Extended Abstract
1. Objectives
he increase in life expectancy is the inevitable result of development in the health sector [1]. By 2050, the number of Iranian elders will be quintupled [2, 3]. Aging affects different aspects of life (Activities of daily living, mobility, health status) [4]. Also, with population aging, the number of people who need nursing care will increase, which results in financial, social, and health burden on society [5, 6]. Orthopedic disorders are the main reasons for calling nursing services [7, 8]. In 2007, the Japanese Orthopedic Association introduced the term Locomotive Syndrome (LS) [9]. LS is the condition of reduced mobility due to impairment of locomotive organs [10, 11]. LS results in a limitation in movement, imbalance, pain sensation, muscle weakness, and high demand for long-term nursing care [12, 13]. Early detection of the risk factors can help prevent this condition. This study aimed to investigate LS in Iranian elderly and its risk factors.
2. Methods and Materials 
This descriptive, cross-sectional study was conducted on randomly selected 320 community-dwelling elderly in Qaem Shahr City, Iran, in 2018. The study was approved by the Ethics Committee of the University of Social Welfare. 
The study inclusion criteria were individuals ≥60 years old of either sex, ability to check and answer questionnaires (checked by AMT), and willingness to participate in the research.
The exclusion criteria were an inability to walk without assistance, having severe neurologic, cardiovascular, pulmonary or renal disease, suffering from mental illness, history of fractures of the lower extremities and or spine within the last 6 months, and receiving treatments for acute trauma.
The study tools were the demographic questionnaire and the Persian version of geriatric locomotive function scale-25 (Persian-GLFS25). The demographic questionnaire required information about study participants’ age, gender, marital status, education, job, falling, and positive history for chronic pain/diseases. The Persian-GLFS25 contains 25 questions; 4 questions for pain assessment, 17 questions related to daily activities and the quality of life of the elderly, and 4 questions related to social and psychological functioning. Each item is rated from 0 to 4 based on a Likert-type scale. The psychometric properties of the tool in Iranian elderly have been assessed and confirmed. The reliability of the scale was assessed by test-retest and internal consistency (The Cronbach alpha) and calculated results were 0.84 and 0.93, respectively (P=0.01). The concurrent criterion validity was conducted between GLFS25 and EQ-5D (European Quality of Life–5 dimensions) and its Pearson correlation coefficient was found as 0.86. The cut-off score for diagnosis of  LS  was set at 16 (sensitivity=0.88, specificity=0.84) in Iranian elders [14]. The obtained data were presented with descriptive statistics. The correlation between the LS and predictor variables were investigated by logistic regression. All statistical analyses were done in SPSS.V 23.
3. Results
The Mean±SD age of the samples was 69.85±7.7 years. About 55% were in the age category of 60-69 years. Also, 66% of the samples were male, 75% were married, and 86% had a diploma or under diploma literacy level. More than 51.5% of the participants were retired. About 78% of the samples have at least 1 chronic disease. Cardiovascular diseases were the most common illness (77.8%). About 49% percent had a positive history of chronic pain, and 57.5% had a positive history of falling, at least once, in the past year. 
Of the study samples, 42% were in the non-LS group and 58% in the LS group. The Mean±SD scores of GLFS-25 questionnaire in the LS group and the non-LS group were 30.5±13.25 and 8.52±4.4, respectively and this difference was statistically significant (P<0.001).
To predict the outcomes of LS among 320 elders, the logistic regression analysis was used. The final model explained 28.9% to 38.9% of the total variance. The model was fitted with data (Hosmer-Lemeshow test, χ2=5.16, P=0.74) and was able to predict the status of the locomotive syndrome (Omnibus tests, χ2=109.29, P<0.001). Finally, the model properly predicted 75% of the cases. Seven predictor variables were entered the model, by ENTER method and 4 variables successfully predicted the status of LS. The results showed that the variables of age, gender, positive history of chronic disease and chronic pain significantly predicted the LS (P<0.05). Variables of age (OR=1.05, increase per 1 year, CI=1.01-1.10), female gender (OR=2.7, CI=1.38-5.15), positive history of chronic disease (OR=3.4, CI=1.71-6.84) and positive history of chronic pain (OR=4.04, CI=2.23-7.32) predicted LS among elders (Table 1). Linear and multi-linear assumptions were also examined. 
4. Conclusion
The results showed that the diagnosis of locomotive syndrome has a strong association with some variables. For example, our study showed that female gender increases the risk of LS up to 5 times. A positive history for chronic pain and chronic diseases increases the odds for LS, 4 and 3.5 times, respectively. Studies by Kimura et al. (2014), Ebihara et al. (2013), Kawaguchi et al. (2014), Youshimura and Nakamura (2016), Sasaki et al. (2012), Nakamura et al. (2016), Chiba et al. (2016), Muramoto et al. (2016), and Iizuka et al. (2015) support our results, too [15-22]. Regarding the high prevalence of LS in the elderly and its known correlation with these factors, screening the older people who are at risk for LS and taking proper precautions are highly recommended. In the future, nurses should play a more proactive role and provide services such as preventive and supportive measures, client teaching, counseling and so on in this regard.

  

Ethical Considerations
Compliance with ethical guidelines
The research was performed according to general ethical guidelines. It obtained the necessary permissions from the Ethics Committee of Tehran University of Social Welfare and Rehabilitation Sciences (IR.USWR.REC.2017.46). 
Funding
This study was funded by the Iranian Research Center on Aging of University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.  
Authors' contributions
All authors contributed in designing, running, and writing all parts of the research.


Conflicts of interest
The authors declared no conflict of interest.
Acknowledgments
We thank all professors who assisted us in this research and especially and Mr. Reza Ghanei for his comments that greatly improved the manuscript.