)	7.7 (8.9)^b	7.0 (8.0)^c	–	0.8
Marital status, % (number)				0.2
Married/cohabitant	32 (23)	38 (20)	47 (77)
Unmarried	8 (6)	8 (4)	8 (14)
Widowed	54 (38)	54 (29)	42 (69)
Divorced	6 (4)	0	3 (5)
Education, % (number)				0.2
Elementary school not completed	3 (2)	0	2 (4)
Elementary school	51 (36)	64 (34)	64 (105)
Secondary school	38 (27)	24 (13)	21 (35)
1 ≥ year extra or university degree	8 (6)	13 (8)	10 (21)
Walking aid, % (number)
Indoor	42 (30)	26 (14)	8 (14)	<0.001
Out of doors	69 (49)	45 (29)	17 (29)	<0.001
Co-morbidity, % (number)
Cardiac/vascular disease	32 (23)	26 (14)	19 (31)	0.07^d
Respiratory disease (COPD/asthma)	8 (6)	13 (7)	5 (9)	0.9
Arthrosis of hip/knee	25 (18)	24 (13)	19 (32)	0.5
Parkinsonism	3 (2)	0	1 (1)	0.2
Minimal Mental State < 27p, % (number)	39 (28)	53 (28)	50 (82)	0.3
Medication with painkillers, % (number)	73 (52)	21 (11)	11 (18)	<0.001
Intensity of pain in the previous month, % (number) ^e
No/little pain	–	100 (53)	100 (165)
Moderate pain	63 (45)	–	–
Severe pain	37 (26)	–	–
Frequency of pain, % (number) ^e
None/once	–	76 (40)	86 (142)
A few times	39 (28)	24 (13)	14 (23)
Often	11 (8)	–	–
Every day	49 (35)	–	–
Duration of pain, % (number) ^e
None/about one minute	–	74 (39)	84 (138)
A few minutes	14 (10)	17 (9)	14 (24)
About one hour	27 (19)	9 (5)	2 (3)
Several hours	8 (6)	–	–
1 day or longer	51 (36)	–	–
Location of pain (%)
Neck /back	62 (44)	23 (12)	18 (29)	<0.001
Upper extremity	39 (28)	13 (7)	17 (28)	<0.001
Lower extremity	69 (49)	40 (21)	32 (53)	<0.001
Pain treatment, % (number) ^e	76 (54)	21 (11)	11 (19)	<0.001
Pain relief after treatment, % (number) ^e
100% relief	0	18 (2)	16 (3)	0.008
<50% relief	22 (12)	54 (6)	58 (11)	0.006

^a Among cases with pain and cases without pain, 45% (32) and 51% (27), respectively, had an earlier episode of hip fracture.

^b Median = 4.0, Q1 = 2.0, Q3 = 9.0.

^c Median = 3.0, Q1 = 2.0, Q3 = 8.0.

^d Comparison of subjects with fracture and pain and controls showed a signi?cant difference (p = 0.02)

^e In the previous month

Table 2.  Comparison of walking 15 m and 2 × 15 m at self-selected and maximal speed, Timed Get-Up-and-Go at self-selected and maximal speed, and maximal hand grip strength between fractured in pain, fractured without pain and controls without pain

	Fractured in pain n = 71			Fractured without pain n = 53			Controls without pain n = 165
	n	Median	Range	n	Median	Range	n	Median	Range	P-value
A	53	16	9.8–31	37	13	9.5–24	154	12	8.6–23	<0.001
B	51	14	7.6–24	37	12	7.4–22	153	10	6.8–23	<0.001
C	53	34	22–66	37	27	19–48	154	26	18–49	<0.001
D	51	30	16–51	37	23	10–44	153	21	10–44	<0.001
E	71	16	8.1–62	53	13	7.8–54	164	11	6.9–42	<0.001
F	70	13	6.5–50	53	9.7	6.3–39	165	8.5	5.2–40	<0.001
G	56	150	36–559	37	174	64–425	151	196	58–465	0.003
H	56	148	36–634	37	153	47–394	151	176	40–477	0.003

• A: walking 15 m, self-selected speed (sec);

• B: walking 15 m, maximum speed (sec);

• C: walking 2 × 15 m, self-selected speed (sec);

• D: walking 2 × 15 maximum speed (sec);

• E: Timed Get-Up-and-Go, self-selected speed (sec);

• F: Timed Get-Up-and-Go, maximum speed (sec);

• G: hand grip strength, right hand maximum (N);

• H: hand grip strength, left hand maximum (N).

Table 3.  Multiple linear regression analysis predicting walking ability and, respectively, Timed-Get-Up-and-Go TUG including all the independent variables age, gender, fracture, pain, hip arthrosis, knee arthrosis, cardiovascular disease, respiratory disease, and cognitive function

Independent variables	Walking 15 m self-selected speed (sec) β	Walking 2 × 15 m self-selected speed (sec) β	Walking 15 m max. speed (sec) β	Walking 2 × 15 m max. speed (sec) β
Age	0.17	0.36	0.16	0.32
p-value	<0.001	<0.001	<0.001	<0.001
Gender ^a	0.41	0.99	0.78	1.80
p-value	0.4	0.4	0.09	0.06
Fracture	2.45	5.01	2.35	4.50
p-value	<0.001	<0.001	<0.001	<0.001
Pain, back/lower extremity	1.30	3.20	1.16	2.74
p-value	0.01	0.004	0.02	0.005
Observations n	231	231	228	228
Independent variables	TUG self-selected speed (sec) β	TUG maximum speed (sec) β	Grip-strength right hand (N) β	Grip-strength left hand (N) β
Age	0.37	0.26	–3.2	–3.3
p-value	<0.001	<0.001	<0.001	<0.001
Gender ^a	–0.59	–0.34	–118.7	–121.3
p-value	0.6	0.7	<0.001	<0.001
Fracture	4.92	3.66	–17.7	–14.0
p-value	<0.001	<0.001	0.04	0.09
Pain ^b	1.97	0.64	–34.4	–41.7
p-value	0.06	0.40	0.001	<0.001
Observations n	272	272	231	231

^a Male = 0 and Female = 1.

^b Pain in testing Timed Get-Up-and Go is referred to pain in back and lower extremity. For grip strength pain is referred to upper extremity.

Table 4.  Comparison of walking 15 m and 2 × 15 m at self-selected and maximal speed between groups fractured in pain and fractured without pain, divided into subgroups fractured less than 3 years ago and fractured 3 years ago or more

	Fractured in pain; <3 years since last fracture			Fractured in pain; ≥3 years since last fracture				Fractured without pain; <3 years since last fracture			Fractured without pain; ≥3 years since last fracture
	n	median	range	n	median	range	p-value	n	median	range	n	median	range	p-value
A	21	20	11–31	32	14	9.8–26	0.04	15	14	11–24	22	12	9.5–22	0.006
B	20	17	9.2–24	31	12	7.6–21	0.03	15	12	8.0–22	22	9.7	7.4–16	0.003
C	21	40	23–65	32	31	22–57	0.04	15	29	24–48	22	25	19–47	0.009
D	20	35	20–51	31	26	16–43	0.02	15	25	10–44	22	21	16–36	0.03

• A: walking 15 m, self-selected speed (sec);

• B: walking 15 m, maximum speed (sec);

• C: walking 2 ×15 m, self-selected speed (sec);

• D: walking 2 ×15 m, maximum speed (sec).