Abstract
Background & Objectives: The current aging on the population has major impacts on public health. The locomotive syndrome (LS) is conceptually defined as a condition present in late middle to elderly population at high risk of developing the musculoskeletal ambulation disability and candidates with LS may require nursing care services as a result of musculoskeletal disorders. As with musculoskeletal degenerative disorders, musculoskeletal pain would be an important factor for LS. We had a multi-faceted analysis of the relevance of musculoskeletal pain and LS. Materials & Methods: Participants were the chronic pain patients (n=415) who had visit the research consortium of Japanese multidisciplinary pain centers between September 2013 and December 2014. They answered all the questionnaires: Locomo-25, a screening tool of LS; an 11-point Numerical Rating Scale (NRS) of pain intensity; Hospital Anxiety and Depression Scale (HADS); Pain Self-Efficacy Questionnaire (PSEQ); Pain Catastrophizing Scale (PCS); frequency of exercise habits; EuroQol 5 Dimension (EQ-5D), measuring the health-related quality of life. These parameters were multivariately analyzed by utilizing a path analysis. Results: The final model of the path analysis demonstrated a vicious cycle among the total score of Locomo-25, NRS, PSEQ and depression subscale of HADS (HADS-D), and these parameters were associated with health related quality of life assessed by use of EQ-5D. This model of the path analysis provided a good fit (CMIN/DF=1.651, GFI=0.994, AGFI=0.986, CFI=1.000, RSMEA=0.011). The model using PSEQ was higher goodness of fit than that of PCS. Anxiety about falling in Locomo-25 was associated with either HADS-D or total score of Locomo-25. All path coefficients were statistically significant at the 0.05 level.Conclusion: The present finding indicates LS and its pain structure a vicious cycle, resulting in impairment of their QOL. The self-efficacy, one of psychologically-modulating factors of pain, had more impact on the cycle than pain catastrophizing, and depression deteriorated their ADL. Thus, treatment strategies for LS should focus on not only musculoskeletal disorders itself but also pain and its psychological factors.
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