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

Abstract

Background The 25-question Geriatric Locomotive Function Scale (GLFS-25) is widely used in daily clinical practice in evaluating locomotive syndrome (LS). The questionnaire contains 25 questions aiming to describe 6 aspects, including body pain, movement-related difficulty, usual care, social activities, cognitive status, and daily activities. However, its potential underlying latent factor structure of the questionnaire has not been fully examined so far. Methods Five hundred participants who were 60 years or older and were able to walk independently with or without a cane but had complaints of musculoskeletal disorders were recruited face to face at the out-patient ward of Aichi Medical University Hospital between April 2018 and June 2019. All participants completed the GLFS-25. Confirmatory factor analysis (CFA) models (single-factor model, 6-factor model as designed by the developers of the GLFS-25) were fitted and compared using Mplus 8.3 with a maximum likelihood minimization function. Modification indices, standardized expected parameter change were used, a standard strategy for scale development was followed in the search for an alternative and simpler model that could well fit the collected data. Cronbach’s α and its 95% confidence interval (CI) were also calculated. Results Mean (standard deviation) participants age was 72.6 (7.4) years old; 63.6% of them were women. Under the current criteria, 132 (26.4%) and 262 (52.4%) of the study subjects would be classified as LS stage 1 and stage 2, respectively. Overall, the Cronbach’s α (95% CI) for GLFS-25 evaluated using these data was 0.959 (0.953, 0.964). The single- and 6-factor models were rejected due to poor fit. The alternative models with either full 25 questions or a shortened GLFS-16 were found to fit the data better. These alternative models included three latent factors (body pain, movement-related difficulty, and psycho-social complication) and allowed for cross-loading and residual correlations. Discussion The findings of the CFA models provided evidence that the factor structure of the GLFS-25 might be simpler than the 6-factor model as suggested by the designers. The complex relationships between the latent factors and the observed items may also indicate that individual sub-scale use or simply combining the raw scores for evaluation is likely to be inadequate or unsatisfactory. Thus, future revisions of the scoring algorithm or questions of the GLFS-25 may be required.

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

“…The GLFS-25 is a self-administered questionnaire, consisting of 25 items graded on a 5-point scale, ranging from no impairment (0 points) to severe impairment (4 points). The sum of these scores is the total possible score, which ranges between 0 and 100; increasing values indicate increasing severity of LS [ 16 – 18 ]. This measurement has been validated as evaluating activities of daily life for the Japanese elderly population and for elderly people of other races.…”

Association between Physical Characteristics and Locomotive Syndrome in Elderly in Surabaya, Indonesia

“…While other studies only measure respondents with one gender only. In some of these studies there are also differences in measuring instruments, in which some studies use the lococheck measurement tool, while other studies use the GLFS-25 measuring instrument 14,15,16,17 .…”

Comparison of long-stemmed cementless hemiarthroplasty with proximal femur nail in unstable intertrochanteric femur fractures over 85 years of age

“…While there are studies in which cemented hemiarthroplasty was performed and patients were mobilized early [25], some other studies regarding uncemented hemiarthroplasty have also been conducted [26]. Wang et al [27] published a research about the need to load weight on the operated extremity for independent mobilization, due to atrophy and arthrosis in the upper extremities of geriatric patients. In our study, in accordance with the literature, it was observed that patients who underwent LFS-PBH were mobilized earlier than those in the PFN group.…”