Validation of replacement questions for slowness and weakness to assess the Fried Phenotype: a cross-sectional study

Abstract

Purpose When screening large populations, performance-based measures can be difficult to conduct because they are time consuming and costly, and require well-trained assessors. The aim of the present study is to validate a set of questions replacing the performance-based measures slowness and weakness as part of the Fried frailty phenotype (FRIED-P). Methods A cross-sectional study was conducted among community-dwelling older adults (≥ 60 years) in three Flemish municipalities. The Fried Phenotype (FRIED-P) was used to measure physical frailty. The two performance-based measures of the Fried Phenotype (slowness and weakness) were also measured by means of six substituting questions (FRIED-Q). These questions were validated through sensitivity, specificity, Cohen’s kappa value, observed agreement, correlation analysis, and the area under the curve (AUC, ROC curve). Results 196 older adults participated. According to the FRIED-P, 19.5% of them were frail, 56.9% were pre-frail and 23.6% were non-frail. For slowness, the observed sensitivity was 47.0%, the specificity was 96.5% and the AUC was 0.717. For weakness, the sensitivity was 46.2%, the specificity was 83.7%, and the AUC was 0.649. The overall Spearman correlation between the FRIED-P and the FRIED-Q was r = 0.721 with an observed agreement of 76.6% (weighted linear kappa value = 0.663, quadratic kappa value = 0.738). Conclusions The concordance between the FRIED-P and FRIED-Q was substantial, characterized by a very high specificity, but a moderate sensitivity. This alternative operationalization of the Fried Phenotype—i.e., including six replacement questions instead of two performance-based tests—can be considered to apply as screening tool to screen physical frailty in large populations.

Validity Properties of a Self-reported Modified Frailty Phenotype Among People With HIV in Clinical Care in the United States

“…For prefrailty diagnostics, the Mod-FP was also better at discriminating nonprefrail (specificity of 92%) than prefrail (sensitivity of 77%) PWH at a cutoff of one component. These results are consistent with a study by Van der Elst et al (2020) evaluating the substitution of the functional status measures with self-reported questions. Van der Elst and colleagues hypothesized that these differences in sensitivity and specificity may be indicators of people overestimating their physical health/status in self-report compared with their performance-based assessment results, which may also be the case in our cohort.…”

“…The agreement between the phenotypes was substantial in all weighting schemes (Cohen's kappa ranged from 0.64 to 0.75). Our results were similar to the study by Van der Elst et al (2020), although they included replacement questions for both weakness and slowness, whereas we replaced slowness and excluded weakness from the Mod-FP. We also confirmed that the substitution of gait speed with the mobility PRO is reasonable.…”

“…phenotype validity but is an important feature of the measure (Kim et al, 2020;McMillan et al, 2021;Van der Elst et al, 2020).…”

Frailty and Determinants of Health Among Older Adults in the United States 2011–2016

“…There is sufficient consensus (∼80%) and adequate precedent in the frailty literature for using rapid screens for individuals >70 years old (Morley et al, 2013). Sensitivity, specificity, positive and negative predictive values of the modified Fried phenotype were not calculated in this study, but it is reported elsewhere in smaller study samples (n = 124, n = 135, and n = 196), (Aprahamian et al, 2017;Op Het Veld et al, 2018;Van der Elst et al, 2020). We examined only three NHANES data cycles, and age groups were a categorical variable since the oldest age that could be reported was 80 years.…”

Screening tools to expedite assessment of frailty in people receiving haemodialysis: a diagnostic accuracy study

“…For this reason, many clinicians still find this procedure time-consuming and potentially unpractical in the context of renal outpatient services [ 12 ]. To overcome this implementability issue, several researchers have designed alternative operationalisations of the Fried phenotype by replacing the performance-based measures with subjective (questionnaire-based) assessments in both CKD [ 16 ] and non-CKD populations [ 17 , 18 ]. Although these self-reported definitions of frailty perform well in predicting adverse outcomes [ 5 ], they are often less accurate than objective assessments of physical performance in diagnosing frailty in people living with CKD-5 [ 12 , 16 ].…”