Assembly

Frailty

Frailty is a clinical syndrome that occurs in response to a complex interplay between various body systems, predisposing factors and environmental impacts resulting in heightened vulnerability to stressor events1. Frailty is gaining increasing recognition as an important treatable trait in the management of people with chronic lung disease due to its strong association with a range of adverse health outcomes. A detailed synthesis of evidence and knowledge regarding frailty in the context of chronic lung disease (the first of its kind) was recently published2 as well as an international workshop report focusing specifically on the role of pulmonary rehabilitation (PR) to manage this condition3.

As no single best method currently exists to assess frailty, we undertook a rapid review of the literature to describe the instruments commonly used in the context of PR. A systematic search of Medline (Ovid) was undertaken in May 2024 using a combination of terms related to frailty, rehabilitation and specific instrument titles (n = 110 papers). Additional handsearching was conducted to identify relevant information regarding instrument description, validity and reliability outside the PR context (n = 42). Only four instruments were found to be used across a range of different PR settings.

The following outcome measures are described:

  1. Clinical Frailty Scale
  2. Edmonton Frailty Scale
  3. Fried Frailty Scale
  4. Short Physical Performance Battery

We thank the following who collated this material: Abdullah Alzubaidi, PT (Monash University, Victoria, Australia), Keith Hill, PhD, PT (Monash University, Victoria, Australia) and Christian Osadnik, PhD, PT (Monash University, Victoria, Australia); supported by Suzanne Lareau, MS, RN (University of Colorado, Denver, US) and Clarice Tang, PhD (Victoria University, Melbourne, Australia).

References

  1. Morley, J. E., Vellas, B., Van Kan, G. A., Anker, S. D., Bauer, J. M., Bernabei, R., ... & Walston, J. (2013). Frailty consensus: a call to action. Journal of the American Medical Directors Association, 14(6), 392-397.
  2. Osadnik, C. R., Brighton, L. J., Burtin, C., Cesari, M., Lahousse, L., Man, W. D. C., Marengoni, A., Sajnic, A., Singer, J. P., Ter Beek, L., Tsiligianni, I., Varga, J. T., Pavanello, S., & Maddocks, M. (2023). European Respiratory Society statement on fr
  3. Maddocks, M., Brighton, L. J., Alison, J. A., Ter Beek, L., Bhatt, S. P., Brummel, N. E., Burtin, C., Cesari, M., Evans, R. A., Ferrante, L. E., Flores-Flores, O., Franssen, F. M. E., Garvey, C., Harrison, S. L., Iyer, A. S., Lahouse, L., Lareau, S., Lee,


Clinical Frailty Scale

  Description
Name of Questionnaire Clinical Frailty Scale
Abbreviation CFS
Description A summary of an individual’s fitness or frailty[1]
Developer Kenneth Rockwood
E-mail kenneth.rockwood@dal.ca 
Cost None
License required Permission required. Non-commercial educational, clinical and research use, as well as for reprint, usually do not require a license agreement (https://www.dal.ca/sites/gmr/our-tools/clinical-frailty-scale.html).
Self-or rater-administered Rater-administered (practitioner assessment and clinical judgement)
Time to complete < 5 minutes
Number of items Not applicable
Domain & categories (#) 1
Name of domains/categories Frailty
Scaling of items Total score range: 1 - 9
Scoring Scores range from 1 (very fit) to 9 (terminally ill), ≥5 considered frail
Test-retest reliability Inter-rater reliability κ= 0.74 (95%CI 0.67–0.80)[2]
Validity Content validity: Predicts hospitalization (23.9%, 95% CI 8.8%–41.2%) and mortality (21.2%, 95% CI 12.5%–30.6%) in elderly[1].
Predicts 1-year all-cause mortality in older stable COPD (AUC=0.7, 95% CI 0.61-0.78)[3].
Responsiveness to PR Prior to PR (n=80 with frailty): CFS score range 1-3: 0 (0%); 4-9: 80 (100%)
Following PR (n=50 with frailty completed): CFS score range 1-3: 20 (40%); 4-9: 30 (60%)[4].
MIDNot available
Languages Available in multiple languages (https://www.dal.ca/sites/gmr/our-tools/translations.html).
References
  1. Rockwood, K et al. Canadian Med Asso J. 2005; 173:489-495.  
  2. Pugh, RJ et al. Anaesthesia. 2019; 74:758-764.
  3. Zhang D et al. BMC Geriatrics. 2022; 22:57.
  4. Goldsmith, I et al. J Cardiothoracic Surg. 2023; 18:356.  
Date this page was updated November 2024


Edmonton Frailty Scale

  Description
Name of Questionnaire Edmonton Frailty Scale
Abbreviation EFS
Description A screening tool to determine the likelihood of frailty[1].
Developer Darryl Rolfson
Official website (resources) https://edmontonfrailscale.org 
E-mail darryl.rolfson@ualberta.ca 
Cost Fee varies, may be waived when used by individual clinicians or in research with fewer participants.
License required Yes
Self-or rater-administered Self-report, and rater administered (observation of function).
Time to complete <5 minutes[1].
Number of items 11 items
Domains assessed 11
Name of domains Cognition, balance & mobility, functional independence, social support, medication use, nutrition, mood, continence, burden of medical illness and quality of life[1].
Scaling of items Each item rated as 0, 1, 2 (6 items) or Yes, No (5 items)
Scoring Total score ranged from 0-17 by summation of ratings for items[1].
Higher scores represented worse frailty.
0-5= not frail; 6-7 vulnerable; 8-9 mild frailty; 10-11 moderate frailty; 12-17 severe frailty[1].
Test-retest reliability Inter-rater reliability: κ=0.77, p<0.001, Cronbach α =0.62[1] - 0.71[2].
Validity Construct validity: EFS scores related significantly with: Geriatrician’s clinical impression of frailty (r = 0.64 p <0.001), age (r = 0.27, p = <0.05), medication count (r = 0.34, p <0.001) and Barthel Index (r = -0.58, p =0.006), but not MMSE (r = -0.05)[1].
Responsiveness to PR A study using virtual reality PR, EFS scores reduced from pre= 6.56 ± 2.07 to post=5.38 ± 2.00[3].
MID Not available
Languages 32 languages (available https://edmontonfrailscale.org/resources) validity and reliability established for Polish[2], Turkish[4], and Portuguese[5].
References
  1. Rolfson, DB et al. Age and Ageing. 2006; 35:526-529. 
  2. Jankowska-Polańska B et al. Aging Male. 2019; 22:177-186.
  3. Jung, T et al. J Med Internet Res. 2020; 22:e14178.
  4. Aygör, H et al. Arch Gerontol Geriatr. 2018; 76:133-137.
  5. Fabrício-Wehbe SCC et al. Rev. Latino-Am. Enfermagem. 2013; 21:1330-1336.
Date this page was updated November 2024


Fried Frailty Phenotype

  Description
Name of Questionnaire Fried Frailty Phenotype
Abbreviation/Alternate Name FFP/Fried Frail Scale, Fried Scale, Fried Frailty Criteria
Description A scale used to assess for frailty[1].
Developer Linda P. Fried
E-mail lfried@welch.jhu.edu
Cost None
License required No
Self-or rater-administered Combination of self-report components and practitioner assessment
Time to complete <10 minutes[2].
Number of items 5
Domains & categories Not applicable
Scaling of items Scores range 0-5.
Items assigned a score of 1 (detected) or 0 (not detected)[1].
Scoring Robust 0, Pre-frail 1–2, Frail ≥ 3[1].
Test-retest reliability ICC range: 0.65 (95% CI 0.49-0.77) to 0.77 (95% CI 0.65 to 0.84)[2]
Validity Predictive validity: mortality risk (frail/pre-frail vs not frail) range Hazard Ratio 1.21 (0.78; 1.87) to 6.03 (3.00; 12.08) [1][3].
Responsiveness to PR PR reduced frailty prevalence by 61.3%[4].
MID Not available
Languages Not available
References
  1. Fried, LP et al. The Journals of Gerontology. 2001; 56:M146-157.
  2. Feenstra, M et al. BMC Geriatrics. 2021; 21:499.
  3. Bouillon, K., et al. BMC geriatrics. 2013; 13: p1-11.
  4. Maddocks, M et al. Thorax. 2016; 71:988-995.
Date this page was updated November, 2024


Short Physical Performance Battery

  Description
Name of Questionnaire Short Physical Performance Battery[1].
Abbreviation SPPB
Description Originally designed to evaluate lower extremity function[1]. Consists of a combination of balance tests, sit-to-stand test (STS) and 4m gait speed.
Developer Jack M Guralnik
E-mail jguralnik@epi.umaryland.edu 
Cost Free https://www.nia.nih.gov/research/labs/leps/short-physical-performance-battery-sppb
License required No
Self-or rater-administered Rater-administrated
Time to complete 10-15 minutes
Number of items Not applicable
Domains & categories (#) 3
Name of domains Balance, gait speed and lower extremity strength
Scoring Each domain is rated from 0-4 points with maximum score of 12. Higher score better[1]. Frail ≤7, pre frail 8–9, robust 10-12[2].
Test-retest reliability Test–retest reliability reported (ICC range 0.82-0.89)[3], ICC=0.82 (95% CI, 0.62-0.91)[4].
Validity Content validity: Correlates with 6MWT (r=0.5, p<0.001)[5], mMRC (r=-0.45, p<0.003)[5] and Performance-Oriented Mobility Assessment (POMA) score (r=0.87, p<0.01)[6].
Responsiveness to PR Responsive to outpatient[5, 7, 8], home-based[9], hospital-based[10, 11], and telerehabilitation programs[12].
MID 1 point in Total Score[7].
Languages Spanish[13], French (Canadian) [3], Portuguese[3].
References
  1. Guralnik, JM et al. J Gerontol. 1994; 49:M85-94.
  2. Cesari, M et al. Aging Clin Exp Res. 2017; 29:81–88.
  3. Freire, AN et al. J Aging Health. 2012;24: 863-78.
  4. Medina-Mirapeix, F et al. Arch Phys Med Rehabil. 2016, 97:2002-2005.
  5. Larsson, P et al. BMC Res Note. 2018; 11:348.
  6. Lauretani, F et al. Aging Clinical and Experimental Research. 2019, 31: 1435-1442.
  7. Stoffels, AA et al. Arch Phys Med Rehabil. 2021; 102: 2377-2384.
  8. Wickerson, L et al. Clin Transplant. 2020; 34:e14905.
  9. Gephine, S et al. Int J Chron Obstruct Pulmon Dis. 2021;17:1381-1392.
  10. Shimoda, M et al. Medicine. 2021; 100(49): e28151.
  11. Vigorè, M et al. Monaldi Archives for Chest Diseases. 2022; 93: 2447.
  12. Jung, T et al. J Med Internet Res. 2020; 22: e14178. 
  13. Gómez, JF et al. Colomb Med (Cali). 2013; 44: 165-171.
Date this page was updated November, 2024