The 25-question Geriatric Locomotive Function Scale predicts the risk of recurrent falls in postoperative patients with cervical myelopathy

• DOI: 10.1016/j.jos.2017.10.006
• Publication Date: 2017-11-01T07:31:45Z
• Authors: Atsushi Kimura; Katsushi Takeshita; Hirokazu Inoue; Atsushi Seichi; Yosuke Kawasaki; Toshitaka Yoshii; Hiroyuki Inose; Takeo Furuya; Kazuhiro Takeuchi; Shunji Matsunaga; Shoji Seki; Mikito Tsushima; Shiro Imagama; Masao Koda; Masashi Yamazaki; Kanji Mori; Hirosuke Nishimura; Kenji Endo; Kei Yamada; Kimiaki Sato; Atsushi Okawa
• Keywords: Male; Risk Assessment; Neurosurgical Procedures; Spinal Cord Diseases; 3. Good health; Cohort Studies; 03 medical and health sciences; Postoperative Complications; 0302 clinical medicine; Japan; ROC Curve; Predictive Value of Tests; Recurrence; Area Under Curve; Cervical Vertebrae; Humans; Accidental Falls; Female; Geriatric Assessment; Locomotion; Aged; Follow-Up Studies; Retrospective Studies

Fall-induced injuries represent a major public health concern for older individuals. The relationship between risk of falling and the severity of locomotive syndrome (LS) remains largely unknown.We conducted a retrospective analysis of patients who had undergone surgery from January 2012 to December 2013 and completed at least 1 year of follow-up at 12 participating institutes. Patients completed a questionnaire survey regarding their fall experience during a routine postoperative follow-up. Questionnaire items included the number of falls during the prior postoperative year and the 25-question Geriatric Locomotive Function Scale (GLFS-25). The severity of cervical myelopathy was assessed using the Japanese Orthopaedic Association (JOA) score. We analyzed the association between the incidence of falling and the severity of LS measured by the GLFS-25.Of 360 patients, 61 (16.9%) experienced 1 fall; 31 (8.6%), 2-3 falls; 4 (1.1%), 4-5 falls; and 6 (1.7%), ≥6 falls during the first postoperative year. Thus, 102 (28%) patients experienced at least 1 fall, and 41 (11%) experienced recurrent falls (2 or more falls) during the time period. The mean GLFS-25 score was 30.2 ± 22.7, and 242 (62%) patients had GLFS-25 scores of 16 or higher, which fulfilled the diagnostic criteria for LS. When subjects were categorized into recurrent fallers and non-recurrent fallers, recurrent fallers had a significantly higher GLFS-25 score and a significantly lower extremity motor function score of the JOA score than non-recurrent fallers. The GLFS-25 and lower extremity motor function score of the JOA score yielded the areas under the receiver operating characteristic curves of 0.674 and 0.607, respectively, to differentiate recurrent fallers from non-recurrent fallers.Postoperative patients with cervical myelopathy had a 62% prevalence of LS. The GLFS-25 may be useful to predict the risk of recurrent falls in patients with cervical myelopathy.