葡萄牙版埃德蒙顿衰弱量表在心脏手术患者中的可重复性和有效性。

Reproducibility and validity of the Portuguese Edmonton Frail Scale version in cardiac surgery patients.

作者信息

Castro Maria de Lurdes, Alves Marta, Martins Ana, Luísa Papoila Ana, Botelho Maria-Amália, Fragata José

机构信息

Anesthesiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal.

Epidemiology and Statistics Unit, Research Center, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal.

出版信息

Rev Port Cardiol. 2023 Apr;42(4):295-304. doi: 10.1016/j.repc.2022.03.009. Epub 2023 Feb 2.

DOI:10.1016/j.repc.2022.03.009

PMID:36738965

Abstract

INTRODUCTION

Frailty is a multidimensional syndrome characterized by the loss of functional reserve, associated with higher mortality and less functional survival in cardiac surgery patients. The Edmonton Frail Scale (EFS) is a comprehensive tool devised for brief frailty detection. To the best of our knowledge, there are no culturally adapted and validated frailty screening tools that enable the identification of vulnerability domains suited for use in the preoperative setting in Portugal. This was the motivation for this study.

OBJECTIVES

To assess the validity and reproducibility of the Portuguese version of the EFS.

METHODS

Prospective observational study, in a sample of elective cardiac surgery patients. The Edmonton Frail Scale (EFS) translation and backtranslation were performed. Demographic and clinical data were collected, and the translated EFS translated, Geriatric Depression Scale, and Mini Mental State Examination Portuguese versions, Katz and Clinical Frailty Scales were administered. To assess validity Mann-Whitney test, Spearman's correlation coefficient, marginal homogeneity test and Kappa coefficient were employed. Reproducibility was assessed estimating kappa coefficient for the frailty diagnosis and the 11 EFS items. Intra-class correlation coefficients and the corresponding 95% confidence interval were estimated using linear mixed effects model.

RESULTS

The EFS Portuguese version revealed construct validity for frailty identification, as well as criterion validity for cognition and mood domains. Reproducibility was demonstrated, with k=0.62 (95% confidence interval (CI) 0.42-0.82) and intraclass correlation (ICC)=0.94 (95% CI 0.89-0.97) in inter-observer test and k=0.48 (95% CI 0.26-0.70) and ICC=0.85 (95% CI 0.72-0.92) in intra-observer test.

CONCLUSIONS

The EFS Portuguese version is valid and reproducible for use, suiting pre-operative frailty screening in a cardiac surgery setting.

摘要

引言

衰弱是一种多维度综合征，其特征为功能储备丧失，与心脏手术患者的较高死亡率和较低功能生存率相关。埃德蒙顿衰弱量表（EFS）是一种为快速检测衰弱而设计的综合工具。据我们所知，在葡萄牙，尚无经过文化调适和验证的衰弱筛查工具能够识别适用于术前环境的脆弱领域。这就是本研究的动机。

目的

评估葡萄牙语版EFS的有效性和可重复性。

方法

对择期心脏手术患者样本进行前瞻性观察研究。进行了埃德蒙顿衰弱量表（EFS）的翻译和回译。收集了人口统计学和临床数据，并使用翻译后的EFS、老年抑郁量表、简易精神状态检查表葡萄牙语版、卡茨量表和临床衰弱量表。为评估有效性，采用了曼-惠特尼检验、斯皮尔曼相关系数、边际同质性检验和卡帕系数。通过估计衰弱诊断和11个EFS项目的卡帕系数来评估可重复性。使用线性混合效应模型估计组内相关系数及其相应的95%置信区间。

结果

葡萄牙语版EFS显示出用于衰弱识别的结构效度，以及用于认知和情绪领域的效标效度。在观察者间测试中，可重复性得到证明，卡帕值k = 0.62（95%置信区间（CI）0.42 - 0.82），组内相关系数（ICC）= 0.94（95% CI 0.89 - 0.97）；在观察者内测试中，k = 0.48（95% CI 0.26 - 0.70），ICC = 0.85（95% CI 0.72 - 0.92）。