Oyedeji Charity I, Hall Katherine, Luciano Alison, Morey Miriam C, Strouse John J
Department of Medicine, Division of Hematology, Duke University School of Medicine, Durham, NC, USA.
Duke Claude D. Pepper Older Americans Independence Center, Durham, NC, USA.
Pilot Feasibility Stud. 2022 Mar 4;8(1):53. doi: 10.1186/s40814-022-01005-3.
The life expectancy for individuals with sickle cell disease (SCD) has greatly increased over the last 50 years. Adults with SCD experience multiple complications such as cardiopulmonary disease, strokes, and avascular necrosis that lead to limitations that geriatric populations often experience. There are no dedicated instruments to measure functional decline and functional age to determine risk of future adverse outcomes in older adults with SCD. The objective of this study was to assess the feasibility of performing the Sickle Cell Disease Functional Assessment (SCD-FA).
We enrolled 40 adults with SCD (20 younger adults aged 18-49 years as a comparison group and 20 older adults aged 50 years and older) in a single-center prospective cohort study. Participants were recruited from a comprehensive sickle cell clinic in an academic center in the southeastern United States. We included measures validated in an oncology geriatric assessment enriched with additional physical performance measures: usual gait speed, seated grip strength, Timed Up and Go, six-minute walk test, and 30-second chair stand. We also included an additional cognitive measure, which was the Montreal Cognitive Assessment, and additional patient-reported measures at the intersection of sickle cell disease and geriatrics. The primary outcome was the proportion completing the assessment. Secondary outcomes were the proportion consenting, duration of the assessment, acceptability, and adverse events.
Eighty percent (44/55) of individuals approached consented, 91% (40/44) completed the SCD-FA in its entirety, and the median duration was 89 min (IQR 80-98). There were no identified adverse events. On the acceptability survey, 95% (38/40) reported the length as appropriate, 2.5% (1/40) reported a question as upsetting, and 5% (2/40) reported portions as difficult. Exploratory analyses of physical function showed 63% (25/40) had a slow usual gait speed (< 1.2 m/s).
The SCD-FA is feasible, acceptable, and safe and physical performance tests identified functional impairments in adults with SCD. These findings will inform the next phase of the study where we will assess the validity of the SCD-FA to predict patient-important outcomes in a larger sample of adults with SCD.
在过去50年里，镰状细胞病（SCD）患者的预期寿命大幅增加。患有SCD的成年人会经历多种并发症，如心肺疾病、中风和缺血性坏死，这些并发症导致了老年人群常出现的身体功能受限。目前尚无专门用于测量功能衰退和功能年龄以确定老年SCD患者未来不良结局风险的工具。本研究的目的是评估进行镰状细胞病功能评估（SCD-FA）的可行性。
我们纳入了40名患有SCD的成年人（20名年龄在18 - 49岁的年轻成年人作为对照组，20名年龄在50岁及以上的老年成年人），进行一项单中心前瞻性队列研究。参与者来自美国东南部一个学术中心的综合镰状细胞诊所。我们纳入了在肿瘤学老年评估中经过验证的测量方法，并增加了额外的身体功能测量指标：日常步行速度、坐位握力、从座椅起身试验、六分钟步行试验和30秒椅子站立试验。我们还纳入了一项额外的认知测量指标，即蒙特利尔认知评估，以及在镰状细胞病和老年医学交叉领域的额外患者报告测量指标。主要结局是完成评估的比例。次要结局是同意参与的比例、评估持续时间、可接受性和不良事件。
80%（44/55）的受邀者同意参与，91%（40/44）的人完整完成了SCD-FA，中位持续时间为89分钟（四分位间距80 - 98）。未发现不良事件。在可接受性调查中，95%（38/40）的人报告评估时长合适，2.5%（1/40）的人报告有一个问题令人不安，5%（2/40）的人报告部分内容较难。身体功能的探索性分析显示，63%（25/40）的人日常步行速度较慢（<1.2米/秒）。
SCD-FA是可行、可接受且安全的，身体功能测试发现了SCD成年患者的功能障碍。这些发现将为研究的下一阶段提供信息，我们将在更大样本的SCD成年患者中评估SCD-FA预测患者重要结局的有效性。
