Assessment of locomotive syndrome among older individuals: a confirmatory factor analysis of the 25-question Geriatric Locomotive Function Scale

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.

Relationship between the 25-question Geriatric Locomotive Function Scale and physical function in the elderly people

INTRODUCTION

Locomotive syndrome (LS) is a condition of reduced mobility. The LS stage can be determined by the stand-up test, two-step test, and 25-question geriatric locomotive function scale (GLFS-25). This study aimed to establish whether the LS stage can be reliably determined using the GLFS-25, and to clarify the correlation between the GLFS-25's six subcategories and physical functions.

MATERIALS AND METHODS

We administered the GLFS-25 and evaluated physical functions using the stand-up test, the two-step test, handgrip strength, the five-times sit-to-stand test, the 4 m walking test, and the duration of single leg standing. We assessed 103 participants over 65 years of age. We analyzed the correlation between LS stage and GLFS-25 score, as well as the correlations between physical functions and the GLFS-25's six subcategories.

RESULTS

There was a discrepancy between the LS stage determined using the GLFS-25 alone and the LS stage determined using all three tools. ROC analysis revealed a cut-off value of 6 for the discrimination of LS stages 0/1 and 14 for stages 1/2. The analysis revealed an AUC of 0.78 and 0.81, respectively. Among the six subcategories of the GLFS-25, movement-related difficulty, usual care, ADL, and social activities were correlated with mobility functions. In contrast, body pain and cognitive showed no correlation.

CONCLUSION

The GLFS-25 is useful for screening those with severe LS stages; however, evaluation of actual physical function is recommended for precise staging of LS in those with low GFLS-25 scores. Among the six subcategories of the GLFS-25, body pain and cognitive were independent of the other four subcategories.

Smartphone Use Is Associated with Low Prevalence of Locomotive Syndrome among Elderly Individuals with Musculoskeletal Disorders

Objectives: Physical activity management through smartphone applications is increasing worldwide; however, it is unclear whether smartphone users among elderly Japanese individuals with musculoskeletal disorders are less likely to experience “locomotive syndrome” (LoS). We aimed to test the hypothesis that LoS in smartphone users had lower prevalence than that in non-smartphone users among elderly individuals with musculoskeletal disorders. Methods: Elderly participants, aged ≥60 years, who visited the outpatient clinic were enrolled. All participants were asked whether or not they used smartphones and were allocated into either the smartphone group or the non-smartphone group. After completing the 25-question Geriatric Locomotive Function Scale (GLFS-25), LoS prevalence was determined by 3-stage cutoff values of the GLFS-25 score (≥7, ≥16, and ≥24), and the total and three subdomain scores (body pain, movement-related difficulty, and psychosocial complications) were compared between the two groups. Generalized linear regression was then performed to confirm whether the use of smartphones was associated with lower GLFS-25 scores, even after controlling for confounders. Results: Overall, 266 participants, aged ≥60 years, were recruited. LoS prevalence was significantly higher in the non-smartphone group than in the smartphone group at all stages (all p < 0.001). Mean GLFS-25 total and subdomain scores were significantly lower in the smartphone group than in the non-smartphone group (all p < 0.001), and these statistical relationships were maintained even after controlling for age and sex. Conclusions: Smartphone use was associated with low LoS prevalence and low GLFS-25 scores among elderly individuals with musculoskeletal disorders, although the causal relationship remains unclear.

The beneficial effect of physical activity on cognitive function in community-dwelling older persons with locomotive syndrome

Background

Cognitive decline is closely related to motor decline. Locomotive syndrome (LS) is defined as a state associated with a high risk of requiring support because of locomotive organ disorders, and can be evaluated using a questionnaire. This study aimed to clarify the effectiveness of daily goal-targeted exercise on cognitive function in two different populations classified by scores on the Locomo 25 questionnaire.

Methods

Seventy community-dwelling older people who participated in a 13-week health class were divided into two populations based on Locomo 25 scores: <7 (non-LS) and ≥7 (LS). Participants were presented with a daily target steps and worked towards that goal. Cognitive function was evaluated using the Japanese version of Addenbrooke’s Cognitive Examination-Revised (ACE-R). Average daily physical activity (exercise [Ex]) for 13 weeks was measured using a portable activity meter. Depression status was assessed using the Geriatric Depression Scale (GDS-15).

Results

No significant differences were observed in age, years of education, body mass index, smooth muscle mass index, GDS-15 scores, or ACE-R scores between the non-LS and LS populations. Multiple logistic regression analysis showed that Ex (odds ratio = 5.01, p = 0.002) for 13 weeks was significantly associated with increased cognitive function in the LS population. The Ex threshold for the increase in cognitive function based on receiver operating curve analysis was 2.29 metabolic equivalents of task (METs) × h (METs · h/day) (p = 0.047) in the LS population. After 13 weeks, ACE-R scores were significantly higher in the Ex ≥ 2.29 than in the Ex < 2.29 METs · h/day group (p = 0.024, η_p² = 0.241) in the LS population based on two-way analysis of covariance. Furthermore, a significant increase in the ACE-R memory domain was seen in the Ex ≥ 2.29 group (p = 0.035, η_p² = 0.213).

Conclusions

These results suggest that Ex ≥ 2.29 METs · h/day is important for improving cognitive function in LS populations.

Increased anxiety about falls and walking ability among community-dwelling Japanese older adults during the COVID-19 pandemic

BACKGROUND

Understanding the physical and mental changes in community-dwelling elderly people is very important during the coronavirus disease 2019 (COVID-19) pandemic when considering preventive measures. The purpose of this study was to clarify the changes of physical function and anxiety for activities of daily living in community-dwelling older adults, focusing on locomotor function during the COVID-19 pandemic.

METHODS

The study participants were 127 older people who participated in successive surveys, in the summers of 2019 and again in 2020, after the state of emergency. The Locomo 25 questionnaire, Geriatric Depression Scale-15 (GDS-15) questionnaire, medical history, and number of people living together were self-reported. The Locomo 25 covers six aspects of physical pain, movement-related difficulty, usual care, daily activity, social activities, and anxiety.

RESULTS

The paired samples t-test revealed that Locomo 25 total scores in 2020 were significantly higher than those in 2019. The GDS-15 score showed no significant difference. The comparison of scores for each item of the Locomo 25 revealed significantly higher scores in 2020 on Q21 ('difficult to perform sports activity', P = 0.0021), Q22 ('restricted from meeting own friends', P < 0.001), Q23 ('restricted from joining social activities', P < 0.001), Q24 ('anxious about falling in own house', P = 0.0023), and Q25 ('anxious about being unable to walk in the future', P = 0.0016).

CONCLUSIONS

About 2 months after declaration of the first state of emergency due to the COVID-19 pandemic in Japan, social activity was severely restricted. Older adults showed almost no changes in body pain and locomotive disabilities, but increases in their anxieties about walking ability and falling were remarkable.

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.