ArticleCureus2025
The Rasch Analysis of the 25-Item Geriatric Locomotive Function Scale (GLFS-25) in Japanese Older Adults With Musculoskeletal Disorders: Identifying Age-Related Differences in Terms of Item Difficulty and Misfitting Items.
Article in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
Background and objective Locomotive syndrome (LS), a condition characterized by diminished mobility due to musculoskeletal disorders (MSDs), is a growing concern among older adults. The 25-item Geriatric Locomotive Function Scale (GLFS-25) is a common tool for LS assessment. However, its reliance on classical test theory (CTT) and the inclusion of non-motor function items raise questions about its accuracy in reflecting the severity of motor dysfunction. This study aimed to evaluate the psychometric properties of the GLFS-25 using Rasch analysis, focusing on variations in item difficulty between young-old (60-74 years) and old-old (75-89 years) individuals with MSDs. Methods This cross-sectional study involved 1,000 outpatients (500 young-old and 500 old-old) with MSDs. The participants completed the GLFS-25. Rasch analysis was performed using Winsteps software (Version 5.2.2; www.winsteps.com) to assess item difficulty, individual ability, and item fit. Wright person-item maps were generated to visualize the distribution of item difficulty and individual ability. Infit and outfit mean-square values were used to identify misfitting items. Results The mean age of participants was 73.8 ± 6.8 years. Mean GLFS-25 scores were 26.4 ± 22.3 (young-old) and 35.1 ± 23.0 (old-old). Cronbach's alpha exceeded 0.95 in both groups. Significant differences in LS severity proportions were observed between age groups (p<0.001). Wright maps revealed a scarcity of differentiating items among low-scoring individuals, particularly in the young-old group. Items related to dressing, toilet use, and bathing were most differentiating for high-scoring individuals. Neck/upper limb pain and social engagement were identified as misfitting items across both age groups. Back/lower back/buttock pain and social interaction were misfitting in the young-old and old-old groups, respectively. Conclusions While the GLFS-25 demonstrated excellent internal consistency, Rasch analysis revealed limitations in its ability to differentiate among individuals with low LS scores, particularly in the young-old group. In addition, several misfitting items were identified, suggesting that some items may not contribute effectively to the measurement of LS.
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