Algorithm for screening and management of locomotive syndrome in elderly individuals and development of a short version of the 25-question Geriatric Locomotive Function Scale-Portuguese

Alves, Jessica Anelise Parreira; Tavares, Daniela Regina Brandao; Okazaki, Jane Erika Frazao; Arbex, Maria Carolyna Fonseca Batista; Galiano, Júlia de Carvalho; Carmo, Sabrina Nascimento do; Santos, Fânia Cristina dos

doi:10.31744/einstein_journal/2022AO6349

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Original Article • Einstein (São Paulo) 20 • 2022 • https://doi.org/10.31744/einstein_journal/2022AO6349 linkcopy

Algorithm for screening and management of locomotive syndrome in elderly individuals and development of a short version of the 25-question Geriatric Locomotive Function Scale-Portuguese

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective To develop a short version of the 25-question Geriatric Locomotive Function Scale-Portuguese and to create an algorithm for locomotive syndrome screening and management.

Methods The 25-question Geriatric Locomotive Function Scale-Portuguese was applied to individuals aged 60 years or older seen at the Geriatrics and Gerontology Department of Universidade Federal de São Paulo, between 2016 and 2018. Items of the 25-question Geriatric Locomotive Function Scale-Portuguese were submitted to exploratory factor analysis using the principal component method. Internal consistency was investigated using Cronbach’s alpha coefficient. The ROC curve was used to determine the cut-off point of the short version developed. Finally, a simple and objective algorithm was created for locomotive syndrome screening and management using the Delphi method.

Results A total of 202 elderly individuals aged 61 to 101 years (mean age, 84.67 years) were evaluated. Fifteen items were excluded from the 25-question Geriatric Locomotive Function Scale-Portuguese to compose the 10-question Geriatric Locomotive Function Scale-Portuguese, a 10-item instrument with appropriate psychometric properties. A cut-off point of ten (ROC curve) was determined for potential locomotive syndrome, with 96.5% sensitivity and 86.2% specificity. A very simple algorithm was developed for locomotive syndrome screening and management.

Conclusion The short version (10-question) of the Geriatric Locomotive Function Scale-Portuguese has appropriate psychometric properties and provides a practical tool for detection of locomotive problems in elderly individuals.

Keywords Aged; Locomotion; Surveys and questionnaires; Validation study; Algorithms

Characteristics
Age, years
	Mean (Min.-Max.)	84.6 (61-101)
	60-70	9 (4.5)
	71-80	30 (14.8)
	81-90	129 (63.9)
	>90	34 (16.8)
Sex
	Male	54 (27)
	Female	148 (73)
Color
	White	112 (55)
	Brown	58 (29)
	Yellow	19 (6)
	Black	12 (9.5)
	Indigenous	1 (0.5)
Marital status
	Widower	116 (57)
	Married	64 (32)
	Single	12 (6)
	Divorced	10 (5)
Level of education, years
	Illiterate	30 (15)
	1-4	112 (55.5)
	5-8	33 (16)
	9-11	9 (4.5)
	≥12	18 (9)
BADL
	Independent	128 (63.3)
	Dependent for 1 activity	68 (33.7)
	Dependent for 2 activities	4 (2)
	Dependent for 3 activities	1 (0.5)
	Dependent for 4 activities	0
	Dependent for 5 activities	0
	Dependent for 6 activities	1 (0.5)
IADL
	Independent	97 (48)
	Mildly dependent	79 (39)
	Moderately dependent	19 (9.5)
	Severe dependent	7 (3.5)

Step	Item removed	Commonality
1	Q17. To what extent has it been difficult to carry objects weighing 2kg?	0.53
2	Q19. To what extent have simple tasks and housework been difficult?	0.55
3	Q14. To what extent has it been difficult to keep yourself neat?	0.58
4	Q1 Did you have any pain in your neck or upper limbs?	0.59
5	Q8. To what extent has it been difficult to put on and take off shirts?	0.62
6	Q2 Did you have any pain in your back, lower back, or buttocks?	0.47
7	Q4. To what extent has it been painful to move your body in daily life?	0.50
8	Q3 Did you have any pain in your lower limbs?	0.55
9	Q9. To what extent has it been difficult to put on and take off trousers and pants?	0.59
10	Q11. To what extent has it been difficult to wash your body in the bath?	0.66
11	Q16. To what extent has it been difficult to go out to visit neighbors?	0.68
12	Q22. Have you been restricted from meeting your friends?	0.52
13	Q23. Have you been restricted from joining social activities?	0.45
14	Q12. To what extent has it been difficult to go up and down stairs?	0.68

Questions	Factor loading
Questions	Factor 1	Factor 2	Factor 3
Q21. To what extent has it been difficult to perform sports activities?	0.843	0.199	0.126
Q13. To what extent has it been difficult to walk briskly?	0.831	0.357	0.044
Q15. How far can you keep walking without rest?	0.794	0.247	0.141
Q20. To what extent have load-bearing tasks and housework been difficult?	0.769	0.234	0.301
Q18. To what extent has it been difficult to use public transportation?	0.682	0.441	0.216
Q10. To what extent has it been difficult to use the toilet?	0.167	0.849	0.135
Q5. To what extent has it been difficult to get up from a bed or lie down?	0.235	0.804	0.111
Q7. To what extent has it been difficult to walk inside the house?	0.266	0.782	0.183
Q6. To what extent has it been difficult to stand up from a chair?	0.403	0.747	0.114
Q25. Have you ever felt anxious about being unable to walk in the future?	0.170	0.067	0.870
Q24. Have you ever felt anxious about falls in your house?	0.148	0.255	0.808

	Factor 1	Factor 2	Factor 3
Eigenvalues	5.10	1.22	1.17
Percentage (%) of total variance explained	29.91	28.87	16.16
Cronbach’s alpha	0.878	0.868	0.687

GLFS 10-P	Age (years)				p value^* * descriptive power of the χ2 test.
GLFS 10-P	60-70 (n=9)	71-80 (n=30)	81-90 (n=131)	≥91 (n=32)	p value^* * descriptive power of the χ2 test.
<10	5/9 (55.6)	20/30 (66.7)	50/131 (38.2)	4/32 (12.5)	<0.001
≥10	4/9 (44.4)	10/30 (33.3)	81/131 (61.8)	28/32 (87.5)

GLFS 10-P score	Total	Age (years)		p value*
GLFS 10-P score	Total	60-79	≥80	p value*
Sensitivity	96.5 (91.3-99.0)	100.0 (75.3-100.0)	96.1 (90.3-98.9)	1.000
Specificity	86.2 (77.1-92.7)	95.2 (76.2-99.9)	83.3 (72.1-91.4)	0.279

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[TFN1] Except when stated otherwise, results are expressed in n (%).

[TFN2] BADL: basic activities of daily living; IADL: instrumental activities of daily living; Min.-Max.: Minimum-Maximum.