# 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

## TL;DR

This study evaluates the GLFS-25, a mobility assessment tool for older adults, using Rasch analysis to identify age-related differences in item difficulty and problematic items.

## Contribution

The study applies Rasch analysis to the GLFS-25, revealing age-specific limitations in item discrimination and identifying misfitting items.

## Key findings

- The GLFS-25 showed excellent internal consistency but limited differentiation among low-scoring young-old individuals.
- Items related to dressing, toilet use, and bathing were most differentiating for high-scoring individuals.
- Neck/upper limb pain and social engagement were misfitting items across both age groups.

## 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.