Risk Factors that Hinder Locomotive Syndrome Improvement Following Surgery for Musculoskeletal Diseases in Older Patients: A Multicenter Prospective Study

Evaluation and Rehabilitation after Adult Lumbar Spine Surgery

Purpose: With an increase in the proportion of elderly patients, the global burden of spinal disease is on the rise. This is gradually expected to increase the number of surgical procedures all over the world in the near future. As we know, rehabilitation following spine surgery is critical for optimal recovery. However, the current literature lacks consensus regarding the appropriate post-operative rehabilitation protocol. The purpose of this review is to evaluate the optimal protocol for rehabilitation after lumbar spine surgery in adults. Materials and Methods: The goals of rehabilitation after lumbar spine surgery are to improve physical and psychosocial function and may include multiple modalities such as physical therapy, cognitive behavioral therapy, specialized instruments, and instructions to be followed during activities of daily living. In recent years, not only are a greater number of spine surgeries being performed, but various different techniques of lumbar spine surgery and spinal fusion have also emerged. (1) Our review summarizes post-operative rehabilitation under the following headings-1. Historical aspects, 2. Subjective functional outcomes, and (3) Actual rehabilitation measures, including balance. Results: Physical therapy programs need to be patient-specific and surgery-specific, such that they consider patient-reported outcome measures and take into consideration the technique of spinal fusion used and the muscle groups involved in these surgeries. By doing so, it is possible to assess the level of functional impairment and then specifically target the strengthening of those muscle groups affected by surgery whilst also improving impaired balance and allowing a return to daily activities. Conclusions: Rehabilitation is a multi-faceted journey to restore mobility, function, and quality of life. The current rehabilitation practice focuses on muscle strengthening, but the importance of spinal balance is less elaborated. We thus equally emphasize muscle strengthening and balance improvement post-lumbar spine surgery.

Association between frailty and locomotive syndrome in elderly patients with lumbar spinal stenosis: A retrospective longitudinal analysis

AIMS

With the aging society worldwide, lumbar spinal stenosis (LSS) has become common, and its incidence has been increasing worldwide. Frailty and locomotive syndrome significantly overlap as disorders in older people. The current study aimed to validate the association between frailty and locomotive syndrome in patients with LSS. In particular, the involvement of frailty in locomotive syndrome following surgery was examined.

METHODS

We retrospectively reviewed the time-course data of consecutive patients aged ≥65 years who underwent lumbar spinal surgery for LSS. The locomotive syndrome stages were determined using the 25-Question Geriatric Locomotive Function Scale: stage 0, score ≤6; stage 1, score ≥7; stage 2, score ≥16; and Stage 3, score ≥24. Robust, pre-frailty, and frailty were defined as a modified frailty index-11 score of 0, <0.21, and >0.21, respectively.

RESULTS

This study included 234 patients. All patients except one were diagnosed with locomotive syndrome preoperatively. Approximately 24.8% of participants were diagnosed with frailty. LSS surgery improved locomotive syndrome regardless of frailty severity. Meanwhile, multivariable analysis indicated that frailty could significantly inhibit improvement in locomotive syndrome after surgery in old patients with LSS (estimated relative risk: 0.6; 95% confidence interval: 0.4-0.9).

CONCLUSIONS

This study first assessed the association between locomotive syndrome and frailty in patients with LSS. Locomotive syndrome could be managed effectively with surgery regardless of frailty severity in old patients with LSS. However, our findings emphasize the need to screen for frailty preoperatively in this patient group. Geriatr Gerontol Int 2024; 24: 116-122.

Clinical characteristics of locomotive syndrome categorised by the 25-question Geriatric Locomotive Function Scale: a systematic review

OBJECTIVES

The purpose of this study was to compile the currently available evidence on the clinical characteristics of the locomotive syndrome (LS) categorised by the 25-question Geriatric Locomotive Function Scale (GLFS-25) and clarify its clinical usefulness for assessing mobility function.

DESIGN

Systematic review.

DATA SOURCES

The PubMed and Google Scholar were searched for the relevant studies on 20 March 2022.

ELIGIBILITY CRITERIA

We included relevant peer-reviewed articles, available in English language, on clinical LS characteristics categorised with the GLFS-25.

DATA EXTRACTION AND SYNTHESIS

Pooled ORs or mean differences (MDs) of the LS groups were calculated and compared with the non-LS groups for each clinical characteristic.

RESULTS

In total, 27 studies that involve 13 281 participants (LS, n=3385; non-LS, n=9896) were examined in this analysis. Older age (MD 4.71; 95% (CI) 3.97 to 5.44; p<0.00001), female gender (OR 1.54; 95% CI 1.38 to 1.71; p<0.00001), higher body mass index (MD 0.78; 95% CI 0.57 to 0.99; p<0.00001), osteoporosis (OR 1.68; 95% CI 1.32 to 2.13; p<0.0001), depression (OR 3.14; 95% CI 1.81 to 5.44; p<0.0001), lower lumbar lordosis angle (MD -7.91; 95% CI -10.08 to -5.74; p<0.00001), higher spinal inclination angle (MD 2.70; 95% CI 1.76 to 3.65; p<0.00001), lower grip strength (MD -4.04; 95% CI -5.25 to -2.83; p<0.00001), lower back muscle strength (MD -15.32; 95% CI -23.83 to -6.81; p=0.0004), lower maximum stride (MD -19.36; 95% CI -23.25 to -15.47; p<0.00001), higher timed up-and-go (MD 1.36; 95% CI 0.92 to 1.79; p<0.00001), lower one-leg standing time (MD -19.13; 95% CI -23.29 to -14.97; p<0.0001) and slower normal gait speed (MD -0.20; 95% CI -0.22 to -0.18; p<0.0001) were found to be associated with LS. No significant differences were noted in other clinical characteristics between the two groups.

CONCLUSIONS

GLFS-25 is clinically useful for assessing mobility function according to the evidence available on the clinical characteristics of LS categorised by the GLFS-25 questionnaire items until.