Temporal validation of a clinical prediction rule for distinguishing locomotive syndromes in community-dwelling older adults: A cross-sectional study from the DETECt-L study.

Objectives: Clinical prediction rules are used to discriminate patients with locomotive syndrome and may enable early detection. This study aimed to validate the clinical predictive rules for locomotive syndrome in community-dwelling older adults. Methods: We assessed the clinical prediction rules for locomotive syndrome in a cross-sectional setting. The age, sex, and body mass index of participants were recorded. Five physical function tests-grip strength, single-leg standing time, timed up-and-go test, and preferred and maximum walking speeds-were measured as predictive factors. Three previously developed clinical prediction models for determining the severity of locomotive syndrome were assessed using a decision tree analysis. To assess validity, the sensitivity, specificity, likelihood ratio, and post-test probability of the clinical prediction rules were calculated using receiver operating characteristic curve analysis for each model. Results: Overall, 280 older adults were included (240 women; mean age, 74.8 ± 5.2 years), and 232 (82.9%), 68 (24.3%), and 28 (10.0%) participants had locomotive syndrome stages ≥ 1, ≥ 2, and = 3, respectively. The areas under the receiver operating characteristics curves were 0.701, 0.709, and 0.603, in models 1, 2, and 3, respectively. The accuracies of models 1 and 2 were moderate. Conclusions: These findings indicate that the models are reliable for community-dwelling older adults.

Does self-reported physical activity relate to physical function and walking ability in female patients with hip osteoarthritis? A cross-sectional multicenter study.

BACKGROUND: The effectiveness of a high level of physical activity in maintaining physical function in patients with hip osteoarthritis has not been adequately examined. OBJECTIVE: This study aimed to determine whether self-reported physical activity is associated with physical function and walking ability in female patients with hip osteoarthritis. METHODS: This was a multicenter cross-sectional study. The dependent variables were the lower-limb range of motion and muscle strength, and walking ability. Self-reported physical activity was assessed according to the guidelines of the Japanese Ministry of Health, Labor, and Welfare. Multiple regression models were used to determine whether physical activity was significantly related to the dependent variables after adjusting for confounding factors (age, body mass index, hip pain, comorbidity, and severity of hip osteoarthritis). RESULTS: A total of 167 participants were included in the study. Physical activity was associated with muscle strength in hip flexion (affected/unaffected, ß = 0.18/ß = 0.16), abduction (ß = 0.19/ß = 0.26), knee extension (ß = 0.22/ß = 0.26), Timed Up-and-Go test (ß = -0.16), and 5-m walking time test (ß = -0.15). CONCLUSION: In female patients with hip osteoarthritis, greater physical activity was associated with greater lower extremity muscle strength and walking ability.

Estimation of Reference Values of Gait Spatiotemporal and Kinematic Parameters in the Lower Extremities and Trunk Using a Markerless Motion Capture System for Healthy Older Japanese Adults.

OBJECTIVE: This preliminary study aimed to explore the reference values of spatiotemporal and kinematic parameters in the lower extremities and trunk during gait for the healthy older adults. METHODS: Walking speed, stride length and time, cadence, walk ratio, and step width were calculated as spatiotemporal parameters of gait. Forward tilting of the trunk (FTT), hip flexion and extension, knee flexion and extension, and their laterality were measured as peak angles during one-gait cycle. The bootstrap method was conducted to estimate the 95% confidence interval (CI). RESULTS: This study included 334 healthy older adults (255 women). The following gait parameters were estimated with 95%CI: walking speed (95%CI 1.21-1.30), cadence (95%CI 116.35-121.20), walk ratio (95%CI 0.0055-0.0060), step width (95%CI 0.15-0.17), FTT (95%CI 1.91-4.19), hip flexion (95%CI 28.54-31.01), hip extension (95%CI 19.30-22.27), knee extension (95%CI 0.09-0.14), laterality of hip flexion (95%CI 1.31-2.02), laterality of hip extension (95%CI 1.32-1.97), laterality of knee flexion (95%CI 3.41-4.77), and laterality of knee extension (95%CI 0.07-0.13) in men, and walking speed (95%CI 1.28-1.34), walk ratio (95%CI 0.0050-0.0054), FTT (95%CI 2.54-3.73), hip flexion (95%CI 32.80-34.28), laterality of hip flexion (95%CI 1.65-2.05), laterality of hip extension (95%CI 2.06-2.57), and laterality of knee flexion (95%CI 3.04-3.89) in women. CONCLUSION: This study suggested provisional reference values of spatiotemporal and kinematic parameters in the lower extremities and trunk during gait for the healthy older adults.

The impact of diabetic polyneuropathy on toe grip strength in patients with type 2 diabetes mellitus: a cross-sectional study.

Purpose: Type 2 diabetes mellitus (T2DM) and concomitant diabetic polyneuropathy (DPN) induce muscle weakness. Muscle weakness in the foot is associated with foot deformities and falls. However, factors affecting toe grip strength (TGS) are not well known. Therefore, the present study investigated factors related to TGS in patients with T2DM. Methods: This was a cross-sectional study involving 100 patients with T2DM who were hospitalized for the treatment of T2DM and 50 healthy adults. The subjects were divided into three groups: a group of healthy subjects, a group of T2DM patients without DPN, and a group of T2DM patients with DPN. Hierarchical multiple regression analysis was performed with TGS and the TGS-to-weight ratio (TGS/Wt%) as dependent variables and with age, the presence of T2DM, and DPN as independent variables, and sex and BMI as confounders. Results: There were no significant differences in age or sex among the three groups. In the final regression analysis, age and presence of T2DM and DPN were associated in both models with TGS and TGS/Wt% as dependent variables. Conclusion: DPN, T2DM, and age were found to be related to TGS. The findings of this study could contribute to healthcare providers developing foot care and rehabilitation programs for diabetic patients. Trial registration: This study was registered with UMIN-CTR (UMIN000034320) on 1 November 2018.

Association of sarcopenia, pre-sarcopenia, and dynapenia with the onset and progression of locomotive syndrome in Japanese older adults: a cross-sectional study.

BACKGROUND: Sarcopenia commonly occurs in older adults with motor disorders requiring long-term care, and the clinical features of sarcopenia are associated with locomotive syndrome. Dynapenia is the age-related loss of muscle strength. However, the association of sarcopenia and dynapenia with the onset and progression of locomotive syndrome in older adults remains unknown. The current study aimed to determine the association of sarcopenia, pre-sarcopenia, and dynapenia with the onset and progression of locomotive syndrome in Japanese older adults. METHODS: This study included older females (n = 264, 73.9 ± 5.8 years) and males (n = 92, 76.3 ± 6.1 years). Sarcopenia was defined as low muscle function and mass; pre-sarcopenia was defined as low muscle mass with normal muscle function; and dynapenia was defined as low muscle function without low muscle mass. Locomotive syndrome (stage 0-2) severity was determined using the stand-up test, the two-step test, and the 25-question geriatric locomotive function scale. Logistic regression analysis was performed to determine the relationship between sarcopenia category and locomotive syndrome stages. RESULTS: Age (1.208, 95% confidence interval (CI) 1.124-1.298), sex (2.455, 95% CI 1.241-4.856), and BMI (1.211, 95% CI 1.077-1.361) were significant variables for determining locomotive syndrome stage ≥ 1, whereas pre-sarcopenia (0.543, 95% CI 0.331-0.891) and sarcopenia (1.664, 95% CI 1.005-2.755) were significant variables for determining locomotive syndrome stage 2. CONCLUSIONS: Only sarcopenia was associated with locomotive syndrome progression, while low muscle mass or low muscle function was not associated with locomotive syndrome. Gaining muscle mass accompanied by an increased muscle function for older adults is warranted to prevent locomotive syndrome progression in the super-aged society.

Derivation of a clinical prediction rule for chronic post-surgical pain after total knee arthroplasty considering biopsychosocial factors: A prospective cohort study.

BACKGROUND: Biopsychosocial factors are involved in the occurrence of chronic post-surgical pain (CPSP) after total knee arthroplasty (TKA). The purpose of this study was to develop a clinical prediction rule (CPR) that considers biopsychosocial factors to predict which patients are more likely to develop CPSP after TKA. METHODS: CPSP after TKA was dichotomized into CPSP and non-CPSP groups using the Likert scale and Minimal clinically important difference, and binomial logistic regression analysis was performed. Cut-off values were then calculated using the extracted factors and dichotomized variables. The cut-off values and dichotomized variables were then used to derive a CPR that discriminates between groups with and without CPSP. RESULTS: Seventy-one TKA patients were included in the study. Binomial logistic regression analysis revealed that Central Sensitization Inventory (CSI) and Pittsburgh Sleep Quality Index (PSQI) were associated with CPSP. The cut-off values for CSI and PSQI were 26 and 7, respectively. The CPSP scale was created using the cut-off values of CSI and PSQI, with a score of 0 for being below the cut-off values of both CSI and PSQI, 1 for being above the cut-off values of either CSI or PSQI, and 2 for being above the cut-off values of both CSI and PSQI. Furthermore, the area under the curve (AUC) for CPR created by the presence of CPSP and using the CPSP scale was significant (AUC = 0.766; P = 0.001). CONCLUSION: The combination of the two tests, CSI and PSQI, suggested the possibility of predicting CPSP after TKA.

Clinical prediction rule for locomotive syndrome in older adults: A decision tree model.

BACKGROUND: No previous studies have proposed a clinical prediction rule that analyzes the factors related to the severity of locomotive syndrome. This study developed and assessed a clinical prediction rule for the severity of locomotive syndrome in older adults. METHODS: A total of 186 patients were assessed using the locomotive syndrome risk test. Classification and regression tree methodologies were used to develop the clinical prediction rule. This study developed three prediction models based on the severity of the locomotive syndrome, of which Model 3 assessed the most severe condition. The following potential predictive factors were measured and entered into each model; single-leg standing time, grip strength, preferred and maximum walking time, and timed up and go test. RESULTS: The single-leg standing test (≤59.4 or >59.4 s) was the best single discriminator for Model 1. Among those with a single-leg standing time >59.4 s, the next best predictor was grip strength (≤37.8 or >37.8 kg). In Model 2, the single-leg standing test was also the best single discriminator (≤12.6 or >12.6 s). Among those with a single-leg standing time ≤12.6, the next best predictor was TUG (≤7.9 or >7.9 s). Additionally, among those with a single-leg standing time >12.6, the next best predictor was single-leg standing time (≤55.3 or >55.3 s). In Model 3, predictive value in Model 2 was the best single discriminator (0 or 1). Among those with 1, the next best predictor was maximum walking time (≤3.75 or >3.75 s). The area under the receiver operating characteristic curves of Models 1, 2, and 3 were 0.737, 0.763, and 0.704, respectively. CONCLUSIONS: A clinical prediction rule was developed to assess the accuracy of the models. These results can be used to screen older adults for suspected locomotive syndrome.

The effects of walking training with poles on walking ability: A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: The purpose of this study was to consolidate the level of evidence for the effects of walking training with poles (pole walking; PW) on walking ability using a systematic review and meta-analysis. TYPE: Systematic review and meta-analysis. LITERATURE SURVEY: Databases including PubMed, Cochrane Library, Physiotherapy Evidence Database (PEDro), Cumulative Index to Nursing and Allied Health Literature databases, and Igaku Chuo Zasshi were searched on June 20, 2021. METHODOLOGY: Data from randomized controlled trials (RCTs) comparing the effects of PW with walking without poles and/or other exercise interventions in disease-specific and aging populations were collected. Data on walking speed, functional mobility, and walking endurance were collected for the meta-analyses. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated from postintervention means and standard deviations. The PEDro scale was used for assessing the risk of bias, and the Grading of Recommendations Assessment, Development, and Evaluation system was used to determine the quality of evidence. SYNTHESIS: This study included 13 RCTs comprising 750 participants; of these, six RCTs were included in the meta-analysis. The results showed that moderate-quality evidence supports the positive effects of PW on walking speed in patients with Parkinson disease (walking speed: SMD = 0.42, 95% CI = 0.04-0.80). In contrast, PW did not significantly improve functional mobility in patients with Parkinson disease and walking speed in older adults. CONCLUSIONS: There was moderate-quality evidence that PW improved walking speed in patients with Parkinson disease.

Effects of Non-Face-to-Face and Noncontact Interventions on Knee Pain and Physical Activity in Older Adults With Knee Osteoarthritis: A Systematic Review and Meta-Analysis.

Increased physical activity is an effective treatment for knee osteoarthritis that causes knee pain. However, due to the coronavirus disease 2019, noncontact and non-face-to-face interventions have increased, but the quality of evidence supporting their effectiveness remains unclear. The purpose of the study was to assess the quality of evidence of the effects of non-face-to-face and noncontact interventions on knee pain and physical activity in older adults with knee osteoarthritis. A meta-analysis was conducted to determine the effects of different intervention methods (education and exercise). The Cochrane Central Register of Controlled Trials, PubMed, Cumulative Index to Nursing and Allied Health Literature, and Physiotherapy Evidence Database were systematically searched. Four randomized controlled trials were included in the analysis. The meta-analysis demonstrated that the educational intervention group was significantly effective, although supportive evidence was low quality. Educational intervention may be effective, but the effects need to be confirmed by higher quality clinical trials.

The effectiveness of group education in people over 50 years old with knee pain: A systematic review and meta-analysis of randomized control trials.

BACKGROUND: International guidelines recommend educational intervention to treat knee osteoarthritis. However, they do not specify the type of intervention and the effectiveness of group educational intervention for knee pain is unclear. OBJECTIVES: We aimed to examine the effectiveness of group educational interventions for people over 50 years old with knee pain compared with a control group. DESIGN: A systematic review and meta-analysis of randomized controlled trials (RCTs). METHOD: We searched Medline, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, and Cumulative Index to Nursing and Allied Health Literature and screened for RCTs involving participants over 50 years old that reported the effects of group education on knee pain. We performed meta-analyses and evaluated the methodological quality and evidence quality using the Physiotherapy Evidence Database scale and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system, respectively. RESULTS: The search retrieved 1,177 studies. Seven RCTs were ultimately included, four of which were subjected to meta-analysis, showing standardized mean differences of -0.22 (95% confidence interval [CI]: -0.42 to -0.02, n = 423; I2 = 0% GRADE: low). All studies included in the meta-analysis involved exercise without individualized instruction in addition to group educational intervention. CONCLUSIONS: Group education, when delivered in addition to exercises, significantly reduces knee pain in people over 50 years old.

Diagnostic Accuracy of Physical Examination Tests for Suspected Acute Anterior Cruciate Ligament Injury: A Systematic Review and Meta-Analysis.

Background: Many tests are used to examine the knee when anterior cruciate ligament (ACL) injury is suspected. However, evidence of diagnostic accuracy in the Lachman, anterior drawer, pivot shift, and lever sign tests is limited. Purpose: The purpose of this study was to perform a systematic review and meta-analysis of original research studies that assessed the diagnostic accuracy of four physical examination tests for ACL injury acutely after an injury. Study design: Systematic review and meta-analysis. Methods: A literature search was conducted in the PubMed, MEDLINE, CINAHL, Web of Science, and Ichushi databases. Original articles with prospective cohort and cross-sectional studies in English and Japanese were included. The searched words were "anterior cruciate ligament", "injury"," rupture"," tear", "lachman test", "pivot shift test", "anterior drawer test", "lever sign test". The methodological quality of the diagnostic studies was evaluated using QUADAS-2. Summary sensitivity, specificity, likelihood ratio (LR)+, and LR- with 95% confidence intervals were calculated. Results: Eight studies were included in this review. The methodological quality of the included studies was mostly favorable. For the domain of flow and timing in the QUADAS-2, three studies did not assess the timing between the reference and index tests. The pooled sensitivities were 0.79, 0.78, 0.55, and 0.82 in the Lachman, anterior drawer, pivot shift, and lever sign tests, respectively, and the pooled specificities were 0.91, 0.91, 0.96, and 0.88, respectively. The lever sign test had the lowest LR- (0.21) and the pivot shift test had the highest LR+ (11.60). The area under the curve for the four physical examinations was > 0.70. Conclusion: The lever sign and pivot shift tests are useful for diagnosing ACL injuries in an acute setting. Level of Evidence: Level 2.

A cutoff value for body composition on the severity of locomotive syndrome in Japanese older women: A cross-sectional study.

We aimed to investigate the relationship between body compositions and locomotive syndrome in older women and derive body composition cutoff values to evaluate locomotive syndrome severity. In total, 236 women were included in this study. The percentage of body fat and skeletal muscle mass index was measured using multi-frequency bioelectrical impedance analysis. The locomotive syndrome severity (stage 0-3) was determined using the standup test, the two-step test, and a self-administered questionnaire. The receiver operating characteristic curve analysis indicated that the cutoff value for body fat percentage was 33.1% for locomotive syndrome stage 1 in women. This finding may aid in designing exercise and nutritional interventions to prevent locomotive syndrome in older women.

Body Composition Characteristics of Community-Dwelling Older Adults With Dynapenia or Sarcopenia.

This study aimed to determine the differences in muscle and fat masses of the arm and leg between older adults with dynapenia, sarcopenia, or presarcopenia and normal individuals. The percent body fat, lean body mass, and skeletal mass index were measured with bioelectrical impedance analysis. Muscle function was evaluated using grip strength and walking speed. Participants were classified into four categories. Dynapenia was defined as low muscle function with normal muscle mass. Sarcopenia was defined as the presence of both low muscle mass and low muscle function. Presarcopenia was defined as low muscle mass with normal muscle function. Control was defined as normal muscle mass and function. Multivariate analyses of variance were performed separately for women and men to test the main effect of sarcopenia category on body composition. Among the 356 enrolled participants, 270 were women, and 86 were men. In older women, the dynapenia and sarcopenia groups had significantly less muscle mass in the leg than the control group. In older men, the dynapenia group demonstrated a higher body fat mass in the leg than the control group. These results suggest that different strategies are necessary to prevent dynapenia in women and men.

Identifying Target Values of Body Composition for Preventing Frailty: A Descriptive Study in Older Adults.

This study investigated the relationship between frailty and body composition and the target values for preventing frailty in body composition. Frailty status and body composition such as the percent body fat and skeletal mass index was measured. Logistic regression analysis was performed by sex. Receiver operating characteristic curve was used to extract the cutoff values for body composition. The participants were 259 in females and 84 in males for 343 of which 75.5% females. Among the females, age was a significant independent variable. Percent body fat was significantly associated with frailty status in males, with a cutoff value of 27.6%. The area under the curve was significant (0.689, p < 0.01, sensitivity = 0.574, specificity = 0.784). New target value of percent body fat in males for preventing frailty is identified. Findings of this study could contribute to the establishment of preventive intervention for frailty in clinical practice.

Self-reported physical activity is related to knee muscle strength on the unaffected side and walking ability in patients with knee osteoarthritis awaiting total knee arthroplasty: a cross-sectional study.

Background: Additional evidence regarding the effectiveness of self-management programs for patients awaiting total knee arthroplasty is required.Objective: The study aimed to determine if self-reported physical activity was related to muscle strength and walking ability in patients with knee osteoarthritis awaiting total knee arthroplasty.Methods: The study included subjects with knee osteoarthritis awaiting total knee arthroplasty (n = 767). Walking ability and bilateral knee muscle strength were measured as dependent variables. Self-report physical activity was assessed based on the guidelines from the Japanese Ministry of Health, Labor and Welfare. Multiple regression models determined if self-reported physical activity was significantly related to dependent variables, after accounting for other related factors.Results: Physical activity was associated with both higher knee flexion (ß = -0.09, p = .013) and higher extension (ß = -0.09, p = .007) muscle strength on the unaffected side only. In addition, physical inactivity was associated with a lower walking ability level (TUG: ß = 0.08, p = .015; 5mWT: ß = 0.10, p = .005).Conclusions: These results can help health-services providers develop educational and/or self-management programs to maintain muscle strength on the unaffected side and walking ability in patients awaiting total knee arthroplasty.

Standard Error of the Mean and Minimal Detectable Change of Gait Speed in Older Adults Using Japanese Long-Term Care Insurance System.

Evaluation of motor function, such as gait ability, can accurately predict the subsequent occurrence of disability in older adults. There are no reports of standard error of the mean (SEM) or minimal detectable change (MDC) with respect to gait in Japanese long-term care insurance-certified individuals. The purpose of this study was to investigate the values of preferred gait, fast gait, and the timed up and go (TUG) test. This study included 46 participants using the Japanese long-term care insurance system. (age 86.5 ± 6.6 years, 12 men, 34 women). The duration of three gait were measured twice using a stopwatch. The SEM was 0.07 for preferred gait, 0.09 for fast gait and 2.59 for TUG. The MDC was 0.19 for preferred gait, 0.26 for fast gait, and 7.17 for TUG. The SEM and MDC values of preferred gait, fast gait, and TUG in this study corroborated with those of previous studies, whereas others were different. Considering that gait speed differs with the country, it may be difficult to compare it among different population groups. We obtained the results of gait speed of Japanese long-term care insurance-certified individuals, which is a new finding.

Reductions in Muscle Strength and Range of Motion Cause Locomotion Disability via Locomotion-Related Functional Limitation in Japanese Older Adults: A Cross-Sectional Study.

BACKGROUND: Functional issues (impairments, functional limitations, and disabilities) gradually occur with age. Nonetheless, maintaining physical capability may help prevent locomotion disabilities at an older age. The present study aimed to determine whether reductions in muscle strength and range of motion (ROM) cause locomotion disability via locomotion-related functional limitations among healthy older adults. METHODS: Data from a total of 144 participants (61 men, 83 women) were analyzed. To assess locomotion disability, the locomotor domain of the activities of daily living (ADLs) survey from the Ministry of Education, Culture, Sports, Science, and Technology of Japan was used. Muscle strength (grip strength) and two ROMs (hip flexion and knee flexion) were measured. To measure locomotion-related functional limitations, participants underwent a 10 m hurdle walking test and side-step test. Thereafter, path analysis was conducted for testing the hypothetical model. The goodness of fit in the model was assessed using statistical parameters, such as the chi-square value, goodness of fit index (GFI), adjusted goodness of fit index (AGFI), comparative fit index (CFI), and root mean square error of approximation (RMSEA). RESULTS: The analysis revealed a nonsignificant chi-square value (chi-square = 41.885; p=0.113), as well as high values of GFI (0.944), AGFI (0.904), CFI (0.970), and RMSEA (0.046), indicating that locomotion disability was caused by locomotion-related functional limitations, which were influenced by muscle strength and ROM. CONCLUSIONS: The present study demonstrated that decreased muscle strength and ROM caused locomotion disability via locomotion-related functional limitations. Older adults should participate in physical exercise programs that focus on strengthening muscles and improving ROM to counteract age-related locomotion disability.

Healthcare-seeking behavior and awareness of physical therapy among Japanese residents in Thailand: a descriptive study.

[Purpose] This descriptive study examined healthcare-seeking behavior and awareness of physical therapy among Japanese residents of different age groups in Thailand. [Participants and Methods] The study included 145 Japanese residents in Thailand. An online questionnaire was used to collect data on the participants' sociodemographic characteristics, healthcare-seeking behavior, and awareness of physical therapy. Participants were categorized into three groups based on age, such as young adults, middle-aged adults, and older adults. The χ2 test and Fisher's exact test were used in the data analysis. [Results] The results showed that compared with the older groups, the youngest group was more likely to visit pharmacies, physical therapy clinics, osteopathic clinics, and Thai massage shops to receive healthcare services for injuries or diseases. The participants learned about healthcare services in Thailand through word-of-mouth. Additionally, more than 50% of all participants knew about physical therapy. [Conclusion] There are some differences in health-seeking behavior and awareness of physical therapy among the groups. The youngest group visited physical therapy clinics and 50% of all participants knew about physical therapy.

Relationship between Mobility-Related Activities of Daily Living and Health-Related Quality of Life among Healthy Older Adults: A Cross-Sectional Study Using Structural Equation Modeling.

Objective: To develop a conceptual model that confirms whether mobility-related activities of daily living (ADLs) abilities are strongly associated with reduced health-related quality of life (HRQOL) in older adults. Methods: A total of 153 participants (63 men, 90 women) were analyzed. The mobility-related ADL survey from the Ministry of Education, Culture, Sports, Science, and Technology of Japan was used. The Japanese version (v1.2) of the Medical Outcomes Study 36-item Short-Form Health Survey was administered to evaluate HRQOL. Structural equation modeling was performed to test a hypothetical model: mobility-related ADL abilities would influence HRQOL. Results: The chi-square value was not significant (chi-square = 9.463, p = .305), and goodness-of-fit values were high, implying that the model was validated; goodness-of-fit index, 0.981; adjusted goodness-of-fit index, 0.949; comparative fit index, 0.996; and root mean square error of approximation, 0.035. Results showed that mobility-related ADL abilities influenced the physical health including physical function and general health in HRQOL. Conclusions: This study developed the conceptual model confirming the influence of mobility-related ADL abilities especially on physical health. Further intervention studies on instructions/training for physical activity of healthy older adults should assess this causal relationship.

Factors characterizing gait performance of patients before and soon after knee arthroplasty.

[Purpose] For monitoring patients with knee osteoarthritis undergoing knee arthroplasty, the Timed Up and Go and maximum walking speed tests are commonly used. To provide appropriate peri-surgical rehabilitation, we evaluated the factors associated with postsurgical changes in Timed Up and Go and maximum walking speed results. [Participants and Methods] We enrolled 545 knee osteoarthritis patients undergoing either of the following knee arthroplasties: conventional total knee arthroplasty, minimally invasive total knee arthroplasty, and unicompartmental knee arthroplasty. Comfortable Timed Up and Go, maximum Timed Up and Go, and maximum walking speed were measured 2 weeks before and soon after surgery. Factors (gender, age, and surgical mode) that might influence changes in test results were evaluated by multiple regression analysis and a two-factor stratification diagram. [Results] Multiple regression analysis revealed that postsurgical changes in comfortable/maximum Timed Up and Go and maximum walking speed results were associated with age and surgical mode after adjustment for preoperative values. Two-factor diagrams showed that the older the patient, the greater was the slowdown in the Timed Up and Go test performed postoperatively. The levels of slowdown in the postoperative Timed Up and Go and maximum walking speed tests were the smallest in those who underwent conventional total knee arthroplasty, followed by those who underwent minimally invasive and unicompartmental knee arthroplasty. Among patients whose preoperative Timed Up and Go and maximum walking speed were slow, slowdown in Timed Up and Go was pronounced with age, and slowdown in maximum walking speed was higher in conventional total knee arthroplasty. [Conclusion] The changes in Timed Up and Go and maximum walking speed results 2 weeks after knee arthroplasty depended on age and surgical modes. These findings are relevant for the implementation of appropriate peri-surgical rehabilitation.