Impact of timing of menopause on musculoskeletal disorders and associated pain in community-dwelling women: the Yakumo study.

Background:Rheumatoid arthritis (RA) is a disease that causes joint dysfunction, which in turn triggers a decline in physical function. Locomotive syndrome (LS), which is a concept that was proposed by...

Physical performance tests are useful for evaluating and monitoring the severity of locomotive syndrome

Prevalence and risk factors of neuropathic pain in survivors of myocardial infarction with pre-diabetes and diabetes. The KORA Myocardial Infarction Registry

The prevalence of neuropathic pain in prediabetes and the associated risk factors in the general population are not known. The aim of this study was to determine the prevalence and risk factors of neuropathic pain in subjects with diabetes, impaired fasting glucose (IFG), impaired glucose tolerance (IGT), or normal glucose tolerance (NGT). Survey of neuropathic painful polyneuropathy assessed by the Michigan Neuropathy Screening Instrument using its pain-relevant questions and an examination score cutpoint >2 in a diabetic and control population. An oral glucose tolerance test was performed in the control subjects. Population of the city of Augsburg and two surrounding counties. Subjects with diabetes (N = 195) and controls matched for age and sex (N = 198) from the population-based MONItoring trends and determinants in CArdiovascular/Cooperative Research in the Region of Augsburg (MONICA/KORA) Augsburg Surveys S2 and S3 aged 25-74 years. Among the controls, 46 (23.2%) had IGT (either isolated or combined with IFG), 71 (35.9%) had isolated IFG, and 81 had NGT. The prevalence (95% confidence interval) of neuropathic pain was 13.3 (8.9-18.9)% in the diabetic subjects, 8.7 (2.4-20.0)% in those with IGT, 4.2 (0.9-11.9)% in those with IFG, and 1.2 (0.03-6.7)% in those with NGT (overall P = 0.003). In the entire population (N = 393), age, weight, peripheral arterial disease (PAD), and diabetes were risk factors significantly associated with neuropathic pain, while in the diabetic group, these factors were age, weight, and PAD (all P < 0.05). The prevalence of neuropathic pain is two- to threefold increased in subjects with IGT and diabetes compared with those with isolated IFG. Apart from diabetes, the predominant risk factors are age, obesity, and PAD.

BackgroundThe Japanese Orthopaedic Association (JOA) proposed the concept of locomotive syndrome (LS) in 2007 for detecting high-risk individuals with mobility limitation. In 2020, the JOA revised the clinical decision limits and introduced LS stage 3, which carried the highest-risk for LS compared to the conventional stages, 1 and 2. The purpose of this study was to characterize the prevalence, comorbidities, and physical characteristics in each LS stage, as per the LS criteria 2020.MethodsWe analyzed 2077 participants (64.9% women; mean age, 68.3 ± 5.4 years) from the Nagahama Study aged ≥60 years. Participants were classified into 4 groups, non-LS and LS stages 1, 2, and 3, based on a 25-question Geriatric Locomotive Function Scale. The prevalence of comorbidities (sarcopenia, osteoporosis, diabetes mellitus, low back pain [LBP], and knee pain) were investigated. Physical characteristics were measured based on the physical performance tests including gait speed, five-times chair-stand, single-leg stand, and short physical performance battery; muscle strength tests including grip, knee extension, hip flexion, and abduction; and body-composition analysis including muscle quantity and quality. Differences in the prevalence of comorbidities between LS stages were tested using the chi-square test. The general linear model was performed for univariate and multivariate analyses with post-hoc test to compare the differences in physical characteristics among the LS stages.ResultsThe prevalence of LS increased with age, and the mean prevalence of LS stages 1, 2, and 3 were 24.4, 5.5, and 6.5%, respectively. The prevalence of comorbidities, including sarcopenia, osteoporosis, LBP, and knee pain, increased with worsening LS stage. Physical performance tests were significantly different between LS stages 2 and 3; and muscle strength differed significantly between LS stages 1 and 2. Additionally, in terms of body composition analysis, muscle quality but not muscle quantity showed significant differences among all the LS stages.ConclusionsOur findings suggest that muscle strengthening and dynamic training, including balance training in LS stage 1 and 2, respectively, were needed for preventing the LS progression. Individuals with LS stage 3 should perform dynamic training and muscle strengthening exercises while receiving treatment for comorbidities.

BackgroundAdult spinal deformity has a substantially debilitating effect on older people’s physical and mental health. However, the impact of sagittal malalignment on locomotive syndrome (LS), sarcopenia, and physical function in community-dwelling older women has not yet been clarified. This study aimed to investigate the association between these factors in community-dwelling middle aged and older women.MethodsA total of 361 women were recruited from participants performing aquatic exercises in a rural area of Japan. The body mass index, skeletal muscle mass index, trunk muscle mass, spinal inclination angle (SIA), grip strength, timed up-and-go test (TUG), maximum stride of the participants, and one-leg standing time were measured. Low back pain (LBP)- and health-related quality of life (HRQOL) were evaluated using the Oswestry Disability Index (ODI) and the Short-Form 8 questionnaire. Associations between the global sagittal alignment using SIA and investigating parameters were analyzed.ResultsThe prevalence of sarcopenia was 3.6%. The prevalence of LS (stages 1, 2, and 3) was 43.8% (158 of 361), and the number of participants in each LS stage was 203 (stage 0), 95 (stage 1), 28 (stage 2), and 35 (stage 3). The SIA was significantly correlated with the 25-question geriatric locomotive function scale (r′ = 0.292, p < 0.001), ODI (r′ = 0.267, p < 0.001), and TUG (r′ = 0.453, p < 0.001) after adjusting for age. In the receiver-operating characteristic curve analysis, the cutoff values of SIA for LS ≥ stage 2 and ODI ≥ 20% were 5°.ConclusionsLBP-related QOL and physical performance were significantly associated with global sagittal alignment. Global sagittal alignment was correlated with the three-stage category of LS. The spinal inclination of 5° was a cutoff value to predict exacerbation of mobility function and HRQOL status.

BackgroundThe prevalence of neuropathic pain (NeP) has been estimated within specific health conditions; however, there are no published data on its broad prevalence in the US. The current exploratory study addresses this gap using the validated PainDetect questionnaire as a screener for probable NeP in a general-population health survey conducted with a multimodal recruitment strategy to maximize demographic representativeness.Materials and methodsAdult respondents were recruited from a combination of Internet panels, telephone lists, address lists, mall-based interviews, and store-receipt invitations using a random stratified-sampling framework, with strata defined by age, sex, and race/ethnicity. Older persons and minorities were oversampled to improve prevalence estimates. Results were weighted to match the total adult US population using US Census data. Demographic information was collected, and respondents who experienced physical pain in the past 12 months completed the PainDetect and provided additional pain history. A cutoff score of 19 or greater on the PainDetect was used to define probable NeP.ResultsA total of 24,925 respondents (average response rate 2.5%) provided demographic data (52.2% female, mean age 51.5 years); 15,751 respondents reported pain (63.7%), of which 2,548 (15.7%, 95% confidence interval 14.9%–16.5%) had probable NeP based on the PainDetect, which was 10% (95% confidence interval 9.5%–10.5%) of all respondents. Among those reporting pain, the prevalence of probable NeP among Blacks and Hispanics was consistently higher than Whites in each age- and sex group. The highest prevalence among those with pain was among male Hispanics 35–44 years (32.4%) and 45–54 years (24.2%) old. The most commonly used medications reported by those with probable NeP were nonsteroidal anti-inflammatory drugs (44.2%), followed by weak opioids (31.7%), antiepileptics (10.9%), and strong opioids (10.9%).ConclusionThis is the first study to provide an estimate of the prevalence of probable NeP in the US, showing significant variation by age and ethnicity.

BackgroundThis study marks the first epidemiological evaluation of the prevalence and burden of chronic neuropathic pain (NeP) in an Asian population. The objective of this nationwide cross‐sectional study was to identify the characteristics of individuals with NeP, detect the NeP features that affect their quality of life (QOL), and demonstrate the negative effects of NeP on social and daily living as well as comorbidities including depression, anxiety and sleep disorders.MethodsWe mailed a cross‐sectional, population‐based epidemiological survey to a random nationwide sample of 10,000 Japanese adults over 20 years old.ResultsThe response rate was 54.4% (2445 men, 2992 women; mean age, 53.4 years). Prevalence of chronic pain was 16.6%, and prevalence of NeP was 3.2% as detected by the PainDETECT. Participants with NeP showed significantly lower quality of life according to scores on the EuroQol‐5 Dimensions scale (p < 0.001), higher levels of psychological distress on the Kessler 6‐item psychological distress scale (p < 0.001), poorer sleep quality (p < 0.001), and more workdays lost (p < 0.001) than did participants without NeP. Linear regression modelling showed that widespread pain, thermal hyperalgesia and pressure‐induced pain had strong associations with lower QOL, with regression coefficients of −0.046 (p < 0.001), −0.038 (p < 0.001), and −0.040 (p < 0.001), respectively.ConclusionsThis study is the first to report the prevalence of NeP in an Asian population using a validated questionnaire. This study provides compelling evidence that chronic NeP is more strongly associated with poorer QOL, mental health and social well‐being than CP without a neuropathic component.SignificanceThis population‐based nationwide epidemiological study revealed the prevalence, characteristics, and negative effects of chronic pain with neuropathic components in Asian society. The prevalence of neuropathic pain was 3.2% with PainDETECT.

To study the prevalence of persistent post-surgical pain (PPSP) and neuropathic pain (NP) after total knee replacement (TKR). MEDLINE and Embase databases were searched for articles published until December 2014 in English language. Published articles were included if they referred to pain that lasts at least 3 mo after primary TKR for knee osteoarthritis, and measured pain with pain specific instruments. Studies that referred to pain caused by septic reasons and implant malalignment were excluded. Both prospective and retrospective studies were included and only 14 studies that match the inclusion criteria were selected for this review. The included studies were characterized by the heterogeneity on the scales used to measure pain and pre-operative factors related to PPSP and NP. The reported prevalence of PPSP and NP seems to be relatively high, but it varies among different studies. There is also evidence that the prevalence of post-surgical pain is related to the scale used for pain measurement. The prevalence of PPSP is ranging at 6 mo from 16% to 39% and at 12 mo from 13.1% to 23% and even 38% of the patients. The prevalence of NP at 6 mo post-operatively is ranging from 5.2% to 13%. Pre-operative factors related to the development of PPSP also differ, including emotional functioning, such as depression and pain catastrophizing, number of comorbidities, pain problems elsewhere and operations in knees with early grade of osteoarthritis. No firm conclusions can be reached regarding the prevalence of PPSP and NP and the related factors due to the heterogeneity of the studies.

Purpose Aging of society has increased the need for prolongation of a healthy lifespan through maintenance of physical function. Prediction of future physical function may be possible by screening for stage 1 locomotive syndrome (LS). In this prospective study, we examined the influence of LS stage 1 at baseline (2011) on physical performance after 5 years (2016) in a community-dwelling cohort. Methods The participants were elderly adults aged >40 years who attended public health checkups as part of the Yakumo Study. LS screening in 2011 and 2016 was performed using the 25-question geriatric locomotive function scale (GLFS-25), the stand-up test, and the two-step test. LS of stage 1 or 2 was defined if the participant met the criteria in any of the three tests. Participants not meeting LS criteria were defined as the no risk group. Physical performance tests (10 m gait time, back muscle strength, 3 m TUG, and maximum stride) were also performed in 2011 and 2016. Results A total of 113 subjects (49 males, 64 females; average age 65.0 years) were followed from 2011 to 2016. At baseline, 73 (65%) had no risk, 29 (25%) had stage 1 LS, and 11 (10%) had stage 2 LS. Five years later, 51 (45%) had no risk, 45 (40%) had stage 1 LS, and 17 (15%) had stage 2 LS. Of the 73 subjects with no risk at baseline, 23 (32%) had stage 1 LS and 1 (1%) had stage 2 LS after 5 years. The baseline stage 1 LS group had significantly worse physical performance after 5 years, compared to the baseline no risk group (p < 0.05). Conclusions This longitudinal study showed that stage 1 LS screening is important for prevention of motor dysfunction in middle-aged and elderly people.

Evidence for an association between locomotive syndrome (LS) and depression is lacking in middle-aged women. This study aimed to investigate the relationship between LS severity and depressive symptoms in community-dwelling middle-aged women. This cross-sectional study included 1520 middle-aged women (mean age 52 ± 6 years). LS severity was evaluated using the 25-question Geriatric Locomotive Function Scale questionnaire and motor function test. Depressive symptoms were assessed using the Zung self-rating depression scale. Multiple logistic regression analyses were performed to determine the association between depressive symptoms and LS severity, adjusting for potential confounding factors. LS severity, as evaluated through both questionnaires and motor function tests, was significantly associated with depressive symptoms (self-rating depression scale ≥ 40 points) in middle-aged women. The relationship between LS and depressive symptoms was only significant when assessed through the 25-question Geriatric Locomotive Function Scale questionnaire rather than the motor function tests. Additionally, a stepwise association was observed between pain severity, as assessed by the 25-question Geriatric Locomotive Function Scale, and the prevalence of depressive symptoms. LS severity is significantly associated with depressive symptoms in community-dwelling middle-aged women, suggesting the need for additional mental status assessment in participants with LS and concurrent pain.

Objectives: Locomotive syndrome (LS) encompasses conditions that may lead to the need for nursing services. We aimed to quantify the association between exercise habits during youth or the middle-age years and both physical function and the presence of LS in Japanese elderly people.Methods: We examined 460 participants of the eighth, ninth, and tenth iterations of the Miyagawa study. Participants were divided into an LS group and a no-LS group according to their scores on the 25-question Geriatric Locomotive Function Scale. The following physical function tests were performed: grip strength, 6-m walk at normal and maximum speed, single-leg stance time with eyes open, and chair stand time. The frequency of past physical activity was determined by interview.Results: Ninety-seven participants (21.1%) were classified as having LS. The LS group had worse physical function than the no-LS group. Exercise habits between the ages of 25 and 50 years were significantly related to later LS.Conclusions: Participants with LS were less likely to report a regular exercise habit between the ages of 25 and 50 years than participants without LS. Participants who reported regular exercise habits in middle age had better physical function during old age. Regular exercise habits in middle age appear to protect against LS during the older years.

Although locomotive syndrome (LS) is a condition of reduced mobility, little information is available regarding the loss of site-specific skeletal muscle mass. The aim of the present study is to examine site-specific muscle loss in elderly males with LS. A total of 100 men ranging in age from 65 to 74 years were divided into two groups (LS and non-LS) using LS risk tests including the stand-up test, two-step test, and the 25-question geriatric locomotive function scale Muscle thickness (MTH) at eight sites-anterior and posterior thigh (AT and PT, respectively), anterior and posterior lower leg (AL and PL, respectively), rectus abdominis (RA), anterior and posterior upper arm (AU and PU, respectively), and anterior forearm (AF)-was evaluated using B-mode ultrasound. Furthermore, the 30-s chair stand test (CS-30), 10-m walking time, zig-zag walking time, and sit-up test were assessed as physical functions. There were no significant differences in age and body mass index between the LS and non-LS groups. The percentage of skeletal muscle was lower in the LS group than in the non-LS group. Although there were no differences in the MTH of AU, PU, AF, PT, Al and PL, site-specific muscle loss was observed at RA and AT in the LS group. CS-30, 10-m walking time, zig-zag walking time, and sit-up test in the LS group were all worse than those in the non-LS group. The MTHs of RA and AT were both correlated to those physical functions. In conclusion, the LS group had site-specific muscle loss and worse physical functions. This study suggests that site-specific changes may be associated with age-related physical functions. These results may suggest what the essential characteristics of LS are.

Background: Previous epidemiological studies on locomotive syndrome (LS) have been mainly conducted in retired elderly people. However, from the view point of its prevention, it is important to assess currently working younger people. The purpose of this study was to examine the status of the level of LS in young and middle-aged adult workers.Methods: This cross-sectional study was performed at four companies. We used the two-step test, stand-up test, and 25-question Geriatric Locomotive Function Scale (GLFS-25) as screening tools of LS. We also questioned the subjects for knee pain and low back pain.Results: A total of 715 workers participated in this study. The percentage of females with LS increased with age. However, the percentage of males with LS was approximately 20% in each age category. Two-step and stand-up test scores worsened in an age-dependent manner, although GLFS-25 scores varied independently of age. Knee pain, low back pain and physical activity were significantly related to LS-level.Conclusion: Our results suggest that there is some degree of LS even in young and middle-aged adults. Knee pain, low back pain and physical activity levels are key factors related to LS even in young and middle-aged adults.

To determine the prevalence of radiographic knee osteoarthritis (OA) as well as knee-related symptoms and functional limitations in female soccer players 12 years after an anterior cruciate ligament (ACL) injury. Female soccer players who sustained an ACL injury 12 years earlier were examined with standardized weight-bearing knee radiography and 2 self-administered patient questionnaires, the Knee Injury and Osteoarthritis Outcome Score questionnaire and the Short Form 36-item health survey. Joint space narrowing and osteophytes were graded according to the radiographic atlas of the Osteoarthritis Research Society International. The cutoff value to define radiographic knee OA approximated a Kellgren/Lawrence grade of 2. Of the available cohort of 103 female soccer players, 84 (82%) answered the questionnaires and 67 (65%) consented to undergo knee radiography. The mean age at assessment was 31 years (range 26-40 years) and mean body mass index was 23 kg/m2 (range 18-40 kg/m2). Fifty-five women (82%) had radiographic changes in their index knee, and 34 (51%) fulfilled the criterion for radiographic knee OA. Of the subjects answering the questionnaires, 63 (75%) reported having symptoms affecting their knee-related quality of life, and 28 (42%) were considered to have symptomatic radiographic knee OA. Slightly more than 60% of the players had undergone reconstructive surgery of the ACL. Using multivariate analyses, surgical reconstruction was found to have no significant influence on knee symptoms. A very high prevalence of radiographic knee OA, pain, and functional limitations was observed in young women who sustained an ACL tear during soccer play 12 years earlier. These findings constitute a strong rationale to direct increased efforts toward prevention and better treatment of knee injury.