The 25-question Geriatric Locomotive Function Scale predicts the risk of recurrent falls in postoperative patients with cervical myelopathy

Assessment of Surgical Outcomes in Patients with Degenerative Cervical Myelopathy Using the 25-Question Geriatric Locomotive Function Scale: A Longitudinal Observational Study

Introduction

Locomotive syndrome caused by degenerative musculoskeletal diseases is reported to improve with surgical treatment. However, it is unclear whether surgical treatment is effective for the locomotive syndrome developing in patients with degenerative cervical myelopathy (DCM). Thus, this study primarily aimed to longitudinally assess the change in locomotive syndrome stage before and after cervical spinal surgery for patients with DCM using the 25-question geriatric locomotive function scale (GLFS-25). A secondary objective was to identify factors associated with the postoperative improvement in the locomotive syndrome stage.

Methods

We retrospectively reviewed clinical data of patients undergoing cervical spine surgery at our institution from April 2020 to May 2022 who had answered the Japanese Orthopaedic Association Cervical Myelopathy Assessment Questionnaire, visual analog scale, and GLFS-25 preoperatively and at 6 months and 1 year postoperatively. We collected demographic data, medical history, preoperative radiographic parameters, presence or absence of posterior longitudinal ligament ossification, and surgical data.

Results

We enrolled 115 patients (78 men and 37 women) in the present study. Preoperatively, using the GLFS-25, 73.9% of patients had stage 3, 10.4% had stage 2, 9.6% had stage 1, 6.1% had no locomotive syndrome. The stage distribution of locomotive syndrome improved significantly at 6-months and 1-year postoperatively. The multivariable Poisson regression analysis revealed that better preoperative lower extremity function (relative risk: 3.0; 95% confidence interval: 1.01-8.8) was significantly associated with postoperative improvement in the locomotive syndrome stage.

Conclusions

This is the first study to longitudinally assess the locomotive syndrome stage in patients with DCM using GLFS-25. Our results indicated that patients with DCM experienced significant improvement in the locomotive syndrome stage following cervical spine surgery. Particularly, the preoperative lower extremity function was significant in postoperative improvement in the locomotive syndrome stage.

Association between locomotive syndrome and fall risk in the elderly individuals in Japan: The Yakumo study

BACKGROUND

Patients with locomotive syndrome (LS) are poor ambulatory status and a high risk of requiring nursing care. The purpose of this study is to investigate the relationship between LS and fall risk among community-dwelling elderly individuals.

METHODS

The subjects were Japanese elderly individuals aged 65 and over who participated in Yakumo study 2019 (N = 189). We defined the fall risk index 5 items version (FRI-5) ≥6 points as the fall risk group. LS was evaluated by stand-up test, two-step test, and 25-Geriatric Locomotive Function Scale (GLFS-25). We divided the subjects into two groups according to the presence or absence of fall risk, and investigated factors associated with fall risk.

RESULTS

The fall risk group (30 patients, 15.9%) had higher GLSF-25 (P = 0.001). The results of logistic regression analysis adjusted for age, sex, BMI, and knee osteoarthritis revealed that GLFS-25 (OR: 1.052; 95%CI: 1.009-1.097) was independent factor associated with fall risk. In the ROC analysis, the optimal cut-off value of the GLFS-25 to predict fall risk was 12, which is equivalent to LS stage 1 (AUC 0.688; 95% CI: 0.588-0.787; sensitivity: 0.467, specificity: 0.836).

CONCLUSIONS

GLFS-25 was associated with fall risk among community-dwelling elderly individuals aged 65 and over.

Does locomotive syndrome severity predict future fragility fractures in community-dwelling women with osteoporosis?

OBJECTIVES

We investigated whether the locomotive syndrome (LS) severity affects future fragility fractures in osteoporosis patients.

METHODS

In this retrospective cohort study, 315 women with osteoporosis (mean follow-up period, 2.8 years) were reviewed, of whom 244 were included in the analysis. At baseline, we obtained medical information, bone mineral density of the lumbar spine and femoral neck, and sagittal vertical axis. Additionally, LS risk was assessed using the two-step test, stand-up test, and 25-question geriatric locomotive function scale scores. The LS risk test results were used to classify LS severity, which was rated on a 4-point scale from stage 0 (robust) to 3 (worsening). Cox proportional hazards regression analysis was used to determine the association of the severity with future fragility fracture.

RESULTS

Fragility fractures occurred in 37 of 315 participants (11.8%). This study showed that sagittal vertical axis (hazard ratio = 1.014; 95% confidence interval, 1.005-1.023; p value = 0.003) and LS severity (hazard ratio =1.748; 95% confidence interval, 1.133-2.699; p = 0.012) were independent risk factors for incidence of fragility fracture.

CONCLUSIONS

This study revealed the LS severity to predicted fragility fractures. We suggested that the progression of LS associated with osteoporosis increases the fracture risk.

Investigating the validity and reliability of the GLFS-25 questionnaire by factor analysis in the elderly hospitalized at the intensive and cardiac care units

Introduction

Geriatric Locomotive Function Scale-25 (GLFS-25) is a 25-item tool most commonly used to diagnose locomotive syndrome in the elderly. The purpose of the present study was to investigate the validity and reliability of the GLFS-25 questionnaire using factor analysis.

Materials and methods

This descriptive-analytical study was conducted on 186 elderly people. The GLFS-25 questionnaire contains 25 items, and each item is scored on a five-point Likert scale from 0 to 4. Data were analyzed by SPSS V.19 software. Descriptive (frequency, percentage, mean, and standard deviation) and inferential (Cronbach's alpha, correlation coefficient, Bartlett test, KMO index, scree plot, and factor analysis) statistics were used to present the findings.

Results

Factor analysis revealed two hidden factors in the four dimensions of the questionnaire (i.e., pain, daily activities, social relations, and mental health). The first factor, named mobility and its consequential concerns), with a variance percentage of 74.323, had an effect on questions No. 19, 11, 25, 16, 6, 24, 5, 4, and 3. The second factor, named the problems and risks associated with daily and social activities, with a variance percentage of 78.680, had an effect on questions No. 17, 22, 7, 18, 14, 20, 13, 9, 12, 8, 10, 21, 2, 15, 1, and 23. Cronbach's alpha coefficient among the questionnaire's dimensions was 78.4%.

Conclusion

The GLFS-25 questionnaire can be used as a valid and reliable tool to diagnose locomotive syndrome in the elderly.

Assessment of locomotive syndrome in patients with visceral cancer, the comparison with non-cancer patients using propensity score matching

BACKGROUND

When treating cancer patients, the progression of symptoms is accompanied by the deterioration of systemic conditions and motor function. From a risk-benefit perspective, a certain level of physical function must be maintained to continue cancer treatment. Recently, outpatient cancer treatment has become more common. Motor function is important to determine the feasibility of continuing cancer treatment. The study aimed to evaluate the motor function of patients with visceral cancer using locomo tests established by Japanese Orthopaedic Association.

METHODS

Locomo tests were performed, and the results were compared with data from non-cancer individuals. Background data were matched by propensity score matching. Data from 53 cancer patients (group C) were compared with that of 75 non-cancer patients (group N).

RESULTS

The average score in the two-step test of group C was lower than that of group N (1.27: 1.37, p = 0.004). The average function in the stand-up test of group C was worse than that of group N (p = 0.001). The average score in the 25-question geriatric locomotive function scale (GLFS) of group C was significantly higher than that of group N (19.92: 5.29, SE 2.21, p < 0.001). Higher 25-question GLFS scores indicate reduced mobility. The proportion of the locomo stage 2 in group C was significantly higher than in group N (51%: 13%, p < 0.001). The results of the two field tests revealed a clinically minimal difference between the two groups, but a statistically significant difference. Locomo tests may be detect potential motor dysfunction in outpatient cancer patients with apparently maintained motor function.

CONCLUSIONS

Even in cancer patients who attend outpatient clinics, their motor functions could be potentially impaired. Therapeutic interventions to maintain and enhance motor function for cancer patients could be useful for continuing cancer treatment, and furthermore, improving prognosis.

Association with sagittal alignment and osteoporosis-related fractures in outpatient women with osteoporosis

The baseline sagittal vertical axis (SVA) and pelvic tilt (PT) are independent risk factors of osteoporosis-related fractures in women with osteoporosis. We clarified the SVA and PT to predict the incidence of osteoporosis-related fractures.

PURPOSE

Sagittal alignment with osteoporosis women deteriorates with advancing age and sagittal alignment may indicate osteoporosis-related fractures in the future. However, whether the sagittal alignment predicts future osteoporosis-related fracture in patients with osteoporosis has not been clarified. We aimed to investigate the association between sagittal alignment and future osteoporosis-related fractures.

METHODS

This was a retrospective cohort study. Of the 313 participants (mean follow-up period, 2.9 years), 236 were included in the analysis. At baseline, we measured bone mineral density (BMD) of the lumbar spine and the femoral neck, sagittal vertical axis (SVA), thoracic kyphosis, pelvic incidence minus lumbar lordosis, sacral slope, pelvic tilt (PT), geriatric locomotive function scale (GLFS), two-step value, and stand-up test. The information on medications and the duration of treatment were reviewed from the medical records. Additionally, participants reported their history of falls at baseline. Multiple logistic regression analysis was used to determine the association of future osteoporosis-related fracture, and adjusted Odds ratios (OR) and 95% confidence interval (CI) were calculated with all predictors as covariates. All continuous variables were calculated using standardized OR (sOR).

RESULTS

Osteoporosis-related fractures occurred in 33 of 313 participants (10.5%). Multiple logistic regression analysis showed that a history of falls (OR =4.092, 95% CI: 1.029-16.265, p =0.045), SVA (sOR =4.228, 95% CI: 2.118-8.439, p <0.001), and PT (sOR =2.497, 95% CI: 1.087-5.733, p =0.031) were independent risk factors for future osteoporosis-related fractures.

CONCLUSIONS

This study revealed the SVA and PT to predict osteoporosis-related fractures.

TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION

UMIN000036516 (April 1, 2019).

The 5-question Geriatric Locomotive Function Scale predicts postoperative fall risk in patients undergoing surgery for degenerative cervical myelopathy

BACKGROUND

Falling is one of the main reasons for which older adults require nursing care. Locomotive syndrome (LS) predicts the need for nursing care; however, the relationship between falling and LS remains unclarified. This study aimed to determine whether the 5-question Geriatric Locomotive Function Scale (GLFS-5) predicts postoperative fall risk in patients with degenerative cervical myelopathy (DCM).

METHODS

This study is a post hoc analysis of the data from a prospective cohort of patients undergoing surgery for DCM. Participants recorded their falls in a fall diary from the time of study enrollment (baseline) to 1 year postoperatively. Functional assessments were conducted at baseline, hospital admission for surgery, and 1 year postoperatively. Outcome measures included the GLFS-5, Japanese Orthopaedic Association score, Neck Disability Index, EuroQol 5 Dimensions, and 12-Item Short Form Health Survey. Risk factors for falls were investigated, including previous falls, number of medications, and grip strength. Fallers were divided into two categories: all fallers (≥1 falls), and recurrent fallers (≥2 falls). Variables that were significant in univariate analyses were applied in multiple logistic regression models to adjust for confounders.

RESULTS

From the initial group of 168 participants, 159 attended the 1-year follow-up, and 132 fall diaries were retrieved and analyzed. Of these 132 patients, 42 (32%) reported at least one fall, while 25 (19%) reported recurrent falls during the postoperative observation period. The GLFS-5 significantly increased from baseline to admission, and significantly decreased from admission to 1 year postoperatively. In multiple logistic regression analysis, the independent predictors of postoperative recurrent falls were previous falls and a higher baseline GLFS-5. The optimal cut-off value of GLFS-5 for predicting all falls/recurrent falls was 12.

CONCLUSIONS

The GLFS-5 reflected time-dependent functional changes in patients undergoing surgery for DCM. Previous falls and a higher baseline GLFS-5 were independent predictors of postoperative recurrent falls.

Cognitive factors associated with locomotive syndrome in chronic pain patients: A retrospective study

BACKGROUND

Prevention and treatment for locomotive syndrome (LS) are important for extending healthy life expectancy. The 25-question geriatric locomotive function scale (GLFS-25) was developed to diagnose LS. The Fear-Avoidance model was proposed to explain pain chronicity. LS and chronic pain decrease activities of daily living; however, the relationships between LS and factors related to chronic pain in the Fear-Avoidance model are unknown. Objective of the current study was to assess the prevalence of LS and examine the factors of the Fear-Avoidance model and the GLFS-25 that affect the prevalence of LS in patients with chronic pain.

METHODS

Participants included 281 patients (99 men, 182 women) aged over 40 years with chronic pain who visited our outpatient clinic for chronic pain. All participants completed the GLFS-25, numeric rating scale (NRS), pain catastrophizing scale (PCS), hospital anxiety and depression scale (HADS), and Athene insomnia scale (AIS). According to a GLFS-25 cutoff point, participants were divided into three groups (LS-2; GLFS-25 ≥ 16, LS-1; 7 ≤ GLFS-25 < 16, and non-LS; GLFS-25 < 7 points) and each parameter was compared among the groups, followed by multiple logistic regression analysis. Next, multiple linear regression analysis was performed to determine the factors associated with the GLFS-25.

RESULTS

Of all 281 patients, 241 (85.8%) patients were diagnosed with LS-2. Univariate analysis revealed there were significant differences in NRS, PCS, HADS anxiety, HADS depression, and AIS among groups. Multiple logistic regression analyses showed PCS was significantly associated with LS-2 prevalence. The GLFS-25 was positively correlated with NRS, HADS depression, AIS in multiple linear regression analysis.

CONCLUSIONS

We found that patients with chronic pain in our outpatient clinic had a significant rate of LS-2. The prevalence of LS-2 was significantly correlate with pain catastrophizing, and the GLFS-25 was significantly correlated with higher pain intensity, depression, and insomnia.

Evaluation of locomotive syndrome in patients receiving surgical treatment for degenerative musculoskeletal diseases: A multicentre prospective study using the new criteria

OBJECTIVES

This study aimed to evaluate the condition of patients with locomotive syndrome (LS) and their improvement after undergoing surgery for degenerative musculoskeletal diseases using the new criteria, including stage 3.

METHODS

In total, 435 patients aged ≥40 years (167 middle-aged and 268 older) were divided into four groups based on the disease location: the lumbar (n = 118), hip (n = 191), knee (n = 80), and foot and ankle (n = 46) groups. Patients were evaluated by pre- and 1 year postoperative LS risk tests, including the stand-up test, two-step test, and 25-Question Geriatric Locomotive Function Scale.

RESULTS

The pre- and postoperative prevalence of LS stage 3 were 78% and 29%, respectively. The postoperative LS stage improved in 62% of patients (77% and 53% in the middle-aged and older groups, respectively). Overall, the knee group showed the worst results, and the foot and ankle groups showed the best pre- and postoperative results. The pre- and postoperative prevalence of LS stage 3 according to the 25-Question Geriatric Locomotive Function Scale were comparable to those based on the total assessment.

CONCLUSIONS

The new LS stage criteria are appropriate, and the 25-Question Geriatric Locomotive Function Scale is a good option for evaluating patients requiring surgery.

Weak hip flexor strength predicts progression of functional capacity decline due to locomotor system dysfunction in community-dwelling older adults: A longitudinal cohort study

PURPOSE

It is critical to determine the risk factors for activities of daily living (ADL) disability caused by locomotor dysfunction. However, no longitudinal study has investigated the association between disability due to locomotive dysfunction and multidimensional factors. Therefore, we investigated the relationship between the progression of functional capacity decline due to locomotive dysfunction and multiple physical functions among older adults in a longitudinal study.

METHODS

The participants comprised of 433 community-dwelling older adults. Physical function was assessed at baseline, which included handgrip strength, maximal isometric strength of hip flexion, hip extension, hip abduction, knee extension, toe flexion (index for muscle strength), the 5-time chair-stand test (index for muscle power), the one-legged stance and timed ''Up & Go'' tests (index for balance function), the 30-s stair test (index for muscle endurance), and range of motion (ROM) (an index of joint condition). Functional capacity decline due to locomotive dysfunction was assessed using the 25-question Geriatric Locomotive Function Scale (GLFS-25) before and after a 12-month period. Based on changes in the GLFS-25 score compared with baseline, the non-decline and decline groups were operationally defined. Logistic regression analyses with the groups as the dependent variable and physical function as independent variables were performed.

RESULTS

Of the 433 participants, 189 (43.6%) were included in the decline group. Logistic regression analysis revealed hip flexor strength as a primary determinant in the progression of functional capacity decline.

CONCLUSION

These results suggest that among physical functions, hip flexor strength influences the progression of disability resulting from locomotive dysfunction in older adults.

Influence of the Sagittal Vertical Axis on the Risk of Falls in Community-Dwelling Elderly People: A Retrospective Longitudinal Study

Introduction

Falling is an age-related problem that increases with age. Compared with younger people, elderly people possess increased risk factors for falls, and falling among the elderly is associated with increased mortality. Risk factors for falls have been reported in elderly outpatients; however, whether sagittal spinal posture affect the risk of falls in community residents remains unclear. Therefore, we aimed to investigate the influence of sagittal spinal posture on the risk of falls in elderly community-dwelling people using spino-plevic sagittal parameters in a retrospective longitudinal study.

Methods

A total of 463 volunteers (96 men and 367 women; mean age, 72.8 years) who underwent a routine physical checkup were evaluated. Baseline whole spine and lower limb radiography, physical tests, bone mineral density (BMD), number of medications and comorbidities, patient-reported outcomes (PROs), and a history of falls in the previous four years period were examined.

Results

Univariate analysis revealed older age, lower height and weight, higher prevalence of vertebral fractures, higher number of medications, poor physical test scores including one-leg standing test and prone trunk extension, poor PROs, a higher sagittal vertical axis, and higher pelvic tilt (PT) as factors significantly associated with the risk of falls, and multivariate analysis revealed a higher sagittal vertical axis [odds ratio (OR), 1.08; 95% confidence interval (CI), 1.002-1.013; P = 0.02] and locomotive syndrome assessed using the 25-Question Geriatric Locomotive Function Scale score (OR, 1.028; 95% CI, 1.004-1.053; P = 0.03) to be associated with the risk of falls, independent of other factors in the univariate analysis.

Conclusions

The sagittal vertical axis was an independent risk factor for falls, and the prevalence of vertebral fractures and prone truck extension correlated with the sagittal vertical axis. Prospective and intervention studies are needed to prevent future falls in elderly community volunteers with a higher sagittal vertical axis.

Validation of the LOCOMO-25 and its minimum clinically important differences in domain scores for Chinese patients with low back pain and neck pain

BACKGROUND

The 25-question Geriatric Locomotive Function Scale (LOCOMO-25) was developed to assess any decline in mobility functions. This study aims to validate the LOCOMO-25 in Chinese patients with chronic low back pain and/or neck pain.

METHODS

Adult patients with chronic low back pain and/or neck pain completed the LOCOMO-25, SF-36, EQ-5D-5L, ODI, VAS and/or NDI. Internal consistency was assessed by Cronbach's alpha coefficient (α). Test-retest reliability was assessed by intra-class correlation coefficients. Construct validity was assessed by Spearman correlation tests against other outcome measures. Sensitivity to detect differences between groups was assessed by Mann-Whitney U or Kruskal-Wallis H test, where appropriate. Intergroup comparison was performed further in terms of domain scores and their changes at test-retest.

RESULTS

A total of 111 patients were consecutively recruited. LOCOMO-25 demonstrated excellent internal consistency (α = 0.915) and test-retest reliability (Intraclass correlation: 0.705 to 0.826). LOCOMO-25 was significantly correlated with all domains of SF-36, EQ-5D, ODI, NDI, and VAS (p < 0.01). It was found to be sensitive in differentiating between patients with neural compression (32.8 ± 16.9) and without (21.2 ± 12.7), with history of fall(s) within the previous one year (30.8 ± 16.0) and without (24.2 ± 15.1), requires assistive devices for ambulation (40.6 ± 21.6) or independent (23.6 ± 13.1) and various pain levels (mild: 17.2 ± 10.6; moderate: 23.5 ± 11.7; severe: 38.5 ± 16.5). Patients with neural compression scored significantly higher in the domain of pain and patients requiring assistive devices for ambulation scored significantly higher in the domains of ADL and social functions. The minimum detectable differences for various domains of the LOCOMO-25 score included pain (2.76), activities of daily living (6.07), social function (1.59), and mental health status (2.06).

CONCLUSIONS

LOCOMO-25 has been validated in Chinese patients with chronic low back and neck pain with satisfactory psychometric properties, and with individual domain minimum clinically important differences. There is adequate internal consistency, test-retest reliability, construct validity and sensitivity to detect differences between patients with/without neural compression, different ambulatory statuses and pain severity.

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.