The current aging of the population has major impacts on public health. As the population continues to age, the number of elderly patients requiring functional dependence is estimated to increase exponentially. To deal with rapid changes in age demographics, the Japanese government introduced a new insurance system in 2000, the ‘‘Kaigo Hoken’’ (‘‘Long-term Care Insurance’’ in English). The number of elderly people needing nursing care has been increasing every year, creating a heavy financial burden on society. Orthopedic problems, including joint diseases, osteoporosis, and spinal disorders, are one of the main reasons for needing nursing care. One researcher described this situation as an ‘‘age-quake’’ in place of an earthquake. In 2006, three professional Japanese medical societies, the Japanese Orthopedic Association (JOA), the Japanese Society for Musculoskeletal Medicine (formerly the Japanese Society for Musculoskeletal Rehabilitation), and the Japanese Clinical Orthopedic Association (JCOA),
proposed a new entity called the ‘‘musculoskeletal ambulation disability system (MADS) complex’’ to identify symptoms of motor organ deterioration and establish preventive strategies. MADS represents a new category to comprehensively deal with overall locomotive dysfunction. Individuals meeting the criteria for MADS need nursing care. The JOA also proposed a new concept of ‘‘locomotive syndrome’’ as a condition present in candidates at high risk of developing MADS. Locomotive syndrome refers to conditions under which the elderly require care services or conditions under which they may soon require care services because of problems of the locomotive organs [1, 2]. Early detection of any deterioration in locomotive ability is mandatory to target interventions to those with locomotive syndrome and to decrease the number of patients needing nursing care. The purpose of this study was to develop and verify an early detection tool for detecting signs of locomotive syndrome, in the form of a simple questionnaire to assess locomotive function and identify the likelihood of needing nursing care. We have developed a new questionnaire called the ‘‘25-question Geriatric Locomotive Function Scale’’ (GLFS-25, also called the ‘‘Ashikoshi Index 25’’ in Japanese) for early detection of locomotive syndrome, and performed a clinical trial to investigate the psychometric properties of this measure in terms of reliability and validity. A preliminary report of this questionnaire was published in a few Japanese journals [3–6]. Since submitting those reports, we have increased the number of participants and reconfirmed the reliability and validity of the questionnaire, and determined a suitable cutoff score for detecting locomotive syndrome. This article reports on the final results.