The 5-question Geriatric Locomotive Function Scale predicts postoperative fall risk in patients undergoing surgery for degenerative cervical myelopathy

J Orthop Sci. 2021 Sep;26(5):779-785. doi: 10.1016/j.jos.2020.08.017. Epub 2020 Oct 24.

Abstract

Background: Falling is one of the main reasons for which older adults require nursing care. Locomotive syndrome (LS) predicts the need for nursing care; however, the relationship between falling and LS remains unclarified. This study aimed to determine whether the 5-question Geriatric Locomotive Function Scale (GLFS-5) predicts postoperative fall risk in patients with degenerative cervical myelopathy (DCM).

Methods: This study is a post hoc analysis of the data from a prospective cohort of patients undergoing surgery for DCM. Participants recorded their falls in a fall diary from the time of study enrollment (baseline) to 1 year postoperatively. Functional assessments were conducted at baseline, hospital admission for surgery, and 1 year postoperatively. Outcome measures included the GLFS-5, Japanese Orthopaedic Association score, Neck Disability Index, EuroQol 5 Dimensions, and 12-Item Short Form Health Survey. Risk factors for falls were investigated, including previous falls, number of medications, and grip strength. Fallers were divided into two categories: all fallers (≥1 falls), and recurrent fallers (≥2 falls). Variables that were significant in univariate analyses were applied in multiple logistic regression models to adjust for confounders.

Results: From the initial group of 168 participants, 159 attended the 1-year follow-up, and 132 fall diaries were retrieved and analyzed. Of these 132 patients, 42 (32%) reported at least one fall, while 25 (19%) reported recurrent falls during the postoperative observation period. The GLFS-5 significantly increased from baseline to admission, and significantly decreased from admission to 1 year postoperatively. In multiple logistic regression analysis, the independent predictors of postoperative recurrent falls were previous falls and a higher baseline GLFS-5. The optimal cut-off value of GLFS-5 for predicting all falls/recurrent falls was 12.

Conclusions: The GLFS-5 reflected time-dependent functional changes in patients undergoing surgery for DCM. Previous falls and a higher baseline GLFS-5 were independent predictors of postoperative recurrent falls.

MeSH terms

  • Aged
  • Geriatric Assessment*
  • Humans
  • Locomotion
  • Prospective Studies
  • Spinal Cord Diseases* / diagnosis
  • Spinal Cord Diseases* / surgery