The influence of locomotive syndrome on health-related quality of life in a community-living population

Reliability and validity tests of the Chinese version of the Geriatric Locomotive Function Scale (GLFS-25) in tumor survivors

Objective

To evaluate the reliability and validity of the Chinese-translated Geriatric Locomotive Function Scale (GLFS-25) for the assessment of locomotive syndrome (LS) in individuals surviving malignancies.

Methods

393 tumor survivors at a general hospital in China were recruited. The Chinese version of GLFS-25 was utilized to conduct a cross-sectional survey to ascertain the tool's efficacy in measuring LS in this cohort. The scale's validity was examined through content, structural and discriminant validity assessments, while its reliability was investigated by determining the internal consistency (via Cronbach's α coefficient) and test-retest reliability (via intragroup correlation coefficient, ICC).

Results

The Chinese-adapted GLFS-25 demonstrated a robust scale-level content validity index of 0.94, while item-level content validity indices ranged from 0.83 to 1.00 across individual items. The suitability of the scale for structural validity assessment was confirmed via exploratory factor analysis, yielding a Kaiser-Meyer-Olkin measure of 0.930 and a significant Bartlett's test of sphericity (χ2 = 3217.714, df = 300, P < 0.001). Subsequent confirmatory factor analysis (CFA) extracted four distinct factors: Social Activity Engagement, Daily Living Ability, Pain Experience and Physical Mobility. These factors accounted for 72.668 % of the variance, indicating substantial construct validity for measuring LS among this population. CFA supported the model's fit with the following indices: χ2/df = 1.559, RMSEA = 0.077, GFI = 0.924, CFI = 0.941, NFI = 0.919, and TLI = 0.933. The factor loadings for the four factors ranged from 0.771 to 0.931, indicating the items corresponding to the four factors effectively represented the constructs they were designed to measure. The correlation coefficients among the four factors were between 0.306 and 0.469, all lower than the square roots of the respective AVEs (0.838-0.867). This suggests a moderate correlation among the four factors and a distinct differentiation between them, indicating the Chinese version of the GLFS-25 exhibits strong discriminant validity in Chinese tumor survivors. Reliability testing revealed a high Cronbach's α coefficient for the overall scale at 0.961, with the subscales yielding coefficients of 0.751, 0.836, 0.930, and 0.952. The overall ICC was determined to be 0.935, with subscale ICCs ranging from 0.857 to 0.941, reinforcing the scale's reliability in this context.

Conclusions

The Chinese version of the GLFS-25 exhibits strong reliability and validity for the assessment of LS in tumor survivors. It may serve as a diagnostic tool for LS, contributing to the prevention and management of musculoskeletal disorders and enhancing the prognosis for this patient population.

Association between Locomotive Syndrome and Hearing Loss in Community-Dwelling Adults

The relationship between hearing and motor function as a function of aging is unclear. Therefore, we aimed to clarify the relationship between age-related hearing loss and locomotive syndrome. In total, 240 participants aged ≥40 years, whose hearing acuity and motor function had been measured, were included in this study. Patients with a hearing acuity of <35 dB and ≥35 dB were categorized into normal and low hearing acuity groups, respectively. Motor function was compared according to sex between the groups. Among men, those in the low hearing acuity group (51/100) were older, had a significantly slower walking speed, and had a higher prevalence of locomotive syndrome than those in the normal group. Among women, those in the low hearing group (14/140) were older and had a significantly slower gait speed than those in the normal group. The multivariate analysis showed that, in the low hearing acuity group, age and gait speed were risk factors in men, while age was the only risk factor in women. In conclusion, hearing loss was associated with walking speed. The association between hearing loss and locomotive syndrome was observed only in men. In the multivariate analysis, hearing loss was associated with walking speed only in men.

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.

Deep Learning for Bone Mineral Density and T-Score Prediction from Chest X-rays: A Multicenter Study

Although the number of patients with osteoporosis is increasing worldwide, diagnosis and treatment are presently inadequate. In this study, we developed a deep learning model to predict bone mineral density (BMD) and T-score from chest X-rays, which are one of the most common, easily accessible, and low-cost medical imaging examination methods. The dataset used in this study contained patients who underwent dual-energy X-ray absorptiometry (DXA) and chest radiography at six hospitals between 2010 and 2021. We trained the deep learning model through ensemble learning of chest X-rays, age, and sex to predict BMD using regression and T-score for multiclass classification. We assessed the following two metrics to evaluate the performance of the deep learning model: (1) correlation between the predicted and true BMDs and (2) consistency in the T-score between the predicted class and true class. The correlation coefficients for BMD prediction were hip = 0.75 and lumbar spine = 0.63. The areas under the curves for the T-score predictions of normal, osteopenia, and osteoporosis diagnoses were 0.89, 0.70, and 0.84, respectively. These results suggest that the proposed deep learning model may be suitable for screening patients with osteoporosis by predicting BMD and T-score from chest X-rays.

Evaluation of gait characteristics in subjects with locomotive syndrome using wearable gait sensors

BACKGROUND

Individuals with locomotive syndrome (LS) require nursing care services owing to problems with locomotion and the musculoskeletal system. Individuals with LS generally have a reduced walking speed compared with those without LS. However, differences in lower-limb kinematics and gait between individuals with and without LS are not fully understood. This study aimed to clarify the characteristics of the gait kinematics of individuals with LS using wearable sensors.

METHODS

We assessed 125 participants (mean age 73.0 ± 6.7 years) who used a public health promotion facility. Based on the 25-question Geriatric Locomotive Function Scale (GLFS-25), these participants were grouped into the non-LS (GLFS-25 < 7), LS-stage 1 (GLFS-25 7-16), and LS-stage 2 (GLFS-25 ≥ 16) groups (larger GLFS-25 scores indicate worse locomotive ability). Spatiotemporal parameters and lower-limb kinematics during the 10-m walk test were analyzed by the "H-Gait system", which is a motion analysis system that was developed by the authors and is based on seven inertial sensors. The peak joint angles during the stance and swing phases, as well as the gait speed, cadence, and step length were compared among all groups.

RESULTS

There were 69 participants in the non-LS group, 33 in the LS-stage 1 group, and 23 in the LS-stage 2 group. Compared with the non-LS group, the LS-stage 2 group showed significantly smaller peak angles of hip extension (9.5 ± 5.3° vs 4.2 ± 8.2°, P = 0.002), hip flexion (34.2 ± 8.8° vs 28.5 ± 9.5°, P = 0.026), and knee flexion (65.2 ± 18.7° vs 50.6 ± 18.5°, P = 0.005). The LS-stage 1 and LS-stage 2 groups had a significantly slower mean gait speed than the non-LS group (non-LS: 1.3 ± 0.2 m/s, LS-stage 1: 1.2 ± 0.2 m/s, LS-stage 2: 1.1 ± 0.2 m/s, P < 0.001).

CONCLUSIONS

The LS-stage 2 group showed significantly different lower-limb kinematics compared with the non-LS group, including smaller peak angles of hip extension, hip flexion, and knee flexion. It would be useful to assess and improve these small peak joint angles during gait for individuals classified as LS-stage 2.

Relationship between the locomotive syndrome and kinetic and kinematic parameters during static standing and level walking

BACKGROUND

Individuals experiencing age-related decline in locomotor functions are at high-risk of developing locomotive syndrome (LS). LS requires long-term care and greatly influences the quality of life and activities of daily living. The LS risk test was established as a diagnostic criterion by the Japanese Orthopedic Association. Although the relationship between the test and motor function has been established, few studies have reported on the characteristics of LS kinematically and kinetically.

RESEARCH QUESTION

Do elderly with LS show different kinetic and kinematic characteristics compared with healthy elderly during static standing and level walking?

METHODS

Forty-four Participants were divided into an LS group and a non-LS group based on the scores of the LS risk test. The standing posture and walking of the participants were measured using a three-dimensional motion capture system. The results of the groups were compared using an unpaired t-test, and then the characteristics of the LS group were extracted using logistic regression analysis.

RESULTS

LS group exhibited trunk flexion during both standing and gait. A higher intervertebral disc compressive force, which is the index of the low-back mechanical stress, during standing and an increase in ankle plantarflexion angle during walking were observed in LS group.

SIGNIFICANCE

This study determined the kinematic and kinetic features of elderly with LS. The findings suggest that parameters related to the trunk and ankle could be associated with LS. Further studying the characteristics of LS in older adults via motion analysis can help develop prevention and intervention methods for 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.

Nutritional Influences on Locomotive Syndrome

Healthy dietary habits are important to prevent locomotive syndrome (LS). We investigated the relationship between LS and nutritional intake using community health checkup data. We included 368 participants who underwent LS staging, blood sampling, and nutritional intake assessments. Participants (163 adults < 65: 205 older adults ≥ 65) were divided into normal (N; LS stage 0) and LS (L; LS stage 1–2) groups, and blood sample data and nutritional intake were compared between groups. Among adults (N group, 71; L group, 92), low-density lipoprotein cholesterol (LDL-C) was significantly lower, and Vitamin B₁ intake was significantly higher in the L than in the N group; LDL-C, p = 0.033; Vitamin B1, 0.029. Among older adults (N group, 85; L group, 120), hemoglobin (Hb), albumin, and calcium levels were significantly lower, and sodium, monounsaturated fatty acids (MUFA), and n-6 polyunsaturated fatty acids (n-6 PUFA) were significantly higher in the L than the N group; Hb, p = 0.036; albumin, 0.030; calcium, 0.025; sodium; 0.029; MUFA; 0.047, n-6 PUFA; 0.0233). Logistic regression analysis indicated that sodium was the risk factor for the L group (exp (B) 1.001, 95% CI: 1–1.001, p = 0.032). In conclusion, salt intake was associated with LS.

Associations between locomotive and non-locomotive physical activity and physical performance in older community-dwelling females with and without locomotive syndrome: a cross-sectional study

Background

Locomotive syndrome (LS) is a condition of reduced mobility due to a disorder of the locomotive system. Increasing moderate to vigorous physical activity (MVPA) has been recommended to prevent LS. However, to increase daily MVPA is difficult for older people with LS. The MVPA consists of not only locomotive activities such as walking but also non-locomotive activities such as household activities. The aim of this study was to examine the associations between locomotive/non-locomotive MVPA and physical performance in older females with and without LS.

Methods

Participants of this cross-sectional study were 143 older community-dwelling Japanese females. The participants were divided into two groups based on the results of the stand-up test: the normal group (NL) (n = 86) and the LS group (n = 57). Both the locomotive and non-locomotive PA seperately measured with its intensity. The intensity of physical activity (PA) was calculated as METs and classified as sedentary behavior (SB 1–1.5 metabolic equivalent tasks (METs)), low-intensity physical activity (LPA 1.6–2.9 METs), and MVPA (≥ 3 METs). For example, locomotive LPA is slow walking speed of 54 m/min, and locomotive MVPA is walking speed of 67 m/min. While non-locomotive LPA is office work and cooking, non-locomotive MVPA is housecleaning. Physical function was evaluated by handgrip strength, walking speed, and 2-step test.

Results

Walking speed, hand-grip strength, 2-step test, daily step counts, and all PA measurements were not significantly different between two groups. In the LS, locomotive MVPA (r = 0.293, p < 0.05) and total MVPA (r = 0.299, p < 0.05) was significantly correlated with walking speed, but not in the NL.

Conclusions

Walking speed was positively correlated with locomotive MVPA and total MVPA in the LS group, but not in NL group. This result suggests that slow walking speed in older people with LS occur in connection with lower locomotive MVPA and total MVPA.

Reciprocal relationship between locomotive syndrome and social frailty in older adults

AIM

States of vulnerability are multidimensional and become more prevalent with advancing age. These states and the causal relationships between them, merit thorough investigation. This study aimed to understand the reciprocal relationship between the constructs of the locomotive syndrome and social frailty among a community of older adults.

METHODS

This 2-year cohort study examined a community of older adults (≥75 years) consisting of 1177 members. Using Makizako's method, social frailty was deemed to be present if more than two out of five questions were answered negatively. Locomotive syndrome was measured with the Geriatric Locomotive Function Scale-25, which consists of 25 items measuring an individual's risk of developing locomotive syndrome; a total score of ≥16 identified the presence of locomotive syndrome. Possible reciprocal associations between locomotive syndrome and social frailty were assessed using Cox proportional hazards analyses.

RESULTS

A total of 748 older adults were analyzed in the following subgroups. Among 574 participants without social frailty at the baseline, the presence of locomotive syndrome at the baseline was associated with new-onset social frailty during the next 2 years, after adjusting for confounding factors (hazard ratio 1.76, 95% confidence interval 1.17-2.65). Conversely, the presence of social frailty among participants without locomotive syndrome in the baseline was not associated with new-onset locomotive syndrome.

CONCLUSION

The presence of locomotive syndrome was determined to be a risk factor for the onset of social frailty. Therefore, interventions that address the negative impact of locomotive syndrome are a first step toward addressing these vulnerable conditions. Geriatr Gerontol Int 2021; 21: 981-984.

Differences of 2-year longitudinal changes of locomotive syndrome among patients treated with thoracolumbar interbody fusion, total hip arthroplasty, and total knee arthroplasty for degenerative diseases

OBJECTIVES

To clarify the longitudinal changes in patients with preoperative Stage-3 locomotive syndrome (LS) according to different types of surgeries, we investigated the changes in the LS stage in patients who underwent surgery for degenerative musculoskeletal diseases.

METHODS

A prospective cohort study was conducted on 168 patients with degenerative diseases [46 spinal deformities treated with thoracolumbar interbody fusion (T/LIF), 86 hips with osteoarthritis treated with total hip arthroplasty (THA), and 36 knees with osteoarthritis treated with total knee arthroplasty (TKA)]. The results for the LS stage, stand-up test, two-step test, and 25-question Geriatric Locomotive Function Scale (GLFS-25) were evaluated preoperatively and at 6 months, 1 year, and 2 years postoperatively.

RESULTS

Preoperatively, most patients had Stage-3 LS (89.1, 90.8, and 80.6% in the T/LIF, THA, and TKA groups, respectively). At 2 years postoperatively, the Stage-3 LS improved in 41.5, 75.6, and 55.2% of patients in the T/LIF, THA, and TKA groups, respectively. All groups showed similar improvements in the two-step test. The THA group showed the best result in the GLFS-25.

CONCLUSIONS

LS stage improved in different patterns over 2 years postoperatively and the LS risk test revealed differences in postoperative movement ability according to the type of surgery.

Relationship between locomotive syndrome and frailty in rheumatoid arthritis patients by locomotive syndrome stage

OBJECTIVES

This study aimed to evaluate the association between locomotive syndrome (LS) and frailty in rheumatoid arthritis (RA) patients.

METHODS

Subjects were 538 RA patients (female, 72.9%; mean age ± standard deviation, 66.8 ± 13.4 years). LS and frailty were defined as ≥16 points on the 25-question Geriatric Locomotive Function Scale (Stage ≥2) and ≥8 points on the Kihon Checklist (KCL), respectively.

RESULTS

There were 214 subjects with Stage ≥2 LS (39.8%) and 213 subjects with frailty (39.6%). Among subjects with Stage 0, 1, 2, and 3 LS, 11.0%, 21.9%, 48.3%, and 84.6% had frailty, respectively. The KCL points for cognitive and psychosocial factors had no significant differences across LS stages. Multivariable logistic regression analysis revealed that the Health Assessment Questionnaire was independently associated with frailty and LS stage, and the Clinical Disease Activity Index was associated with LS stage but not frailty.

CONCLUSIONS

As LS worsens in RA patients, the likelihood of developing physical frailty increases. RA patients with a low LS stage can still develop frailty, and suppressing disease activity may not be sufficient to prevent frailty. These findings highlight the need to screen for frailty in RA patients and consider appropriate interventions based on each patient's condition, focusing on nonphysical factors.

Human Nonmercaptalbumin Is a New Biomarker of Motor Function

The ratio of human nonmercaptalbumin (HNA) and reduced albumin (HMA) may be a new marker for oxidative stress. Locomotive syndrome (LS) is reduced mobility due to impairment of locomotive organs. We investigated whether the HNA/HMA ratio could be a new biomarker of LS. This study included 306 subjects (mean age 64.24 ± 10.4 years) who underwent LS tests, grip strength, walking speed, and tests for HNA and HMA. Oxidative stress was measured by the ratio of HMA (f(HMA) = (HMA/(HMA + HNA) × 100)), and the subjects were divided into normal (N group; f[HMA] ≥ 70%) and low (L group; f[HMA] < 70%) groups. There were 124 non-elderly (<65 years) and 182 elderly subjects (≥65 years). There were no significant differences in LS, grip strength, and walking speed between the L and N groups in the non-elderly subjects. However, significant differences were found in the elderly subjects. In logistic regression analysis, there was an association between f(HMA) and the LS severity at older ages. LS in the elderly is associated with a decline in HMA and, thus, an increase in oxidative stress. Thus, f(HMA) is a new biomarker of LS.

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.

Improvement of locomotive syndrome after total hip arthroplasty: A two-year longitudinal cohort study

OBJECTIVES

Patients requiring total hip arthroplasty (THA) may possibly have locomotive syndrome (LS). Therefore, we investigated changes of LS in patients undergoing THA and clarified key factors that affected LS stage.

METHODS

A prospective cohort study was conducted with 88 patients undergoing THA (74 females, 14 males, mean age: 67.6 years). Data collected using LS stage, stand-up test, two-step test, and 25-question Geriatric Locomotive Function Scale results were evaluated before THA, and 6 months, 1 year, and 2 years after THA. Key factors were determined using multivariate analysis and receiver operating characteristic (ROC) curve analysis.

RESULTS

Before THA, all patients had fallen LS (stage1: 3.4% and stage2: 96.6%). Overall, 56.8% patients improved their LS stage, and 17.0% of patients overcame LS at 2 years after THA. The key factors that affected LS stage were preoperative two-step test and age. ROC analyses showed a preoperative two-step test score of 0.988 and an age of 67.5 years as a cut-off value for the change of LS stage.

CONCLUSIONS

Patients experiencing LS due to hip disorders have the potential to recover after THA. Additional postoperative training may be beneficial for patients with low preoperative two-step test scores to improve their LS stage.

Influence of Global Spine Sagittal Balance and Spinal Degenerative Changes on Locomotive Syndrome Risk in a Middle-Age and Elderly Community-Living Population

Purpose

The aim of this study was to describe the characteristics of each locomotive syndrome (LS) risk stage, including global spine sagittal alignment, spinal degenerative changes evident on plain radiographs, low back pain (LBP), muscle strength, and physical ability in middle-aged and elderly people in a health checkup.

Methods

This study included 211 healthy Japanese volunteers (89 men and 122 women; mean age, 64.0 years) who underwent assessment with both radiographs and Spinal Mouse. Spinal sagittal parameters included thoracic kyphosis angle (TKA), lumbar lordosis angle (LLA), sagittal vertical axis, and spinal inclination angle (SIA). Lumbar disc height (LDH) and lumbar osteophyte formation (LOF) at each level were evaluated as the spinal degenerative changes. The LS assessment comprised three tests: stand-up test, two-step test, and 25-question Geriatric Locomotive Function Scale (GLFS-25). The subjects were divided into three groups (no risk, stage 1 LS, or stage 2 LS) according to LS risk test criteria. The prevalence of LBP was investigated with a visual analogue scale (VAS), and physical performances were also compared among the groups.

Results

Of the participants, 122 had no risk of LS, 56 had stage 1 LS risk, and 29 had stage 2 LS risk. With increasing LS risk stage, the prevalence of and VAS score for LBP increased significantly, and back muscle strength and physical abilities decreased significantly. The TKA did not differ among the three groups. The LLA decreased gradually with LS risk stage (P = 0.0001). At each level except L1–L2 and L5–S1, LDH decreased gradually with LS risk stage. The prevalence of LOF increased significantly with increasing LS risk stage. The SIA increased significantly with LS risk stage (P = 0.0167).

Conclusions

Participants with LS had higher prevalence of spinal degeneration, small LLA, and global spinal imbalance by anterior spinal inclination.

Relationship between disease activity of rheumatoid arthritis and development of locomotive syndrome: A five-year longitudinal cohort study

OBJECTIVE

This study aimed to longitudinally evaluate the association between rheumatoid arthritis (RA) and locomotive syndrome (LS) in RA patients using the 25-question Geriatric Locomotive Function Scale (GLFS-25).

METHODS

Subjects were 58 RA patients (female, 48 (82.8%); mean age, 60.9 ± 10.9 years) who had GLFS-25 scores available for five consecutive years and who did not have LS at baseline (i.e. GLFS-25 < 16 points). Associations between DAS28-CRP and the development of LS were determined using linear regression analysis and receiver operating characteristic (ROC) curve analysis.

RESULTS

Subjects were divided into the LS group (n = 15, GLFS-25 ≥ 16 points) and non-LS group (n = 43, GLFS-25 < 16 points) based on GLFS-25 scores at the 5th year of the study period. In the LS group, DAS28-CRP worsened every year. The linear regression model adjusted for age and sex revealed that ΔGLFS-25 increased by 3.80 (95% confidence interval: 1.81-5.79) each time ΔDAS28-CRP increased by 1 (p<.001). Among patients in remission (DAS28-CRP < 2.3), 13.5% had LS. ROC curve analysis yielded a five-year mean DAS28-CRP of 1.99 (sensitivity, 86.7%; specificity, 62.8%) as the cut-off point for the development of LS.

CONCLUSION

Tight control of RA disease activity for deeper remission may be needed to prevent the development of LS.

Differences of lumbopelvic sagittal parameters among community-dwelling middle-age and elderly individuals: Relations with locomotor physical function

This study aims to establish radiographic parameters of lumbopelvic sagittal alignment, gender related differences, and age-related changes in a middle-aged community, to investigate whether age-related changes of lumbopelvic alignment reflect the risk of locomotive syndrome (LS). This study included 448 healthy Japanese volunteers who attended a basic health checkup supported by the local government. The subjects (184 males and 264 females, mean age: 62.7 years) were grouped according to their age by decade. Sagittal lumbopelvic parameters were collected by lateral spine radiographs including lumbar lordosis (L1-S1, LL), lower lumbar lordosis (L4-S1, LLL), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS). The three tests (stand-up test, two-step test, and 25-question geriatric locomotive function scale [GLFS-25]) composing the LS risk test were performed. LL was significantly lower in males than in the females. A significant decrease of LL and LLL was observed from 60 s to 70 s in the females. PI did not markedly change with aging in either gender but was lower in males. A remarkable increase of PT was seen from 60 s to 70 s in the females. SS did not markedly change with aging and was lower in males in all decades. The prevalence of LS risk in males and females increased gradually with age and was greater in females in any decade. 70 s females with LS risk had significantly lower LL and higher PT compared to them without LS risk. Radiographic parameters of lumbopelvic sagittal alignment were established in community-dwelling middle-age and elderly individuals.

Musculoskeletal Factors and Geriatric Syndromes Related to the Absence of Musculoskeletal Degenerative Disease in Elderly People Aged over 70 Years

Purpose

To investigate factors with a significant relationship with the absence of musculoskeletal disease (MSD: osteoporosis, knee osteoarthritis (K-OA), and lumbar spondylosis (L-OA)) in elderly people ≥70 years old.

Methods

The subjects were 279 people (134 males, 145 females, mean age: 75.2 years) who attended an annual health checkup and were prospectively included in the study. Osteoporosis was defined as %YAM ≤70%, K-OA as Kellgren–Lawrence grade ≥2, and L-OA as osteophytes of Nathan class ≥3. Subjects were divided into those with (group D) and without (group N) any MSD. Clinical variables including locomotive syndrome (LS), frailty, sarcopenia, and QOL (SF-36) were compared between the groups.

Results

There was no significant difference in age or gender between group N (n = 54) and group D (n = 225). Lower BMI and pain, including neuropathic pain; greater back muscle strength, physical ability, and balance with eyes closed; larger lumbar lordosis, sacral inclination, and lumbar ROM; and smaller spinal inclination were found in group N. The rates of LS and sarcopenia were significantly lower and QOL was significantly higher in group N.

Conclusions

This study firstly revealed the significant musculoskeletal factors and geriatric syndromes related to an absence of MSD, which may form the basis of interventions to improve QOL in elderly people ≥70 years old.

The Relationship Between Neuropathic Pain and Spinal Alignment: Independent Risk Factors for Low Quality of Life in Middle-Aged and Elderly People

STUDY DESIGN

Prospective research in middle-aged and elderly people.

OBJECTIVE

To investigate low back pain (LBP) and neuropathic pain (NeP); spinal alignment and range of motion (ROM); spinal degenerative changes in plain radiography; osteoporosis; muscle strength; and physical ability as possible risk factors for poor quality of life (QOL).

SUMMARY OF BACKGROUND DATA

The aging of society has led to an increase in elderly people with chronic pain, including LBP and NeP. However, there has been no analysis of NeP and spinal sagittal alignment as potential risk factors for decreased QOL in the healthy general population.

METHODS

The subjects were 1128 people (male 473, female 655, average age: 64.3 yrs) who attended an annual health checkup in Yakumo study. The prevalence of LBP and sciatica were investigated using a visual analogue scale (VAS), and NeP was defined as more than or equal to 13 points on the painDETECT questionnaire. Sagittal spinal alignment with spinal ROM was also measured. Body mass index, muscle strength, physical ability, osteoporosis, and lumbar degenerative changes were measured, and 36-item short-form health survey (SF-36) was used for QOL analysis.

RESULTS

NeP was present in 113 people (10%). The NeP (+) subjects had significantly more severe pain, lower gait speed, higher osteoporosis rate, lumbar kyphosis, and larger spinal inclination (P < 0.01) compared with NeP (-) subjects. On SF-36, physical and mental QOL were significantly lower for NeP (+) subjects (P < 0.0001). In multivariate logistic regression analysis adjusted for age and sex, NeP (+) (odds ratio [OR]: 3.01), positive spinal inclination (OR: 1.14), and high VAS for LBP (OR: 1.04) were identified as risk factors for low physical QOL, and NeP (+) (OR: 5.32) was the only significant risk factor for low mental QOL.

CONCLUSION

These results suggest that interventions for NeP and other identified risk factors may contribute to improvement of low physical and mental QOL in middle-aged and elderly people.

LEVEL OF EVIDENCE

2.

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.

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.

The decrease in phase angle measured by bioelectrical impedance analysis reflects the increased locomotive syndrome risk in community-dwelling people: The Yakumo study

OBJECTIVES

The locomotive syndrome (LS) risk test has recently been advocated for the evaluation of physical ability. Phase angle measurement by bioelectrical impedance analysis (BIA) is an indicator of cellular health and muscle mass. We aimed to investigate how muscle mass and phase angle are related to LS risk stage.

METHODS

A prospective cohort study was conducted in 311 patients who were undergoing a health checkup. All participants performed the two-step test, stand-up test, and 25-question geriatric locomotive function scale components of the LS risk test. Muscle mass and phase angle were measured using BIA. A comparison study was conducted among the three LS risk stages.

RESULTS

In the trend test, phase angle decreased significantly as the LS risk stage progressed, whereas muscle mass did not show a significant difference. After adjusting for age and sex, phase angle showed a significant difference among all LS risk stages. Muscle mass did not show a significant difference between no risk and stage 1.

CONCLUSION

Compared to muscle mass, phase angle more strongly reflects LS risk and becomes significantly reduced at later LS risk stages. Phase angle can be a useful screening tool for LS risk.

Early clinical results of total hip arthroplasty assessed with the 25-question Geriatric Locomotive Function Scale and muscle strength testing

BACKGROUND

We think that it is necessary to evaluate whether the patient after total hip arthroplasty has achieved age-appropriate locomotor ability by improvement in hip joint function. The 25-question Geriatric Locomotive Function Scale (GLFS-25) have been determined age-specific standard values for the general population. The aim of this study was to compare postoperative hip muscle strength and functional performance at 3 months after THA with preoperative levels, and to compare the outcomes at 3 months after THA with the function of age-matched adults without hip disease.

METHODS

The GLFS-25 scores and muscle strength were investigated before THA and 3 months after surgery in 12 men and 75 women who underwent total hip arthroplasty.

RESULTS

The mean preoperative and postoperative GLFS-25 score was 55.4 and 19.1, respectively. With regard to the influence of age, the mean scores before and after THA were respectively 52.0 versus 18.2 for patients aged 60-69 years and 61.2 versus 17.3 for those aged 70-79 years in the normal/mild OA group. When female patients from the normal/mild OA group and the implant group classified into levels 4-7 after THA were combined (n = 15), their mean preoperative and postoperative straight leg raising (SLR) strength was 0.56 Nm/kg and 0.75 Nm/kg, respectively. On the other hand, the mean preoperative and postoperative SLR strength was respectively 0.54 Nm/kg and 0.86 Nm/kg for patients classified into levels 1-3 after THA (n = 45).

CONCLUSION

Before THA, 90% of the patients who has severe hip disturbance were in need of nursing care (levels 4-7), while the percentage decreased to 30% after surgery. There was a difference of SLR muscle strength between the patients in levels 4-7 and those in levels 1-3 after THA, suggesting that achieving levels 1-3 postoperatively might depend on whether SLR muscle strength shows improvement.

The utility of 25-question Geriatric Locomotive Function Scale for evaluating functional ability and disease activity in Japanese rheumatoid arthritis patients: A cross-sectional study using NinJa database

OBJECTIVES

To investigate the distribution of 25-question Geriatric Locomotive Function Scale (GLFS-25) scores in Japanese rheumatoid arthritis (RA) patients and evaluate relationships with clinical variables.

METHODS

Among 15,115 patients registered in the NinJa database for fiscal year 2015, 1710 with complete GLFS-25 and disease activity score-28 (DAS28) data were analyzed. Correlations between GLFS-25 score and clinical variables were assessed by Spearman coefficients. Mean GLFS-25 scores were compared among DAS28 groups (<2.6, 2.6-3.1, 3.2-5.0, ≥5.1) using the Kruskal-Wallis test. To evaluate the performance of the GLFS-25 and Health Assessment Questionnaire Disability Index (HAQ-DI) for predicting DAS28 ≥ 3.2 (moderate/high disease activity), receiver operator characteristic (ROC) curves were constructed.

RESULTS

GLFS-25 score was significantly correlated with age, disease duration, DAS28, and HAQ-DI. GLFS-25 score increased in parallel with DAS28. The proportion of patients with locomotive syndrome stage 2 also increased with DAS28. Area under the curve values for HAQ-DI and GLFS-25 score were 0.739 and 0.768, respectively. At a GLFS-25 positive cutoff score ≥16, sensitivity was 0.716 and specificity was 0.661 for predicting DAS28 ≥ 3.2.

CONCLUSION

This study documents the GLFS-25 score distribution in Japanese RA patients and demonstrates that GLFS-25 is a useful measure for evaluating functional ability in RA.

Locomotive function and quality of life among older people in Liaoning, China: Falls efficacy as mediator or moderator?

OBJECTIVES

This study aimed to examine the role of falls efficacy in the relationship between the locomotive function and quality of life.

METHODS

From March to May in 2016, we conducted a cross-sectional survey among 830 community residents aged ≥60 years from Jinzhou,China.GLFS-25 (25-question Geriatric Locomotive Function Scale), FES-I(International edition of Falls Efficacy Scale),and SF-12 (12-item Short Form Health Survey) were used to estimate locomotive function, falls efficacy and quality of life, respectively. The higher score of GLFS-25, the worse the locomotive function.

RESULTS

Median age was 68.69 years (ranges 60-88). Locomotive function, falls efficacy and quality of life all presented a linear relationship within each other, locomotive function score was negatively correlated with falls efficacy score (-0.461, P < 0.01). locomotive function score was negatively correlated with quality of life score (-0.523, P < 0.01).Falls efficacy score was positively correlated with quality of life score (0.415, P < 0.01).Falls efficacy exerted both a mediating and moderating role between locomotive function and quality of life, and the mediation effect accounted for 45.5% of the total effect.

CONCLUSIONS

Poorer locomotive function was associated with poorer quality of life, and greater falls efficacy was associated with better quality of life. In addition, falls efficacy was demonstrated to be both a mediator and moderator variable in the linkage between locomotive function and quality of life. Aged care professional practitioners and our policy makers should strengthen the awareness of the psychological role of the elderly falls efficacy.

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.

Staged decrease of physical ability on the locomotive syndrome risk test is related to neuropathic pain, nociceptive pain, shoulder complaints, and quality of life in middle-aged and elderly people - The utility of the locomotive syndrome risk test

OBJECTIVES

A locomotive syndrome (LS) risk test for evaluation of physical ability is recently proposed. The objective of this study is to evaluate the utility of this test by examining physical ability, neuropathic pain, nociceptive pain, shoulder complaints, and quality of life (QOL).

METHODS

A prospective cohort study was conducted in 523 subjects (240 males, 283 females; mean age: 63.3 years) at a health checkup. Data collected using visual analog scales (VAS) for shoulder pain, low back pain, sciatica, and knee pain, neuropathic pain, shoulder complaint, body mass index (BMI), osteoporosis, and SF-36 were compared among three LS risk stages.

RESULTS

Subjects in LS risk stage 1 (24%) had significantly more osteoporosis, slower gait speed, weaker muscle strength and higher VAS, with no difference in age and BMI compared to those with no LS risk (50%). Subjects in stage 2 (26%) had significantly poorer results for all items. Shoulder complaint, neuropathic pain and QOL differed significantly among all three groups and worsened with decline in mobility on the LS risk test.

CONCLUSIONS

LS risk test is easy and useful screening tool for evaluation of mobility and for screening for pain and complaint associated with activity of daily living and QOL.

Locomotive syndrome in the elderly: translation, cultural adaptation, and Brazilian validation of the tool 25-Question Geriatric Locomotive Function Scale

OBJECTIVE

The term Locomotive Syndrome refers to conditions in which the elderly are at high risk of inability to ambulate due to problems in locomotor system. For Locomotive Syndrome screening, the 25-Question Geriatric Locomotive Function Scale was created. The objective here was to translate, adapt culturally to Brazil, and study the psychometric properties of 25-Question Geriatric Locomotive Function Scale.

METHOD

The translation and cultural adaptation of 25-Question Geriatric Locomotive Function Scale were carried out, thus resulting in GLFS 25-P, whose psychometric properties were analyzed in a sample of 100 elderly subjects. Sociodemographic data on pain, falls, self-perceived health and basic and instrumental functionalities were determined. GLFS 25-P was applied three times: in one same day by two interviewers, and after 15 days, again by the first interviewer.

RESULT

GLFS 25-P showed a high internal consistency value according to Cronbach's alpha coefficient (0.942), and excellent reproducibility, according to intraclass correlation, with interobserver and intraobserver values of 97.6% and 98.4%, respectively (p<0.01). Agreements for each item of the instrument were considerable (between 0.248 and 0.673), according to Kappa statistic. In its validation, according to the Pearson's coefficient, regular and good correlations were obtained for the basic (BADL) and instrumental (IADL) activities of daily living, respectively (p<0.01). Statistically significant associations with chronic pain (p<0.001), falls (p=0.02) and self-perceived health (p<0.001) were found. A multivariate analysis showed a significantly higher risk of Locomotive Syndrome in the presence of chronic pain (OR 15.92, 95% CI 3.08-82.27) and with a worse self-perceived health (OR 0.23, 95% CI 0.07-0.79).

CONCLUSION

GLFS 25-P proved to be a reliable and valid tool in Locomotive Syndrome screening for the elderly population.

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.

Comparison of health-related quality of life between type 2 diabetic patients with and without locomotive syndrome

OBJECTIVE

The aim of this study was to compare health-related quality of life (HRQOL) between type 2 diabetic patients with and without locomotive syndrome, which is a risk for becoming bedridden because of deteriorating locomotive organs.

SUBJECTS AND METHODS

A total of 135 patients with type 2 diabetes mellitus (69.2 ± 10.2 years) were enrolled in this cross-sectional study. HRQOL was evaluated by the Euro-QOL-5 (EQ-5D), and locomotive syndrome was evaluated by "loco-check," established the Japanese Orthopedic Association. Clinical data, such as anthropometric parameters, blood and urine examination results, blood pressure (BP), drug usage, and psychological distress, were analyzed.

RESULTS

Average HbA1c in all patients was 7.2 ± 1.0 %, and 74 patients (54.8 %) were identified as having the locomotive syndrome. EQ-5D scores were significantly lower in type 2 diabetic patients with locomotive syndrome than in those without locomotive syndrome, even after adjusting for age, sex, body mass index (BMI), and HbA1c. By the multiple regression analysis, locomotive syndrome and age were identified as determinant factors of HRQOL in type 2 diabetic patients.

CONCLUSION

In type 2 diabetic patients, lower HRQOL was a characteristic feature of subjects with locomotive syndrome, even after adjusting for confounding factors. Prevention or management of locomotive syndrome may be beneficial for improving HRQOL in type 2 diabetic patients.

Gait variability analysed using an accelerometer is associated with locomotive syndrome among the general elderly population: The GAINA study

BACKGROUND

Gait variability analysed using an accelerometer provides a unique measurement of locomotive dysfunction in patients with musculoskeletal disease or in frail elderly subjects. Therefore, assessing gait variability may become a clinical screening method for the locomotive syndrome. The purpose of this study was to investigate whether gait variability analysed using an accelerometer was associated with locomotive syndrome in the general elderly population.

METHODS

A total of 273 residents were screened after a yearly medical check-up, and of these, 223 subjects (mean age, 73.6 ± 8.3 years) met the eligibility criteria. Demographic information, body function and structure measurements (bone mass, grip strength, muscle mass, and postural alignment), and gait parameters were assessed. Gait variability analysis was based on acceleration using a wireless tri-axial accelerometer attached to the 3rd lumbar vertebra process by a trunk belt. Autocorrelation coefficients were used to represent gait variability in three directions: vertical, mediolateral, and anteroposterior. The subjects were classified as either having or not having the locomotive syndrome based on the 5-question Geriatric Locomotive Function Scale.

RESULTS

Of the 223 subjects, 41 (18.3%) had the locomotive syndrome. Autocorrelation coefficients in three directions were lower in the subjects with locomotive syndrome. Using multivariate logistic regression analysis with adjustment factors, of the autocorrelation coefficients only gait variability in the vertical axis remained a significant independent associated with the locomotive syndrome.

CONCLUSION

This finding suggested that gait variability based on evaluation of autocorrelation coefficients in the vertical axis measured using an accelerometer has the potential to become a screening method for the locomotive syndrome in the general elderly population.

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.

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".

Impact of low back pain, knee pain, and timed up-and-go test on quality of life in community-living people

BACKGROUND

The Japanese Orthopaedic Association (JOA) has proposed the term "locomotive syndrome" (LS) to designate a condition in people from high-risk groups with musculoskeletal disease who are highly likely to require nursing care at some point. This syndrome is caused by weakening of the musculoskeletal organs such as bone, joint, and muscle. The current study investigated factors that influence quality of life (QOL) loss caused by LS, which builds upon our previous study showing that LS affects individuals' QOL.

METHODS

We enrolled 386 subjects >50 years old. Sex, age, body mass index and bone mineral density, plus physical function tests of grip strength, back muscle strength, maximum stride, 10-m gait time, functional reach (cm), timed up-and-go test (TUG) (s) and one-leg standing time (s), and the visual analogue scale assessments for leg numbness and knee, low back and leg pain were selected as independent variables in a multiple regression model for the JOA Back Pain Evaluation Questionnaire (JOABPEQ), the Short Form-36 (SF-36), and the Roland Morris Disability Questionnaire (RDQ) scores.

RESULTS

Low back pain contributed significantly to all JOABPEQ scores. Knee pain and TUG contributed significantly to 4/5 and 3/5 of the JOABPEQ scores, respectively. Age, TUG, knee pain, and low back pain contributed significantly to the RDQ and the physical component summary of the SF-36.

CONCLUSIONS

Low back and knee pain proved to be significant contributors to individuals' QOL. TUG might be the most valuable function test for effectively evaluating an individual's QOL.