Restricted activity and persistent pain following motor vehicle collision among older adults: a multicenter prospective cohort study.
BACKGROUND
Restricted physical activity commonly occurs following acute musculoskeletal pain in older adults and may influence long-term outcomes. We sought to examine the relationship between restricted physical activity after motor vehicle collision (MVC) and the development of persistent pain.


METHODS
We examined data from a prospective study of adults ≥65 years of age presenting to the emergency department (ED) after MVC without life-threatening injuries. Restricted physical activity 6 weeks after MVC was defined in three different ways: 1) by a ≥25 point decrease in Physical Activity Scale in the Elderly (PASE) score, 2) by the answer "yes" to the question, "during the past two weeks, have you stayed in bed for at least half a day?", and 3) by the answer "yes" to the question, "during the past two weeks, have you cut down on your usual activities as compared to before the accident?" We examined relationships between each definition of restricted activity and pain severity, pain interference, and functional capacity at 6 months with adjustment for confounders.


RESULTS
Within the study sample (N = 164), adjusted average pain severity scores at 6 months did not differ between patients with and without restricted physical activity based on decreased PASE score (2.54 vs. 2.07, p = 0.32). In contrast, clinically and statistically important differences in adjusted average pain severity at 6 months were observed for patients who reported spending half a day in bed vs. those who did not (3.56 vs. 1.91, p < 0.01). In adjusted analyses, both decreased PASE score and cutting down on activity were associated with functional capacity at 6 months, but only decreased PASE score was associated with increased ADL difficulty at 6 months (0.70 vs. -0.01, p = 0.02).


CONCLUSIONS
Among older adults experiencing MVC, those reporting bed rest or reduced activity 6 weeks after the collision reported higher pain and pain interference scores at 6 months. More research is needed to determine if interventions to promote activity can improve outcomes after MVC in older adults.
Department of Emergency Medicine, University of North Carolina, 170 Manning Dr, Chapel Hill, NC, USA. tplattsm@med.unc.edu.
Timothy F
TF
Platts-Mills
Department of Emergency Medicine, University of North Carolina, 170 Manning Dr, Chapel Hill, NC, USA.
Robert J
RJ
Nicholson
Department of Emergency Medicine, University of North Carolina, 170 Manning Dr, Chapel Hill, NC, USA.
Natalie L
NL
Richmond
Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, USA.
Kushang V
KV
Patel
Intramural Research Program, National Institute on Aging, 251 Bayview Boulevard, Suite 100, Baltimore, MD, USA.
Eleanor M
EM
Simonsick
Department of Emergency Medicine, Saint Joseph Mercy Health System, 5301 McAuley Drive, Ypsilanti, MI, USA.
Robert M
RM
Domeier
Department of Emergency Medicine, William Beaumont Hospital, 3601 W 13 Mile Rd, Royal Oak, MI, USA.
Robert A
RA
Swor
Department of Emergency Medicine, University of Florida College of Medicine Jacksonville, 1515 SW Archer Road, Gainesville, FL, USA.
Phyllis L
PL
Hendry
Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, USA.
David A
DA
Peak
Department of Emergency Medicine, Baystate Medical Center, 759 Chestnut Street, Springfield, MA, USA.
Niels K
NK
Rathlev
Department of Emergency Medicine, Spectrum Health - Butterworth Campus, 100 Michigan St. NE, 49503, Grand Rapids, MI, USA.
Jeffrey S
JS
Jones
Department of Emergency Medicine, North Shore University Hospital, 300 Community Dr, Manhasset, NY, USA.
David C
DC
Lee
Department of Medicine, University of North Carolina, 170 Manning Dr, Chapel Hill, NC, USA.
Mark A
MA
Weaver
Department of Psychiatry, Duke University, Durham, 17 Chapel Drive, Durham, NC, USA.
Francis J
FJ
Keefe
Department of Anesthesiology, University of North Carolina, 170 Manning Dr, Chapel Hill, NC, USA.
Samuel A
SA
McLean
D000063:Accidents, Traffic / Q000639:trends*; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000639:trends; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D051346:Mobility Limitation; D009043:Motor Activity / Q000502:physiology; D018986:Motor Vehicles; D010146:Pain / Q000175:diagnosis* / Q000453:epidemiology; D010147:Pain Measurement / Q000379:methods / Q000639:trends*; D011446:Prospective Studies
Aged; Emergency medicine; Geriatrics; Motor Activity; Pain; Traffic accidents