Physical performance tests are useful for evaluating and monitoring the severity of locomotive syndrome

BackgroundThe concept of the locomotive syndrome (LS), first proposed in Japan in 2007, has become widely accepted, and the 25-question Geriatric Locomotive Function Scale (GLFS-25), a quantitative, evidence-based diagnostic tool for LS, has been developed. However, the association between the GLFS-25 score and the outcome of physical capacity tests has never been investigated. Furthermore, which physical tests are good indices for evaluating and monitoring the severity of locomotive syndrome have not been identified. In addition, the impact of knee and low back pain on locomotive syndrome is unclear. The purpose of this study is to confirm the validity of GLFS-25 by demonstrating its significant correlation with the outcome of physical function tests and to determine which tests are good indicators for monitoring the severity of LS. The secondary aim of the project is to investigate how much influence knee and low back pain may have on the LS of the middle-aged and elderly.MethodsA total of 358 subjects were drawn from a general health checkup in a rural area of Japan. We measured back muscle strength, grip strength, one-leg standing time with eyes open, 10-m gait time, timed up-and-go test, maximum stride, functional reach, height, weight, % body fat and bone mineral density, and we obtained a visual analog scale of low back pain and knee pain. The degree of the locomotive syndrome was evaluated using the GLFS-25. Associations of all the variables with the GLFS-25 score were analyzed using both univariate and multivariate analyses.ResultsThe GLFS-25 score was significantly higher in females than in males in both the total and in the age older than 60 years groups. The GLFS-25 score showed a significant positive correlation with age (r = 0.360), knee pain (r = 0.576), low back pain (r = 0.526), timed up- and-go test (r = 0.688) and 10-m gait time (r = 0.634), and it showed a significant negative correlation with one-leg standing time with eyes open (r = ?0.458), maximum stride (r = ?0.408), functional reach test (r = ?0.380), back muscle strength (r = ?0.364) and grip strength (r = ?0.280). Multiple regression analysis indicated that knee pain (β = 0.282), low back pain (β = 0.304), one-leg standing time (β = ?0.116), timed up-and-go test (β = ?0.319) and back muscle strength (β = ?0.090) were significantly associated with the GLFS-25 score. Grip strength (β = ?0.99) was a good substitute for back muscle strength in the multiple regression analysis.ConclusionsWe confirmed the validity of GLFS-25 by demonstrating a significant correlation and association of its score with the outcome of a series of functional performance tests. One-leg standing time with eyes open, timed up-and-go test and grip strength proved to be easy, reliable and safe performance tests to evaluate and monitor an individual’s severity of LS as a complement to the GLFS-25. We also proved that knee and low back pain significantly impact the degree of LS.     

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

BackgroundLocomotive 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.MethodsThis 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.ResultsPrior 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.ConclusionsTHA 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.     

Waist circumference is associated with locomotive syndrome in elderly females

Background

Central obesity has been proved to be a strong risk factor for numerous health-related problems as well as mortality. However, there have been no studies on the relationship between central obesity and locomotive syndrome (LS). The present study investigated the influence of central obesity on LS.

Methods

A total of 217 females between the ages of 60 and 79 years (mean 68.2 ± 5.0 years) who completed the questionnaires, physical examination and physical performance tests in the Yakumo study in 2011–2012 were enrolled in this study. Participants were assessed according to the 25-Question Geriatric Locomotive Function Scale (GLFS-25), visual analog scale (VAS) for lower back pain (LBP) and knee pain, and the Roland Morris Disability Questionnaire (RDQ). LS was defined as having a score of >16 points on the GLFS-25. Height, weight, waist circumference (WC), hip circumference, % body fat and bone mineral density were measured. Body mass index and waist-to-hip ratio were calculated. The timed up-and-go test, one-leg standing time with eyes open, 10-m gait time and maximum stride were assessed. Back muscle strength and grip strength were measured. The relationships between obesity-related parameters and GLFS-25, RDQ, VAS and physical performance tests were analyzed.

Results

The GLFS-25, LBP and knee pain showed significant correlation with most of obesity-related parameters. Among obesity-related parameters, WC was most strongly related to the GLFS-25, LBP and knee pain. When participants were stratified by WC, larger WC was significantly associated with a higher GLFS-25 score, higher prevalence of LS and higher VAS for LBP and knee pain as well as poorer results in some physical performance tests even after adjustment by age.

Conclusions

The present study revealed that central obesity is significantly associated with LS, and WC can be a useful parameter to assess the risk of LS in elderly women.     

Threshold values of physical performance tests for locomotive syndrome

Background

Our previous study determined which physical performance tests were the most useful for evaluating locomotive syndrome. Our current study establishes reference values for these major physical performance tests with regards to diagnosing and assessing risk of locomotive syndrome (LS).

Methods

We measured timed-up-and-go test, one-leg standing time, back muscle strength, grip strength, 10-m gait time and maximum stride in 406 individuals (167 men, 239 women) between the ages of 60–88 years (mean 68.8 ± 6.7 years) during Yakumo Study 2011-12. The LS was defined as having a score of >16 points on the 25-Question Geriatric Locomotive Function Scale (GLFS-25). The reference value of each physical test was determined using receiver operating characteristics analysis.

Results

Women had a significantly higher prevalence of LS than men did and also scored significantly higher on the GLFS-25: women, 9.2 ± 10.3 pts; men, 6.7 ± 8.0 pts. Both genders in the non-LS group performed significantly better in all physical performance test gender except for back muscle strength in men and grip strength in both genders than those in the LS group, even after adjusting for age. The results of all the physical performance tests correlated significantly with the GLFS-25 scores of both genders even after adjusting for age except for grip strength. Reference values for TUG, one-leg standing time, back muscle strength, 10-m gait time, maximum stride and grip strength in men were 6.7 s, 21 s, 78 kg, 5.5 s and, 119 cm and 34 kg, respectively, and those for women were 7.5 s, 15 s, 40 kg, 6.2 s, 104 cm, and 22 kg, respectively.

Conclusions

We established reference values for major physical performance tests used when assessing locomotive syndrome as defined by the GLFS-25. Our results can be used to characterize physical function and to help tailor an anti-LS training program for each individual.     

Prevalence of locomotive syndrome in Japanese patients more than 10 years after total hip arthroplasty: A cross-sectional cohort study

BackgroundLocomotive syndrome (LS) is a high risk condition that requires nursing care. It is important to investigate the prevalence of and factors related to LS to maintain a healthy life expectancy for patients; however, only a few reports have focused on the relationship between LS and total hip arthroplasty (THA). The purpose of this study was to evaluate the prevalence of LS and to identify factors associated with LS in patients more than 10 years after THA.MethodsThis is a cross-sectional cohort study. Patients were assessed via a mail survey that included items regarding demographic data, cardiometabolic and motor disorders, the incidence of falls, physical activity level, and the 25-question Geriatric Locomotive Function Scale (GLFS-25) questionnaire. LS was defined as having a score ≥16 on the GLFS-25, and the respondents were categorized into two groups: an LS group and a non-LS group. The prevalence of LS was calculated in each gender and age group. Differences in variables between the groups were determined using the unpaired t-test and chi-squared test.ResultsA total of 593 patients were included in the study (mean age, 70.4 years; 525/593 females). According to the GLFS-25, 164 patients (27.7%; 21.1% men and 28.8% women) were classified as having LS, which increased with age. In addition, compared with the non-LS group, the LS group had a significantly higher prevalence of motor diseases, cardiometabolic diseases, and falls and significantly lower levels of activity.ConclusionThese findings suggest that the prevalence of LS in patients more than 10 years after THA is 27.7%. The result suggest that the prevalence of LS in patients more than 10 years after THA is similar to the prevalence of LS in the general elderly population. Furthermore, LS is related to not only motor diseases but also cardiometabolic diseases.     

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

BackgroundIn 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).MethodsOf 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.ResultsBefore 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.ConclusionsThree 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.DesignProspective cohort study design.     

The association of comorbidities with the 25-question geriatric locomotive function scale and the diagnosis of locomotive syndrome

BackgroundNo studies have provided statistical evidence of the relationship between comorbidities and locomotive syndrome (LS). We therefore investigated the association of comorbidities with the 25-question Geriatric Locomotive Function Scale (GLFS-25) and the diagnosis of LS in community-dwelling residents.MethodsThis cross-sectional study was conducted on 2612 community-dwelling residents (≥40 years old) who attended a ‘basic health checkup’. There were 432 participants with comorbidities (45 with cerebrovascular diseases, 133 with cardiovascular diseases, 83 with pulmonary diseases, 108 with renal diseases, and 63 with multiple diseases) and 2180 participants without comorbidities. Subjects with a GLFS-25 total score of ≤6 points, 7–15 points, 16–23 points, and ≥24 points were diagnosed with non-LS, LS-1, LS-2, and LS-3, respectively. The domain scores covered body pain (items 1–4), movement-related difficulty (items 5–7), usual care (items 8–11 and 14), social activities (items 12, 13, and 15–23), and cognition (items 24 and 25). A multivariate regression analysis and multivariate logistic regression analysis were performed to assess the association between the GLFS-25 scores and comorbidities and between the diagnosis of LS and comorbidities after adjusting for age, sex, body mass index, and smoking status.ResultsA multivariate regression analysis showed that comorbidities were significantly related to the GLFS-25 total score and all domain scores. A multivariate logistic regression analysis revealed that comorbidities were significantly related to a diagnosis of LS-1 or more, LS-2 or more, and LS-3 or more.ConclusionsComorbidities were associated with increased GLFS-25 domain scores and total score and consequent diagnosis of LS. Therefore, attention should also be paid to the presence of comorbidities when diagnosing LS. Nevertheless, the causal relationship between comorbidities and the GLFS-25 remains unclear, and further studies are therefore required.     

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

BackgroundThe 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.MethodsWe 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.ResultsOnly 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).ConclusionThe expression level of miRNA-199 was associated with the risk of LS in community-dwelling Japanese people.     

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

BackgroundFalling is one of the main reasons for which older adults require nursing care. Locomotive syndrome (LS) predicts the need for nursing care; however, the relationship between falling and LS remains unclarified. This study aimed to determine whether the 5-question Geriatric Locomotive Function Scale (GLFS-5) predicts postoperative fall risk in patients with degenerative cervical myelopathy (DCM).MethodsThis study is a post hoc analysis of the data from a prospective cohort of patients undergoing surgery for DCM. Participants recorded their falls in a fall diary from the time of study enrollment (baseline) to 1 year postoperatively. Functional assessments were conducted at baseline, hospital admission for surgery, and 1 year postoperatively. Outcome measures included the GLFS-5, Japanese Orthopaedic Association score, Neck Disability Index, EuroQol 5 Dimensions, and 12-Item Short Form Health Survey. Risk factors for falls were investigated, including previous falls, number of medications, and grip strength. Fallers were divided into two categories: all fallers (≥1 falls), and recurrent fallers (≥2 falls). Variables that were significant in univariate analyses were applied in multiple logistic regression models to adjust for confounders.ResultsFrom the initial group of 168 participants, 159 attended the 1-year follow-up, and 132 fall diaries were retrieved and analyzed. Of these 132 patients, 42 (32%) reported at least one fall, while 25 (19%) reported recurrent falls during the postoperative observation period. The GLFS-5 significantly increased from baseline to admission, and significantly decreased from admission to 1 year postoperatively. In multiple logistic regression analysis, the independent predictors of postoperative recurrent falls were previous falls and a higher baseline GLFS-5. The optimal cut-off value of GLFS-5 for predicting all falls/recurrent falls was 12.ConclusionsThe GLFS-5 reflected time-dependent functional changes in patients undergoing surgery for DCM. Previous falls and a higher baseline GLFS-5 were independent predictors of postoperative recurrent falls.     

The efficacy of surgical treatment on locomotive syndrome and physical function in patients with lumbar spinal canal stenosis

BackgroundLocomotive syndrome is a condition of reduced mobility due to problems with locomotive organs. Although lumbar spinal canal stenosis is one of the major diseases constituting locomotive syndrome, only few studies have focused on the association between the two pathologies. We aimed to investigate the effect of surgery on lumbar spinal canal stenosis with respect to locomotive syndrome using various physical function tests, including locomotive syndrome risk tests, before and after surgery.MethodsClinical data of 101 consecutive patients (male = 46; female = 55; mean age, 69.3 years) who underwent surgery for lumbar spinal canal stenosis at our institute were prospectively collected. Results of physical function tests, including stand-up test, two-step test, and 25-Question Geriatric Locomotive Function Scale, and the sagittal vertical axis were evaluated before and 1 year after surgery. The association between several parameters and improvement of risk level in locomotive syndrome was evaluated.ResultsIn the total assessment, 93.1% of cases were in stage 2 and 6.9% in stage 1 preoperatively, while 72.4% were in stage 2, 22.4% in stage 1, and 5.2% in stage 0 at 1 year postoperatively. Postoperative improvement in the total assessment was observed in 28.7% of cases. Several physical function tests and sagittal vertical axis showed significant improvement after surgery. On multiple logistic regression analysis, age >75 years (odds ratio = 10.9, confidence interval = 1.09–109) and postoperative sagittal vertical axis >40 mm (odds ratio = 17.8, confidence interval = 1.78–177) were significant risk factors associated with non-improvement in risk level of locomotive syndrome.ConclusionsSurgical treatment for lumbar spinal canal stenosis improved physical function, including locomotive syndrome. Risk factors associated with non-improvement of locomotive syndrome were later-stage elderly and postoperative sagittal balance impairment.     

Development of a simple screening tool based on the 5-question geriatric locomotive function scale for locomotive syndrome

BackgroundThe optimal cut-off values of the 5-question Geriatric Locomotive Function Scale (GLFS-5) as a screening tool to identify Locomotive Syndrome (LS) diagnosed with the 25-question Geriatric Locomotive Function Scale (GLFS-25) has yet to be fully investigated. This study aimed to construct a simple screening tool, based on the GLFS-5, for the detection of LS-1, LS-2, and LS-3 diagnosed with the GLFS-25.MethodsThis research was approved by the institutional review board of Fukushima Medical University School of Medicine (No. 2907). A cross-sectional study of 1258 consecutive Japanese volunteers with a mean age of 76.0 ± 6.0 years who consecutively attended a basic health checkup was conducted. We excluded individuals of <65 years of age, individuals with comorbidities, and individuals who did not fully complete the GLFS-25. Subjects with a GLFS-25 total score of 0–6 points, 7–15 points, 16–23 points, and 24–100 points were diagnosed with non-LS, LS-1, LS-2, and LS-3, respectively. A conventional receiver-operating characteristic curve analysis was used to confirm the optimal cut-off values of the GLFS-5 total score and their sensitivity and specificity in the identification of LS-1, LS-2, and LS-3, with a preference for slightly higher sensitivity as the intended use of the tool is primarily for screening purposes.ResultsThe diagnoses of the 1258 subjects were as follows: non-LS (n = 559), LS-1 (n = 396), LS-2 (n = 134), and LS-3 (n = 169). The mean GLFS-5 was 3.3 ± 3.5 points. The optimal cut-off values of the GLFS-5 total score for discriminating LS-1, LS-2, and LS-3 (as a screening tool) were 2 points (sensitivity 91.7% and specificity 77.8%), 4 points (sensitivity 95.7% and specificity 81.7%), and 6 points (sensitivity 92.9% and specificity 90.0%), respectively.ConclusionsThis simple screening tool based on GLFS-5 could help physicians and surgeons to easily and practically predict the severity of LS.     

Locomotive Syndrome is associated with chronic pain and poor quality of life in Brazilian oldest old: LOCOMOV Project

BackgroundIn 2007, the Japanese Orthopedic Association established the term “Locomotive Syndrome” (LS) for the concept of locomotor organ dysfunction with potential loss of independence. The purpose of this study was to identify characteristics of LS and establish a diagnostic cut-off for the Geriatric Locomotive Function Scale (GLFS 25-p) for the Brazilian population.MethodsA cross-sectional observational study of the LOCOMOV Project cohort of independent outpatients aged ≥80 years was conducted. Questionnaires on functional status in Basic and Instrumental Activities of Daily Living (Katz and Lawton, respectively) and quality of life (WHOQOL-Bref) were applied, together with the Geriatric Locomotive Function Scale (GLFS 25-p) to identify individuals with LS. Mobility was assessed using the five-times sit-to-stand test, 4-m gait speed, two-step test, one-leg standing time with eyes open and hand-grip test. The data were analyzed using Student's t-test, the Chi–Square test, and multiple logistic regression (stepwise). The significance level was set at 0.05 (5%).ResultsA sample of 102 individuals with mean age of 87.3 (±4.2) years and predominantly female (73.5%) was assessed. We determined a cut-off score of 19 (sensitivity of 0.86 and specificity of 0.67) for diagnosis of LS, as assessed by the GLFS 25-p, and a high prevalence (55%) of the syndrome was found in the sample. In the multiple regression analysis, LS was directly associated with chronic pain (OR 22.24, 95%CI 3.13–157.87), use of a walking device (OR 17.121, 95%CI 1.94–150.49), and inversely associated with gait speed ≥0.8 m/s (OR 0.42, 95%CI 0.006–0.278), perception of good health (OR 0.153, 95%CI 0.029–0.799) and male gender (OR 0.086, 95%CI 0.0105–0.714).ConclusionThe LS in the oldest old proved a very common condition in this survey, especially in women, and was strongly associated with chronic pain, worse performance on physical tests and poor quality of life.     

Prevalence of locomotive syndrome in Japan: a nationwide,cross-sectional Internet survey

Background

The authors recently developed a screening tool, the 25-question Geriatric Locomotive Function Scale (GLFS-25), for the early detection of locomotive syndrome (LS). However, the nationwide prevalence of LS based on the GLFS-25 remains unknown.

Methods

A nationwide, cross-sectional Internet survey was conducted to estimate sex- and age-specific mean values of the GLFS-25 and the total number of individuals with LS in Japan. The distribution of the subjects’ sex, age, geographical location, and population size was approximated by that observed in the national population census conducted in 2010. In total, 4,500 subjects who completed the GLFS-25 questionnaire on the Internet were included in the present study.

Results

The age-specific mean values for the GLFS25 were 5.8 in the 40s, 6.0 in the 50s, 5.9 in the 60s, and 8.8 in the 70s. The mean value for the GLFS-25 was significantly higher in the 70s than in the other age groups. The mean value for the GLFS-25 was significantly higher in females than in males. The prevalence of LS was 8.4 % in the 40s and remained stable until the 60s, but increased rapidly in the 70s. The overall mean prevalence of LS was 10.2 %. The total number of individuals between the 40s and 70s with LS in Japan was roughly estimated to be 6.5 million.

Conclusions

This study determined sex- and age-specific estimates for the GLFS-25 using a nationwide, cross-sectional Internet survey. The current results highlight the magnitude of the problem associated with LS and encourage further large-scale population-based epidemiologic studies to determine the accurate prevalence of LS using stratified random sampling.     

Is grip strength useful in screening to predict the severity of locomotive syndrome?

BackgroundThis study was conducted to investigate the relationship between grip strength and the 25-question Geriatric Locomotive Function Scale (GLFS-25) score and the diagnosis of locomotive syndrome (LS), and the usefulness of grip strength in screening for LS.MethodsThis cross-sectional study was conducted on 2251 community-dwelling residents (male, n = 1035; female, n = 1216). Subjects with GLFS-25 scores of 0–6 points, 7–15 points, 16–23 points, and 24–100 points were diagnosed with non-LS, LS-1, LS-2, and LS-3, respectively. Multivariate linear regression and multivariate logistic regression analyses were performed to assess the relationship between grip strength and the GLFS-25 score and LS after adjustment for age, sex, and body mass index. A conventional receiver operating characteristic (ROC) curve analysis was used to calculate the optimal cutoff value of grip strength for predicting the severity of LS. The discriminative ability of the model was assessed using the area under the ROC curve (AUC).ResultsThe multivariate linear regression analysis showed that grip strength was significantly associated with the GLFS-25 score. The multivariate logistic regression analysis revealed that grip strength was significantly associated with the diagnosis of LS. The optimal cutoff values of grip strength for identifying LS-1 or more, LS-2 or more, and LS-3 or more were 36.0 kg (sensitivity 65.7%, specificity 57.1%, AUC 0.66), 35.0 kg (sensitivity 70.0%, specificity 57.5%, AUC 0.70), and 34.0 kg (sensitivity 67.2%, specificity 62.5%, AUC 0.70), respectively, in males, and 24.0 kg (sensitivity 69.1%, specificity 45.4%, AUC 0.61), 23.0 kg (sensitivity 69.5%, specificity 52.3%, AUC 0.67), and 22.0 kg (sensitivity 69.1%, specificity 61.0%, AUC 0.69) in females.ConclusionsThe use of grip strength in screening to predict the severity of LS may not be clinically useful. However, the results will increase our understanding of the relationship between grip strength and the GLFS-25 scores and LS.     

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

Background

Fall-induced injuries represent a major public health concern for older individuals. The relationship between risk of falling and the severity of locomotive syndrome (LS) remains largely unknown.

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

BackgroundPrevention and treatment for locomotive syndrome (LS) are important for extending healthy life expectancy. The 25-question geriatric locomotive function scale (GLFS-25) was developed to diagnose LS. The Fear-Avoidance model was proposed to explain pain chronicity. LS and chronic pain decrease activities of daily living; however, the relationships between LS and factors related to chronic pain in the Fear-Avoidance model are unknown. Objective of the current study was to assess the prevalence of LS and examine the factors of the Fear-Avoidance model and the GLFS-25 that affect the prevalence of LS in patients with chronic pain.MethodsParticipants included 281 patients (99 men, 182 women) aged over 40 years with chronic pain who visited our outpatient clinic for chronic pain. All participants completed the GLFS-25, numeric rating scale (NRS), pain catastrophizing scale (PCS), hospital anxiety and depression scale (HADS), and Athene insomnia scale (AIS). According to a GLFS-25 cutoff point, participants were divided into three groups (LS-2; GLFS-25 ≥ 16, LS-1; 7 ≤ GLFS-25 < 16, and non-LS; GLFS-25 < 7 points) and each parameter was compared among the groups, followed by multiple logistic regression analysis. Next, multiple linear regression analysis was performed to determine the factors associated with the GLFS-25.ResultsOf all 281 patients, 241 (85.8%) patients were diagnosed with LS-2. Univariate analysis revealed there were significant differences in NRS, PCS, HADS anxiety, HADS depression, and AIS among groups. Multiple logistic regression analyses showed PCS was significantly associated with LS-2 prevalence. The GLFS-25 was positively correlated with NRS, HADS depression, AIS in multiple linear regression analysis.ConclusionsWe found that patients with chronic pain in our outpatient clinic had a significant rate of LS-2. The prevalence of LS-2 was significantly correlate with pain catastrophizing, and the GLFS-25 was significantly correlated with higher pain intensity, depression, and insomnia.     

The one-leg portion of the Stand–Up Test predicts fall risk in aged individuals: A prospective cohort study

BackgroundFalls are a primary cause of physical disability in older adults, making them a major public health problem. Locomotive syndrome risk assessments have proven to be simple to administer, practical, and useful as screening tools in detecting decreased mobility in middle-aged and elderly adults. The current prospective study investigated whether these tests were associated with future falls among elderly Japanese.MethodsThis study was a two-year prospective observational study. A total of 1800 individuals (aged 65–79 years) who were without certification of long-term care or physical disability were initially invited through letters to participate in the study. Of these, 499 individuals (225 men, 274 women) agreed to participate and underwent baseline assessments. Demographic information, body function physical performance measurements, and locomotive syndrome risk tests [Stand–Up Test (SUT), Two-Step Test (TST), and the 25-question Geriatric Locomotive Function Scale (GLFS-25)] were assessed. Following baseline evaluation, we sent a follow-up questionnaire to assess fall history in the past two years. Participants were classified as either “non-fallers” or “fallers” (denoted by one or more falls). Multiple logistic regression was used to evaluate the association between falls and each factor by providing adjusted odds ratio estimates.ResultsThe follow-up questionnaire was returned by 399 participants, 54 of whom (13.5%) fell at least once during the two-year observation period. The multiple logistic regression analysis revealed that difficulty with standing on one leg from a 40-cm-high seat (a portion of the SUT) was a significant predictor of future falls (odds ratio = 2.20, 95%CI = 1.04–4.69, p = 0.04). A history of falling was also a risk factor of falls.ConclusionOur results suggest that standing on one leg from a 40-cm-high seat is predictive of falling in older adults, even after adjustment for previous falls and other confounding variables.     

Significance of long corrective fusion to the ilium for physical function in patients with adult spinal deformity

BackgroundWe aimed to investigate the impact of long corrective fusion to the ilium on the physical function in elderly patients with adult spinal deformity and its correlation with spinopelvic parameters and health-related quality of life outcomes.MethodsWe included 60 female patients who underwent long corrective fusion from T9 or T10 to the pelvis for adult spinal deformities (mean age of 69.8 years, range 55–78 years). The radiographic parameters, health-related quality of life outcomes using the Scoliosis Research Society Outcome Instrument-22 and physical function assessments were reviewed preoperatively and at 1-year postoperatively.ResultsAll spinopelvic parameters, except for thoracolumbar kyphosis, and all domains of the Scoliosis Research Society Outcome Instrument-22 significantly improved at 1-year postoperatively (p < 0.0001). Physical function results, including those for one-leg standing time, timed up-and-go test, and 6-min walk tests, significantly improved at 1-year postoperatively (p < 0.005). Based on forward stepwise multivariate logistic regression, the predicted timed up-and-go test and 6-min walk test outcomes at 1-year postoperatively were as follows: timed up-and-go test, 7.8 + 0.47 × preoperative timed up-and-go test – 0.21 × 1-year postoperative grasping power +0.015 × 1-year postoperative C1 sagittal vertical axis (R2 = 0.6209, p < 0.0001); 6-min walk test, 309.2–9.1 × body mass index + 11.6 × 1-year postoperative grasping power + 3.3 × 1-year postoperative thoracolumbar kyphosis – 0.59 × 1-year postoperative C1 sagittal vertical axis (R2 = 0.4409, p < 0.0001).ConclusionsCorrective long fusion surgery for adult spinal deformity in normalizing sagittal alignment improves trunk balance and gait performance. Postoperative physical function depends on the preoperative physical performance status and skeletal muscle status; thus, preoperative interventions for improved physical function are recommended.     

The critical cutoff point of the Zurich Claudication Questionnaire and the Japanese Orthopaedic Association score indicating locomotive syndrome in patients with lumbar spinal canal stenosis

BackgroundLocomotive syndrome (LS) is a condition of decreased mobility caused by disorders of the locomotive organs. Lumbar spinal stenosis (LSS) is a LS disorder. The Japanese Orthopaedic Association score (JOA score) and the Zurich Claudication Questionnaire (ZCQ) are international evaluation tools for LSS. However, the relationship between LS and JOA score or ZCQ is unknown. This study aimed to clarify the correlations between LS progression and the values/parameters of the JOA score or ZCQ and to determine the critical cutoff point of the JOA score or ZCQ that indicates LS progression.MethodsWe recruited preoperative LSS patients (n = 82). Patients' mean age was 73.4 years. The study participants were evaluated using the 25-question Geriatric Locomotive Function Scale (GLFS), JOA score, and ZCQ (which consists of symptom severity and physical function), and the patients' health-related quality of life was assessed using EuroQoL-5 dimension (EQ-5D) utility values and the EuroQoL-visual analog scale (EQ-VAS). We investigated the correlations between the 25-question GLFS and each clinical variable and evaluated the critical cutoff point of each international evaluation tool to detect LS.ResultsThere was a statistically significant correlation between 25-question GLFS and each clinical evaluation tool. LSS patients with LS showed significantly worse scores in the evaluation tools than LSS patients without LS. Moreover, we found that critical cutoff points of 17.5 on JOA score, 3.1 on ZCQ-symptom, and 2.3 on ZCQ-function could detect LS.ConclusionsA statistically significant correlation exists between the 25-question GLFS and the JOA score or ZCQ. It might be important to perform decompression surgery for LSS patients before they reach the cutoff values of the several clinical evaluation tools to avoid LS progression.Study designClinical prospective case–control study.     

Factors related to length of hospital stay after two-stage corrective surgery for adult spinal deformity in elderly Japanese

BackgroundPostoperative recovery of activities of daily living after surgery in elderly patients often takes a longer time because of their frailty. However, it is unclear how long it takes for patients with adult spinal deformity (ASD) to recover their abilities to live their daily lives in their home after corrective fusion surgery. This study aimed to investigate the length of hospital stay required to perform activities of daily living (ADL) in patients undergoing two-stage corrective fusion surgery for ASD in our institution and to detect factors associated with the length of hospital stay.MethodsThirty-four consecutive female ASD patients (median age, 70 years) who underwent two-stage corrective fusion surgery (lateral lumbar interbody fusion at the first stage and posterior corrective fusion at the second stage) from T9 or T10 to the pelvis were included. The length of hospital stay from admission to return home was determined, and correlations between length of hospital stay and demographics, skeletal muscle mass, operative invasion and perioperative complications, and spino-pelvic alignment were investigated.ResultsThe median length of hospital stay was 51 days, exceeding 100 days in 25% of cases. Age at surgery (ρ = 0.545, p = 0.001), estimated glomerular filtration rate (ρ = ?0.603, p < 0.001), age-adjusted Charlson comorbidity index (ρ = 0.437, p = 0.01), and preoperative pelvic incidence (ρ = 0.356, p = 0.04) were correlated with length of hospital stay. Preoperative skeletal muscle mass, preoperative spinal imbalance, perioperative changes in spino-pelvic alignment, operative invasion, and perioperative complications were not correlated with length of hospital stay.ConclusionsAfter >50 days, ADL performance of each patient reached the extent required for daily living to return home after two-stage corrective fusion surgery for ASD. Factors related to length of hospital stay were age and indices related to frailty.