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Interventions to improve locomotive syndrome: a systematic review and meta-analysis of randomized controlled trials

Iwamoto, Yoshitaka Imura, Takeshi Takahashi, Makoto Tanaka, Ryo 名古屋大学

2023.05

概要

Locomotive syndrome is a common concept proposed by the Japanese Orthopaedic Association
(JOA). It is a musculoskeletal disease that will highly likely require nursing care.1 The intent
behind this proposed concept is to promote locomotive system (bones, muscles, joints, and
peripheral nerves) health awareness for elderly people in Japan to prevent nursing care and bed
rest. Frailty and sarcopenia are similar concepts that describe a declining condition in elderly
people similar to locomotive syndrome. Locomotive syndrome is used especially to identify
physical frailty with musculoskeletal disorders without social and cognitive frailty, although
frailty is a state in which older adults are at high risk of death, disability, and institutionalization.2 Sarcopenia is muscle degeneration with aging and a component of locomotive syndrome.2
Therefore, we believe that this is an adaptable concept to not only older adults but also all
age groups to prevent musculoskeletal disorders and the unfavorable conditions of locomotive
syndrome in the future. In recent years, it has been used as an indicator to evaluate the decline
in motor function not only in Japan but also in other countries.3-6
There have been many intervention studies for frailty and sarcopenia, including systematic
reviews and meta-analyses of several randomized controlled trials (RCTs), which have shown
that interventions with exercise, nutrition, and drugs are effective.7-10 The guidelines for frailty or
sarcopenia have already been reported as a result and have been applied in various clinical and
community settings to standardize prevention, diagnosis, and treatment.11,12 JOA proposed sets
of exercises for locomotive syndrome called locomotion training to strengthen lower extremity
muscle power and improve balance.13 Aoki et al investigated the effects of the exercise included
in locomotion training (single-leg standing with the eyes open and squatting) and vitamin D
supplementation on physical function and locomotor dysfunction in community-dwelling elderly
individuals.14 They found that the two-step test results of all participants in the exercise only,
vitamin D only, and exercise and vitamin D groups were improved, but it was still unclear
which was the most effective intervention because there was no significant difference between
the groups and the degree of change.
The recent publication of guidelines for locomotive syndrome edited by JOA and the Japanese
Society for Musculoskeletal Medicine has enormous significance. It indicates recommendations
and standardized prevention, assessment, and treatment.15 Substantive evidence from high-quality
RCT is needed from the evidence-level perspective. However, there are currently a few recommendations based on high-quality RCTs. There is no review that systematically evaluates and
consolidates the findings of RCTs, although the number of RCTs considering the intervention
effect on locomotive syndrome has been increasing with the concept’s spread. Therefore, this systematic review of RCTs aims to consolidate evidence regarding effective interventions to improve
locomotive syndrome. Furthermore, we believe in its importance in maintaining musculoskeletal
health to widely promote this concept, which is not yet widely recognized internationally. ...

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参考文献

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Appendix 1

Search strategy

【Medline】

#1 locomotive syndrome[Title/Abstract]

#2 (((((randomized[Title/Abstract]) OR (placebo[Title/Abstract])) OR (drug therapy[Title/

Abstract])) OR (randomly[Title/Abstract])) OR (trial[Title/Abstract])) OR (groups[Title/Abstract])

#3 #1 AND #2

【Cochrane Central Register of Controlled Trial】

#1 (locomotive syndrome):ti,ab,kw

#2 (randomized):ti,ab,kw OR (placebo):ti,ab,kw OR (drug therapy):ti,ab,kw OR (randomly):ti,ab,kw

OR (trial):ti,ab,kw OR (groups):ti,ab,kw

#3 #1 AND #2

【Physiotherapy Evidence Database (PEDro)】

“locomotive syndrome”

【Scopus】

TITLE-ABS-KEY ( “locomotive syndrome” ) AND ( TITLE-ABS-KEY ( randomized ) OR

TITLE-ABS-KEY ( placebo ) OR TITLE-ABS-KEY ( “drug therapy” ) OR TITLE-ABS-KEY

( randomly ) OR TITLE-ABS-KEY ( trial ) OR TITLE-ABS-KEY ( groups ) )

【Web of Science】

#1 ALL=(“locomotive syndrome”)

#2 (((((ALL=(randomized)) OR ALL=(placebo)) OR ALL=(“drug therapy”)) OR ALL=(randomly))

OR ALL=(trial)) OR ALL=(groups)

#3 (#1) AND (#2)

【Ichushi Web [in Japanese]】

(ロコモティブシンドローム/TH or ロコモティブシンドローム/AL) and (RD=ランダム化比

較試験)

【Cumulative Index to Nursing and Allied Health Literature】

“locomotive syndrome” AND (randomized OR placebo OR “drug therapy” OR randomly OR

trial OR groups)

References End

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