The Development of the Short-form of “25-Question Geriatric Locomotive Function Scale”
Yu Tanabe
Department of Orthopaedic Surgery, Juntendo University School of Medicine, Japan.
Yoshiyuki Suehara *
Department of Orthopaedic Surgery, Juntendo University School of Medicine, Japan.
Yongji Kim
Department of Orthopaedic Surgery, Juntendo University School of Medicine, Japan.
Shuko Nojiri
Clinical Research Support Center, Juntendo University, Japan.
Taketo Okubo
Department of Orthopaedic Surgery, Juntendo University School of Medicine, Japan.
Midori Ishii
Department of Orthopaedic Surgery, Juntendo University School of Medicine, Japan.
Takayuki Kawasaki
Department of Orthopaedic Surgery, Juntendo University School of Medicine, Japan.
Kiyoshi Matsuoka
Clinical Research Support Center, Juntendo University, Japan.
Keisuke Akaike
Department of Orthopaedic Surgery, Juntendo University School of Medicine, Japan.
Kenta Mukaihara
Department of Orthopaedic Surgery, Juntendo University School of Medicine, Japan.
Naoko Okubo
Faculty of Health and Sports Science, Juntendo University, Japan.
Tsuyoshi Saito
Department of Human Pathology, Juntendo University School of Medicine, Japan.
Kazuo Kaneko
Department of Orthopaedic Surgery, Juntendo University School of Medicine, Japan.
*Author to whom correspondence should be addressed.
Abstract
Objectives: In 2007, the Japanese Orthopaedic Association (JOA) proposed the term “locomotive syndrome” (LS) to describe a condition in high-risk musculoskeletal disease patients who are highly likely to require nursing care. The JOA developed a screening tool, the 25-question Geriatric Locomotive Function Scale “GLFS-25” and the 5-question Geriatric Locomotive Function Scale “GLFS-5” in 2012.
However, there are some issues about these screening tools. GLFS-25 has 25 questions, and complete response is needed to diagnose LS, but our previous studies revealed that the complete response rates were extremely low (50-70%). GLFS-5 which has only 5 questions and it can only screen Normal and LS, but it can’t classify Grade 1 LS and Grade 2 LS. We thought we need short-form of GLFS-25 which is easier than GLFS-25 and more accurate than GLFS-5.
Methods: We developed a short-form of GLFS-25 by performing an exploratory/explanatory factor analysis (EFA) of approximately 1000 orthopaedic outpatients. We also performed confirmation studies in an additional cohort using an item response theory (IRT) analysis, a principal component analysis (PCA) and a receiver operating characteristic (ROC) analysis.
Results: We used an EFA to develop a short-form of GLFS-25 (GLFS-9), which consisted of 9 questions that were included in the GLFS-25. These 9 items were graded on the 5-point scale; the total score (0–36) was used to diagnose patients with Grade 1 LS (3–5 points) or Grade 2 LS (≥6 points) LS; while No-LS (normal) was defined by a score of ≤2 points. The ability of GLFS-9 to predict LS was confirmed by an IRT analysis, a PCA, and an ROC analysis.
Conclusion: We developed the GLFS-9 which can classify Grade 1 LS and Grade 2 LS, a short-form of the GLFS-25. We believe that the GLFS-9 may allow for the more accessible screening and prevention of LS.
Keywords: 25-Question geriatric locomotive function scale, locomotive syndrome, orthopedic patients, short-form