Validity and reliability of the Thai version of the simple frailty questionnaire (T-FRAIL) with modifications to improve its diagnostic properties in the preoperative setting (original) (raw)
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FRAIL scale: Predictive validity and diagnostic test accuracy
Australasian Journal on Ageing, 2020
ObjectiveTo examine the predictive validity of the FRAIL scale for mortality, and diagnostic test accuracy (DTA) against the frailty phenotype (FP).MeasurementFrailty was measured in 846 community‐dwelling adults (mean age 74.3 [SD 6.3] years, 54.8% female) using a modified FRAIL scale and modified FP. Mortality was matched to death records.ResultsThe FRAIL scale demonstrated significant predictive validity for mortality up to 10 years (Frail adjHR: 2.60, P < .001). DTA findings were acceptable for specificity (86.8%) and Youden index (0.50), but not sensitivity (63.6%), or area under the receiver operator curve (auROC) (0.75). DTA estimates were more acceptable when a cut‐point of ≥2 characteristics was used rather than ≥3 in the primary DTA analysis.ConclusionThe FRAIL scale is a valid predictor of mortality. DTA estimates depend on FRAIL scale cut‐point used. This instrument is a potentially useful frailty screening tool.
The frailty dilemma. Review of the predictive accuracy of major frailty scores
European Journal of Internal Medicine, 2012
Background: To identify frail elderly individuals, several index or scoring systems have been developed for research purposes. The practical value of these scores for screening and diagnostic use is uncertain. Aim: The available scoring systems were reviewed to determine whether they can be used in daily practice. Methods: Literature study on relevant test instruments developed for the detection of frailty on the basis of theoretical views on the frailty concept. Data on sensitivity and specificity and predictive values were extracted. Results: Several (n = 6) frailty scores were described with respect to their value as a screening or diagnostic test. Outcome of the selected test instruments is presented as a risk of negative health outcome when a test is positive. The reported AUCs of ROCs varied from 0.55 for functional decline in people admitted to an accident and emergency department to 0.87 for prediction of mortality on the basis of a co-morbidity score. As the prevalence of frailty and resulting negative health outcomes in published reports was low (5-41%), presented sensitivity and specificity values lead to low positive predictive values (6-49%) but reasonable negative predictive values (73-96%). Conclusions: As the number of false positive values of most available tests is substantial, these frailty scores are of limited value for both screening and diagnostic purposes in daily practice. As diagnostic instruments they can best be used to exclude frailty. The false-positive rate of currently available tests is too high to allow major decisions on medical care to be made on the basis of a positive test.
BJGP Open
BackgroundThere is little knowledge of the diagnostic accuracy of screening programmes for frailty in primary care settings.AimTo assess a two-step strategy consisting of the administration of the FRAIL scale to those who are non-dependent and aged ≥75 years, followed-up by measurement of the Short Physical Performance Battery (SPPB) or gait speed in those who are positive.Design & settingCross-sectional and longitudinal cohort study. Analysis of primary care data from the FRAILTOOLS project at five European cities.MethodAll primary care patients consecutively attending were enrolled. They received the index tests, plus the Fried frailty phenotype (FP) and the frailty index to assess their frailty status. Mortality and worsening of dependency in basic and instrumental activities of daily living (BADL and IADL) over 1 year were ascertained.ResultsPrevalence of frailty based on FP was 14.9% in the 362 participants. A FRAIL scale score ≥1 had a sensitivity of 83.3% (95% confidence inte...
Screening for Frailty With the FRAIL Scale: A Comparison With the Phenotype Criteria
Journal of the American Medical Directors Association, 2017
Background: Reliable and valid frailty screening instruments are lacking. The aim of the present study was to compare the diagnostic properties of the FRAIL-BR with Fried's frailty phenotype (CHS), which has not been done. Methods: Cross-sectional observational study of 124 older adults aged 60 or older from 2 universitybased geriatric outpatient units in the state of São Paulo, Brazil. In ROC analyses, we evaluated different cutoff points and AUC areas of the FRAIL-BR compared with the CHS criteria. Also, components of both diagnostic strategies had head-to-head comparisons whenever possible. Results: The sample was composed mostly of overweight (mean BMI ¼ 29.5 kg/m 2) women (83%) with mean age of 78.6 (AE7.1) years. Prevalence of frailty varied according to the FRAIL-BR (23.3%) and the CHS criteria (14.5%) (P ¼ .04). A cutoff of 3 points in the FRAIL-BR presented a sensitivity of 28% and specificity of 90% (P ¼ .049). A cutoff of 2 points resulted in a sensitivity of 54% and specificity of 73% (P ¼ .01). Comparisons of 4 FRAIL-BR items (ie, weight loss, aerobic capacity, fatigue, and physical resistance) to the respective CHS components showed an independent diagnostic property of all measures, with the exception for weight loss. Conclusion: The FRAIL scale can be used as a screening instrument for frailty (time and cost-effective).
Aging and Disease, 2023
The concept frail elderly has been used to highlight the biological, rather than chronological, age. International and national bodies recommend that individuals over age 70 who visit healthcare facilities should be screened for frailty. There are important objections to the concept. Diagnostics: 'Frailty' is used for several completely different types of health problems. There are no useful biomarkers, but more than 60 different published rating methods for frailty, where different methods provide very different prevalence of frailty and also do not identify the same groups of elderly people. There is significant overlap between Clinical Frailty Scalescores and activity of daily living (ADL)-scores. There is no gold standard method against which published frailty rating scales can be validated. It is unclear when, where and how often screening for frailty should occur in healthcare. Treatment: The evidence for treatment of frailty is very weak. A recent systematic overview found that the 21 included randomised, controlled studies (RCTs) were very heterogeneous as regards inclusion/exclusion criteria, how the condition of frailty was defined, what treatment was given and what health outcomes were assessed. In addition, there are often problems with the quality of the studies. The lack of a clear definition and evidence-based treatment of frailty means that it is inappropriate to introduce assessments of frailty in individual elderly patients in health care
IntechOpen Publishers, 2021
Geriatrics is an applied science as its practice is an art of medicine. As a scientific discipline, there exists a potential race for measurements. Frailty stands as among poorly defined concepts in geriatric medicine. There are philosophical, circumstantial, and practical justifications behind this rather seemingly clinical tragedy. This chapter contributes toward reliability and validity aspects of currently applied frailty scales and indicators across different population base. It acknowledges the contribution of Fried's frailty scale. It also describes different frailty scales and indicators tested in America, Europe, and Asia. Lastly, the chapter contrasts the popular belief behind applications of Cronbach's α coefficient of test scores for reliability assessment in clinical research. Other research gaps are also highlighted including merging clinical research findings in geriatrics with psychosocial aspects under the emerging field of geropsychology. It also proposes a solution for usage in future studies that aim at assessing reliability of test scores in clinical and biomedical sciences.
BMC Geriatrics
Background: The objectives of this study were to determine: 1) the prevalence of frailty using Fried's phenotype method and the Short Performance Physical Battery (SPPB), 2) agreement between frailty assessment methods, 3) the feasibility of assessing frailty using Fried's phenotype method and the SPPB. Methods: This cross-sectional study was conducted at a geriatric outpatient clinic in Hamilton, Canada. A research assistant conducted all frailty assessments. Patients were classified as non-frail, pre-frail or frail according to Fried's phenotype method and the SPPB. Agreement among methods is reported using the Cohen kappa statistic (standard error). Feasibility data included the percent of eligible participants agreeing to attempt the frailty assessments (criterion for feasibility: ≥90% of patients agreeing to the frailty assessment), equipment required, and safety considerations. A p-value of <0.05 is considered significant. Results: A total of 110 participants (92%) and 109 participants (91%) agreed to attempt Fried's phenotype method and SPPB, respectively. No adverse events occurred during any assessments. According to Fried's phenotype method, the prevalence of frailty and pre-frailty was 35% and 56%, respectively, and according to the SPPB, the prevalence of frailty and pre-frailty was 50% and 35%, respectively. There was fair to moderate agreement between methods for determining which participants were frail (0.488 [0.082], p < 0.001) and pre-frail (0.272 [0.084], p = 0.002). Conclusions: Frailty and pre-frailty are common in this geriatric outpatient population, and there is fair to moderate agreement between Fried's phenotype method and the SPPB. Over 90% of the patients who were eligible for the study agreed to attempt the frailty assessments, demonstrating that according to our feasibility criteria, frailty can be assessed in this patient population. Assessing frailty may help clinicians identify high-risk patients and tailor interventions based on baseline frailty characteristics.
BMC Geriatrics
Background There is growing interest for interventions aiming at preventing frailty progression or even to reverse frailty in older people, yet it is still unclear which frailty instrument is most appropriate for measuring change scores over time to determine the effectiveness of interventions. The aim of this prospective cohort study was to determine reproducibility and responsiveness properties of the Frailty Index (FI) and Frailty Phenotype (FP) in acutely hospitalized medical patients aged 70 years and older. Methods Reproducibility was assessed by Intra-Class Correlation Coefficients (ICC), standard error of measurement (SEM) and smallest detectable change (SDC); Responsiveness was assessed by the standardized response mean (SRM), and area under the receiver operating characteristic curve (AUC). Results At baseline, 243 patients were included with a median age of 76 years (range 70–98). The analytic samples included 192 and 187 patients in the three and twelve months follow-up ...
Asian Journal of Gerontology and Geriatrics
Objective. To adapt and validate the Indonesian version of the FRAIL scale (Ina-FRAIL) and the SARC-F (Ina-SARC-F). Methods. The Ina-FRAIL and the Ina-SARC-F were developed through forwards-backwards translation, and their validity (itemtotal item correlations), internal consistency (Cronbach's alpha), and test-retest reliability (kappa statistic) were determined. The diagnostic performance of the Ina-FRAIL and the Ina-SARC-F was evaluated using the receiver operating characteristic curve analysis. Results. A total of 101 (57 men and 44 women) and 64 (23 men and 41 women) patients were included in the validation of the Ina-FRAIL scale and the Ina-SARC-F, respectively. For the Ina-FRAIL scale, internal consistency coefficient was 0.530, and test-retest reliability was 0.951 (p<0.001). The correlation coefficients between the total score and items of fatigue, resistance, ambulation, illness, and loss of weight were 0.503, 0.813, 0.679, 0.561, and 0.317, respectively (all p<0.001). Correlation between the Ina-FRAIL scale and the Cardiovascular Health Study was strong (rs=0.696, p<0.001). Using the cutoff value of ≥2, the diagnostic performance of the Ina-FRAIL was 80% sensitivity and 70.4% specificity. For the Ina-SARC-F, internal consistency was 0.851, and test-retest reliability was 1.00 (p<0.001). The correlation coefficients between the total score and items of strength, ambulation, rising, climbing, and falls were 0.646, 0.775, 0.653, 0.685, and 0.580, respectively (all r>0.361 and p<0.001). Using the cutoff value of ≥3, the diagnosis performance of the Ina-SARC-F was 100% sensitivity and 61.7% specificity. Conclusions. The Ina-FRAIL scale and the Ina-SARC-F are valid and reliable tools to screen for frailty syndrome and sarcopenia, respectively.