Translation, Cross-Cultural Adaptation and Turkish Validation of the 25-Question Geriatric Locomotive Function Scale

Locomotive syndrome in the elderly: translation, cultural adaptation, and Brazilian validation of the tool 25-Question Geriatric Locomotive Function Scale

BackgroundKnee osteoarthritis (KOA) is prevalent among the elderly, often necessitating total knee arthroplasty (TKA) for severe cases. However, traditional assessment tools primarily focus on pain and physical function, neglecting the psychosocial aspects that influence postoperative satisfaction. The 25-question Geriatric Locomotive Function Scale (GLFS-25) is a comprehensive measure of locomotor function, however, it has limited validation within populations in Mainland China.ObjectivesThis study aimed to translate, cross-culturally adapt, and validate the Chinese version of the GLFS-25 (GLFS-25CV) for evaluating postoperative outcomes in TKA patients with KOA.MethodsFollowing established guidelines, the English GLFS-25 was both forward- and back-translated, subjected to expert review, and pretested in 30 patients. End-stage KOA patients scheduled for primary unilateral TKA were then recruited, with a subset completing the GLFS-25CV twice, one week apart, to assess test-retest reliability. Exploratory factor analysis (EFA) was conducted to evaluate structural validity, while convergent validity was assessed through Pearson correlations with the Oxford Knee Score (OKS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the 5-Level EuroQol Five-Dimensional Questionnaire (EQ-5D-5L). Internal consistency was evaluated using Cronbach’s α, and standard deviations (SD) were calculated. Additionally, floor and ceiling effects were analyzed based on score distributions.ResultsA total of 295 participants completed the study. Both the four-factor model identified by EFA, which explained 58% of the total variance, and the strong correlations with the OKS (rho = 0.85), the WOMAC (rho = 0.77), and the EQ-5D-5L (rho = 0.66) collectively confirm the excellent validity of the GLFS-25CV. Internal consistency was excellent (Cronbach’s α = 0.94, SD > 0.85), and test-retest reliability (ICC = 0.94–0.97) was also strong, confirming its overall reliability. Neither floor nor ceiling effects were significant, and no participants reported difficulty completing the instrument.ConclusionThe GLFS-25CV is a reliable, valid, and user-friendly tool for assessing knee function in individuals in mainland China undergoing TKA for KOA. By incorporating both physical and psychosocial domains, it offers a comprehensive evaluation that is well-suited for both clinical practice and research applications.

The increasing prevalence of locomotive syndrome (LoS) among older adults underscores the necessity of valid and reliable assessment tools to facilitate early diagnosis and intervention. The 25-Question Geriatric Locomotive Function Scale (GLFS-25) is a widely used self-reported measure for evaluating locomotive dysfunction. However, a culturally adapted and validated version for Turkish older adults was lacking. This study aims to translate, culturally adapt, and validate the Turkish version of GLFS-25 to ensure its applicability in clinical and research settings. A cross-sectional study was conducted with 133 community-dwelling older adults (mean age: 75.3 ± 7.2 years) in Turkey. The translation process followed international guidelines, including forward-backward translation, expert panel review, and pilot testing. The psychometric validation involved confirmatory factor analysis (CFA), internal consistency (Cronbach's α), test-retest reliability (intraclass correlation coefficient, ICC), and criterion validity. Correlations with established functional assessment tools such as the Barthel Daily Living Index, Instrumental Activities of Daily Living (IADL), and Activities-Specific Balance Confidence (ABC) Scale were examined. A receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cut off score for detecting locomotive dysfunction. The Turkish GLFS-25 demonstrated excellent internal consistency (Cronbach's α = 0.984) and test-retest reliability (ICC = 0.986). CFA confirmed a four-factor structure, similar to previous adaptations in Iran and China, supporting its construct validity. Strong correlations were observed between GLFS-25 scores and functional assessment tools (Barthel Index: r = -0.78, IADL: r = -0.72, ABC Scale: r = -0.65, p < 0.001), establishing its criterion validity. ROC analysis identified a cut off score of 16 for detecting locomotive dysfunction, with a sensitivity of 85.3% and specificity of 88.7%. The Turkish adaptation of GLFS-25 is a valid, reliable, and culturally appropriate tool for assessing locomotive dysfunction in Turkish older adults. Its strong psychometric properties and high correlation with functional mobility indicators suggest that it can be effectively integrated into geriatric healthcare and rehabilitation programs. Given the rapid aging of Turkey's population, this tool can support early detection, prevention strategies, and policy development to mitigate mobility-related disabilities.

The critical cutoff point of the Zurich Claudication Questionnaire and the Japanese Orthopaedic Association score indicating locomotive syndrome in patients with lumbar spinal canal stenosis

ABSTRACTThis study aimed to understand the clinical state of locomotive syndrome (LS) in patients with rheumatoid arthritis (RA) and to validate the use of the 25-question Geriatric Locomotive Function Scale (GLFS-25) in patients with RA and compare it side-by-side with the Health Assessment Questionnaire-Disability Index (HAQ-DI). Subjects were 159 patients with RA (female, 112 (70.4%); mean age, 66.2 ± 12.0 years) who consecutively visited Yokkaichi Municipal Hospital between June and August 2017. Mean disease duration was 11.4 ± 9.3 years, mean HAQ-DI score was 0.5 ± 0.7 points, and mean GLFS-25 score was 17.8 ± 19.1 points. The correlation between GLFS-25 and HAQ-DI was analyzed using Spearman’s rank correlation coefficient. The cut-off point of GLFS-25 corresponding to HAQ-DI≤0.5, which represents functional remission in patients with RA, was calculated by ROC analysis. GLFS-25 and HAQ-DI were positively and strongly correlated (correlation coefficient=0.798). The cut-off point of GLFS-25 corresponding to HAQ-DI≤0.5 was 20 points (sensitivity, 81%; specificity, 90%). Thus, the cut-off point of GLFS-25 corresponding to functional remission is higher than that for developing LS (i.e., 16 points). Moreover, the proportion of patients with LS among those with HAQ-DI ≤0.5 was 17.9%. In conclusion, our findings suggest that some patients with RA in remission may have LS, as well as the need to consider appropriate interventions for such patients.

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.

This study aimed to evaluate the condition of patients with locomotive syndrome (LS) and their improvement after undergoing surgery for degenerative musculoskeletal diseases using the new criteria, including stage 3. In total, 435 patients aged ≥40 years (167 middle-aged and 268 older) were divided into four groups based on the disease location: the lumbar (n = 118), hip (n = 191), knee (n = 80), and foot and ankle (n = 46) groups. Patients were evaluated by pre- and 1 year postoperative LS risk tests, including the stand-up test, two-step test, and 25-Question Geriatric Locomotive Function Scale. The pre- and postoperative prevalence of LS stage 3 were 78% and 29%, respectively. The postoperative LS stage improved in 62% of patients (77% and 53% in the middle-aged and older groups, respectively). Overall, the knee group showed the worst results, and the foot and ankle groups showed the best pre- and postoperative results. The pre- and postoperative prevalence of LS stage 3 according to the 25-Question Geriatric Locomotive Function Scale were comparable to those based on the total assessment. The new LS stage criteria are appropriate, and the 25-Question Geriatric Locomotive Function Scale is a good option for evaluating patients requiring surgery.

Development of a screening tool for risk of locomotive syndrome in the elderly: the 25-question Geriatric Locomotive Function Scale

Locomotive syndrome (LS) is a condition of reduced mobility. The LS stage can be determined by the stand-up test, two-step test, and 25-question geriatric locomotive function scale (GLFS-25). This study aimed to establish whether the LS stage can be reliably determined using the GLFS-25, and to clarify the correlation between the GLFS-25's six subcategories and physical functions. We administered the GLFS-25 and evaluated physical functions using the stand-up test, the two-step test, handgrip strength, the five-times sit-to-stand test, the 4m walking test, and the duration of single leg standing. We assessed 103 participants over 65years of age. We analyzed the correlation between LS stage and GLFS-25 score, as well as the correlations between physical functions and the GLFS-25's six subcategories. There was a discrepancy between the LS stage determined using the GLFS-25 alone and the LS stage determined using all three tools. ROC analysis revealed a cut-off value of 6 for the discrimination of LS stages 0/1 and 14 for stages 1/2. The analysis revealed an AUC of 0.78 and 0.81, respectively. Among the six subcategories of the GLFS-25, movement-related difficulty, usual care, ADL, and social activities were correlated with mobility functions. In contrast, body pain and cognitive showed no correlation. The GLFS-25 is useful for screening those with severe LS stages; however, evaluation of actual physical function is recommended for precise staging of LS in those with low GFLS-25 scores. Among the six subcategories of the GLFS-25, body pain and cognitive were independent of the other four subcategories.

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

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...

Association of the 25-question Geriatric Locomotive Function Scale with all-cause mortality in older adults: The Nagahama study

The 25-question Geriatric Locomotive Function Scale (GLFS-25) is a tool to identify locomotive syndrome, however, this tool is associated with the problem of a low complete response rate. We conducted this cross-sectional study of 2,474 community-dwelling residents to investigate the clinical characteristics of individuals who are prone to provide incomplete responses to the GLFS-25 questionnaire. The participants were divided into the following four groups based on the number of the GLFS-25 items they answered: 0 (n=279), 1-21 (n=36), 22-24 (n=273), and 25 (n=1,886). We investigated clinical characteristics including age, sex, body mass index, health consciousness, housemate status, smoking and drinking habits, physical activity level, the presence of body pain, and comorbidities. To achieve the study objective, we focused on a comparison of the clinical characteristics between the group of participants who answered 22-24 items (target group) and 0 items (control group). The participants who answered 22-24 items were older, more likely to be health-conscious, more likely to live alone, less likely to have lower levels of physical activity, and were more likely to report neck pain, low back pain, shoulder pain, elbow pain, wrist pain, hip pain, knee pain, ankle pain, and ophthalmic disease than those who answered 0 items. Among the significant factors, the only factor that can be changed to improve the number of answered items on the GLFS-25 is health consciousness.

Objectives: To investigate the distribution of 25-question Geriatric Locomotive Function Scale (GLFS-25) scores in Japanese rheumatoid arthritis (RA) patients and evaluate relationships with clinical variables.Methods: Among 15,115 patients registered in the NinJa database for fiscal year 2015, 1710 with complete GLFS-25 and disease activity score-28 (DAS28) data were analyzed. Correlations between GLFS-25 score and clinical variables were assessed by Spearman coefficients. Mean GLFS-25 scores were compared among DAS28 groups (<2.6, 2.6−3.1, 3.2−5.0, ≥5.1) using the Kruskal–Wallis test. To evaluate the performance of the GLFS-25 and Health Assessment Questionnaire Disability Index (HAQ-DI) for predicting DAS28 ≥ 3.2 (moderate/high disease activity), receiver operator characteristic (ROC) curves were constructed.Results: GLFS-25 score was significantly correlated with age, disease duration, DAS28, and HAQ-DI. GLFS-25 score increased in parallel with DAS28. The proportion of patients with locomotive syndrome stage 2 also increased with DAS28. Area under the curve values for HAQ-DI and GLFS-25 score were 0.739 and 0.768, respectively. At a GLFS-25 positive cutoff score ≥16, sensitivity was 0.716 and specificity was 0.661 for predicting DAS28 ≥ 3.2.Conclusion: This study documents the GLFS-25 score distribution in Japanese RA patients and demonstrates that GLFS-25 is a useful measure for evaluating functional ability in RA.

BackgroundThe 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.MethodsFive 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.ResultsMean (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.DiscussionThe 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.