泰语版简易虚弱问卷（T-FRAIL）的有效性和可靠性，对其进行修改以提高其在术前环境中的诊断性能。
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.
机构信息
Department of Medicine, Faculty of Medicine Khon Kaen University, Khon Kaen, 40002, Thailand.
Department of Anesthesiology, Faculty of Medicine Khon Kaen University, Khon Kaen, 40002, Thailand.
出版信息
BMC Geriatr. 2022 Feb 28;22(1):161. doi: 10.1186/s12877-022-02863-5.
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.
背景
有多种方法可用于识别虚弱，但在泰国背景下，经过验证的工具有限。我们的目的是评估经许可使用标准化协议翻译的泰国简易虚弱问卷（T-FRAIL）与泰国虚弱指数（TFI）相比的有效性和可靠性，并探讨改进其诊断特性的方法。
方法
T-FRAIL 经许可使用标准化协议翻译，包括正向和反向翻译。内容有效性分析采用 5 位老年医学专家的意见。测试-重测信度、同时有效性、诊断特性以及提高问卷敏感性的选择进行了探讨。在一家大学医院接受择期手术的 300 名 60 岁或以上的患者中进行了横断面研究，以评估有效性和可靠性。
结果
每个问卷条目的内容有效性指数（I-CVI）均为 1.0。在 30 名患者中进行了为期 7 天的间隔测试-重测，内类相关系数为 0.880，具有良好的信度。与 TFI 相比，T-FRAIL 具有极好的准确性（曲线下面积为 0.882）。使用 2 分或以上的评分来识别虚弱可获得最佳的 Youden 指数（63.1%），敏感性为 77.5%（95%CI 69.0-84.6），特异性为 85.6%（95%CI 79.6-90.3）。原始 T-FRAIL 的 5 个项目中得分 1 分的截断点提供了 93.3%的敏感性和 61.1%的特异性。通过将“疾病”标准减少到 4 种或以上疾病，将截断点设置为 1 的改良 T-FRAIL（T-FRAIL_M1）的敏感性为 94.2%，特异性为 57.8%。另一个改良 T-FRAIL（T-FRAIL_M2）通过组合三个部分，在 1 分的截断点下，敏感性为 85.8%，特异性为 80.6%。
结论
T-FRAIL 及其改良版可用于识别老年患者的虚弱，具有令人满意的有效性和可靠性。原始 T-FRAIL 版本的 5 个项目中得分 1 分的截断点和 T-FRAIL_M1 提供了高度敏感的筛查工具。T-FRAIL_M1 的截断点为 2，T-FRAIL_M2 的敏感性和特异性合理，适用于实际应用。
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