Evaluation of the association between locomotive syndrome and metabolic syndrome

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.

Systemic Chronic Diseases Coexist with and Affect Locomotive Syndrome: The Nagahama Study

OBJECTIVES

The concept of locomotive syndrome was proposed to highlight older adults who require nursing care services due to the malfunctioning of their locomotive organs. With the coming of a super-aging society, there is a growing need to understand relation between systemic chronic diseases and locomotive syndrome.

METHODS

We analyzed the second-visit dataset of the Nagahama Study. The association analysis was performed to identify the chronic diseases that were risk factors associated with the occurrence and the progression of locomotive syndrome in both the cross-sectional and longitudinal studies.

RESULTS

Hypertension, stroke, coronary heart disease, rheumatoid arthritis, chronic renal failure, osteoporosis, anemia, and gastroesophageal reflux disease were independently correlated with locomotive syndrome through the deterioration of body pain, social activity, and cognitive function in the cross-sectional study. Multiple chronic diseases had additive effects and significantly increased the risk of locomotive syndrome. In the longitudinal study, osteoporosis and kidney disease were significantly correlated with the worsening of the total GLFS-25 score.

CONCLUSIONS

Locomotive syndrome coexisted with various systemic chronic diseases, especially cardiovascular diseases. Osteoporosis and kidney disease were significantly correlated with the progression of locomotive dysfunction. The management of various chronic diseases may be useful to prevent locomotive syndrome and vice versa.

A preliminary examination of the association between locomotive syndrome and circulating miRNA-199 in community-dwelling people: The Yakumo study

BACKGROUND

The risk of locomotive syndrome (LS) has been proposed as a criterion for evaluating physical ability. The expression levels of circulating miRNAs (c-miRNAs) are predictors of various diseases. This preliminary study aimed to evaluate the relationship between serum levels of several miRNAs and LS.

METHODS

We enrolled 423 participants in whom we conducted a survey with the 25-question Geriatric Locomotive Function Scale (GLFS-25) and measured the serum levels of 21 c-miRNAs. The relationship between the GLFS-25 and each c-miRNA was evaluated with a linear regression analysis, and independent associations between the GLFS-25 and each c-miRNA were assessed with a multiple regression analysis using various independent variables.

RESULTS

Only the serum level of miR-199 was significantly associated with LS after adjustment for age, BMI, sex, and all comorbidities. The receiver operating characteristics curve for the predictive value of the miR-199 level to indicate the presence or absence of LS risk had an area under the curve (AUC) of 0.576 (95% confidence interval: 0.501-0.651).

CONCLUSION

The expression level of miRNA-199 was associated with the risk of LS in community-dwelling Japanese people.

Effect of total hip arthroplasty on improving locomotive syndrome in hip disease patients: A prospective cohort study focused on total clinical decision limits stage 3

BACKGROUND

In 2020, the Japanese Orthopaedic Association established a new stage 3 in clinical decision limits (CDL) to evaluate the stage of locomotive syndrome (LS). This study focused on total CDL stage 3 with the aim of investigating indicators related to improvements in total CDL by evaluating the improvement of LS in patients who underwent total hip arthroplasty (THA).

METHODS

Of the 125 patients who underwent THA at our hospital, the subjects of the analysis were 105 patients determined to be total CDL stage 3 in an evaluation performed before THA. LS was evaluated using the stand-up test, two-step test, and 25-Question Geriatric Locomotive Function Scale (GLFS-25). Indicators related to improvements in total CDL were also investigated. All evaluation items were measured before THA and three months after THA.

RESULTS

Before THA, all subjects (n = 105) were classified as total CDL stage 3. Three months after THA, improvements in total CDL were seen in 49 subjects (46.7%). The results of stepwise multiple logistic regression analysis showed that the before THA stand-up test and GLFS-25 were significantly related to improvements in total CDL.

CONCLUSIONS

Three months after THA, improvements in LS were seen in approximately half of the subjects. The stand-up test and GLFS-25 can be used as indicators of improvement in total CDL.

DESIGN

Prospective cohort study design.

Does the Presence of Metabolic Syndrome Alter Serum Uric Acid Concentrations, Pain, and Well-Being in Patient with Chronic Musculoskeletal Pain?

Objective: To compare serum uric acid concentrations, pain and well-being in patients having chronic musculoskeletal pain with and without MetS, and investigate cut-off values. Methods: Patients having chronic musculoskeletal pain with (MetS group, n=48) and without MetS (control group, n=52) were included. The serum uric acid concentration, pain intensity, body composition, physical activity level, quality of life, and psychological status were evaluated by a uric acid blood test, Visual Analogue Scale, Bio-impedance Analyzer, International Physical Activity Questionnaire-7 (IPAQ-7), Nottingham Health Profile, and Hospital Anxiety and Depression Scale, respectively. Results: Uric acid level, fat mass, waist/hip ratio were found higher in the MetS group in comparison to the control group (P

Prevalence of Locomotive Dysfunction Exacerbating Systolic Blood Pressure and Abdominal Circumference: A Longitudinal Cohort Analysis

Background: We aimed to investigate the influence of locomotive dysfunction (LD) on the future prevalence of metabolic syndrome (MetS) in community-dwelling people using propensity score matching (PSM). Materials and Methods: Two hundred and twenty-five volunteers (87 men and 138 women, mean age: 66.9 years) underwent a health screening program in 2012 and 2014. We extracted 92 volunteers with LD and 133 without LD in 2012. After performing 1:1 PSM using clinical variables, including age, sex, individual MetS components, and comorbidities between the two groups, we investigated the prevalence of MetS between the two groups (LD and non-LD) in 2014. Results: Seventy-three subjects were enrolled in each group. In 2012, the mean the 25-question Geriatric Locomotive Function Scale was 2.6 in the non-LD group and 13.4 in the LD group. The baseline prevalence of MetS was 9 (12.3%) in non-LD group and 8 (11%) in LD group. After 2 years, the prevalence of MetS in the LD group increased to 18 (24.7%), but only by 8 (11%) (P = 0.031) in the non-LD group. Among MetS components, waist circumference (84.9 vs. 82.5 cm) and systolic blood pressure (SBP) (145 vs. 140 mmHg) in the LD group were significantly higher than in the non-LD group (P = 0.047, P = 0.023). Conclusions: The longitudinal analysis showed that LD increases the prevalence of MetS and deteriorates SBP and abdominal circumference over 2 years.

Locomotive syndrome in hemodialysis patients and its association with quality of life—a cross-sectional study

Background

Locomotive syndrome (LS) is defined as impairment of mobility function.

This study aimed to clarify LS and its association with quality of life in hemodialysis patients.

Methods

This is a cross-sectional study. The subjects were chronic kidney disease patients undergoing maintenance hemodialysis treatment. LS was assessed using two physical tests (two-step test, stand-up test) and one self-reported test (Geriatric Locomotive Function Scale-25). LS has two stages of severity; the beginning of the decline in mobility function is known as Locomo stage 1, and the progression of the decline of mobility function is known as Locomo stage 2. We used SF-36 to assess quality of life and examined their relationships with the Locomo stages. Chi-square test, Kruskal-Wallis test, Jonckheere-Terpstra test, and Mantel-Haenszel test were used for analysis. Multiple linear regression was used to model the cross-sectional association of Locomo stages with each component and summary score of SF-36.

Results

A total of 76 hemodialysis patients were included. The number of subjects with Locomo stage 1 and stage 2 were 19 (25%) and 53 (70%), respectively, while only four (5%) subjects did not have mobility dysfunction. Each component and summary score of the SF-36 for physical function, role emotional, physical component summary, and mental component summary were significantly associated with Locomo stages.

Conclusion

A high prevalence and severity of LS in hemodialysis patients was found, and the severity was associated with quality of life.

Factors predicting discharge after two years for inpatients in the psychiatric long-term care wards who can walk independently

[Purpose] The purpose of this study was to investigate the factors that affected the discharge of walkable patients admitted to psychiatric long-term care wards. [Participants and Methods] The participants were walkable patients admitted to psychiatric long-term care wards at three different hospitals in Japan. The baseline assessments of all 73 patients were conducted between September and December 2018. During the 2 year follow-up period, five patients died, while 68 were included in the analysis. The baseline assessment includes the basic information of the participants and the risk of locomotive syndrome. [Results] In the comparisons between the discharged (n=12) and hospitalizing groups (n=56), the age, length of stay, and two-step and stand-up test scores at the baseline assessment were significantly different. The multiple logistic regression analysis, which discriminates between the two groups, adopted age as a significant variable in the baseline assessment as a predictor of dischargeability (odds ratio: 1.08; 95% confidence interval: 1.01, 1.16). [Conclusion] Age was considered to be a discharge likelihood predictor, as it affects the decline in motor function, such as locomotive syndrome, as well as the social resources that would be needed after discharge, such as family support.

The efficacy of total hip arthroplasty on locomotive syndrome and its related physical function in patients with hip osteoarthritis

BACKGROUND

Locomotive syndrome (LS) is a predictive factor of future motor dysfunction. Our aim was to evaluate the change in the total LS grade and, its the association with the Japanese Orthopaedic Association (JOA) hip score after total hip arthroplasty (THA) among patients with hip osteoarthritis.

METHODS

This was a prospective case-control study of 72 patients who underwent primary THA. The functional outcomes were measured before, and at 6 and 12 months after THA. LS was evaluated using the following tests: stand-up test, 2-step test, and 25-question Geriatric Locomotive Function Scale (GLFS-25). In addition, factors affecting the improvement of LS grade were examined.

RESULTS

Prior to THA, 7% and 93% of patients were classified as LS grades 1 and 2. At 6 months after THA, an improvement in the total LS grade was observed in 57% of patients, with this percentage further increasing to 65% at 1 year. Only the preoperative GLFS-25 was correlated with the preoperative JOA hip scores. The postoperative GLFS-25 and the two-step test were correlated with the postoperative JOA hip scores. The preoperative functional reach test (FRT) was significantly correlated with the total LS grade improvement.

CONCLUSIONS

THA can improve the total LS grade in 65% of patients at 1 year postoperatively. Improvement was largely achieved in the first 6 months after THA, with a change from LS grade 2 to grade 1. FRT could be used an indicator of the total LS grade improvement.

Relationship between whether the planned discharge destination is decided and locomotive syndrome for admitted patients in psychiatric long-term care wards

OBJECTIVE

We focused on locomotive syndrome as a low physical function factor that may prevent patients with psychiatric disease from being discharged. The purpose of this study is to clarify the factors, including locomotive syndrome, that prevent discharge from psychiatric long-term care wards.

METHOD

We enrolled 74 patients who were admitted to psychiatric long-term care wards at three different hospitals in Japan. Nurses or medical social workers in the ward were asked whether the planned discharge destination had been decided, and patients were categorized into a decided group and an undecided group. Outcome measures were age, sex, F code in the ICD-10 Classification of Mental and Behavioral Disorders, length of stay, chlorpromazine equivalent dose of antipsychotics, locomotive syndrome test scores (25-question GLFS, two-step test, stand-up test), and Barthel Index.

RESULTS

Based on the multivariate logistic regression analysis results, the length of stay and the two-step test score significantly explained the difference between the two groups. The odds ratio of a length of stay greater than 10 years was 8.42 times that of a length of stay less than 2 years (P=0.012, 95% CI=1.59, 44.53). Regarding the twostep test, the odds ratio for obtaining stage 2 was 10.62 times that for obtaining stage 0 (P=0.013, 95% CI=1.65, 68.23).

CONCLUSION

Those who with longer length of stays and lower two-step test scores tended not to be decided the planned discharge destination.