Musculoskeletal disorders have been reported to be the second largest cause of disability globally.1 Notably, among the elderly, musculoskeletal disorders were the dominant cause of disability.1 Thus, in 2012, the Global Burden of Disease 2010 Study proposed that musculoskeletal health required urgent policy responses.1 As a super‐aging society, Japan has been tackling the rapid increase in the number of the disabled elderly and the associated increasing financial burden.2 The Japanese Government launched the national Long‐Term Care Insurance (LTCI) system in 2000, with the goal of providing suitable care services for each elderly person with disability.2 Presently, the total expense covered by the LTCI system is more than one hundred billion dollars, three times the expense noted 20 years ago.2 Moreover, musculoskeletal disorders are the primary cause for LTCI certification.3 Considering these trends, the Japanese Orthopaedic Association (JOA) proposed the concept of “Locomotive Syndrome” in 2007. The Locomotive Syndrome was defined as a condition of decreased mobility observed during daily activities, such as walking, standing up from a chair, and climbing stairs, stemming from impairments in the locomotive organs.3 This concept was aimed to raise public awareness regarding mobility decrease in individuals across all ages and musculoskeletal disorders being the main reason of disability.3 This concept entailed the necessity to establish management strategies for this syndrome throughout life by identifying the risk factors since mobility decrease could start even during early stages of life.4 To quantify mobility decrease that leads to LTCI certification, that is, disability, the JOA developed the Locomotive Syndrome Risk Test in 2013, which comprises two physical tests and a self‐administered questionnaire.3 The aims of the Locomotive Syndrome Risk Test are twofold: it serves as a screening tool to detect the early signs of mobility decrease leading to disability in the comparatively healthier population, and it is used to quantify mobility decease in the already disabled elderly to prevent disability progression to a more severe form. Therefore, this test was designed as a simple and feasible tool to continuously quantify mobility decrease from young‐ or middle‐age to old age. Additionally, it must be noted that floor or ceiling effects have not been reported for this test. Based on these observations, the JOA defined the stages 0, 1, 2 of the Locomotive Syndrome as follows: Stage 0: not applicable, Stage 1: starting mobility decrease, and Stage 2: progressing mobility decrease.3 Stage 1 indicated the risk level to encourage individuals across all ages to notice their own mobility decrease, while Stage 2 was defined in view of determining the effectiveness of future intervention for mobility decrease, especially among the elderly who were already experiencing a disability. Considering that physical abilities, such as balance, lower extremity muscle strength, and flexibility, peak when the individuals are in their teens or early twenties and decline with age,5 it is reasonable to assume that a certain proportion of the young or middle‐aged adults could have Stage 1 of Locomotive Syndrome. However, if marked prevalence of the Locomotive Syndrome is observed among young or middle‐aged adults, the adoption of suitable management measures is an urgent issue for the society since the decrease in the number of the disabled elderly in the future is a matter of vital importance in a super‐aging society. Generally, mobility decrease is affected by many factors, including age, sex, socioeconomic status, physical activities, and chronic conditions.4 Nowadays, additional risk factors for Locomotive Syndrome have been investigated for the selection of the appropriate intervention for different age groups. Especially, risk factors among the young or middle‐aged adults have been drawing attention since evaluation of these factors may aid in reducing the number of the disabled elderly in the future by generating awareness regarding the Locomotive Syndrome and behavioral modifications. Otsuki et al suggested assessing the prevalence of Stage 1 among the young or middle‐aged adults at workplaces and identifying the lifestyle habits possibly associated with the Locomotive Syndrome,6 which would provide us insights for the prevention of the development of disability, thus, reducing the number of the disabled elderly in the future. Because of the wide range of application from young or middle aged‐adults to the elderly, the Locomotive Syndrome Risk Tests could be adopted not only in Japan but also globally, to address the concerns of decreased mobility leading to disability. Moreover,

中文翻译：

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在超老龄化社会中挑战导致残疾的流动性下降

4 为了量化导致 LTCI 认证的流动性下降，即残疾，JOA 于 2013 年开发了机车综合症风险测试，其中包括两个身体测试和一个自我管理的问卷。 3 机车综合症风险测试的目的是双重的：它作为一种筛查工具，用于在相对健康的人群中检测导致残疾的行动能力下降的早期迹象，并用于量化已经残疾的老年人的行动能力下降，以防止残疾发展为更严重的形式。因此，该测试被设计为一种简单可行的工具，用于持续量化从青年或中年到老年的流动性下降。此外，必须注意的是，此测试未报告地板或天花板效应。基于这些观察，JOA 定义了阶段 0、机车综合症的 1、2 如下：第 0 阶段：不适用，第 1 阶段：开始行动能力下降，第 2 阶段：逐渐减少行动能力。3 阶段 1 表示鼓励所有年龄段的人注意自己行动能力下降的风险水平，而第 2 阶段的定义是为了确定未来干预措施对行动不便的有效性，尤其是在已经患有残疾的老年人中。考虑到平衡、下肢肌肉力量和柔韧性等身体能力在青少年或 20 岁出头时达到顶峰，并随着年龄的增长而下降，5 可以合理假设一定比例的年轻人或中年人成年人可能患有机车综合症的第一阶段。然而，如果机车综合症在青年或中年人中显着流行，那么如何采取合适的管理措施是社会的当务之急，因为未来残疾老年人数量的减少是一个至关重要的问题。超老龄化社会。一般来说，行动不便受许多因素的影响，包括年龄、性别、社会经济地位、身体活动和慢性病。4 如今，已经研究了机车综合症的其他危险因素，以选择适合不同年龄组的干预措施。尤其，年轻人或中年人的危险因素一直受到关注，因为对这些因素的评估可能有助于通过提高对机车综合症和行为改变的认识来减少未来残疾老年人的数量。Otsuki 等人建议评估工作场所中青年或中年人中第一阶段的患病率，并确定可能与机车综合症相关的生活习惯，6 这将为我们预防残疾的发展提供见解，从而减少未来残疾老人的数量。由于从中青年到老年人的广泛应用，机车综合症风险测试不仅可以在日本而且在全球范围内采用，解决因行动不便导致残疾的问题。而且，