Evaluation of locomotive disability using loco-check: a cross-sectional study in the Japanese general population

Risk factors for progression of the severity of locomotive syndrome: A two-year longitudinal observational study

BACKGROUND

The risk factors for progression of severity of locomotive syndrome (LS) remain unclear.

METHODS

We conducted a longitudinal observational study of 1148 community-dwelling residents (median age, 68.0 years old; 548 males, 600 females) from 2016 to 2018. LS was assessed by the 25-question Geriatric Locomotive Function Scale (GLFS-25), and total scores of ≤6 points, 7-15 points, 16-23 points, and ≥24 points were diagnosed as non-LS, LS-1, LS-2, and LS-3, respectively. If the LS severity in 2018 was higher than in 2016, the case was defined as progression of LS severity; otherwise, it was defined as non-progressive LS. We compared the age, gender, body mass index, smoking status, alcohol consumption, living situation, car use, chronic musculoskeletal pain, comorbidities, metabolic syndrome, physical activity, and LS severity in 2016 between the progression and non-progression groups. Furthermore, a multivariate logistic regression analysis was performed to elucidate the risk factors for progression of LS severity.

RESULTS

Participants in the progression group had a significantly older age, a lower rate of car use, a higher rate of low back pain, a higher rate of hip pain, a higher rate of knee pain, a higher GLFS-25 total score, and a higher rate of LS-2 than those in the non-progression group. The multivariate logistic regression analysis revealed that older age, female gender, higher body mass index (≥25.0 kg/m2), presence of low back pain, and presence of hip pain were risk factors for the progression of LS within two years.

CONCLUSIONS

To prevent the progression of LS severity, related prophylaxis strategies should be implemented, especially for individuals with the above-mentioned characteristics. Further longitudinal studies with a longer observation period are necessary.

The prevalence of locomotive syndrome and its associated factors in patients with Type 2 diabetes mellitus

OBJECTIVES

We investigated the prevalence of locomotive syndrome (LS) and related musculoskeletal diseases [osteoarthritis (OA), lumbar spondylosis, and spinal alignment] in Type 2 diabetes mellitus (DM) patients.

METHODS

Clinical data were collected from 101 patients (55 males; 46 females) admitted to our hospital for diabetes education from October 2018 to April 2021. Patients underwent full-spine and whole-legs standing radiography and physical measurements (10-m walking and grip strength tests and three LS risk tests).

RESULTS

The estimated prevalence of LS was 86.1% (Stage 1: 44.5%, Stage 2: 41.6%), lumbar spondylosis was 11.9%, and hip, knee, and ankle OA were 16.9%, 51.5%, and 12.9%, respectively. Multiple logistic regression analysis identified grip strength [odds ratio (OR) = 0.89, confidence interval (CI) = 0.83-0.94], diabetic retinopathy (OR = 5.85, CI = 1.64-20.78), knee OA (OR = 3.34, CI = 1.11-10.02), and a sagittal vertical axis >40 mm (OR = 3.42, CI = 1.13-10.39) as significantly associated risk factors for worsening LS in Type 2 DM patients.

CONCLUSIONS

This study clarified the epidemiological indicators of LS and associated factors in DM patients. Exercise therapy and DM management are effective strategies to reduce the occurrence and progression of LS.

Clinical Efficacy of Melon GliSODin® for the Treatment of Aging-Related Dysfunction in Motor Organs-A Double Blind, Randomized Placebo-Controlled Study

BACKGROUND

Locomotive syndrome is a concept proposed in Japan involving decreased mobility due to osteoarthritis, osteoporosis, and sarcopenia. This double-blind, randomized study aimed to investigate the effects of superoxide dismutase (SOD)-rich melon extract (Melon GliSODin®) on locomotive syndrome.

METHODS

For 6 months, we administered oral Melon GliSODin® (500.4 mg/day) or a placebo to 24 and 22 women, respectively (aged 50-80 years), with knee or lower back discomfort or pain. Using baseline and 6-month data, changes in the Verbal Rating Scale and in subjective symptoms (determined using the Japanese Knee Osteoarthritis Measure, Locomo 25, the Roland-Morris Disability questionnaire, and the Chalder Fatigue Scale) were assessed, along with various oxidative markers, antioxidants, inflammatory markers, renal and liver function biochemical markers, bone metabolism markers, body composition, and motor function.

RESULTS

Oral Melon GliSODin® administration tended to be associated with a larger improvement in subjective symptom scores, a reduction in oxidative markers (malondialdehyde and diacron reactive oxygen metabolites) and tumor necrosis factor-α, and a significant increase in non-fat mass between baseline and 6 months. However, no statistically significant differences were observed between the groups for outcomes at 6 months.

CONCLUSIONS

Melon GliSODin® tended to improve the subjective symptoms of participants who had knee or lower back pain or discomfort. Melon GliSODin® administration may help to prevent the progression of locomotive syndrome. Future studies involving larger sample sizes and more stringent randomization protocols are needed to determine differences between the placebo and Melon GliSODin® groups.

Development of a tool for screening the severity of locomotive syndrome by the loco-check

BACKGROUND

The loco-check has been widely used to raise awareness of locomotive syndrome (LS) not only in the general population but also among medical practitioners. However, a screening tool of the loco-check for LS-1, LS-2, and LS-3 has not yet been established. The present study developed a screening tool for use with the loco-check to detect LS-1, LS-2, and LS-3.

METHODS

A cross-sectional study of 1659 community-dwelling older adults (730 males, 929 females) with a mean age of 73.8 ± 6.0 years old (range, 65-96 years old) was conducted, based on the Standards for Reporting Diagnostic Accuracy (STARD). All subjects underwent the loco-check as an index test and the 25-question Geriatric Locomotive Function Scale (GLFS-25) as a reference standard at the same time. Subjects with a GLFS-25 total score of ≤6 points, 7-15 points, 16-23 points, and ≥24 points were diagnosed with non-LS, LS-1, LS-2, and LS-3, respectively. A conventional receiver-operating characteristic curve analysis was used to confirm the optimal cut-off values of the loco-check score and their sensitivity and specificity to identify LS-1, LS-2, and LS-3, with a preference for a slightly higher sensitivity as the tool is intended primarily for screening purposes.

RESULTS

The optimal cut-off values of the loco-check score to discriminate LS-1, LS-2, and LS-3 as a screening tool were 1 point (sensitivity 85.4% and specificity 64.9%), 2 points (sensitivity 88.8% and specificity 75.1%), and 3 points (sensitivity 87.6% and specificity 84.6%), respectively.

CONCLUSIONS

Our findings may help both the general population and medical practitioners become roughly aware of and estimate the severity of LS, which will contribute to its use in community health activities and the dissemination of the concept of LS.

Is grip strength useful in screening to predict the severity of locomotive syndrome?

BACKGROUND

This study was conducted to investigate the relationship between grip strength and the 25-question Geriatric Locomotive Function Scale (GLFS-25) score and the diagnosis of locomotive syndrome (LS), and the usefulness of grip strength in screening for LS.

METHODS

This cross-sectional study was conducted on 2251 community-dwelling residents (male, n = 1035; female, n = 1216). Subjects with GLFS-25 scores of 0-6 points, 7-15 points, 16-23 points, and 24-100 points were diagnosed with non-LS, LS-1, LS-2, and LS-3, respectively. Multivariate linear regression and multivariate logistic regression analyses were performed to assess the relationship between grip strength and the GLFS-25 score and LS after adjustment for age, sex, and body mass index. A conventional receiver operating characteristic (ROC) curve analysis was used to calculate the optimal cutoff value of grip strength for predicting the severity of LS. The discriminative ability of the model was assessed using the area under the ROC curve (AUC).

RESULTS

The multivariate linear regression analysis showed that grip strength was significantly associated with the GLFS-25 score. The multivariate logistic regression analysis revealed that grip strength was significantly associated with the diagnosis of LS. The optimal cutoff values of grip strength for identifying LS-1 or more, LS-2 or more, and LS-3 or more were 36.0 kg (sensitivity 65.7%, specificity 57.1%, AUC 0.66), 35.0 kg (sensitivity 70.0%, specificity 57.5%, AUC 0.70), and 34.0 kg (sensitivity 67.2%, specificity 62.5%, AUC 0.70), respectively, in males, and 24.0 kg (sensitivity 69.1%, specificity 45.4%, AUC 0.61), 23.0 kg (sensitivity 69.5%, specificity 52.3%, AUC 0.67), and 22.0 kg (sensitivity 69.1%, specificity 61.0%, AUC 0.69) in females.

CONCLUSIONS

The use of grip strength in screening to predict the severity of LS may not be clinically useful. However, the results will increase our understanding of the relationship between grip strength and the GLFS-25 scores and LS.

Locomotive Syndrome and Lumbar Spine Disease: A Systematic Review

Locomotive syndrome (LS) is defined based on the Loco-Check, 25-question Geriatric Locomotive Function Scale (GLFS-25), 5-question Geriatric Locomotive Function Scale (GLFS-5), Stand-Up Test, Two-Step Test, or a total assessment (i.e., positive for one or more of the GLFS-25, Stand-Up Test, and Two-Step Test). Lumbar spine disease has been reported to be one of the most common musculoskeletal disorders leading to LS. We therefore conducted a systematic review via PubMed, Google Scholar, Cochrane Library, Web of Science, and MEDLINE, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 26 studies were considered to be eligible for inclusion in this systematic review. The GLFS-25 showed an association with low back pain, sagittal spinopelvic malalignment, and lumbar spinal stenosis but not vertebral fracture. The GLFS-5 showed an association with low back pain and lumbar spinal stenosis. The Loco-Check and Two-Step Test showed an association with low back pain, sagittal spinopelvic malalignment, and lumbar spinal stenosis. The Stand-Up Test showed no association with lumbar spinal stenosis. The total assessment showed an association with low back pain and lumbar spinal stenosis. Furthermore, the GLFS-25, Two-Step Test, and total assessment were improved by spinal surgery for lumbar spinal stenosis. The current evidence concerning the relationship between LS and lumbar spine disease still seems insufficient, so further investigations are required on this topic.

Impact of the COVID-19 pandemic on the development of locomotive syndrome

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has affected people in various ways, including restricting their mobility and depriving them of exercise opportunities. Such circumstances can trigger locomotor deterioration and impairment, which is known as locomotive syndrome. The purpose of this study was to investigate the incidence of locomotive syndrome in the pandemic and to identify its risk factors. Methods: This was a multicenter questionnaire survey performed between 1 November 2020 and 31 December 2020 in Japan. Patients who visited the orthopedics clinic were asked to answer a questionnaire about their symptoms, exercise habits, and locomotor function at two time points, namely, pre-pandemic and post-second wave (current). The incidence of locomotive syndrome in the COVID-19 pandemic was investigated. Additionally, multiple logistic regression analysis was used to identify the risk factors for developing locomotive syndrome during the pandemic. Results: A total of 2829 patients were enrolled in this study (average age: 61.1 ± 17.1 years; 1532 women). The prevalence of locomotive syndrome was 30% pre-pandemic, which increased significantly to 50% intra-pandemic. Among the patients with no symptoms of locomotive syndrome, 30% developed it in the wake of the pandemic. In the multinomial logistic regression analysis, older age, deteriorated or newly occurring symptoms of musculoskeletal disorders, complaints about the spine or hip/knee joints, and no or decreased exercise habits were independent risk factors for developing locomotive syndrome. Conclusions: The prevalence of locomotive syndrome in patients with musculoskeletal disorders has increased during the COVID-19 pandemic. In addition to age, locomotor symptoms, especially spine or hip/knee joint complaints, and exercise habits were associated with the development of locomotive syndrome. Although the control of infection is a priority, the treatment of musculoskeletal disorders and ensuring exercise habits are also essential issues to address during a pandemic such as COVID-19.

Differences in the prevalence of locomotive syndrome and osteoporosis in Japanese urban and rural regions: The Kashiwara and Yakumo studies

OBJECTIVES

To clarify whether the prevalence of locomotive syndrome (LS) and osteoporosis differed according to region, gender, and physical functions in Japan.

METHODS

Data were collected in Kashiwara City (urban region) and Yakumo Town (rural region). Totally, 208 participants from the urban region and 782 participants from the rural region were included in this study. LS was assessed using the 25-item Geriatric Locomotive Function Scale and osteoporosis was assessed using a quantitative ultrasound. Physical functions were measured using grip strength and the 3-m timed up-and-go test. Differences between urban and rural regions were investigated using standardized incidence ratio and multivariate analysis.

RESULTS

The prevalence of LS and osteoporosis was 24.5% and 42.8% in the urban region and 10.9% and 28.8% in the rural region, respectively. The standardized incidence ratio of the urban region versus the rural region was 1.80 (95% confidence intervals [CI] = 1.35-2.39) for LS and 1.21 (95% CI = 1.32-2.43) for osteoporosis, showing that the prevalence of LS was significantly higher in the urban region. Multivariate analysis indicated that LS was significantly associated with the urban sample and timed up-and-go was significantly longer in the urban sample.

CONCLUSION

Regional differences may be considered when evaluating LS in health checkups. Understanding the results of this study may help reduce LS prevalence.

Reductions in the Frequency of Going Out Due to the COVID-19 Pandemic Negatively Affect Patients with Spinal Disorders

Introduction

The coronavirus disease 2019 (COVID-19) pandemic has greatly changed the lifestyles of individuals due to the need to prevent disease spread. Globally, governments have enforced various policies, including travel bans, quarantine, home confinement, and lockdowns, as safety measures. Consequently, the frequency of individuals going out has decreased. This survey aimed to assess how decreasing the frequency of going out due to the COVID-19 pandemic impacts patients with spinal disorders.

Methods

This multicenter cross-sectional questionnaire survey included patients who visited four private spine clinics for any symptoms. Participants completed questionnaires pre- and post-pandemic that assessed the following topics: frequency of leaving home, exercise habits, locomotive syndrome, and health-related quality of life (HRQOL). Patients were divided into decreased and non-decreased frequency of going out groups, according to observed changes in their frequencies of leaving home. Both groups were statistically compared using univariate and multivariate logistic regression analyses to identify factors associated with the frequency of going out.

Results

Among 855 patients, 160 (18.7%; the decreased group) reported that they went out less frequently, and 695 (81.3%; the non-decreased group) reported that they left home equally frequently post- versus pre-pandemic. Multivariate analyses showed that exercise habits significantly decreased (adjusted odds ratio (aOR) = 2.67, p = 0.004), the incidence of locomotive syndrome significantly increased (aOR = 2.86, p = 0.012), and HRQOL significantly deteriorated (aOR = 4.14, p < 0.001) in the decreased group compared to the non-decreased group.

Conclusions

Restrictions regarding leaving home due to the COVID-19 pandemic significantly decreased exercise frequency, increased the occurrence of locomotive syndrome, and were associated with deterioration of HRQOL in patients with spine disorders. It may be beneficial for spine surgeons to encourage patients with spinal disorders to leave home at a frequency similar to what they did pre-pandemic while avoiding crowded areas, despite the presence of the COVID-19 pandemic.

Measurement of ultrasonic echo intensity predicts the mass and strength of the tongue muscles in the elderly

PURPOSE

The purpose of this study was to investigate the relationship between the echo intensity (EI) on ultrasound images of the tongue, tongue thickness, and tongue pressure to examine the effectiveness of EI measurement for assessing the tongue function.

METHODS

A total of 100 elderly outpatients were enrolled. Tongue thickness and EI were measured using ultrasonography. The distance from mylohyoid muscle surface to dorsal surface of the tongue was measured for tongue thickness. Subsequently, this area was vertically divided into four areas: top of tongue dorsal side (DT), bottom of tongue dorsal side (DB), top of basal tongue side (BT), and bottom of basal tongue side (BB), and the EI was measured in each area.

RESULTS

The mean EIs of DT and DB were lower than those of BT and BB. In the three areas apart from BB, the EI decreased with an increase in tongue thickness. In particular, a significant correlation between the EI in DB and tongue thickness was found. In all areas, the EI decreased with an increase in tongue pressure.

CONCLUSION

The results of this study suggested that the measurement of EI could be an important indicator for assessing the tongue function in the elderly.

Prevalence of Locomotive Organ Impairment and Associated Factors among Middle-Aged and Older People in Nan Province, Thailand

While locomotive organ impairment among older people is attracting worldwide attention, this issue has not yet been widely investigated in Thailand. This study aimed to measure locomotive organ impairment prevalence and identify the determinants of locomotive function decline among middle-aged and older people in Nan Province, Thailand. This cross-sectional study included anthropometric measurements, a two-step test to investigate locomotive function, and a structured questionnaire to obtain socio-demographic and related information. Logistic regression analysis and multiple regression analysis were used to identify the determinants of locomotive organ impairment. The study participants were aged 50–87 years old (n = 165), and 71.5% of them had begun experiencing declining locomotive function; < 6 years of school education (adjusted odds ratio: 4.46), body mass index ≥25 kg/m² (AOR: 3.06), comorbidities (AOR: 2.55), and continuous walking for <15 min (AOR: 2.51) were identified as factors associated with locomotive organ impairment. Moreover, age, knee pain, anxiety about falling in daily life, and difficulty with simple tasks were identified as factors significantly associated with exacerbated locomotive organ impairment (p < 0.05). Appropriate interventions such as guidance or follow-up and recommendations for exercises are needed to prevent locomotive organ impairment and improve treatment.

Association Between Central Sensitization and Increasing Prevalence of Nocturnal Knee Pain in the General Population with Osteoarthritis from the Iwaki Cohort Study

Purpose

Knee pain is associated with osteoarthritis (OA) and increases during this condition; however, its correlation with central sensitization (CS) in arthritis patients requires greater understanding. The present cross-sectional cohort study to explore the prevalence of knee OA, nocturnal knee pain and disability in general population and to examine the association of CS with sleep quality in Japanese general population.

Patients and Methods

From among 1056 community-dowelling volunteers, 942 were enrolled as participants in this study. Bilateral weight-bearing anterior-posterior knee radiographs were classified by the Kellgren-Lawrence grade. Nocturnal knee pain and disability were assessed with self-reported questionnaires. Using the CS inventory with nine items (CSI-9), CS was defined as 10 points or higher. Sleep quality was scored using the Pittsburgh Sleep Quality Index (PSQI). Linear regression analysis, adjusted by age, sex, body mass index, Kellgren-Lawrence grade, nocturnal knee pain, and lifestyle habits, was performed to investigate the association of CS with PSQI.

Results

The prevalence of OA, nocturnal knee pain, and disability was 37.9%, 7.6%, and 6.2%, respectively. The mean CSI-9 score was 4.9 ± 4.4, with a CS prevalence of 14.0%. The mean PSQI score was 3.9 ± 2.4, which was correlated with the CSI-9 value. CS was not correlated with OA severity; however, nocturnal knee pain prevalence increased from 13.3% to 25.5% in knee OA patients with CS. The CSI-9 value correlated with PSQI total score and subscales.

Conclusion

Knee OA severity correlated with nocturnal pain and disability; however, its association with CS was unproven. The combined effect of knee OA and CS elevated nocturnal pain and disability, resulting in diminished sleep quality.

Treatment Efficacy of Single Topical NSAID (S-Flurbiprofen Plaster) for Knee Symptoms and Locomotive Dysfunction in Knee Osteoarthritis Patients

Objective:

The aim of this study was to demonstrate the non-inferiority of S-flurbiprofen plaster (SFPP) monotherapy for treating knee osteoarthritis compared with the combination of conventional oral and topical non-steroidal anti-inflammatory drugs (NSAIDs).

Methods:

A total of 222 participants (114, SFPP group; 108, control group) were treated for 4 weeks. The primary endpoint was the change in the degree of pain felt while rising from a chair after 2 and 4 weeks of treatment as determined using the visual analog scale (VAS) . The secondary endpoint was the change in functional scores and test results. Safety was evaluated in terms of the adverse effects.

Results:

The VAS score significantly decreased in both groups after 2 and 4 weeks of treatment. Non-inferiority in the VAS score was established only at 2 weeks. There were no significant differences in the secondary endpoints between the groups. Skin disorders were more frequent in the SFPP group; however, there was no difference in gastrointestinal (GI) adverse effects.

Conclusions:

The therapeutic efficacy of SFPP monotherapy for knee OA, with respect to changes in the VAS, was not shown to be non-inferior to conventional treatment at 4 weeks; however, non-inferiority was established at 2 weeks. The functional improvement in the SFPP group was comparable to that of the control group. No severe GI adverse effects associated with SFPP administration were observed; however, it is necessary to pay more attention to the occurrence of skin disorders with SFPP than with conventional topical NSAIDs.

Impact of Habitual Exercise on Locomotive Function of Middle-aged and Elderly Volunteers: A Longitudinal Study

OBJECTIVES

This longitudinal study aimed to evaluate the effect of acquisition of an exercise habit on locomotive dysfunction (LD).

METHODS

The subjects were 121 male and 196 female volunteers aged more than 50 years who attended health checkups in Toei, central Japan, in 2012 and 2014. We divided the subjects into three groups: an acquiring exercise group (Ac-Ex) composed of those who acquired an exercise habit between 2012 and 2014, a non-exercise group (Non-Ex) who did not acquire an exercise habit, and an exercise group (Ex) who already had an exercise habit in 2012. We compared the 25-question Geriatric Locomotive Function Scale (GLFS-25) score among the three groups.

RESULTS

In men in the Ac-Ex group, the GLFS-25 score improved significantly between 2012 and 2014 (P=0.046), and sub-analysis of the GLFS-25 responses showed that fundamental and instrumental activities of daily living (ADL) improved significantly. In women in the Ac-Ex group, the prevalence of radiologically diagnosed knee osteoarthritis was significantly higher (P=0.027) than that for the other two groups, and there was no significant improvement in GLFS-25 score over the 2-year period.

CONCLUSIONS

The acquisition of an exercise habit had a positive effect on the locomotive function in men. Orthopedic surgeons must enlighten people on the need for a continuous exercise habit.

Association of physical fitness and motor ability at young age with locomotive syndrome risk in middle-aged and older men: J-Fit+ Study

Background

Physical fitness and motor ability are associated with the incidence of locomotive syndrome (LS) in older adults. The relationships between physical fitness and motor ability at a young age to LS risk in later life remain unclear. This study examined the association between physical fitness and motor ability among university students and their risk of LS in middle and old age.

Methods

The participants were 231 male alumni aged 48–65 years from the Department of Physical Education of a university in Japan. Physical fitness and motor ability test results during their fourth year at the university were used. Physical fitness tests included the side-step test, vertical jump test, back muscle, grip strength, trunk lift, standing trunk flexion, and step-test. Motor ability was tested using the 50-m and 1500-m run, running long jump, hand-ball throw, and pull-up test. LS risk was assessed using a seven-question standardized self-administered Loco-check questionnaire. Participants were divided into three groups (low, medium, and high) based on physical fitness and motor ability test results at young age, and LS risk was assessed at an older age across the three groups using Cox proportional hazards models.

Results

From the 2017 follow-up survey, the median follow-up period was 37 years (interquartile range, 33–41), and LS risk was suspected for 31 (13.4%) participants. Better performance on the side-step test was associated with the reduced risk of LS (hazard ratio 0.32; 95% confidence interval, 0.101–0.983, P = 0.047).

Conclusions

Good agility (side-step test) at a young age may reduce the future risk of LS among middle-aged and older men.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02047-7.

Structure and Validity of Questionnaire for Oral Frail Screening

Oral frailty is defined as the mild decline in oral function and located at the early and reversible stage of frailty. Therefore, early detection and early treatment of oral frailty is very useful. Simple and easy questionnaires, such as an oral frailty checklist, have been widely used for the screening and enlightenment of oral frailty of the Japanese people. We evaluate the structure and validity of the oral frailty checklist. The questionnaire of oral frailty was distributed for the citizens more than 50 years old from December 2018 to January 2019. The structural validity of the questionnaire is analyzed by structural equation modeling (SEM). The characteristics of the items are analyzed by Item Response Theory (IRT). The data of 725 subjects (360 men, 359 women, 6 no answer, mean age 71.3 ± 9.05) are analyzed. The questionnaire consisted of three latent variables. Items of "Brushing teeth at least twice a day", "Regular attendance of dental clinic", and "Using denture", had low discrimination ability. The questionnaire used in this study is a useful tool for the screening of oral frailty. However, its scoring system needs to be improved.

Locomotive Syndrome Is Associated with Health-Related Quality of Life and Low Back Pain in the Elderly, Including Individuals More Than 80 Years Old

Objectives:

The extent to which locomotive syndrome is associated with low back pain (LBP), health-related quality of life (HRQOL), and impairment of activities of daily living among elderly men and women remains poorly documented. This study evaluated associations between locomotive syndrome and both HRQOL and LBP as assessed using a questionnaire completed by elderly individuals, including some >80 years old.

Methods:

We conducted a survey assessing locomotive syndrome using the loco-check, HRQOL using the Short-Form 36 questionnaire (SF-36), and LBP using the Roland-Morris Disability Questionnaire (RDQ) among individuals >60 years old. SF-36 and RDQ scores were compared between 253 subjects with and without locomotive syndrome.

Results:

Fifty-seven men (48%) and 71 women (53%) were diagnosed with locomotive syndrome. Subjects of both sexes with locomotive syndrome scored significantly lower for eight items from SF-36. Physical and mental component summary scores were significantly worse in women with locomotive syndrome in their 60s and 70s. RDQ scores were significantly higher in participants with locomotive syndrome for men in their 60s and for both men and women in their 70s.

Conclusions:

Locomotive syndrome was associated with impaired HRQOL and worse LBP among men and women >60 years old. Differences in HRQOL and LBP between subjects with and without locomotive syndrome were significant for both men and women in their 60s and 70s, but not in their 80s. Locomotive syndrome should be prevented to maintain HRQOL, particularly for men and women in their 60s and 70s.

Association of Bone Metabolism with Fatty Liver Disease in the Elderly in Japan: A Community-based Study

Objective With the aging of society, both osteoporosis and fatty liver disease (FLD) are becoming important issues. However, the relationship between osteoporosis and FLD remains controversial. We investigated the association between bone metabolism and FLD in a Japanese community in a cross-sectional study. Methods A total of 1,020 participants were enrolled in a health survey. FLD was diagnosed by ultrasonography. Bone metabolism was evaluated based on bone mineral density (BMD), which was assessed using dual-energy X-ray absorptiometry, and with the bone formation index (total type I procollagen N-terminal propeptide/bone-alkaline phosphatase ratio; P1NP/BAP ratio) and the bone resorption index (crosslinked N-telopeptide of type I collagen/tartrate-resistant acid phosphatase-5b ratio; NTx/TRACP-5b ratio) calculated from serum bone turnover markers. Results The BMD (percentage of the young adult mean) was the same level in both male and female participants with and without FLD. Both men and women showed an age-dependent decrease in their bone formation index and bone resorption index values. Men of ≥70 years of age and women of 60-69 years of age with FLD had significantly lower bone formation index values and higher bone resorption index values. However, similar findings were not seen in women of ≥70 years of age. Conclusion Although the BMD levels were the same, regardless of the presence or absence of FLD, elderly participants with FLD showed decreased bone formation and increased bone resorption, with sex differences. Because our results suggest that FLD in elderly individuals is detrimental for bone metabolism, and that it leads to bone loss and osteoporosis, further studies using a cohort population are warranted.

Adverse effects of the coexistence of locomotive syndrome and sarcopenia on the walking ability and performance of activities of daily living in Japanese elderly females: a cross-sectional study

[Purpose] The aim of this study was to investigate whether the coexistence of locomotive syndrome and sarcopenia is associated with the risk of fall or performance of activities of daily living in elderly females. [Participants and Methods] We categorized 112 Japanese elderly female participants under three groups: control, locomotive syndrome, and locomotive syndrome and co-existing sarcopenia. We compared the groups based on the mean scores of anthropometric and physical function measurements, the Timed Up and Go test, and the Tokyo Metropolitan Institute of Gerontology Index of Competence to evaluate activities of daily living. [Results] The Timed Up and Go test score significantly differed among the groups. The score of the Timed Up and Go test significantly correlated with scores of the skeletal muscle mass index, skeletal muscle strength grading, and usual gait speed. The total score of the Tokyo Metropolitan Institute of Gerontology Index of Competence significantly decreased in all the groups. [Conclusion] The coexistence of locomotive syndrome and sarcopenia is associated with an increased risk of fall and worsened performance of activities of daily living. Further, the risk of fall is associated with the skeletal muscle mass, skeletal muscle strength, and gait speed. It seems likely that, compared to sarcopenia, locomotive syndrome is more sensitive to lower limb dysfunctions.

Assessment of potential clinical cascade between oral hypofunction and physical frailty: Covariance structure analysis in a cross-sectional study

No report has yet examined the impact of oral hypofunction on physical frailty in relation to intra-relationships of physical frailty assessment items. The purpose of this study was to verify the potential of a clinical cascade between oral hypofunction and physical frailty, and especially to support the hypothesis that the influence of oral hypofunction on physical frailty is greater than the intra-relationships among elements of physical frailty and that sex differences significantly affect these relationships. The participants were 272 older adults (101 men and 171 women; mean age 75.1 ± 7.5 years). Maximum occlusal force (MOF) and oral dryness (OD), as indicators of oral hypofunction, and grip strength (GS) and walking speed (WS), as indicators of physical frailty, were measured. Mutual relationship of four variables was verified using covariance structure analysis. In men, three paths from MOF to WS and GS and from WS to GS were confirmed, and those from MOF to WS and from WS to GS were found to be significant (P < .01). In women, three paths from MOF to WS and GS and from WS to GS were also confirmed, as with the men, and those from MOF to WS and from MOF to GS were found to be significant (P < .01). Model adaptability was shown to be good for both men and women. The results suggest our hypothesis was verified, and it is expected that the early detection of oral hypofunction, that is MOF, may be important for assessing physical frailty, especially in women.

Loco-check presents a useful tool to determine health-related quality of life in elderly people with lumbar spinal stenosis

BACKGROUND

Locomotive syndrome (LS) is a condition of decreased mobility caused by disorders of the locomotive organs. Lumbar spinal stenosis (LSS) is an LS disorder. The loco-check is a simple questionnaire comprising seven questions that can detect LS. The differences between the health-related quality of life (HRQoL) of elderly persons without LSS and those with LSS remain unclear. The primary aim of this study was to clarify these differences using the European quality of life (EuroQoL) scale. The secondary aim was to clarify the differences between the groups based on loco-check questionnaire responses.

METHODS

We recruited patients aged ≥65 years. Our age- and sex-matched case/control cohorts included 28 elderly patients with LSS and 28 without LSS. The study participants were evaluated by the number of "yes" answers on the loco-check, the HRQoL using EuroQoL-5 dimension (EQ-5D) utility values, and the EuroQoL-visual analog scale (EQ-VAS). We compared differences between patients with and without LSS regarding HRQoL using EQ-5D utility values, EQ-VAS scores, the number of "yes" answers on the loco-check, and details of the loco-check.

RESULTS

Patients with LSS had significantly lower EQ-5D utility values (p < 0.01) and more "yes" answers on the loco-check (p < 0.01) than those without LSS. There were no significant differences in EQ-VAS scores between groups (p = 0.09). There were statistically significant differences between groups in all questions except two: You often trip up or slip around the house and You can't make it across the road before the light turns red.

CONCLUSIONS

Elderly patients with LSS had lower EQ-5D utility values and more "yes" answers on the loco-check than elderly persons without LSS. Our results may clarify differentiating features of elderly patients with and without LSS.

Investigating Eating Behaviors and Symptoms of Oral Frailty Using Questionnaires

A questionnaire survey was conducted to investigate eating behavior and the subjective symptoms of oral frailty, and to examine the relationship between them. A total of 744 subjects with ages over 65 years were included. The questionnaire comprised 18 question items indicating eating behavior and seven question items indicating oral frailty. All items were assessed according to 4 grades on a scale of 1 (not applicable) to 4 (applicable). The total score of oral frailty gradually increased with age. Regarding the scores for “eating recognition” and “eating habits”, no changes were observed, however the scores for “eating action” demonstrated a decreasing tendency with age and the scores of ≥ 85 years age group was significantly lower than the 65–69, 70–74, and 75–79 years age groups. As a result of multiple regression analysis, among the significant independent variable, the scores of “I do not chew foods well” under the category of “eating action” showed the highest standard partial regression coefficients for dependent variable of symptoms of oral frailty. The significant association was found between the eating behavior and subjective symptoms of oral frailty, and this study suggests that the good chewing habit might be an important criterion for the prevention of oral frailty.

Affirmative answers on loco-check as a predictor of health-related quality of life and locomotive syndrome progression in the elderly: A cross-sectional study

Objectives: To clarify the correlation between locomotive syndrome (LS) stages and the loco-check or health-related quality of life (HRQoL) and whether the loco-check can predict HRQoL and LS stages.Methods: Overall, 298 subjects (106 men, 192 women) were evaluated for LS and HRQoL using EuroQoL-5 dimensions (EQ-5D) and the EuroQoL-visual analog scale (EQ-VAS). The correlation between LS stages and HRQoL using EQ-5D and EQ-5D-VAS scores and the number of affirmative answers on the loco-check were evaluated.Results: The numbers of non-LS, Stage 1 LS, and Stage 2 LS subjects were 143, 130, and 25, respectively. EQ-5D and EQ-5D-VAS scores decreased from non-LS to Stage 2 LS. EQ-5D and EQ-5D-VAS scores in LS Stage 2 subjects were significantly lower. The number of affirmative answers on the loco-check increased from non-LS to Stage 2. Two affirmative answers on the loco-check was the cut-off to detect Stage 2 LS. The number of affirmative answers on the loco-check was significantly negatively correlated with HRQoL in elderly subjects.Conclusion: The number of affirmative answers on the loco-check positively correlated with LS stages and negatively correlated with HRQoL. The loco-check might help to predict LS stage and HRQoL, especially in elderly people aged over 65 years.

Association between locomotive syndrome and blood parameters in Japanese middle-aged and elderly individuals: a cross-sectional study

Background

Locomotive syndrome (LS) is associated with weakness and loss of function in the musculoskeletal organs. We aimed to determine the association between LS components and blood parameters in middle-aged and elderly individuals.

Methods

We included 223 middle-aged and elderly individuals in this study (104 men and 119 women; age: 40–85 years). All participants were asked to fast for at least 3 h before the venous blood samples were obtained and the hemoglobin, total protein, glycated hemoglobin (HbA1c), growth hormone, albumin and lipid profile were measured. Three functional tests, the stand-up test, the two-step test, and the 25-question geriatric locomotive function scale (GLFS) were used to assess the risk of LS. Walking speed was assessed by the 10-m walking test. Maximal isometric muscle strengths of the knee extensors were examined, and the weight bearing index (knee extension strength/body weight) was calculated. To assess an independent association between blood parameters and LS, the area under the receiver operating characteristic curve analysis (area under the curve, sensitivity, and specificity) and a binary logistic regression analysis were performed with adjustment for age.

Results

Of the 223 subjects, 119 (53.3%) fulfilled the diagnostic criteria for LS (including a two-step test score < 1.3, difficulty with one-leg standing from 40 cm in the stand-up test, and a 25-question GLFS score ≥ 7). Increased levels of HbA1c were significant risk factors for LS with an OR of 2.62 (OR_95%CI = 1.43–4.80), as determined by a logistic regression analysis. Additionally, dehydroepiandrosterone-sulfate (DHEA-S) levels were significant only in the male subjects (OR = 0.992 [OR_95%CI = 0.986–0.998]), at a threshold of 88 (AUC; 0.70, sensitivity; 79.6%, specificity; 49.1%). Moreover, 101 of 223 participants (41 men, 60 women) were analyzed for serum albumin levels, with a prevalence of LS at 55.4%, indicating that low levels of albumin were significant risk factors for LS (OR = 0.148 [OR_95%CI = 0.023–0.954], p = 0.0445).

Conclusions

These results suggest that higher HbA1c and lower albumin are associated with the prevalence of LS in Japanese middle-aged and elderly individuals. Furthermore, low DHEA-S levels may be useful screening tools for LS in men.

Locomotive syndrome in Japan

The present aging rate in Japan of some 28% will continue to increase along with the advancing age of elderly persons. Therefore, the demand for care will also increase. Approximately 25% of the need for nursing-care defined by the Japanese long-term care insurance system is associated with disorders or deterioration of locomotive organs. Therefore, the prevention and treatment of diseases in the locomotor system and maintenance of motor function are important for extended healthy life span and to decrease the demand for long-term care. Based on this background, the Japanese Orthopaedic Association (JOA) proposed the concept of locomotive syndrome (LS) in 2007, which is defined as reduced mobility due to impaired locomotive organs. Changes in locomotion must be noticed early to ensure the timely implementation of appropriate checks and measures of locomotion can uncover risk of acquiring LS. The acquisition of an exercise habit, appropriate nutrition, being active and evaluating and treating locomotion-related diseases are important to delay or avoid LS. The JOA recommends locomotion training consisting of four exercises to prevent and improve LS. Countermeasures against LS should become a meaningful precedent not only for Japan, but for other countries with rapidly aging populations.

Effects of a progressive walking program on the risk of developing locomotive syndrome in elderly Japanese people: a single-arm trial

[Purpose] This study aimed to identify the efficacy of a progressive walking program on the risk of developing locomotive syndrome among untrained elderly Japanese people. [Participants and Methods] Twenty-four untrained elderly individuals (68 ± 4 years) completed a 17-week progressive walking program. The stand-up, two-step tests and the 25-question geriatric locomotive function scale were used to assess the risk of locomotive syndrome at baseline, the 8-week midpoint (2 months), and the 17-week endpoint (4 months). Maximal isometric muscle strength of the knee extensors and flexors were measured using a dynamometer with the hip joint angle at 90° of flexion and physical function (the 30-s sit-to-stand, sit-up, 10-meter walk, and grip strength) were evaluated. [Results] The 4-month walking program significantly improved the two-step test and geriatric locomotive function scale scores. This may be attributable to the improvement in knee flexor strength and physical function. [Conclusion] A 4-month program of progressive walking effectively lowered the risk of developing locomotive syndrome in elderly Japanese people by improving knee flexor muscle strength and physical function.

Screening program including the Loco-check and fracture risk assessment tool (FRAX®) questionnaires for assessing locomotive syndrome in a municipality in Japan: A pilot study

BACKGROUND

Although the concept of locomotive syndrome and its relevant test methods have been established, approaches for incorporating them into regular health checkups have not been established. We aimed to assess the utility and problems of including Loco-check and the fracture risk assessment tool (FRAX^®) as primary screening for locomotive syndrome during health checkups under the Act on Assurance of Medical Care for Elderly People (specified health checkup) in the municipality.

METHODS

Loco-check and FRAX^® questionnaires were mailed to subjects eligible for the 2015 specified health checkup in Asahi-machi, Japan. Subjects with more than one affirmative response in the Loco-check questionnaire (Loco-check positive) or whose FRAX^® major osteoporotic fracture risk was ≥10% (FRAX^® positive) were identified as high risk and were evaluated in secondary checkups that included an locomotive syndrome risk test and sarcopenia and bone mineral density screenings. The degree of locomotive syndrome was assessed according to clinical diagnostic criteria of the Japanese Orthopaedic Association.

RESULTS

Questionnaires were collected from 2209 subjects and included 1193 Loco-check-positive and 1108 FRAX^®-positive subjects. There were 367 FRAX^®-positive subjects who were Loco-check-negative and 452 Loco-check-positive subjects who were FRAX^®-negative. Three hundred fifty-one subjects completed secondary checkups (42 in the no locomotive syndrome group, 171 in the locomo stage 1 group, and 138 in the locomo stage 2 group). Fourteen subjects had sarcopenia.

CONCLUSION

The locomotive syndrome prevalence is high among subjects eligible for specified health checkups; these subjects were appropriate for locomotive syndrome screening. Using Loco-check and FRAX^® in primary screening, many subjects can be evaluated for locomotive syndrome in a timely and cost-effective manner, a more diversified risk of fall/fracture can be obtained, and the sensitivity of screening may be increased. These checkup protocols will assist in promoting locomotive syndrome checkups in municipalities throughout Japan.

The impact of musculoskeletal diseases on the presence of locomotive syndrome

OBJECTIVES

We assessed the impact of musculoskeletal diseases, depressive mental state, and hypertension on locomotive syndrome, a condition of reduced mobility requiring nursing care. Since locomotive syndrome is a major public health issue that needs attention, its relationship with functional inconvenience in performing daily activities was also investigated.

METHODS

We conducted a cross-sectional study using an Internet panel survey, comprising 747 persons aged 30-90 years. Demographics, personal medical history, and daily activity data were assessed. The 25-question Geriatric Locomotive Function Scale was used to diagnose locomotive syndrome. Stepwise linear regression analysis and logistic regression analysis were conducted to evaluate the association between locomotive syndrome, musculoskeletal diseases, and functional inconvenience.

RESULTS

Aging, osteoporosis, and low back pain significantly increased the risk of locomotive syndrome, followed by knee osteoarthritis and lumbar spinal stenosis. Locomotive syndrome was significantly related to depressive mental state and hypertension, and led to functional inconvenience in Seiza sitting, cleaning, shopping, and strolling.

CONCLUSION

Locomotive syndrome was associated with functional inconvenience in performing common daily activities involving the lower extremities and spine. Osteoporosis and aging were significantly associated with locomotive syndrome. The risk of locomotive syndrome may be decreased by treating comorbid osteoporosis and instituting exercise and diet-related modifications.

The Value of Phenotypes in Knee Osteoarthritis Research

Background:

Over the past decade, phenotypes have been used to help categorize knee osteoarthritis patients relative to being subject to disease, disease progression, and treatment response. A review of potential phenotype selection is now appropriate. The appeal of using phenotypes is that they most rely on simple physical examination, clinically routine imaging, and demographics. The purpose of this review is to describe the panoply of phenotypes that can be potentially used in osteoarthritis research.

Methods:

A search of PubMed was used singularly to review the literature on knee osteoarthritis phenotypes.

Results:

Four phenotype assembly groups were based on physical features and noninvasive imaging. Demographics included metabolic syndrome (dyslipidemia, hypertension, obesity, and diabetes). Mechanical characteristics included joint morphology, alignment, the effect of injury, and past and present history. Associated musculoskeletal disorder characteristics included multiple joint involvement, spine disorders, neuromuscular diseases, and osteoporosis. With the knee as an organ, tissue characteristics were used to focus on synovium, meniscus, articular cartilage, patella fat pad, bone sclerosis, bone cysts, and location of pain.

Discussion:

Many of these phenotype clusters require further validation studies. There is special emphasis on knee osteoarthritis phenotypes due to its predominance in osteoarthritic disorders and the variety of tissues in that joint. More research will be required to determine the most productive phenotypes for future studies.

Conclusion:

The selection and assignment of phenotypes will take on an increasing role in osteoarthritis research in the future.

Lifestyle factors are significantly associated with the locomotive syndrome: a cross-sectional study

Background

The Japanese Orthopedic Association first proposed the concept of “locomotive syndrome” in 2007. It refers to circumstances in which elderly people need nursing care services or are at high risk of requiring such services within a short time. Recently, the public health burden of providing nursing care for elderly individuals has increased. Therefore, locomotive syndrome, and the means of preventing it, are a major public health focus in Japan. The purpose of this study was to investigate the relationships of lifestyle factors, such as smoking, alcohol consumption, sleep duration, and dental health, with locomotive syndrome.

Methods

We conducted a cross-sectional study using an internet panel survey. The participants comprised 747 individuals aged 30–90 years. Factors related to demographics (age, sex), general health (number of teeth, presence of periodontal disease), and lifestyle (smoking, alcohol consumption, sleep duration) were assessed. We also used the 25-question Geriatric Locomotive Function Scale to determine whether each participant had locomotive syndrome. Multivariate analysis was conducted using logistic regression to investigate the independent relationships between locomotive syndrome and lifestyle factors after adjusting for sex and age.

Results

A greater proportion of women (17.7%) than men (11.2%) had locomotive syndrome (p < 0.05). Participants aged ≥65 years showed significantly higher percentages (men: 21.4%, women: 75.7%) of locomotive syndrome compared with those aged <65 years (p < 0.05). Logistic regression analysis revealed that older age (≥ 65 years), sex, current smoking status, number of existing teeth, and presence of periodontal disease were associated with locomotive syndrome, whereas sleep duration was not. The frequency of alcohol consumption, except for daily drinking, was also associated with locomotive syndrome.

Conclusion

Our study indicates that lifestyle factors, such as smoking and number of existing teeth, may partly affect the prevalence of locomotive syndrome. Hence, lifestyle modifications, such as improving oral hygiene and promoting cessation of smoking, are important means to reduce the risk of locomotive syndrome and should be promoted by public health staff.

Quantitative assessment of locomotive syndrome by the loco-check questionnaire in older Japanese females

[Purpose] Locomotive syndrome (LS) is a condition by which older people may require care service because of problems with locomotive organs. This study examined whether the loco-check, a 7-item questionnaire, is useful for quantitatively assessing the severity of LS. [Subjects and Methods] Seventy-one community dwelling Japanese females aged 64–96 years (81.7 ± 8.0 years) participated in this study. The associations of the loco-check with thigh muscle mass measured by X-ray CT, physical performance, nutritional status, and quality of life (QOL) were investigated. [Results] The results showed that the number of times that “yes” was selected in the loco-check was significantly correlated with thigh muscle mass, major measures of physical performance, nutritional status, and QOL. This number was also significantly larger in the participants experiencing falling, fracture, and lumbar pain than in those without these episodes. [Conclusion] These results suggest that the loco-check might be useful for quantitatively evaluating LS.

Relationship of locomotive syndrome with health-related quality of life among patients with obstructive sleep apnea syndrome

[Purpose] This study aimed to examine the prevalence of locomotive syndrome among patients with obstructive sleep apnea syndrome (OSAS) using the “loco-check” recently developed by the Japanese Orthopedic Association, and to compare health-related quality of life (HRQOL) among patients with and without locomotive syndrome. [Subjects and Methods] This cross-sectional study evaluated 1,195 outpatients with OSAS (1,030 males and 165 females). Locomotive syndrome was evaluated using the Japanese Orthopedic Association’s “loco-check”. HRQOL and psychological distress were evaluated using the EuroQol 5-dimensional (EQ-5D) and 6-item Kessler questionnaires. [Results] Locomotive syndrome was detected in 578 patients (48.4%), including 398 males (38.6% of males) and 119 females (70.3% of females). Patients with OSAS and locomotive syndrome had significantly lower EQ-5D scores, compared to patients without locomotive syndrome. Multiple regression analysis revealed that HRQOL among patients with OSAS was independently associated with locomotive syndrome, age, gender, body mass index, apnea hypopnea index, the Japanese version of the Epworth Sleepiness Scale score, and exercise habits. [Conclusion] The prevalence of locomotive syndrome was thought to be comparatively high in patients with OSAS, and locomotive syndrome was associated with lower HRQOL, even after adjusting for confounding factors. Prevention or management of locomotive syndrome may be beneficial for improving HRQOL among patients with OSAS.

Association between dysfunction of upper extremity and locomotive syndrome in general population

OBJECTIVE

This study investigated the relation between self-assessment of upper extremity function and locomotive syndrome in a general population.

METHODS

Using the 25-question Geriatric Locomotive Function (GLFS-25) test, 320 Japanese people (115 men, 205 women, mean age 67.6 years, 40-92 years) were evaluated for locomotive dysfunction. All had completed a self-administered questionnaire including items for sex, weight, height, dominant hand, and the degree of frequency of hand in ADL. We measured the bilateral hand grip and key pinch strength as indicators of hand muscle function. Study participants were assessed for upper extremity dysfunction using Hand 10, a self-administered questionnaire for upper extremity disorders, and using the Japanese Society for Surgery of the Hand Version of Disability of the Arm, Shoulder, and Hand. Statistical analyses were conducted to clarify the association between upper extremity dysfunction and screening results for locomotive dysfunction.

RESULTS

Participants reporting any upper extremity dysfunction were 137 (47 men, 90 women) out of 320 participants. The GLFS25 score was found to have significant positive correlation with age and Hand 10 scores. Significant negative correlation was found with the GLFS25 score and dominant grip strength, non-dominant grip strength, dominant key pinch strength, and non-dominant key pinch strength. Univariate analysis revealed a significant association with age, sex, bilateral hand grip, and key pinch, and with the Hand 10 score and Locomotive syndrome. Logistic regression analysis applied after adjustment for age, sex, height, and weight revealed a significant association between Locomotive syndrome and each of non-dominant hand grip (OR 0.73, 95%CI 0.61-0.87) and the Hand 10 questionnaire score (OR 1.10, 95%CI 1.06-1.14).

CONCLUSION

Locomotive syndrome is associated with the decline of self-assessed and observed upper extremity function.

STUDY DESIGN

Cross-sectional study.

Locomotive syndrome is associated with body composition and cardiometabolic disorders in elderly Japanese women

Background

A concept referred to as locomotive syndrome (LS) was proposed by the Japanese Orthopaedic Association in order to help identify middle-aged and older adults who may be at high risk of requiring healthcare services because of problems associated with locomotion. Cardiometabolic disorders, including obesity, hypertension, diabetes, and dyslipidemia, have a high prevalence worldwide. The purpose of this study was to determine the associations between LS and both body composition and cardiometabolic disorders.

Methods

The study participants were 165 healthy adult Japanese women volunteers living in rural areas. LS was defined as a score ≥16 on the 25-question Geriatric Locomotive Function Scale (GLFS-25). Height, body weight, body fat percentage, body mass index (BMI), and bone status were measured. Bone status was evaluated by quantitative ultrasound (i.e., the speed of sound [SOS] of the calcaneus) and was expressed as the percent of Young Adult Mean of the SOS (%YAM). Comorbid conditions of hypertension, hyperlipidemia, and diabetes were assessed using self-report questionnaires.

Results

Twenty-nine participants (17.6 %) were classed as having LS. The LS group was older, shorter, and had a higher body fat percentage, a higher BMI, and lower bone status than the non-LS group. Multiple logistic regression analysis showed that participants with a BMI ≥23.5 kg/m² had a significantly higher risk for LS than those with a BMI <23.5 kg/m² (odds ratio [OR] = 3.78, p < 0.01). Furthermore, GLFS-25 scores were higher in participants with than those without hypertension, diabetes, or obesity, and significantly increased with the number of present disorders.

Conclusions

These findings suggest that BMI may be a useful screening tool for LS. Furthermore, because hypertension and diabetes were associated with LS, the prevention of these disorders accompanied by weight management may help protect against LS.

Electronic supplementary material

The online version of this article (doi:10.1186/s12877-016-0339-6) contains supplementary material, which is available to authorized users.

Relationship between knee osteoarthritis and the locomotive syndrome risk tests: A cross-sectional study

OBJECTIVE

To determine the relationship between locomotive syndrome (LS) risk tests and knee osteoarthritis (KOA).

STUDY DESIGN

Cross-sectional cohort study.

METHODS

In 2015, 225 people (male 84, females 141, mean age 67.9, range 30-90) were examined using LS risk tests, including the stand-up test, the two-step test, and the 25-question risk assessment, in Katashina Village in Gunma prefecture. The Japanese orthopaedic association defined LS risk test stage 1, difficulty with standing from a 40-cm-high seat using one-leg in the stand-up test, two-step test <1.3, the 25-question risk assessment ≧7, and defined stage 2, difficulty with standing from a 20-cm-high seat using both legs in the stand-up test, two-step test <1.1, the 25-question risk assessment ≧16. Persons with two or more of the following on the ultrasound (US) assessment were defined as having KOA: peripheral joint space (PJS) < 5 mm during weight-bearing; medial radial displacement (MRD) > 5 mm during weight-bearing; and osteophytes > 2 mm. If the residents had KOA in either knee, they were defined as having KOA.

RESULTS

45 residents had KOA in either knee. Logistic regression analysis adjusted for age, height, weight, gender, and knee pain was performed with stage 0 as reference. On the stand-up test, the odds ratio was 5.484 (95% confidence interval (CI) 1.966-15.297) for stage 1 and 2.067 (95% CI 0.426-10.017) for stage 2. On the two-step test, the odds ratio was 1.497 (95% CI 0.557-4.021) for stage 1 and 0.71 (95% CI 0.210-2.395) for stage 2. On the 25-question risk assessment, the odds ratio was 1.73 (95% CI 0.646-4.631) for stage 1 and 1.5 (95% CI 0.508-4.433) for stage 2.

CONCLUSIONS

A stand-up test of stage 1 had a significant relationship with KOA. This might suggest that proper care of KOA is needed to prevent progressive disability.

Locomotive syndrome presents a risk for falls and fractures in the elderly Japanese population

“Locomotive syndrome” is used to designate the condition of individuals with musculoskeletal disease who are highly likely to require nursing care. This article reviews screening, prevalence, causal and related factors, and the relationship between locomotive syndrome and falls and fractures in older adults with this syndrome. A few self-administered questionnaire tools are available to assess individuals for locomotive syndrome. Additionally, screening methods, including a physical functioning assessment, are appropriate for detailed discrimination of locomotive syndrome. The prevalence of locomotive syndrome is significantly higher in women than in men, and tends to increase markedly from 70 years of age. More severe locomotive syndrome is related to knee pain, osteoporosis, sarcopenia, and lumbar disease. The incidence of falling in locomotive syndrome is higher than the incidence for the older population in general. Locomotive training including squats and a unipedal standing exercise has been recommending to prevent locomotive syndrome. This training improves muscle strength and balance function for older people who have a risk for locomotive syndrome.

Physical Performance Measures Associated With Locomotive Syndrome in Middle-Aged and Older Japanese Women

BACKGROUND

The Japanese Orthopaedic Association proposed a concept called locomotive syndrome (LS) to identify middle-aged and older adults at high risk of requiring health care services because of problems with locomotion. It is important to identify factors associated with the development of LS. Physical performance measures such as walking speed and standing balance are highly predictive of subsequent disability and mortality in older adults. However, there is little evidence about the relationship between physical performance measures and LS.

PURPOSE

To determine the physical performance measures associated with LS, the threshold values for discriminating individuals with and without LS, and the odds ratio of LS according to performance greater than or less than these thresholds in middle-aged and older Japanese women.

METHODS

Participants were 126 Japanese women (mean age = 61.8 years). Locomotive syndrome was defined as a score of 16 or more on the 25-question Geriatric Locomotive Function Scale. Physical performance was evaluated using grip strength, unipedal stance time with eyes open, seated toe-touch, and normal and fast 6-m walk time (6 MWT). Variables were compared between LS and non-LS groups.

RESULTS

Fourteen participants (11.1%) were classed as having LS. Unipedal stance time, normal 6 MWT, and fast 6 MWT were significantly different between the 2 groups. The LS group had a shorter unipedal stance time and a longer normal and fast 6 MWT than the non-LS group. For these 3 variables, the area under the receiver operating characteristic curve was greater than 0.7, and the threshold for discriminating the non-LS and LS groups was 15 s for unipedal stance time, 4.8 s for normal 6 MWT and 3.6 s for fast 6 MWT. These variables were entered into a multiple logistic regression analysis, which indicated that unipedal stance time less than 15 s was significantly related to LS (odds ratio = 8.46; P < .01).

CONCLUSION

Unipedal stance time was the physical performance measure that was most strongly associated with LS. This measure may be useful for early detection of LS.

Relationship Between Difficulties in Daily Activities and Falling: Loco-Check as a Self-Assessment of Fall Risk

Background

People aged 65 years or older accounted for 25.1% of the Japanese population in 2013, and this characterizes the country as a “super-aging society.” With increased aging, fall-related injuries are becoming important in Japan, because such injuries underlie the necessity for nursing care services. If people could evaluate their risk of falling using a simple self-check test, they would be able to take preventive measures such as exercise, muscle training, walking with a cane, or renovation of their surroundings to remove impediments. Loco-check is a checklist measure of early locomotive syndrome (circumstances in which elderly people need nursing care service or are at high risk of requiring the service within a short time), prepared by the Japanese Orthopaedic Association (JOA) in 2007, but it is unclear if there is any association between this measure and falls.

Objective

To investigate the association between falls during the previous year and the 7 “loco-check” daily activity items and the total number of items endorsed, and sleep duration.

Methods

We conducted an Internet panel survey. Subjects were 624 persons aged between 30 and 90 years. The general health condition of the participants, including their experience of falling, daily activities, and sleep duration, was investigated. A multivariate analysis was carried out using logistic regression to investigate the relationship between falls in the previous year and difficulties with specific daily activities and total number of difficulties (loco-check) endorsed, and sleep duration, adjusting for sex and age.

Results

One-fourth of participants (157 persons) experienced at least one fall during the previous year. Fall rate of females (94/312: 30.1%) was significantly higher than that of males (63/312: 20.2%). Fall rate of persons aged more than 65 years (80/242: 33.1%) was significantly higher than that of younger persons (77/382: 20.2%). Logistic regression analysis revealed that daily activities such as “impossibility of getting across the road at a crossing before the traffic light changes” are significantly related to falling. Logistic regression analysis also demonstrated a relationship between the number of items endorsed on loco-check and incidence of falling, wherein persons who endorsed 4 or more items appear to be at higher risk for falls. However, logistic regression found no significant relationship between sleep duration and falling.

Conclusions

Our study demonstrated a relationship between the number of loco-check items endorsed and the incidence of falling in the previous year. Endorsement of 4 or more items appeared to signal a high risk for falls. The short self-administered checklist can be a valuable tool for assessing the risk of falling and for initiating preventive measures.

Lumbar spondylosis, lumbar spinal stenosis, knee pain, back muscle strength are associated with the locomotive syndrome: Rural population study in Japan

OBJECTIVES

To comprehensively investigate the clinical and physical factors associating with locomotive syndrome (Loc-S); the locomotorium-disability for daily life.

METHODS

647 volunteers participated (247 males, 400 females, Age: 58.4 ± 11.0, BMI: 22.5 ± 3.3). Three self-assessment questionnaires were administered: 1) "25-question Geriatric Locomotive Function Scale" (GFLS-25) for evaluating Loc-S (GLFS-25 ≥ 16 defined as Loc-S); 2) "diagnostic support tool for LSS" (LSS-DST) for evaluating the prevalence of lumbar spinal stenosis (LSS); 3) Knee injury and Osteoarthritis Outcome Score (KOOS). Plain radiographs of the bilateral knees and lumbar spine were evaluated, and the severity of lumbar spondylosis (LS) and knee osteoarthritis (KOA) defined by Kellgren-Lawrence grade. Bone status was evaluated by using the osteo-sono assessment index (OSI) at the calcaneus. Isometric muscle strength of trunk and leg (Nm/kg, both extension and flexion) were evaluated. Linear regression analysis was performed to elucidate the factors concerned with GFLS-25 including age, sex, and BMI.

RESULTS

Thirty-nine subjects (6.0%, 13 males, 26 females) were defined as having Loc-S. Single regression model showed that age, height, BMI, skeletal muscle mass, OSI, LSS, KOOS, the severity of LS and KOA, and trunk- and leg-muscle strength were correlated with the degree of GLFS-25. Stepwise multiple regression model showed that sex, height, LSS, KOOS, the severity of LS, and back muscle strength were significantly correlated with that of GLFS-25.

CONCLUSION

In this cross-sectional study, pain status associated with LSS and knee joint, structural severity for LS, and back muscle strength primarily affected the degree of GFLS-25. For managing Loc-S, we must pay more intensive attention to these factors.

Spinal sagittal balance substantially influences locomotive syndrome and physical performance in community-living middle-aged and elderly women

OBJECTIVES

Spinal sagittal imbalance has been well known risk factor of decreased quality of life in the field of adult spinal deformity. However, the impact of spinal sagittal balance on locomotive syndrome and physical performance in community-living elderly has not yet been clarified. The present study investigated the influence of spinal sagittal alignment on locomotive syndrome (LS) and physical performance in community-living middle-aged and elderly women.

METHODS

A total of 125 women between the age of 40-88 years (mean 66.2 ± 9.7 years) who completed the questionnaires, spinal mouse test, physical examination and physical performance tests in Yakumo study were enrolled in this study. Participants answered the 25-Question Geriatric Locomotive Function Scale (GLFS-25), the visual analog scale (VAS) for low back pain (LBP), knee pain. LS was defined as having a score of >16 points on the GLFS-25. Using spinal mouse, spinal inclination angle (SIA), thoracic kyphosis angle (TKA), lumbar lordosis angle (LLA), sacral slope angle (SSA), thoracic spinal range of motion (TSROM), lumbar spinal range of motion (LSROM) were measured. Timed-up-and-go test (TUG), one-leg standing time with eyes open (OLS), and maximum stride, back muscle strength were also measured. The relationship between spinal sagittal parameters and GLFS-25, VAS and physical performance tests were analyzed.

RESULTS

26 people were diagnosed as LS and 99 were diagnosed as non-LS. LBP and knee pain were greater, physical performance tests were poorer, SIA were greater, LLA were smaller in LS group compared to non-LS group even after adjustment by age. SIA significantly correlated with GLFS-25, TUG, OLS and maximum stride even after adjustment by age. The cutoff value of SIA for locomotive syndrome was 6°. People with a SIA of 6° or greater were grouped as "Inclined" and people with a SIA of less than 6° were grouped as "Non-inclined". 21 people were "Inclined" and 104 were "Non-inclined". Odds ratio to fall in LS of Inclined group compared to Non-inclined group is 5.0. GLFS-25 were significantly higher, VAS for LBP were greater, TUG, OLS and maximum stride were poorer in Inclined group compared to Non-inclined group even after adjustment by age.

CONCLUSIONS

The present study demonstrated that spinal sagittal balance influences the LS and physical performance in community-living middle-aged and elderly women. SIA is a useful spinal parameter to evaluate the risk of LS, and its cutoff value is 6°.

Relation between the stand-up test and gait speed, knee osteoarthritis, and osteoporosis using calcaneal quantitative ultrasound - Cross-sectional study

OBJECTIVE

The aim of the present study was to clarify the relationship between the stand-up test and gait speed, knee osteoarthritis (OA), and osteoporosis using calcaneal quantitative ultrasound.

STUDY DESIGN

Cross-sectional study.

METHODS

A total of 185 subjects (55 men, 130 women) aged ≥40 years (mean age, 63.7 years; range, 40-79 years) were evaluated using the stand-up test to screen for locomotive syndrome. We also assessed OA of the knee using X-rays and a subjective questionnaire, physical characteristics, 6-m gait speed (m/s), and bone density. If results on the stand-up test were worse than benchmarks by age group (i.e., the height at which 50% of each age group could stand-up), the subject was defined as having a risk for locomotive syndrome (L group). We analyzed the relationship between the stand-up test and other variables.

RESULTS

Of 185 subjects, 50 (27.0%) were classified into the L group. In univariate analysis, there were significant differences between the L group and non-L group in bone density (p < 0.001), gait speed (p < 0.001), osteoporosis (p < 0.001), slow gait speed group (SGSG) (cut off 1 m/s), and Japanese knee osteoarthritis measure score. Multivariate logistic regression analysis adjusted for age, height, weight, and gender showed a significant association between the stand-up test and bone density (OR 0.960, 95% confidence interval (95% CI) 0.927-0.994), gait speed (m/s) (OR 0.073, 95% CI 0.016-0.342), osteoporosis (OR 3.710, 95% CI 1.410-9.764), and SGSG (OR 7.849, 95% CI 1.628-37.845).

CONCLUSIONS

The stand-up test to screen for the risk for locomotive syndrome was associated with bone density, gait speed, osteoporosis, SGSG. The stand-up test is an easy test to use to screen for possible disability among the elderly.

The Knee injury and Osteoarthritis Outcome Score reflects the severity of knee osteoarthritis better than the revised Knee Society Score in a general Japanese population

PURPOSE

The purposes of this study were to examine population-based reference data for sex- and age-related differences between the 2011 revised Knee Society Score (KSS2011) and the Knee injury and Osteoarthritis Outcome Score (KOOS), to assess the correlation between those scores and radiographic knee osteoarthritis (OA), and to validate the use of the scores in a general Japanese population.

METHODS

This cross-sectional study included 963 volunteers (368 males, 595 females; mean age: 54.7years). Participants were classified into five subgroups by age: under 40, 40s, 50s, 60s, and over 70years old. The KSS2011 and KOOS were determined using self-administered questionnaires. Weight-bearing radiographs of the bilateral knee were taken and graded according to the Kellgren-Lawrence (KL) scale. The mean KSS2011 and KOOS were compared among age groups. Correlations between the severity of knee OA and each score were assessed using multiple regression analysis.

RESULTS

The overall KSS2011 tended to gradually decrease with age. Most subscales of the KSS2011 did not show sex-related differences. Similarly, the overall KOOS and all its subscales steadily decreased by approximately 20 points per decade with age. Most subscales of the KOOS were significantly decreased in females over 50. The KL grade was significantly related to both the overall KOOS (β=-0.42, p<0.001) and KSS2011 (β=-0.13, p=0.001), though the correlation to the KOOS was stronger.

CONCLUSION

The overall KSS2011 and KOOS appear to decrease with age. In this population, the KOOS reflects the severity of knee OA better than the KSS2011.

Population-based study of the association of osteoporosis and chronic musculoskeletal pain and locomotive syndrome: the Katashina study

BACKGROUND

"Locomotive syndrome", a concept proposed by the Japanese Orthopaedic Association (JOA), refers to risk conditions among the elderly population that may lead to the need for nursing care services. The association between osteoporosis (OP) or chronic musculoskeletal pain (CMSP) and the screening results of locomotive dysfunction identified by the GLFS-25 (a 25-question geriatric locomotive function scale) has not yet been adequately investigated.

MATERIALS AND METHODS

Two hundred eighty-seven Japanese subjects were evaluated for locomotive dysfunction using the GLFS-25 and were also evaluated for their bone status by a quantitative ultrasound (QUS) assessment of the bone status (i.e., the measurement of the speed of sound (SOS) of the calcaneus). Furthermore, a questionnaire survey concerning CMSP persisting for 3 months or longer was given to those subjects. Statistical analyses were conducted to clarify the association between the bone status or CMSP and the screening results for locomotive dysfunction.

RESULTS

The % young adult mean (%YAM) of the SOS was significantly lower among the 43 subjects with locomotive dysfunction identified by the GLFS-25 than in the 244 subjects without locomotive dysfunction (p < 0.001). Moreover, low back pain (p < 0.01), shoulder pain (p < 0.05) and knee pain (p < 0.001) were significantly more frequently observed in the 43 subjects with locomotive dysfunction than the 244 subjects without locomotive dysfunction. The screening results of the %YAM of the SOS was significantly associated with the population demonstrating locomotive dysfunction screened by the GLFS-25 based on the age-, gender- and BMI-adjusted analysis (OR 0.95, 95 % CI 0.91-0.98). Furthermore, the %YAM of SOS correlated with the GLFS-25 score (β = -0.212, p = 0.001). Furthermore, low back pain (OR 2.60, 95 % CI 1.29-5.24), shoulder pain (OR 2.16, 95 % CI 1.00-4.66), and knee pain (OR 2.97, 95 % CI 1.41-6.28) were found to be associated with locomotive dysfunction based on the results of the age-, gender- and a BMI-adjusted analysis.

CONCLUSIONS

The %YAM of the SOS was associated with the population demonstrating locomotive dysfunction which was identified using the GLFS-25, and the severity of locomotive dysfunction evaluated by the GLFS-25 was found to correlate with the %YAM of the SOS. Furthermore, low back pain, shoulder pain and knee pain were found to be associated with the screening results for locomotive dysfunction by the GLFS-25.

Nocturnal knee pain increases with the severity of knee osteoarthritis, disturbing patient sleep quality

OBJECTIVE

Sleep disturbances frequently accompany chronic pain from osteoarthritis (OA). Effective management of sleep disturbances may require successful treatment of chronic pain, a key factor in the clinical evaluation of knee OA. However, the relationship between the severity of knee OA and sleep quality is unclear. Our purpose was to correlate the prevalence of nocturnal knee pain with different OA severity levels and to determine its influence on sleep quality.

METHODS

Subjects included 1,214 local volunteers with mean ± SD age 58.1 ± 13.0 years. The existence and severity of knee OA were determined by the Kellgren/Lawrence (K/L) grade, and joint space widths were measured. The presence of nocturnal knee pain and Knee Injury and Osteoarthritis Outcome Scores (KOOS) were assessed by self-completed questionnaires. Sleep quality was evaluated by the Pittsburgh Sleep Quality Index. Knee-related factors affecting sleep quality were detected using statistical methods.

RESULTS

The prevalence of nocturnal knee pain was 3.6%, 6.9%, 19.4%, 32.7%, and 75.0% in K/L grades 0, 1, 2, 3, and 4, respectively. Also, prevalence significantly increased with OA severity (P < 0.001). Sleep problems also increased with K/L grade (P = 0.038), and KOOS quality of life (QOL) was significantly lower in those with OA and sleep problems. Logistic regression showed that sleep problems were related to joint space narrowing (P = 0.016) and nocturnal knee pain (P = 0.039). Severe OA also disturbed onset and maintenance of sleep.

CONCLUSION

The prevalence of nocturnal knee pain and sleep problems increased with the severity of OA, impacting QOL. These results suggest the necessity of appropriate nocturnal pain control.

Association between "loco-check" and EuroQol, a comprehensive instrument for assessing health-related quality of life: a study of the Japanese general population

BACKGROUND

The concept of "locomotive syndrome" (LS) was proposed by the Japanese Orthopaedic Association (JOA) in 2007 to refer to the risk of elderly individuals becoming bedridden because of reduced function of locomotive organs, for example muscles, bones, and joints. The purpose of this study was to clarify the association between LS screening results based on "loco-check" and health-related quality of life (HRQoL) assessed by use of EuroQol.

MATERIALS AND METHODS

Four-hundred and forty-two Japanese subjects (183 males and 259 females) were evaluated for LS and HRQoL by use of "loco-check," EuroQol-5 dimensions (EQ-5D), and EuroQol-VAS (EQ-VAS). If the subjects answered "yes" to one or more of the seven items of "loco-check," they were assigned to a locomotive syndrome suspected group (L group). If they answered "no" to all seven items, they were assigned to a locomotive syndrome not suspected group (NL group). We investigated the association between the screening LS results obtained by use of "loco-check" and HRQoL status determined by use of EQ-5D utility value and EQ-VAS score.

RESULTS

LS was suspected among 39.6% of the subjects on the basis of "loco-check." In univariate analysis, significantly higher age, higher female-to-male ratio, and more reduced HRQoL were observed in the L group than in the NL group, according to EQ-5D and EQ-VAS. Logistic regression analysis showed that EQ-5D utility value and EQ-VAS score were associated with LS and the difference was statistically significant. Furthermore, correlations were found between the number of items with a "yes" answer on "loco-check", EQ-5D, or EQ-VAS. That is, a larger number of items with a "yes" answer on "loco-check" was associated with reduced HRQoL assessed by use of EQ-5D and EQ-VAS.

CONCLUSIONS

We demonstrated that a finding of LS on the basis of "loco-check" is significantly associated with EQ-5D utility value and EQ-VAS score, and that a population identified as having LS by use of "loco-check" also had reduced HRQoL. Furthermore, it is speculated that the severity of reduced HRQoL because of locomotive dysfunction can be determined by use of "loco-check".

Waist circumference is associated with locomotive syndrome in elderly females

BACKGROUND

Central obesity has been proved to be a strong risk factor for numerous health-related problems as well as mortality. However, there have been no studies on the relationship between central obesity and locomotive syndrome (LS). The present study investigated the influence of central obesity on LS.

METHODS

A total of 217 females between the ages of 60 and 79 years (mean 68.2 ± 5.0 years) who completed the questionnaires, physical examination and physical performance tests in the Yakumo study in 2011-2012 were enrolled in this study. Participants were assessed according to the 25-Question Geriatric Locomotive Function Scale (GLFS-25), visual analog scale (VAS) for lower back pain (LBP) and knee pain, and the Roland Morris Disability Questionnaire (RDQ). LS was defined as having a score of >16 points on the GLFS-25. Height, weight, waist circumference (WC), hip circumference, % body fat and bone mineral density were measured. Body mass index and waist-to-hip ratio were calculated. The timed up-and-go test, one-leg standing time with eyes open, 10-m gait time and maximum stride were assessed. Back muscle strength and grip strength were measured. The relationships between obesity-related parameters and GLFS-25, RDQ, VAS and physical performance tests were analyzed.

RESULTS

The GLFS-25, LBP and knee pain showed significant correlation with most of obesity-related parameters. Among obesity-related parameters, WC was most strongly related to the GLFS-25, LBP and knee pain. When participants were stratified by WC, larger WC was significantly associated with a higher GLFS-25 score, higher prevalence of LS and higher VAS for LBP and knee pain as well as poorer results in some physical performance tests even after adjustment by age.

CONCLUSIONS

The present study revealed that central obesity is significantly associated with LS, and WC can be a useful parameter to assess the risk of LS in elderly women.

Prevalence and symptom of ossification of posterior longitudinal ligaments in the Japanese general population

BACKGROUND

Ossification of the posterior longitudinal ligaments (OPLL) causes myelopathy with progression or trauma. Most OPLL patients visit the hospital after severe symptoms occur, and surgery did not supply complete relief in severe symptoms related to OPLL. While it is necessary to diagnose OPLL early and observe carefully, the nature of symptoms and asymptomatic OPLL have been unclear. The purposes of this study were to investigate the prevalence and symptoms of ossification of the posterior longitudinal ligaments (OPLL) of the cervical spine in the general population.

METHODS

The subjects were 1291 Japanese general residents. Radiographic OPLL was detected by lateral view of the cervical spine, and subjects were classified into OPLL and non-OPLL groups. Visual analog scales of neck stiffness, neck pain, arm pain, and the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire were examined. Neck and arm symptoms were compared among the presence of OPLL, and among subtypes (continuous, segmental, and mixed types) statistically.

RESULTS

Prevalence of OPLL was 3.7 % in overall participants, 3.9 % in symptomatic participants, and 2.2 % in asymptomatic participants. While 86.7 % of participants with OPLL had symptoms, the consultation rate was only 6.7 %. The female OPLL group had higher neck pain than the non-OPLL group, and neck function of JOACMEQ in the continuous type of OPLL was significantly restricted compared to those without OPLL and with the mixed type of OPLL.

CONCLUSIONS

Prevalence of OPLL was 3.7 %, and most of them had neck and arm symptoms; however, they did not visit hospitals. Asymptomatic OPLL had the potential risk for spinal cord injury and myelopathy. Early detection and careful observation would prevent the severe symptoms induced by OPLL.

Threshold values of physical performance tests for locomotive syndrome

BACKGROUND

Our previous study determined which physical performance tests were the most useful for evaluating locomotive syndrome. Our current study establishes reference values for these major physical performance tests with regards to diagnosing and assessing risk of locomotive syndrome (LS).

METHODS

We measured timed-up-and-go test, one-leg standing time, back muscle strength, grip strength, 10-m gait time and maximum stride in 406 individuals (167 men, 239 women) between the ages of 60-88 years (mean 68.8 ± 6.7 years) during Yakumo Study 2011-12. The LS was defined as having a score of >16 points on the 25-Question Geriatric Locomotive Function Scale (GLFS-25). The reference value of each physical test was determined using receiver operating characteristics analysis.

RESULTS

Women had a significantly higher prevalence of LS than men did and also scored significantly higher on the GLFS-25: women, 9.2 ± 10.3 pts; men, 6.7 ± 8.0 pts. Both genders in the non-LS group performed significantly better in all physical performance test gender except for back muscle strength in men and grip strength in both genders than those in the LS group, even after adjusting for age. The results of all the physical performance tests correlated significantly with the GLFS-25 scores of both genders even after adjusting for age except for grip strength. Reference values for TUG, one-leg standing time, back muscle strength, 10-m gait time, maximum stride and grip strength in men were 6.7 s, 21 s, 78 kg, 5.5 s and, 119 cm and 34 kg, respectively, and those for women were 7.5 s, 15 s, 40 kg, 6.2 s, 104 cm, and 22 kg, respectively.

CONCLUSIONS

We established reference values for major physical performance tests used when assessing locomotive syndrome as defined by the GLFS-25. Our results can be used to characterize physical function and to help tailor an anti-LS training program for each individual.