Effect of outpatient cardiac rehabilitation on motor function and health-related quality of life in stroke survivors.

BACKGROUND: Outpatient cardiac rehabilitation (CR) is a promising tool for improving functional outcome in stroke survivors, however, evidence for improving emotional health is limited. We aimed to clarify the effects of outpatient CR following in-hospital stroke rehabilitation on health-related quality of life (HRQOL) and motor function. METHODS: Patients with acute ischemic stroke or transient ischemic attack discharged directly home were recruited, and 128 patients who fulfilled criteria for insurance coverage of CR were divided into the CR (+) group (n = 46) and CR (-) group (n = 82). All patients underwent in-hospital stroke rehabilitation, and within 2 months after stroke onset, patients in the CR (+) group started a 3-month outpatient CR program of supervised sessions. Changes of motor function and HRQOL assessed by the short form-36 version 2 (SF-36) from discharge to 3 months post-discharge were compared between the two groups. RESULTS: Twenty-six patients in the CR (+) group completed the program and 66 patients in the CR (-) group were followed up at a 3-month examination. Least-square mean changes in 6-minute walk distance and isometric knee extension muscle strength were significantly higher in the CR (+) group than the CR (-) group (52.6 vs. 16.3 m; 10.1 vs. 3.50 kgf/kg). Improvement of HRQOL at 3 months was not observed in the CR (+) group. CONCLUSIONS: Outpatient CR following in-hospital stroke rehabilitation within 2 months after stroke onset improved exercise tolerance and functional strength but not HRQOL assessed by the SF-36 after completion of CR in the present cohort.

Pneumococcal vaccination coverage and vaccination-related factors among older adults in Japan: LIFE Study.

PURPOSE: To investigate individual and environmental vaccination-related factors among the older adults in Japan, using administrative data. METHODS: We conducted a cohort study and included people who reached the relevant age (≥65 years) for routine pneumococcal vaccination of older adults between April 2015 and March 2020. Monthly data of residents in the two municipalities from April 2014 to March 2020 and vaccination records from April 2015 to March 2020 were used. We defined five cohorts according to the year in which routine vaccinations were available. Each cohort was followed for a total of two years, with the first year being the "baseline period" and second year being the "vaccine follow-up period." Pneumococcal vaccination data was extracted from vaccination records at "first dose." Age, sex, socioeconomic status, comorbidities, hospital visit history, hospitalization history, Specific Health Check-ups participation, and information on contracted hospitals for pneumococcal vaccination were used as covariates. A multivariate logistic regression model was used to investigate the relationship between pneumococcal vaccination and vaccination-related factors. Odds ratios (OR) and 95 % confidence intervals (95 % CI) were calculated. RESULTS: Analysis included 17,991 patients. Vaccination coverage was 33.6 % for all subjects. Multivariate analysis found the following as significant vaccination-related factors: female (OR: 1.18, 95 % CI: 1.11-1.26), not low income (1.76, 1.17-2.76), hospital visits: ≥once/month (1.27, 1.19-1.35), and Specific Health Check-ups participation (2.10, 1.95-2.27). No significant results were found for hospitals that contracted pneumococcal vaccination. CONCLUSIONS: Individual factors, such as sex and Specific Health Check-ups participation, were found to be important factors affecting pneumococcal vaccination among older adults in Japan. Environmental factors, such as the characteristics of residential areas, should be evaluated in further investigations.

Cognitive transitions based on functional status in older adults with heart failure: a population-based study.

AIMS: Cognitive impairment and functional status are both important determinants of poor outcomes in heart failure (HF). However, little is known about how functional status impacts the changes in cognitive status during the disease course. This study aimed to describe the cognitive transitions in patients with HF and assess the relationship of these transitions to functional status, which was assessed by the dependency of activities of daily living (ADL). METHODS AND RESULTS: This retrospective cohort study included 1764 patients with an International Classification of Diseases-10 code of HF (≥65 years, mean age 82.3 ± 7.9 years, 39% male) from a long-term care and medical insurance database from Nobeoka city, a rural city of south-western Japan. Cognitive status at baseline and 6, 12, 18, and 24 month time points was collected, and participants were stratified based on ADL status at baseline. Generalized estimating equations and multi-state modelling were used to examine associations between ADL dependency and cognitive changes/mortality. Transition probabilities were estimated using multi-state modelling. At baseline, there were 1279 (73%) and 485 (27%) patients with independent and dependent ADL, respectively. In overall patients, 1656 (93.9%) patients had normal/mild cognitive status and 108 (6%) patients had a moderate/severe cognitive status at baseline. The majority [104 (96%) patients] of patients with moderate/severe cognitive status at baseline had dependent ADL. In patients with moderate/severe cognitive status, the number of patients with dependent ADL always outnumbered that of the independent ADL throughout the follow-up. Multi-state modelling estimated that patients with dependent ADL and normal/mild cognitive status at baseline had 47% probability of maintaining the same cognitive status at 24 months, while the probability of maintaining the same cognitive status was 86% for those with independent ADL. Patients with normal/mild cognitive status in the dependent ADL group at baseline had a higher risk of experiencing a transition to moderate/severe cognitive status at any time point during 24 months compared with those with independent ADL [hazard ratio 5.24 (95% confidence interval 3.47-7.90)]. CONCLUSIONS: In older patients with HF, the prevalence of cognitive impairment was always higher for those with reduced functional status. Despite having a normal/mild cognitive status at baseline, patients with dependent ADL are at high risk of experiencing cognitive decline over 24 months with substantially less chance of maintaining their cognitive status. ADL dependency was an important risk factor of cognitive decline in patients with HF.

Analysis of post-extraction bleeding in patients taking antithrombotic therapy using data from the longevity improvement and fair evidence study.

BACKGROUND: Several studies have investigated post-extraction bleeding in patients on antithrombotic therapy, but most included a small sample size. OBJECTIVE: This study aimed to analyse post-extraction bleeding in patients on antithrombotic therapy using data from a large database. MATERIALS AND METHODS: Claims data of National Health Insurance and Late-Stage Elderly Healthcare System enrollees who underwent tooth extraction between October 2014 and March 2019 (n = 107 767) in a large multiregional cohort study (Longevity Improvement and Fair Evidence study) were included. Antithrombotic therapy was determined based on the drug codes used at the time of tooth extraction (classified into six groups: no antithrombotic, single antiplatelet, dual antiplatelet, Direct Oral Anticoagulant, warfarin and combined antiplatelet and anticoagulant therapies). The outcome was defined as the presence of "post-extraction bleeding" as a receipt disease name in the same month as tooth extraction. To examine the association between antithrombotic therapy and post-extraction bleeding in detail, multiple logistic regression analysis was performed with post-extraction bleeding as the objective variable; each antithrombotic therapy as the explanatory variable; and age, sex and comorbidities as adjustment variables. RESULTS: Antithrombotic therapy was administered in 14 343 patients (13.3%), and post-extraction bleeding was observed in 419 patients (0.4%). The rate of post-extraction bleeding was significantly lower in the no antithrombotic therapy and single antiplatelet groups than that in the other groups (odds ratio: 2.00-9.02). CONCLUSION: The frequency of post-extraction bleeding is high in patients on anticoagulation or dual antithrombotic therapy. Therefore, careful preparation before extraction is necessary in these patients.

Claimed-based frailty index in Japanese older adults: a cohort study using LIFE Study.

BACKGROUNDS: We aimed to assess whether the U.S. developed claimed-based frailty index (CFI) can be implemented in Japanese older adults using claim data. METHODS: We used the monthly claims data and certification of long-term care (LTC) insurance data of residents from 12 municipalities from April 2014 to March 2019. The 12 months from first recording was defined as the "baseline period," and the time thereafter as "follow-up period". Participants aged ≥65 years and those with no certified LTC insurance or who died at baseline were included. New certification of LTC insurance and all-cause mortality during the follow-up period were defined as outcome events. CFI categorization consisted of three steps including: 1) using 12 months deficit-accumulation approach that assigned different weights to each of the 52 items; 2) the accumulated score to derive the CFI; and 3) categorizing the CFI as "robust" (<0.15), "prefrail" (0.15-0.24), and "frail" (≥0.25). Kaplan-Meier survival curves and Cox proportional hazard models were used to determine the association between CFI and outcomes. Hazard ratios (HR) and 95% confidence intervals (95%CI) were calculated. RESULTS: The participants were 519,941 in total. After adjusting for covariates, the severe CFI category had a high risk of certification of LTC insurance (prefrail, HR: 1.33, 95%CI:1.27-1.39; frail, HR: 1.60, 95%CI: 1.53-1.68) and all-cause mortality (prefrail, HR: 1.44, 95%CI: 1.29-1.60; frail, HR: 1.84, 95%CI: 1.66-2.05). CONCLUSIONS: This study suggests that CFI can be implemented in Japanese claims data by predicting the certification of LTC insurance and mortality.

Walking and perception of green space among older adults in Japan: subgroup analysis based self-efficacy.

Self-efficacy is the key factor for promoting physical activity. Older adults with low self-efficacy tend to be physical inactive than those with high self-efficacy, and an approach is needed to promote physical activity. Among several approaches, increasing the perception of green space may be an effective approach for low self-efficacy not high self-efficacy, but no study has investigated. This study investigated the association between walking and perception of green space among older adults with high and low self-efficacy, respectively. We conducted a cross-sectional study among 204 community-dwelling older adults (mean age = 78.3 years, 62.3% females). Using the median split, the participants were divided into high and low self-efficacy groups based on the median score of 12. Walking was measured using the International Physical Activity Questionnaire and 'more walking' was defined as ≥150 min of walking time per week. Perception of green space was measured using an 8-item questionnaire. We performed logistic regression analysis to investigate the association between walking and perception of green space adjusted for age, gender, years of education, living with someone and income level. For all participants, 94 participants (46.1%) fell under low self-efficacy. After adjustment, higher perception of green space is associated with more walking among older adults with low self-efficacy [adjusted odds ratio (aOR) = 1.07, 95% confidence interval (CI) = 1.00-1.15], but not among those with high self-efficacy (aOR = 1.09, 95% CI= 0.99-1.20). To increase perception of green space, experts should design/improve green spaces considering beneficiaries' characteristics.

Low self-efficacy has a negative effect on Activities of Daily Living and Quality of Life through physical inactivity among older adults. Encouraging physical activity among those with low self-efficacy can help solve the problem, but individual intervention towards low self-efficacy requires great effort. Therefore, we focused on environmental factors as they affect more people, and investigated the association between perception of green space and walking among older adults with high and low self-efficacy, respectively. This cross-sectional study was conducted among community-dwelling older adults in Japan, the variables used in this study were asked by a questionnaire. We examined whether older people who have higher perception of green space do more walking. As a result of the analysis, high perception of green space was associated with more walking among community-dwelling older adults with low self-efficacy, but not among older adults with high self-efficacy. This result may lead to solves the problem of physical inactivity in older adults with low self-efficacy from the perspective of environmental factors. To increase perception of green space, experts such as urban planners and policy makers should design/improve green spaces considering beneficiaries' characteristics such as quantity, quality and accessibility.

Effect of Excessive Screen Time on Cardiorespiratory Fitness in Children: A Longitudinal Study.

BACKGROUND: This study investigated the effect of different components of screen time (mobile phone use, TV/video viewing, and video gaming) on cardiorespiratory fitness (CRF) development in children aged 9-12 years. METHODS: This was a two-year longitudinal study conducted with 175 children (49.7% girls, mean age = 9.5) in Japan. CRF was assessed using a 20 m shuttle run test conducted at baseline and again at follow-up. Children were categorized as "Good" or "Poor" based on the change in CRF scores for each gender. Screen time was assessed using a self-reported questionnaire at baseline and termed as "high" if children reported ≥ 2 h/day. Univariate and multivariate logistic regression analyses were performed after adjusting for gender, physical activity, and time of data collection. RESULTS: Children scoring "high" on mobile phone use had lower odds of being categorized as "Good" in CRF change (crude odds ratio (OR): 0.34; 95% confidence interval (CI): 0.15-0.90 (adjusted OR: 0.33; 95% CI: 0.12-0.91)). There were no significant effects of TV/video viewing (crude OR: 1.54; 95% CI: 0.84-2.81) and video gaming (crude OR: 0.98; 95% CI: 0.48-1.97) on changes in CRF. CONCLUSIONS: Limiting excessive mobile phone usage might be important for ensuring healthy development of CRF in children.

Frequency of working at home, body mass index, and productivity in Japanese office workers: A cohort study.

BACKGROUND: Since the start of the COVID-19 pandemic, the number of people working at home has grown significantly. OBJECTIVE: This cohort study aimed to investigate whether the frequency of working at home was associated with changes in body mass index (BMI) and productivity from 2018 to 2020. METHOD: Frequency of working at home was self-reported. Participants were classified into three groups based on mean frequency of working at home per week (no working at home: ≦ 0.5 days, low frequency: 0.5 to 2.5 days, and high frequency: >2.5 days). Productivity was measured using a numerical rating scale, and BMI was calculated using height and weight. Changes in BMI and productivity were calculated by subtracting 2018 data from 2020 data. Linear regression analysis was performed by considering BMI and productivity change as outcomes and frequency of working at home as explanatory variable. RESULTS: BMI change in the high frequency group was significantly smaller than in the group that did not work at home (crude; coefficient: -0.27; 95% CI: -0.55--0.01, adjusted; coefficient: -0.30; 95% CI: -0.60--0.01). Frequency of working at home was not associated with productivity change. CONCLUSION: Working at home may be a solution for preventing BMI from increasing significantly.

Joint effect of cognitive decline and walking ability on incidence of wandering behavior in older adults with dementia: A cohort study.

OBJECTIVES: Wandering behavior is one of the most troublesome behavioral disturbances in dementia. Inconsistent associations between physical function and wandering behavior were reported, and the effect of cognitive decline may be different according to walking ability. The purposes of this study are to investigate whether high walking ability is a risk factor for wandering behavior and to investigate the interaction of walking ability and cognitive function with wandering behavior in older adults with dementia. METHODS: This retrospective cohort study included 3979 elderly adults with dementia. The association of cognitive function and walking ability with incidence of wandering behavior during a 5-year follow-up period were examined using a generalized linear model, and relative excess risk due to interaction (RERI) was calculated. RESULTS: Severe cognitive decline and high walking ability were associated with a higher risk for wandering behavior. Additionally, some joint effects of cognitive decline and walking ability decline were higher than the sum of its individual effects (RERI [95% confidence interval], severe cognitive decline × 'walk with help': 1.58 [0.35, 2.81]; severe cognitive decline × 'independent': 3.09 [1.05, 5.14]). CONCLUSIONS: Effects of cognitive decline and walking ability on incidence of wandering behavior were observed, and the effects varied depending on their combination.

Association Between Workplace Social Capital and Neck Pain: A Cross-Sectional Study Among Workers.

OBJECTIVE: We examined the association between workplace social capital (WSC) and presence of neck pain (NP) among workers. METHODS: This cross-sectional study included 595 workers. Presence of NP was assessed using Numerical Rating scale. WSC (overall, bonding, bridging, and linking) was divided into three categories (low, middle, and high) based on tertile distributions. We used logistic regression analysis to investigate the association between WSC and presence of NP. RESULTS: Low overall, bonding, and linking social capital were significantly associated with presence of NP in comparison with each high social capital (overall: adjusted odds ratio [aOR] = 1.76, 95% confidence interval [CI] = 1.14 to 2.73; bonding: aOR = 1.78, 95% CI = 1.19 to 2.67, linking: aOR = 2.18, 95% CI = 1.32 to 3.63). CONCLUSION: Lower WSC had an association with higher prevalence of NP among workers.

Economic Status and Mortality in Patients with Alzheimer's Disease in Japan: The Longevity Improvement and Fair Evidence Study.

OBJECTIVES: As more countries are implementing measures to address Alzheimer's disease (AD), it is essential to update the available knowledge on the relationship between economic status and mortality in patients with AD. This study examined the influence of economic status on mortality in Japanese individuals with AD using a medical claims dataset. DESIGN: This was a retrospective cohort study. SETTING AND PARTICIPANTS: Medical claims data from April 2014 to March 2019 were obtained from 13 local cities participating in the Longevity Improvement and Fair Evidence study. The inclusion criteria were patients aged 65 years and older who were newly diagnosed with AD during the study period. METHODS: The outcome was death during the follow-up period. We assessed economic status by household income (middle to high income and low income); data were obtained from the use of the Medical Expenditure Ceiling Application and Standard Copayment Reduction Card (fee reduction card) when receiving an AD diagnosis, as an indicator of low-income status. We performed multivariate Cox proportional hazards analyses to examine the relationship between economic status and mortality; the model was adjusted for age, sex, the Charlson comorbidity index, and antidementia drug use. RESULTS: We identified 39,081 newly diagnosed patients with AD from the Longevity Improvement and Fair Evidence study database (mean age, 83.6 years; female, 67.1%). Of these, 3189 individuals were identified as having a low-income status. After adjusting for possible confounders, low-income status was associated with mortality (hazard ratio, 1.95; 95% confidence interval, 1.84-2.07). CONCLUSIONS AND IMPLICATIONS: Low-income status was associated with substantially poorer prognoses in new AD cases, indicating a need for a thorough examination of medical and nursing care services utilized by low-income individuals with AD and to explore improvement strategies.

Indirect effects of social activity on appetite via depressive symptoms in community-dwelling older adults: A cross-sectional study.

Depressive symptoms have a strong effect on appetite decline in older adults. There is also an association between social activity and decreased depressive symptoms, but the mechanism between appetite and social activity with respect to depressive symptoms is unclear. This cross-sectional study examined the direct and indirect effects of social activity on appetite, via depressive symptoms. A total of 259 community-dwelling older adults (mean age 75.1 ± 5.3 years; 55% female) completed the Council on Nutrition Appetite Questionnaire (CNAQ) and the 15-item version of the Geriatric Depression Scale (GDS). We used a cutoff score of 6 on the GDS-15 to determine whether participants displayed depressive symptoms. Social activity was assessed based on the number of activities participated in at least 1-3 times per month. The types of social activity consisted of local community, hobby, sports, citizen, industry, religion, volunteer, and others. Other assessed factors included age, sex, education, financial status, living situation, and comorbidities. To examine the relationships among social activity, depressive symptoms, and appetite, structural equation modeling (SEM) was used, adjusting for variables associated with depressive symptoms or appetite in multivariate analyses. SEM revealed that participation in more types of social activity had a significant indirect effect on higher appetite score via less having depressive symptoms (ß = 0.04, p = 0.018). Our findings suggest that active participation in social activities may have a positive effect on good appetite via not having depressive symptoms among older adults. Further longitudinal or intervention studies are needed to confirm our findings.

Effectiveness of workplace active rest programme on low back pain in office workers: a stepped-wedge cluster randomised controlled trial.

OBJECTIVE: This study aimed to investigate the effectiveness of workplace active rest programme (WARP) on chronic low back pain (LBP) among office workers. DESIGN: A closed cohort, stepped-wedge cluster randomised trial was conducted. The total duration of the study was 16 weeks (4 weeks for each step). Sequence allocation was randomised, but no one was blinded. SETTING: This study was conducted in three offices in a Japanese electronics company. One office was for the administrative department, the others are for the engineering department. PARTICIPANTS: We recruited 29 office workers with LBP greater than 3 months. LBP due to specific injury or disease was excluded. The median age was 38 years, and 26 (90%) were male. All participants completed the study. INTERVENTIONS: In the intervention phase, participants performed WARP comprising frequent stand-up and individualised brief exercise/physical activity during work. Physical therapists held an LBP workshop and developed tailor-made programmes before introducing WARP. We instructed participants to perform WARP at five timings during work. Control phase was set before the intervention and participants stayed as usual. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was pain intensity of LBP assessed using the Brief Pain Inventory. The secondary outcomes were work productivity loss measured using the Work Limitations Questionnaire, LBP disability assessed using the Roland-Morris Disability Questionnaire, psychosocial subscale assessed using the STarT Back Screening Tool and physical activity measured using triaxial accelerometers. These outcomes were collected at baseline and at 4-month follow-up evaluation. RESULTS: In the intention-to-treat analysis, WARP did not show any significant effects on pain intensity (ß, 0.01; 95% CI -0.50 to 0.52) and on the secondary outcomes. The median adherence to WARP was 28.6% (IQR, 16.8-41.1), which was equal to 1.43 times per day. No adverse effect was observed. CONCLUSIONS: The present study was unable to confirm the effectiveness of active rest in improving LBP. Hence, further study needs to investigate its effectiveness. TRIAL REGISTRATION NUMBER: UMIN000033210.

Association between sleep disturbance and low back and pelvic pain in 4-month postpartum women: A cross-sectional study.

PURPOSE: Persistent low back and pelvic pain (LBPP) is a postpartum-specific health problem. Sleep disturbances' association with persistent LBPP is not yet clear. We aimed to examine the cross-sectional association between sleep disturbance and persistent LBPP at 4 months postpartum. METHODS: We enrolled 120 women with LBPP during pregnancy (mean age, 31.8; standard deviation, 4.9 years). The primary outcome was persistent LBPP. We assessed LBPP severity at 4 months postpartum using the Numerical Rating Scale (NRS), where women with an NRS score of ≥ 4 at 4 months postpartum were allocated to the persistent LBPP group. We assessed sleep disturbance at 4 months postpartum using the Japanese version of the Pittsburgh Sleep Quality Index with a total score of ≥ 6 indicating sleep disturbance. Moreover, we performed univariate and multiple logistic regression analyses to examine the cross-sectional association of sleep disturbance with persistent LBPP. The relevant confounding variables were age, body mass index, parity, and history of LBPP before pregnancy. RESULTS: Among the 120 women, 45 women had persistent LBPP (37.5%) with 32 (71.1%) of them reporting sleep disturbance. There was a significant association of sleep disturbance with persistent LBPP (odds ratio [OR], 2.81; 95% confidence interval [95% CI], 1.28-6.19), which remained after adjustments for confounding variables (OR, 2.98; 95% CI, 1.31-6.75). CONCLUSION: Our findings indicate that sleep disturbance is associated with persistent LBPP at 4 months postpartum; therefore, it should be taken into consideration in postpartum women with persistent LBPP.

Association between comprehensive workstation and neck and upper-limb pain among office worker.

OBJECTIVES: Our study aimed to investigate the association between comprehensive workstations and neck and upper-limb pain (NUP) among office workers. METHODS: This cross-sectional study included 307 office workers (median age, 39 years; 88% men). Workstations (presence of armrest, armrest position, number of monitors used, mouse position, mouse usage, keyboard usage, and keyboard position) were investigated in terms of 17 items and judged as "adequate" or "inadequate." NUP was assessed using a numerical rating scale. NUP locations included the neck, shoulder, elbow, and wrist. In the statistical analysis, outcome variables were the presence of pain in each part, while explanatory variables were the number of inadequate workstations. Logistic regression analyses were conducted with adjustment for age, gender, working duration, and exercise habit. RESULTS: The prevalence of neck pain was 47% (n = 143), shoulder pain was 50% (n = 153), elbow pain was 7.2% (n = 22), and wrist pain was 13% (n = 40). In the adjusted model, the number of inadequate workstations had significant positive associations with elbow pain (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.06.1.81) and wrist pain (OR, 1.80; 95% CI, 1.17.2.26). However, the number of inadequate workstations was not significantly associated with neck pain or shoulder pain. CONCLUSIONS: Workstation-related factors (presence of armrest, armrest position, mouse usage, and keyboard usage) were significantly associated with elbow and wrist pain. Our findings suggest that workstations can contribute to elbow and wrist pain in office workers.

Association Between Kinesiophobia and Life Space Among Community-Dwelling Older People with Chronic Musculoskeletal Pain.

OBJECTIVE: Kinesiophobia (i.e., fear of movement caused by pain) is increasingly acknowledged as a determinant of disuse among patients with chronic musculoskeletal pain. Kinesiophobia may affect life space-a crucial indicator of an active lifestyle among older people. This study aimed to investigate the previously unexamined association between kinesiophobia and life space among community-dwelling older people with chronic musculoskeletal pain. DESIGN: Cross-sectional study. SETTING: Community. SUBJECTS: We analyzed data from 194 community-dwelling older people (age ≥65 years, mean age = 75.7 years, 71.6% women) with chronic musculoskeletal pain. METHODS: Kinesiophobia, life space, and pain severity were assessed using the Tampa Scale for Kinesiophobia, Life Space Assessment, and Brief Pain Inventory. Linear regression models were applied to analyze the associations between kinesiophobia and life space, and pain severity and life space. RESULTS: In our sample, the prevalence rates for chronic musculoskeletal pain were 10.82% (N = 21) for neck, 55.15% (N = 107) for lower back, 25.26% (N = 49) for shoulder, and 50.00% (N = 97) for knee. The results suggest that higher kinesiophobia is associated with smaller life space (adjusted beta = -0.91, 95% CI = -1.43 to -0.45, P < 0.001), even after adjustment for age, gender, years of education, pain severity, and presence of comorbidity. On the contrary, no significant association between pain severity and life space was observed (adjusted beta = -0.61, 95% CI = -2.92 to 1.72, P = 0.624). CONCLUSIONS: Our findings suggest that kinesiophobia plays an important role in the determination of life space among older people with chronic musculoskeletal pain.