Locomotive Syndrome and Lumbar Spine Disease: A Systematic Review

Abstract

Locomotive syndrome (LS) is defined based on the Loco-Check, 25-question Geriatric Locomotive Function Scale (GLFS-25), 5-question Geriatric Locomotive Function Scale (GLFS-5), Stand-Up Test, Two-Step Test, or a total assessment (i.e., positive for one or more of the GLFS-25, Stand-Up Test, and Two-Step Test). Lumbar spine disease has been reported to be one of the most common musculoskeletal disorders leading to LS. We therefore conducted a systematic review via PubMed, Google Scholar, Cochrane Library, Web of Science, and MEDLINE, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 26 studies were considered to be eligible for inclusion in this systematic review. The GLFS-25 showed an association with low back pain, sagittal spinopelvic malalignment, and lumbar spinal stenosis but not vertebral fracture. The GLFS-5 showed an association with low back pain and lumbar spinal stenosis. The Loco-Check and Two-Step Test showed an association with low back pain, sagittal spinopelvic malalignment, and lumbar spinal stenosis. The Stand-Up Test showed no association with lumbar spinal stenosis. The total assessment showed an association with low back pain and lumbar spinal stenosis. Furthermore, the GLFS-25, Two-Step Test, and total assessment were improved by spinal surgery for lumbar spinal stenosis. The current evidence concerning the relationship between LS and lumbar spine disease still seems insufficient, so further investigations are required on this topic.

Keywords: 25-question Geriatric Locomotive Function Scale; 5-question Geriatric Locomotive Function Scale; Loco-Check; Stand-Up Test; Two-Step Test; locomotive syndrome; lumbar spine.

Figure 1

The Loco-Check. The Loco-Check includes seven items related to activities of daily living (ADLs); the possible scores range from 0 to 7. Total scores of 0, 1, 2, and 3–7 points are to reflect non-locomotive syndrome (LS), LS-1, LS-2, and LS-3, respectively.

Figure 2

The 25-question Geriatric Locomotive Function Scale (GLFS-25). The GLFS-25 includes 25 items that are each graded on a 5-point scale (0–4 points) (possible scores range from 0 to 100). The domains covered by this scale include 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). Total scores of 0–6, 7–15, 16–23, and 24–100 are considered to reflect non-LS, LS-1, LS-2, and LS-3, respectively.

Figure 3

The 5-question Geriatric Locomotive Function Scale (GLFS-5). The GLFS-5 is a 5-item version of the questionnaire and includes five items that are each graded on a 5-point scale (0–4 points) (possible scores range from 0 to 20). Total scores of 0–2, 3–5, 6–8, and 9–20 are considered to reflect non-locomotive syndrome (LS), LS-1, LS-2, and LS-3, respectively.

Figure 4

The Stand-Up Test. The Stand-Up Test evaluates lower limb strength according to stand—in a single-leg or double-leg stance—from 4 different heights (10, 20, 30, and 40 cm). The test is scored as 0–8, with the scores defined as follows: 0 (unable to stand); 1–4 (able to stand—using both legs—from 40, 30, 20, and 10 cm, respectively); and 5–8 (able to stand—using one leg—from 40, 30, 20, and 10 cm, respectively). Stand-Up Test scores of 0–1, 2, 3–4, and 5–8 points are equivalent to LS-3, LS-2, LS-1, and non-LS, respectively. The reproduction of this figure is permitted by the Japanese Orthopaedic Association (JOA) locomotive syndrome prevention awareness official website [9].

Figure 5

The Two-Step Test. The Two-Step Test evaluates walking ability. It is scored by normalizing the maximal length of two steps by the height. Two-Step Test scores <0.9, <1.1, <1.3, and ≥1.3 points correspond to LS-3, LS-2, LS-1, and non-LS, respectively. The reproduction of this figure is permitted by the Japanese Orthopaedic Association (JOA) locomotive syndrome prevention awareness official website [9].

Figure 6

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRIZMA) [13] flow chart of the paper selection.

Figure 7

Sagittal spinopelvic alignment includes the pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), sagittal vertical axis (SVA), and spinal inclination angle (SIA). The PI is the angle between a line perpendicular to the sacral plate at its midpoint and a line connecting this point to the bi-coxo-femoral axis. The PT is the angle between a vertical line passing through the bi-coxo-femoral axis and a line joining the bi-coxo-femoral axis with the center of the upper sacral endplate. The SS is the angle between a tangent line to the superior endplate of S1 and the horizontal plane. The LL is the angle between the superior endplate of L1 and the upper sacral endplate. The SVA is the horizontal distance between a plumb line drawn from the center of C7 and a line drawn from the center of C7 to the posterior superior corner of S1. The SIA is the angle between the true vertical and a straight line from the tip of the T1 spinous process to that of S1.