Original Article| Volume 28, ISSUE 2, P453-459, March 2023

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

Published:January 03, 2022DOI:



      No 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.


      This 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.


      A 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.


      Comorbidities 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.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Orthopaedic Science
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Seichi A.
        • Hoshino Y.
        • Doi T.
        • Akai M.
        • Tobimatsu Y.
        • Iwaya T.
        Development of a screening tool for risk of locomotive syndrome in the elderly: the 25-question Geriatric Locomotive Function Scale.
        J Orthop Sci. 2012 Mar; 17: 163-172
        • Ohe T.
        The history of locomotive syndrome-3. Japanese Orthopaedic Association (JOA) news.
        122. 2020 Jul: 6 ([in Japanese)])
      1. The Japanese Orthopedic Association official locomotive syndrome prevention awareness official website.
        Date accessed: February 17, 2021
        • Fujita N.
        • Michikawa T.
        • Miyamoto A.
        • Sakurai A.
        • Otaka Y.
        • Suzuki S.
        • Tsuji O.
        • Nagoshi N.
        • Okada E.
        • Yagi M.
        • Tsuji T.
        • Kono H.
        • Ishii K.
        • Nakamura M.
        • Matsumoto M.
        • Watanabe K.
        Lumbar spinal surgery improves locomotive syndrome in elderly patients with lumbar spinal canal stenosis: a multicenter prospective study.
        J Orthop Sci. 2020 Mar; 25: 213-218
        • Imai E.
        • Horio M.
        • Iseki K.
        • Yamagata K.
        • Watanabe T.
        • Hara S.
        • Ura N.
        • Kiyohara Y.
        • Hirakata H.
        • Moriyama T.
        • Ando Y.
        • Nitta K.
        • Inaguma D.
        • Narita I.
        • Iso H.
        • Wakai K.
        • Yasuda Y.
        • Tsukamoto Y.
        • Ito S.
        • Makino H.
        • Hishida A.
        • Matsuo S.
        Prevalence of chronic kidney disease (CKD) in the Japanese general population predicted by the MDRD equation modified by a Japanese coefficient.
        Clin Exp Nephrol. 2007 Jun; 11: 156-163
        • Nojiri S.
        • Itoh H.
        • Kasai T.
        • Fujibayashi K.
        • Saito T.
        • Hiratsuka Y.
        • Okuzawa A.
        • Naito T.
        • Yokoyama K.
        • Daida H.
        Comorbidity status in hospitalized elderly in Japan: analysis from National database of health insurance claims and specific health checkups.
        Sci Rep. 2019 Dec; 9: 20237
        • Fuchs Z.
        • Blumstein T.
        • Novikov I.
        • Walter-Ginzburg A.
        • Lyanders M.
        • Gindin J.
        • Habot B.
        • Modan B.
        Morbidity, comorbidity, and their association with disability among community-dwelling oldest-old in Israel.
        J Gerontol A Biol Sci Med Sci. 1998 Nov; 53: M447-M455
      2. Guidelines for data processing and analysis of the international physical activity questionnaire (IPAQ).
        (Available at:)
        • Wondergem R.
        • Pisters M.F.
        • Wouters E.J.
        • Olthof N.
        • de Bie R.A.
        • Visser-Meily J.M.
        • Veenhof C.
        The course of activities in daily living: who is at risk for decline after first ever stroke?.
        Cerebrovasc Dis. 2017; 43: 1-8
        • Rafsten L.
        • Danielsson A.
        • Sunnerhagen K.S.
        Anxiety after stroke: a systematic review and meta-analysis.
        J Rehabil Med. 2018 Sep 28; 50: 769-778
        • Szczepanska-Sadowska E.
        • Cudnoch-Jedrzejewska A.
        • Sadowski B.
        Differential role of specific cardiovascular neuropeptides in pain regulation: relevance to cardiovascular diseases.
        Neuropeptides. 2020 Jun; 81: 102046
        • Yohannes A.M.
        • Junkes-Cunha M.
        • Smith J.
        • Vestbo J.
        Management of dyspnea and anxiety in chronic obstructive pulmonary disease: a critical review.
        J Am Med Dir Assoc. 2017 Dec; 18: 1096.e1-1096.e17
        • Lowe K.M.
        • Robinson Jr., D.R.
        Pain management for patients with chronic kidney disease in the primary care setting.
        Nurs Pract. 2020 Jan; 45: 18-26
        • Lin M.Y.
        • Liu M.F.
        • Hsu L.F.
        • Tsai P.S.
        Effects of self-management on chronic kidney disease: a meta-analysis.
        Int J Nurs Stud. 2017 Sep; 74: 128-137
        • Gelaw A.Y.
        • Janakiraman B.
        • Gebremeskel B.F.
        • Ravichandran H.
        Effectiveness of Home-based rehabilitation in improving physical function of persons with Stroke and other physical disability: a systematic review of randomized controlled trials.
        J Stroke Cerebrovasc Dis. 2020 Jun; 29: 104800
        • Ades P.A.
        • Maloney A.
        • Savage P.
        • Carhart Jr., R.L.
        Determinants of physical functioning in coronary patients: response to cardiac rehabilitation.
        Arch Intern Med. 1999 Oct; 159: 2357-2360
        • Vogiatzis I.
        • Zakynthinos G.
        • Andrianopoulos V.
        Mechanisms of physical activity limitation in chronic lung diseases.
        Pulm Med. 2012; 2012: 634761
        • Weiner D.E.
        • Seliger S.L.
        Cognition and physical function in chronic kidney disease.
        Curr Opin Nephrol Hypertens. 2014 May; 23: 291-297
        • Kitabayashi K.
        • Yamamoto S.
        • Katano Y.
        • Giustini K.
        • Ei I.
        • Ishii Y.
        • Narita I.
        Locomotive syndrome in hemodialysis patients and its association with quality of life—a cross-sectional study.
        Ren Replace Ther. 2021 Jun; 36: 7
        • Kataoka H.
        • Miyatake N.
        • Ichikawa H.
        • Arakawa Y.
        • Mori Y.
        Relationship of locomotive syndrome with health-related quality of life among patients with obstructive sleep apnea syndrome.
        J Phys Ther Sci. 2017 Jul; 29: 1129-1133
        • McKevitt S.
        • Healey E.
        • Jinks C.
        • Rathod-Mistry T.
        • Quicke J.
        The association between comorbidity and physical activity levels in people with osteoarthritis: secondary analysis from two randomised controlled trials.
        Osteoarthr Cartil. 2020 Jun; 2: 100057
        • Nakamura M.
        • Tazaki F.
        • Nomura K.
        • Takano T.
        • Hashimoto M.
        • Hashizume H.
        • Kamei I.
        Cognition impairment associated with locomotive syndrome in community-dwelling elderly women in Japan.
        Clin Interv Aging. 2017 Sep 12; 12: 1451-1457
        • Kobayashi T.
        • Morimoto T.
        • Shimanoe C.
        • Ono R.
        • Otani K.
        • Mawatari M.
        Development of a tool for screening the severity of locomotive syndrome by the loco-check.
        J Orthop Sci. 2022 May; 27: 701-706
        • Kobayashi T.
        • Morimoto T.
        • Shimanoe C.
        • Ono R.
        • Otani K.
        • Mawatari M.
        Development of a simple screening tool based on the 5-question geriatric locomotive function scale for locomotive syndrome.
        J Orthop Sci. 2022 Jul; 27: 913-920