Associations between curve severity and revised Scoliosis Research Society-22 and scoliosis Japanese Questionnaire-27 scores in female patients with adolescent idiopathic scoliosis: a multicenter, cross-sectional study.

BACKGROUND: Patient-reported outcome measures are widely utilized to assess health-related quality of life (HRQOL) in patients with adolescent idiopathic scoliosis (AIS). However, the association between HRQOL and curve severity is mostly unknown. The aim of this study is to clarify the association between HRQOL and curve severity, and to determine the optimal cutoff values of patient-reported outcomes for major curve severity in female patients with AIS. METHODS: Female patients with AIS treated conservatively were recruited. The patients' HRQOL outcomes were examined using the revised Scoliosis Research Society-22 (SRS-22r) and the Scoliosis Japanese Questionnaire-27 (SJ-27). The correlations of the SRS-22r and SJ-27 scores with the major Cobb angle were assessed using Spearman's correlation coefficient analysis. The association between HRQOL issues in the SJ-27 and the major Cobb angle was evaluated by calculating Akaike's Information Criterion (AIC). Furthermore, the optimal cutoff values of the SRS-22r and SJ-27 scores for the major Cobb angle were determined by AIC analysis. RESULTS: The study cohort comprised 306 female patients with AIS. The SRS-22r and SJ-27 scores were significantly correlated with the major Cobb angle. Questions in the SJ-27 regarding discomfort when wearing clothes showed a lower AIC value in patients with severe scoliosis. The optimal cutoff values were a SRS-22r score of 3.2 for the discrimination of severe scoliosis (Cobb angle ≥48°), and a SJ-27 score of 32 for the discrimination of moderate scoliosis (Cobb angle ≥33°). CONCLUSION: Discomfort when wearing clothes was the most important HRQOL problem caused by severe scoliosis. The SRS-22r and SJ-27 scores are useful for the discrimination of clinical status in female patients with severe scoliosis or moderate scoliosis.

Immediate effect of mechanical lumbar traction in patients with chronic low back pain: A crossover, repeated measures, randomized controlled trial.

BACKGROUND: Lumbar traction is a treatment method traditionally used for chronic low back pain (CLBP) in many countries. However, its clinical effectiveness has not been proven in medical practice. The purpose is to conduct a multi-center, crossover, randomized controlled trial (RCT) to prove the efficacy and safety of traction on CLBP patients, using equipment capable of precise traction force control and of reproducibility of the condition based on the previous biomechanical and pre-clinical studies. METHODS: Ninety-five patients with non-specific CLBP from 28 clinics and hospitals were randomly assigned to either the intermittent traction with vibration (ITV) first group (A: sequence ITV to ITO) or the intermittent traction only (ITO) first group (B: sequence ITO to ITV); the former was treated with repeated traction and vibration force added to preload. All patients were followed up weekly for 2 periods after study-initiation. The primary outcome measures were disability level including pain and quality of life (based on Japan Low back pain Evaluation Questionnaire; JLEQ), and JLEQ was measured repeatedly. Statistical analysis was performed using linear mixed model. RESULTS: Comparing to pre-traction data, both traction modes significant improvement except the first intervention of ITO treatment. The differences in JLEQ scores over time showed significant improvements in the treatment to which vibrational force was added in contrast to the conventional traction treatment; Mean difference was significant to compare ITV treatment and ITO treatment (-1.75 (p = 0.001), 95% CI; -2.69 to -0.80). However, neither difference between the two sequences (p = 0.884) nor carryover effect (p = 0.527) was observed. CONCLUSIONS: Altogether, the results indicate that lumbar traction was able to improve the pain and functional status immediately in patients with CLBP. This study contributes to add some evidence of the efficacy of lumbar traction.

Effect and usability of anti-inflammatory drug plasters for knee osteoarthritis: A crossover, double-blind, repeated measures, randomized controlled trial.

BACKGROUND: The use of plasters is a well-accepted treatment with high adherence. However, the characteristics such as its cool feeling or extensibility favored by elderly have a possibility to contribute to clinical utility. The purpose is to examine the effect of anti-inflammatory drug plasters for knee osteoarthritis and the clinical preference of the patients for using plasters. We conducted a crossover, double-blind, randomized controlled trial (RCT) recruited 168 patients with knee osteoarthritis. METHODS: We included a "run-in-period" to evaluate the patients' preference among A (first-generation; methyl salicylate), B (second-generation; indomethacin), and N (base substrate for B) before the crossover sequence of two treatment periods with A and B plasters; four arms (N-A-B, A-A-B, N-B-A, and B-B-A) were made to compare the assessment of A, B, and N plasters. We used two measures: The Japanese Knee Osteoarthritis Measure (JKOM), for clinical functions, and the usability questionnaire to evaluate the clinical value of plasters. RESULTS: At baseline, there were no significant differences in characteristics. The subjects in groups A and B showed improved overall JKOM scores at the end of each intervention. Comparison of the change of the mean difference showed that A and B were statistically significant improvement over N (-2.40, (95%CI = -3.58 to -1.21), -2.52, (-3.65 to -1.40)) but no significant difference between A and B - 0.13, (-1.14 to 0.89)). In network analysis for usability, twelve items were independent of JKOM's network structure and consisted of two domains. The analysis of usability showed that N and B were preferred over A significantly. CONCLUSION: Both the first- and second-generation plasters were statistically superior to the base only, but no significant difference between two generations. The patient is surely aware of the effect of the drug itself, but the two feelings are important in the preference.

Relationship between X-ray findings of lumbar spondylosis and knee pain.

BACKGROUND: The aim of this study was to investigate the correlation between radiographic measurement in lumbar spine and clinical information including symptoms or results of functional testing using a baseline data of longitudinal cohort study. METHODS: A total of 314 elderly subjects were recruited from 5 orthopedic clinics or affiliated facilities. Data for the present investigation were collected via an interviewer-administered questionnaire, which included questions on past medical history, drug history, pain area. And also results of functional testing and X-ray imaging of the lumbar spine were collected. Analysis was carried out to determine any correlation between results of X-ray imaging of the lumbar spine and other collected data, and sorted regarding Akaike Information Criterion (AIC). The correlations among these variables and odds ratio were also analyzed. RESULTS: T12/L1% disc height showed a minimum AIC value with buttock pain (- 4.57) and history of vertebral fracture (- 4.05). The L1/L2, L2/L3, and L3/L4% disc height had a minimal AIC value with knee pain (- 4.11, - 13.3, - 3.15, respectively), and odds ratio of knee pain were 3.5, 3.8, and 2.7, respectively. CONCLUSIONS: Correlation was recognized between the T12/L1% disc height and both buttock pain and previous vertebral fractures, and the L1/L2, L2/L3, and L3/L4% disc height showed a correlation with knee pain. Especially the L2/L3% disc height and knee pain had a strong correlation. It was suggested that these findings may provide additional basis to the concept that lumbar spinal lesion associates with knee pain clinically.

Lumbar mechanical traction: a biomechanical assessment of change at the lumbar spine.

BACKGROUND: Lumbar traction is a traditional treatment modality for chronic low back pain (CLBP) in many countries. However, its effectiveness has not been demonstrated in clinical practice because of the following: (1) the lack of in vivo biomechanical confirmation of the mechanism of lumbar traction that occurs at the lumbar spine; (2) the lack of a precise delivery system for traction force and, subsequently, the lack of reproducibility; and (3) few randomized controlled trials proving its effectiveness and utility. METHODS: This study was planned as a preparatory experiment for a randomized clinical trial, and it aimed (1) to examine the biomechanical change at the lumbar area under lumbar traction and confirm its reproducibility and accuracy as a mechanical intervention, and (2) to reconfirm our clinical impression of the immediate effect of lumbar traction. One hundred thirty-three patients with non-specific CLBP were recruited from 28 orthopaedic clinics to undergo a biomechanical experiment and to assess and determine traction conditions for the next clinical trial. We used two types of traction devices, which are commercially available, and incorporated other measuring tools, such as an infrared range-finder and large extension strain gauge. The finite element method was used to analyze the real data of pelvic girdle movement at the lumbar spine level. Self-report assessments with representative two conditions were analyzed according to the qualitative coding method. RESULTS: Thirty-eight participants provided available biomechanical data. We could not measure directly what happened in the body, but we confirmed that the distraction force lineally correlated with the movement of traction unit at the pelvic girdle. After applying vibration force to preloading, the strain gauge showed proportional vibration of the shifting distance without a phase lag qualitatively. FEM simulation provided at least 3.0-mm shifting distance at the lumbar spine under 100 mm of body traction. Ninety-five participants provided a treatment diary and were classified as no pain, improved, unchanged, and worsened. Approximately 83.2% of participants reported a positive response. CONCLUSION: Lumbar traction can provide a distractive force at the lumbar spine, and patients who experience the application of such force show an immediate response after traction. TRIAL REGISTRATION: University Hospital Medical Information Network - Clinical Trial Registration: UMIN-CTR000024329 (October 13, 2016).

Reliability and validity of a novel quality of life questionnaire for female patients with adolescent idiopathic scoliosis: Scoliosis Japanese Questionnaire-27: a multicenter, cross-sectional study.

BACKGROUND: A progressive deformity associated with adolescent idiopathic scoliosis (AIS) negatively affects a patient's health-related quality of life (HRQOL). Although the Scoliosis Research Society-22 (SRS-22) is the standard measurement tool for assessing HRQOL in patients with AIS, it is partially suboptimal for evaluating HRQOL in Japanese patients with AIS because of cultural differences. The purpose of this study was to develop a novel patient-reported outcome measure for Japanese female patients with AIS and to evaluate the reliability and validity of this questionnaire in comparison with the SRS-22 tool. METHODS: We developed 27 questions based on the psychosocial problems in the daily life of young female patients with AIS in Japan, the Scoliosis Japanese Questionnaire-27 (SJ-27). To evaluate its reliability, the internal consistency was assessed using Cronbach's alpha coefficient. Concurrent validity was evaluated using Spearman's correlation coefficient between the SJ-27 and the SRS-22. To investigate the construct validity of the SJ-27, the correlation between the SJ-27 questions was assessed using Akaike's information criterion (AIC). RESULTS: We analyzed 384 female patients with AIS. Cronbach's alpha coefficients were 0.914 and 0.829 for the SJ-27 and the SRS-22, respectively. Spearman's correlation coefficient between the SJ-27 and the SRS-22 was 0.692 (p < 0.001). The AIC analysis indicated that the SJ-27 items are divided into five domains, indicating that the SJ-27 covered a wide range of health-related problems among female patients with AIS. CONCLUSIONS: The results suggest that the SJ-27 is a reliable and valid patient-reported outcome measure for evaluating HRQOL in female patients with AIS in Japan.

Effect of elcatonin versus nonsteroidal anti-inflammatory medications for acute back pain in patients with osteoporotic vertebral fracture: a multiclinic randomized controlled trial.

The aim of this study was to compare the efficacy of elcatonin injections and oral nonsteroidal anti-inflammatory drugs (NSAIDs) for patients with osteoporosis who have acute lumbar pain after experiencing new vertebral compression fractures. Two hundred twenty-eight Japanese female patients (mean age 77.3 years) with acute lumbar pain from osteoporotic vertebral fractures were randomly divided into two groups. Patients in one group were given an NSAID (NSAIDs group) and patients in the other group were given weekly intramuscular injections of 20 units of elcatonin (elcatonin group). All patients underwent follow-up examinations up to 6 weeks from the start of the trial. Outcome measures were the level of functional impairment according to the Japan Questionnaire for Osteoporotic Pain (JQ22), the Roland-Morris Disability Questionnaire (RDQ), and a visual analog scale (VAS) of pain intensity. Statistical analyses focused on (1) the time course of pain and functional level using linear mixed effects models to analyze the longitudinal data and (2) the effectiveness of elcatonin injection with mean difference values and 95 % confidence intervals. Significant differences were seen over time between the initial values and the postintervention values (4 and 6 weeks) in JQ22, RDQ, and VAS scores (effect size d > 0.4) in each group. The mean differences between the elcatonin group and the NSAIDs group in each measure at 4 and 6 weeks were -4.8 and -8.3 for the JQ22, -1.3 and -2.6 for the RDQ, and -11.3 and -11.5 for the VAS, shifted to elcatonin. Once weekly elcatonin injection was more effective than NSAIDs for treating acute lumbar pain and improving mobility in Japanese women with osteoporotic vertebral fractures.

Relationship between physician-judged functioning level and self-reported disabilities in elderly people with locomotive disorders.

PURPOSE: Locomotive disorders due to musculoskeletal involvement are one of the main causes requiring long-term care services in aging Japan. "Locomotive syndrome (LoS)" is a concept referring to the condition under which people require assistance from others or at risk in future. The object of this study is to examine the relationship between self-reported measure and physician-judged degrees on ADL disability in elder people with locomotive disorders. METHODS: In a cross-sectional study, 711 patients who were aged 65 years old or more were recruited from 49 outpatient clinics and hospitals. We investigated ADL disabilities by self-reported questionnaire (Geriatric Locomotive Function Scale-25: GLFS-25) and physician-judged grading (Locomotive Dysfunction Grade: LDG) and examined the relationship between these two. RESULTS: We classified the severity of locomotive disability by clinical phenotype into six grades: LDG Grade 1 (N = 77), Grade 2 (213), Grade 3 (139), Grade 4 (162), Grade 5 (78), and Grade 6 (42). The mean of GLFS-25 was 25.9. The mean of GLFS-25 was 5.68 for Grade 1, 14.33 for Grade 2, 22.34 for Grade 3, 35.40 for Grade 4, 43.25 for Grade 5, and 60.24 for Grade 6. Significant differences of GLFS-25 scores were found between adjacent LDGs. CONCLUSIONS: Physician-judged grade of locomotive dysfunction was significantly related to self-reported assessment scale on ADL disability. Physician-judged dysfunction grade is readily administered scale and useful to assess the severity of locomotive dysfunction. Self-reported scale provides precise information on ADL disabilities due to locomotive organ dysfunction and is useful to develop intervention programs.

Characteristics of disability in activity of daily living in elderly people associated with locomotive disorders.

BACKGROUND: Ageing is associated with a decline of motor function and ability to perform daily activities. Locomotive disorders are one of the major disorders resulting in adverse health condition in elderly people. Concept of Locomotive syndrome (LoS) was proposed to tackle the problems and prolong healthy life expectancy of people with locomotive disorders. To develop intervention strategy for LoS it is mandatory to investigate impairments, functional disabilities which people with locomotive disorder experience and to examine relationships among these parameters. For this purpose we have developed Geriatric Locomotive Function Scale-25 (GLFS-25). Though several physical performance tests were reported for identification or monitoring the severity of LoS, there are few studies reported on characteristics of disability which people with locomotive disorders experience. The aim of this study was to report the characteristics of ADL disabilities in elderly people with locomotive disorders in terms of numbers and degree of activity limitations. METHODS: We organized a cohort study and recruited 314 participants aged 65 years and over from five orthopedic clinics or nursing care facilities. This was a cross-sectional study to use the baseline data of such cohort. ADL disabilities were assessed using GLFS-25 scale arranging the GLFS-25 scores in ordinal levels using "R language" program. Numbers and degrees of activity limitations were determined and compared among the levels. Frequency of limitation in activities regarding social activity, housework, locomotion, mobility and self-care was compared among across the disability level. RESULTS: The GLFS-25 score was mathematically categorized into 7 levels. The number of activity limitations and the degrees of each activity limitation were significantly greater in high GLFS-25 levels than in low levels. Difficulties in mobility appeared in less severe level, difficulties in domestic and social life appeared in moderately severe level, and difficulties in self-care appeared in advanced level. CONCLUSIONS: High GLFS-25 score represented high degree of disability on ADLs. Concordant increase of numbers of activity limitation and severity progression in activity limitation may contribute to progression of disability. Activity limitation may occur in the following order: sports activity, walking, transferring, and self-care.

A novel patient-reported outcome measure for anterior cruciate ligament injury: evaluating the reliability, validity, and responsiveness of Japanese anterior cruciate ligament questionnaire 25.

PURPOSE: Despite objectively good results, up to 70 % of individuals may not return to their pre-injury level of sports activity after anterior cruciate ligament (ACL) reconstruction surgery. Although psychological responses have been shown to affect outcomes after ACL injury, an appropriate means of measuring their effects, in addition to functional status, has not been determined. The purpose of this study was to develop a patient-reported questionnaire for measuring psychological factors associated with outcomes after ACL injury and to evaluate its reliability, validity, and responsiveness. METHODS: After item analysis based on the results of two pilot studies and a short relevance assessment, 25 questionnaire items were selected for the Japanese Anterior Cruciate Ligament Injury Questionnaire 25 (JACL-25) and assessed for validity, reliability, and responsiveness in subjects with ACL injury. RESULTS: The JACL-25 had no floor or ceiling effects and no confounding factors. A Cronbach's alpha coefficient of 0.981 and a Guttman split-half coefficient of 0.983 indicated excellent reliability. Large standardized response means (1.30-1.62) and effect sizes (0.96-1.51) from the preoperative to postoperative period indicated good responsiveness. Construct structures were created, and these items were separated into three domains. Strong correlations between the JACL-25 and the International Knee Documentation Committee Subjective Knee Form (r s = -0.86), Lysholm Score (r s = -0.73), and Tegner Activity Scale (r s = -0.65) indicated good concurrent validity of the JACL-25. CONCLUSIONS: The present study demonstrated that the JACL-25 was valid, reliable, and responsive enough to evaluate psychological factors associated with outcomes in individuals with ACL injuries. LEVEL OF EVIDENCE: Diagnostic study, Level III.

The usefulness of neutrophil CD64 expression for diagnosing infection after orthopaedic surgery in dialysis patients.

BACKGROUND: Dialysis patients undergoing orthopaedic surgery are at high risk for postoperative infection. Diagnosis of postoperative infection is difficult in dialysis patients due to presentation of signs and symptoms similar to infection, such as fever and elevated inflammatory marker levels. Neutrophil CD64 expression (CD64), a marker of infection, is upregulated by microbial wall components and several cytokines (interferon-γ and tumor necrosis factor-α). The purpose of this study is to evaluate the usefulness of CD64 for diagnosing postoperative infection in dialysis patients post orthopaedic surgery. PATIENTS AND METHODS: Between 2013 and 2014, we prospectively studied 36 dialysis patients (18 men, 18 women; mean age 65.9 years; 49 to 83) who underwent orthopaedic surgery. Dialysis patients were classified into three groups according to their postoperative course as follows; non-infected patients, infection suspected patients, and infected patients. Inflammatory markers such as white blood cell count (WBC), C-reactive protein (CRP) and CD64 were measured before operation and one week after surgery. Using the receiver-operating characteristic (ROC) curve and Akaike's Information Criterion (AIC), the cutoff value of CD64 and CRP was calculated leading to a determination of which inflammatory marker is best accurate for detecting postoperative infection. RESULTS: We found that postoperative CD64 and CRP levels presented a statistically significant difference between infected patients and non-infected patients (p < 0.05). Furthermore, comparison of the ROC curve and AIC value between postoperative CD64 and CRP levels exhibited that CD64 was more accurate infectious marker than CRP. CONCLUSION: CD64 is a useful marker for detecting postoperative infection after orthopaedic surgery in dialysis patients.

Determination of the optimal cutoff time to use when screening elderly people for locomotive syndrome using the one-leg standing test (with eyes open).

OBJECTIVE: To establish the cutoff time for the one-leg standing (OLS) test (with eyes open) to use when screening elderly people for locomotive syndrome. METHODS: Patients visiting orthopedic clinics and healthy volunteers, all ≥65 years old, were recruited. Participants were asked to complete the 25-question Geriatric Locomotive Function Scale (GLFS-25) and then underwent the OLS test. Using the previously determined GLFS-25 cutoff value, participants were divided into two groups: the locomotive and the non-locomotive syndrome groups (GLFS-25 scores of ≥16 and <16, respectively). Conventional receiver operating characteristic curve (ROC) analysis was used to calculate the optimal cutoff time for the OLS. RESULTS: Data from 880 individuals (261 men, 619 women; mean age (SD), 77 (6) years; range 65-96 years) were analyzed; 497 were in the locomotive syndrome group and 383 were in the non-locomotive syndrome group. A significant difference was seen between each group mean for individual average (IA) OLS times (IA-OLS: the average of the OLS times obtained for both legs of an individual). According to ROC analysis without age adjustment, when the IA-OLS time was ~9 s, the sum of the sensitivity and specificity of the test was highest. However, because of a statistically significant difference in IA-OLS time among the three age groups (aged ≤70, aged >70 and ≤75, and aged >75), we determined the optimal cutoff value for IA-OLS time for each of the three age groups using ROC analysis. According to additional ROC analysis, the optimal cutoff for IA-OLS time was 19 s for individuals aged ≤70, 10 s for individuals aged >70 and ≤75, and 6 s for individuals aged >75 when screening elderly persons for locomotive syndrome. CONCLUSIONS: We propose using a GLFS-25 score of 16 and/or a cutoff for the IA-OLS time of 19 s for individuals aged ≤70, 10 s for individuals aged >70 and ≤75, and 6 s for individuals aged >75 when screening elderly persons to determine who should receive medical intervention or undergoing training programs.

Dynamic change and influence of osteoporotic back pain with vertebral fracture on related activities and social participation: evaluating reliability and validity of a newly developed outcome measure.

The objective of this study was to record the clinical course of osteoporosis over time in Japanese women. We hypothesized that successful control of acute pain associated with osteoporosis will allow better treatment for health-related problems. To confirm this working hypothesis, we developed the Japan Questionnaire for Osteoporotic Pain (JQ22) to measure health status associated with osteoporosis. We examined the validity and reliability of the JQ22 compared with the current gold standard scale for back pain, the Roland Morris questionnaire (RDQ). A total of 125 women who were more than 65 years old, had an acute back pain episode, and had a fragile vertebral fracture confirmed by X-ray and clinical signs, participated in this study. The psychometric analyses for validity and reliability were tested for the JQ22 and the RDQ. The time course up to 6 weeks was observed by investigating both changes in pain characteristics and its influence on related activities and social participation. Cronbach's alpha coefficient was 0.979 and 0.919 for the JQ22 and RDQ, respectively. The Akaike Information Criterion (AIC) indicated that the JQ22 items were separated into four domains, which were sequentially arranged at the baseline and subsequently changed. This structure reflected osteoporotic back characteristics covering a range from pain to social activities. The JQ22 was shown to be a valid and reliable scale for patient-based measurement of osteoporotic back pain. It also revealed both changes in pain characteristics and the influence of pain on related activities and participation.

Reference intervals of serum hyaluronic acid corresponding to the radiographic severity of knee osteoarthritis in women.

BACKGROUND: While serum levels of hyarulonic acid (sHA) is known to be useful for a burden of disease biomarker in knee OA, it is far from practical. The reference intervals must be established for biomarkers to be useful for clinical interpretation. The aim of this study was to establish the reference intervals of sHA corresponding to the radiographic severity of knee OA for elucidating whether sHA can be useful as a burden of disease marker for individual patient with knee OA. METHODS: 372 women with Kellgren & Lawrence grade (K/L) 1 through 4 painful knee OA were enrolled in this study. The patients included 54 with K/L 1, 96 with K/L 2, 97 with K/L 3, and 118 with K/L 4. Serum samples were obtained from all subjects on the day that radiographs taken. A HA binding protein based latex agglutination assay that employed an ELISA format was used to measure sHA. Age and BMI adjusted one way ANOVA was used to set the reference intervals of sHA. RESULTS: The reference intervals for sHA corresponding to the patients with K/L 4 (49.6 - 66.5 ng/ml) was established without any overlap against to those with K/L 1, 2 and 3, while those with K/L 1, 2 and 3 showed considerable overlap. CONCLUSIONS: These results indicate that sHA can be available as a burden of disease marker for the individuals with severe knee OA (K/L 4), while it is not for those with primary to moderate knee OA (K/L 1-3).

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

OBJECTIVE: To evaluate the reliability and validity of a new questionnaire, the 25-question Geriatric Locomotive Function Scale (GLFS-25), for early detection of locomotive syndrome. METHODS: This new screening tool was designed to detect Japanese individuals under high-risk conditions who may soon require care services because of problems of the locomotive organs. Content validity, construct validity, criterion validity, internal-consistency reliability, and reproducibility (test-retest reliability) were examined using psychometric analysis, and a cutoff score to detect locomotive syndrome was determined. To investigate construct validity of the GLFS-25 and determine the cutoff score, the Akaike Information Criteria (AIC) were used. RESULTS: Study 1 analyzed 711 Japanese elderly people ≥65 years old. No floor or ceiling effects were included in the GLFS-25. Internal consistency was confirmed by a Cronbach's α reliability coefficient of 0.961. As for the association between the GLFS-25 and European Quality of Life Scale-5 Dimensions (EQ-5D), Spearman's correlation coefficient was 0.85 (P < 0.001), showing excellent concurrent validity of the GLFS-25. Categorical principal component analysis showed that the construct structure consisted of one item cluster or the GLFS-25 was unifactorial. The AIC showed that one cluster of seven items was located in the center, with significant associations with the other five clusters. In study 2, 205 individuals were analyzed, and the test-retest interclass correlation was satisfactory (range 0.712-0.924). The cutoff score for identifying locomotive syndrome was set at 16. Validity and reliability of this new measurement were psychometrically confirmed as sufficient. CONCLUSIONS: The GLFS-25 offers a valid and reliable questionnaire scale for detecting locomotive syndrome in elderly Japanese individuals.

[Development and evaluation of a patient-reported outcome measure of pain-related sleep disturbances for pain clinic patients].

BACKGROUND: The purpose of this study was to develop a new tool, the Pain Sleep questionnaire, consisting of 20 items (PS-20) for measuring pain-related sleep disturbances in pain clinic patients, and to examine its reliability and validity. METHODS: The internal consistency, criterion validity compared with the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36v2), and construct validity of the PS-20 were tested. RESULTS: A total of 125 patients participated in this study. Cronbach's alpha coefficient was 0.969, indicating good internal consistency. The PS-20 score correlated moderately with the physical component summary of SF-36v2 and correlated weakly with the mental component summary of SF-36v2. From the graphical model using the Akaike information criterion and the Categorical principal component analysis, the items were divided into four domains: physical pain, trouble falling asleep, awakened by pain, and general health problems. CONCLUSIONS: The PS-20 was shown to be a valid and reliable questionnaire scale for measuring pain-related sleep disturbances among pain clinic patients.

Effect of nonsteroidal anti-inflammatory drug plasters for knee osteoarthritis in Japanese: a randomized controlled trial.

The objective of this study was to examine the effect of a nonsteroidal anti-inflammatory drug (NSAID) plaster for knee osteoarthritis among Japanese patients. An open-labeled, randomized, controlled, multiclinic trial was performed involving outpatient clinic groups. Two comparative groups-plaster NSAIDs and oral NSAIDs-were randomly allocated. The drugs used were limited to the current top three in both groups in Japan. Treatments were assessed after four weeks and compared with the baseline scores. Outcomes were evaluated by two psychometric measures: Japanese knee osteoarthritis measure, and pain with the visual analogue scale. The total number of patients included in the final evaluation was 165 (87 for the plaster group and 78 for the oral group). Between these two groups there were no significant differences in gender, age, body height and weight, body mass index, and X-ray grading. The subjects in both groups showed improvements in both scores at the end of intervention. The differences in the improvements in scores between the two groups were not significant, though the mean rank score and the 95% CI of the plaster group were slightly better than those of the oral group. In conclusion, the local application of a plaster with NSAIDs leads to the same level of improvement in knee osteoarthritis as oral NSAIDs.

Development of a patient-oriented outcome measure for patients with hand and elbow disorder: HandQ.

PURPOSE: The Disabilities of the Arm, Shoulder, and Hand (DASH) is the most widely used patient-oriented outcome measure for the upper extremities in the world, and high reliability and validity of it has already been confirmed. However, there are several problems with using the DASH, some of which are culturally related. We aimed to (1) develop a patient-oriented disease-specific outcome measure for patients with disorders of the hand and elbow, which we call the HandQ and (2) examine the practical applicability, reliability, and validity of the HandQ for any patient with disorders of the hand and elbow. METHODS: A total of 216 patients were surveyed with the HandQ, as well as the Hand20 and the DASH to assess psychometric characteristics. RESULTS: There were no considerable floor and ceiling effects regarding the total HandQ score. Test-retest reliability and internal consistency determined using the intraclass correlation coefficient (0.942) and Cronbach's α test (0.961) were excellent. The HandQ was well correlated with the Hand20 and the DASH scores. Scree plot showed unidimensionality of the HandQ, and the graphical model showed the questionnaire items of the HandQ had reasonable correlation among each item. CONCLUSIONS: The HandQ has a sufficient reliability and internal consistency, and an excellent validity, and was shown to be able to be practically applicable in all patients with hand and elbow disorders.

Muscles Cooperation Analysis Using Akaike Information Criteria for Anterior Cruciate Ligament Injury Prevention.

In this paper, we propose the analysis method for finding out the similarity of the muscle force patterns to mine the risk factor of the anterior cruciate ligament (ACL) injury. Akaike information criteria (AIC) under the assumption of the auto-regression model is adapted to analyze the similarities of muscle force patterns in time-series. The difference of AIC values between 2 muscles is considered to be the distance between 2 muscle force patterns and the dexterity of the maneuver is expected to be discussed. We measured drop vertical jump (DVJ) and use the data around the contact timing of whom hadn't had ACL injury experiments. The results showed that we could successfully calculate AIC distance according to the similarity of the time-series data pattern and it can be useful to discuss one's dexterity of controlling body maneuvers soon after contact timing of DVJ motion.

Therapeutic home exercise versus intraarticular hyaluronate injection for osteoarthritis of the knee: 6-month prospective randomized open-labeled trial.

BACKGROUND: Treatment for osteoarthritis (OA) of the knee is controversial. Only a few studies have compared the effects of intraarticular injection of hyaluronate with those of home exercise for knee OA. We prospectively evaluated the therapeutic effects of each treatment. METHODS: A total of 102 female subjects (mean age 70.4 years) were randomly divided into two groups and followed up to the 24th week. The primary outcome measure was judged by three pain/function scales as follows: a visual analogue scale, the Japanese Knee Osteoarthritis Measure, and the Outcome Measures in Rheumatology Clinical Trials and Osteoarthritis Research Society International criteria. For secondary outcome measures, all data were categorized for logistic regression analysis and the chi-squared test to address factors affecting these outcomes. RESULTS: The two treatment groups demonstrated equal improvement regarding all three scales, and there was statistically no difference in between-group analyses, although there seemed to be better improvement in range of motion at 24 weeks in the home exercise group. In categorical analysis, OA stage was classified as early and advanced OA at 3 mm of joint space width obtained from standing anteroposterior radiographs. Logistic regression analysis revealed that the OA stage at the baseline of the knee affected these improvements. For early OA the improvement rate regarding hydrops was significantly higher in the home exercise group, whereas for advanced OA there was a tendency for the rate of improvement in ROM to be inferior in the hyaluronidate group. CONCLUSIONS: Taking into account the cost, convenience, and invasiveness to patients, exercise is thought to have some advantage over intraarticular injection of hyaluronate for the therapy of OA of the knee.