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

Abstract

Background Several methods are available for identifying frailty, but limited tools have been validated in Thai context. Our objective was to evaluate the validity and reliability of the Thai version of the Simple Frailty Questionnaire (T- FRAIL) compared to the Thai Frailty Index (TFI) and to explore modifications to improve its diagnostic properties. Methods The T-FRAIL was translated with permission using a standardized protocol, that included forward and back-translation. Content validity analysis was performed using input from 5 geriatricians. Test-retest reliability, concurrent validity, diagnostic properties, and options to increase the sensitivity of the questionnaire were explored. A cross-sectional study for evaluation validity and reliability was carried out among 3 hundred patients aged 60 or more undergoing elective surgery at a university hospital. Results The item content validity index (I-CVI) showed 1.0 for each questionnaire item. Test-retest reliability within a 7-day interval was done in 30 patients with a good intraclass correlation coefficient of 0.880. Compared with the TFI, the T-FRAIL yielded an excellent accuracy (area under the curve = 0.882). The identification of frailty using a score of 2 points or more provided the best Youden’s index at 63.1 with a sensitivity of 77.5% (95% CI 69.0–84.6) and a specificity of 85.6% (95% CI 79.6–90.3). A cutoff point of 1 out of 5 items for original T-FRAIL provided a sensitivity of 93.3% and a specificity of 61.1%. The modified T-FRAIL (T-FRAIL_M1), by reducing the “illnesses” criterion to 4 or more diseases, at a cutoff point at 1 had a sensitivity of 94.2% and a specificity of 57.8%. Another modified T-FRAIL (T-FRAIL_M2), by combining three components, at a cutoff point at 1 yielded a sensitivity of 85.8% and a specificity of 80.6%. Conclusion The T-FRAIL and its modification demonstrated satisfactory validity and reliability to identify frailty in elderly patients. The cutoff score of 1 point from 5 items from the original version of T-FRAIL and T-FRAIL_M1 provides a highly sensitive screening tool. T-FRAIL_M1 with a cutoff point of 2 and T-FRAIL_M2 yields reasonable sensitivity and specificity for practical use.

Associations between frailty and mild cognitive impairment in older adults: Evidence from rural Chiang Mai Province

“…It is recommended that Thai older adult populations living in rural communities undergo early frailty screening with T-FRAIL and cognitive screening with TMSE [ 27 – 29 ]. Community health volunteers and primary care physicians could play a pivotal role in administering that screening tool to identify older adults at risk.…”

“…The total score ranges from 0 to 5 points and those with a score of 3 to 5 points are categorized as "frail." [ 29 ].…”

The Prevalence of Elder Abuse and its Association with Frailty in Elderly Patients at the Outpatient Department of a Super-Tertiary Care Hospital in Northern Thailand

“…Scores range from 0 to 60, with a psychopathology cut-off of 29 or higher [ 24 ]. Functional assessment, which includes the FRAIL scale [ 25 ] and Barthel Activities of Daily Living [ 26 ]. The FRAIL scale is a short frailty screening tool consisting of 5 questions that assess fatigue, resistance, aerobic capacity, illnesses, and weight loss.…”

“…The FRAIL scale is a short frailty screening tool consisting of 5 questions that assess fatigue, resistance, aerobic capacity, illnesses, and weight loss. Each question is scored from 0 to 1, categorizing patients into three groups: normal (score = 0), prefrail (score = 1–2), and frail (score = 3–5) [ 25 ]. The Barthel index is an ordinal scale used to measure functional independence in personal care and mobility domains.…”

Groningen Frailty Indicator–Chinese (GFI-C) for pre-frailty and frailty assessment among older people living in communities: psychometric properties and diagnostic accuracy

“…The literature accepted that Fried's frailty phenotype can be served as a gold standard for validating the other frailty measurements [48,49,52,61]. However, there were several cautions in the result interpretation [41,62].…”