Van der Elst Michael C J, Schoenmakers Birgitte, Op Het Veld Linda P M, De Roeck Ellen E, Van der Vorst Anne, Schols Jos M G A, De Lepeleire Jan, Kempen Gertrudis I J M
Department of Public Health and Primary Care, University of Leuven, Kapucijnenvoer 33 Bus 7001, 3000, Leuven, Belgium.
Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
Eur Geriatr Med. 2020 Oct;11(5):793-801. doi: 10.1007/s41999-020-00337-8. Epub 2020 Jun 4.
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).
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).
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).
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.
在对大量人群进行筛查时，基于表现的测量可能难以实施，因为它们耗时且成本高，还需要训练有素的评估人员。本研究的目的是验证一组问题，以取代基于表现的动作迟缓及虚弱测量，作为弗里德衰弱表型（FRIED-P）的一部分。
在弗拉芒地区三个市镇的社区居住老年人（≥60岁）中开展了一项横断面研究。采用弗里德表型（FRIED-P）来测量身体衰弱情况。弗里德表型的两项基于表现的测量（动作迟缓及虚弱）也通过六个替代问题（FRIED-Q）进行测量。这些问题通过敏感性、特异性、科恩kappa值、观察一致性、相关性分析以及曲线下面积（AUC，ROC曲线）进行验证。
196名老年人参与了研究。根据FRIED-P，其中19.5%为衰弱，56.9%为衰弱前期，23.6%为非衰弱。对于动作迟缓，观察到的敏感性为47.0%，特异性为96.5%，AUC为0.717。对于虚弱，敏感性为46.2%，特异性为83.7%，AUC为0.649。FRIED-P与FRIED-Q之间的总体斯皮尔曼相关性为r = 0.721，观察一致性为76.6%（加权线性kappa值 = 0.663，二次kappa值 = 0.738）。
FRIED-P与FRIED-Q之间的一致性较高，其特点是特异性非常高，但敏感性中等。弗里德表型的这种替代操作化方式，即包括六个替代问题而非两项基于表现的测试，可被视为一种筛查工具，用于在大量人群中筛查身体衰弱情况。
