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J Orthop Sci. 2014 May;19(3):489-96. doi: 10.1007/s00776-014-0537-z. Epub 2014 Feb 8.

Association of physical activities of daily living with the incidence of certified need of care in the long-term care insurance system of Japan: the ROAD study.

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Department of Clinical Motor System Medicine, 22nd Century Medical and Research Center, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan,



The present study aimed to investigate association of physical activities of daily living with the incidence of certified need of care in the national long-term care insurance (LTCI) system in elderly Japanese population-based cohorts.


Of the 3,040 participants in the baseline examination, we enrolled 1,773 (699 men, 1,074 women) aged 65 years or older who were not certified as in need of care-level elderly at baseline. Participants were followed during an average of 4.0 years for incident certification of need of care in the LTCI system. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used assess function. Associated factors in the baseline examination with the occurrence were determined by multivariate Cox proportional hazards regression analysis. Receiver operating characteristic curve analysis was performed to evaluate cut-off values for discriminating between the occurrence and the non-occurrence group.


All 17 items in the WOMAC function domain were significantly associated with the occurrence of certified need of care in the overall population. Cut-off values of the WOMAC function score that maximized the sum of sensitivity and specificity were around 4-6 in the overall population, in men, and in women. Multivariate Cox hazards regression analysis revealed that a WOMAC function score ≥4 was significantly associated with occurrence with the highest hazard ratio (HR) for occurrence after adjusting for confounders in the overall population (HR [95 % confidence interval (CI)] 2.54 [1.76-3.67]) and in women [HR (95 % CI) 3.13 (1.95-5.02)]. A WOMAC function score ≥5 was significantly associated with the highest HR for occurrence in men [HR (95 % CI) 1.88 (1.03-3.43)].


Physical dysfunction in daily living is a predictor of the occurrence of certified need of care. Elderly men with a WOMAC function score ≥5 and women with a score ≥4 should undergo early intervention programs to prevent subsequent deterioration.

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