Mayo Nancy E, Aubertin-Leheudre Mylène, Mate Kedar, Figueiredo Sabrina, Fiore Julio Flavio, Auais Mohammad, Scott Susan C, Morais José A
Department of Medicine, McGill University, Montreal, QC.
Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montreal, QC.
Can Geriatr J. 2023 Mar 1;26(1):133-143. doi: 10.5770/cgj.26.601. eCollection 2023 Mar.
The current measurement approach to frailty is to create an index of frailty status, rather than measure it. The purpose of this study is to test the extent to which a set of items identified within the frailty concept fit a hierarchical linear model (e.g., Rasch model) and form a true measure reflective of the frailty construct.
A sample was assembled from three sources: community organization for at-risk seniors (n=141); colorectal surgery group assessed post-surgery (n=47); and hip fracture assessed post-rehabilitation (n=46). The 234 individuals (age 57 to 97) contributed 348 measurements. The frailty construct was defined according to the named domains within commonly used frailty indices, and items drawn to reflect the frailty came from self-report measures. Performance tests were tested for the extent to which they fit the Rasch model.
Of the 68 items, 29 fit the Rasch model: 19 self-report items on physical function and 10 performance tests, including one for cognition; patient reports of pain, fatigue, mood, and health did not fit; nor did body mass index (BMI) nor any item representing participation.
Items that are typically identified as reflecting the frailty concept fit the Rasch model. The Frailty Ladder would be an efficient and statistically robust way of combining results of different tests into one outcome measure. It would also be a way of identifying which outcomes to target in a personalized intervention. The rungs of the ladder, the hierarchy, could be used to guide treatment goals.
目前对衰弱的测量方法是创建一个衰弱状态指数，而非直接测量衰弱。本研究的目的是测试在衰弱概念中确定的一组项目在多大程度上符合分层线性模型（如拉施模型），并形成一个反映衰弱结构的真实测量指标。
样本来自三个来源：高危老年人社区组织（n = 141）；结直肠手术组术后评估（n = 47）；髋部骨折康复后评估（n = 46）。这234名个体（年龄57至97岁）提供了348次测量数据。根据常用衰弱指数中的指定领域定义衰弱结构，选取反映衰弱的项目来自自我报告测量。对这些项目进行性能测试，以检验它们符合拉施模型的程度。
68个项目中，29个符合拉施模型：19个关于身体功能的自我报告项目和10个性能测试项目，包括1个认知测试项目；患者关于疼痛、疲劳、情绪和健康的报告不符合；体重指数（BMI）以及任何代表参与度的项目也不符合。
通常被认为反映衰弱概念的项目符合拉施模型。衰弱阶梯将是一种将不同测试结果整合为一个结果测量指标的有效且统计稳健的方法。它也是确定个性化干预中目标结果的一种方式。阶梯的各个层级，即层次结构，可用于指导治疗目标。
