Validation of the revised 9-scale clinical frailty scale (CFS) in ...

Among many screening tools that have been developed to detect frailty in older adults, Clinical Frailty Scale (CFS) is a valid, reliable and ... Skiptomaincontent Advertisement SearchallBMCarticles Search DownloadPDF Research OpenAccess Published:29June2021 Validationoftherevised9-scaleclinicalfrailtyscale(CFS)inGreeklanguage IoannisVrettos1,2,PanagiotaVoukelatou1,StefaniPanayiotou1,AndreasKyvetos1,AndreasKalliakmanis1,KonstantinosMakrilakis3,4,PetrosP.Sfikakis4,5&DimitrisNiakas2  BMCGeriatrics volume 21,Article number: 393(2021) Citethisarticle 919Accesses Metricsdetails AbstractBackgroundAmongmanyscreeningtoolsthathavebeendevelopedtodetectfrailtyinolderadults,ClinicalFrailtyScale(CFS)isavalid,reliableandeasy-to-usetoolthathasbeentranslatedinseverallanguages.TheaimofthisstudywastodevelopavalidandreliableversionoftheCFStotheGreeklanguage.MethodsAGreekversionwasobtainedbytranslation(EnglishtoGreek)andbacktranslation(GreektoEnglish).The“known-group”constructvalidityoftheCFSwasdeterminedbyusingtestfortrends.CriterionconcurrentvaliditywasassessedbyevaluatingtheextentthatCFSrelatestoBarthelIndex,usingPearson’scorrelationcoefficient.Bothinter-raterandtest–retestreliabilitywereassessedusingintraclasscorrelationcoefficient.ResultsKnowngroupscomparisonsupportstheconstructvalidityoftheCFS.ThestrongnegativecorrelationbetweenCFSandBarthelIndex(rs = − 0,725,p ≤ 0.001),supportsthecriterionconcurrentvalidityoftheinstrument.Theintraclasscorrelationwasgoodforbothinter-rater(0.87,95%CI:0.82–0.90)andtest-retestreliability(0.89:95%CI:0.85–0.92).ConclusionTheGreekversionoftheCFSisavalidandreliableinstrumentfortheidentificationoffrailtyintheGreekpopulation. 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BackgroundOlderadultsareahighlyheterogeneousgroup,withdifferencesintheirhealthandfunctionalstatus.Consequently,peoplewiththesamechronologicalagecanhavedifferentbiologicalages[1].Inthelast30yearsthetermfrailtyisusedmoreandmore[2]tounderstandanddescribethehealthdiversityamongthem.Frailtyisconceptualizedastheresultoftheagingprocessthatleadstocumulativedeclineinmanyphysiologicalsystemsandtoincreasedriskofvulnerability[3].Accordingtothedefinitionofaconsensusgroup,consistingofdelegatesfromsixmajorinternational,European,andUSsocieties,frailtyis“amedicalsyndromewithmultiplecausesandcontributorsthatischaracterizedbydiminishedstrength,endurance,andreducedphysiologicfunctionthatincreasesanindividual’svulnerabilityfordevelopingincreaseddependencyand/ordeath”[4].Amongmanyscreeningtoolsthathavebeendevelopedtodetectfrailtyinolderadults[5]ClinicalFrailtyScale(CFS)isavalid,reliableandeasy-to-usetoolthatallowshealth-careproviderstoassignascorebasedonlyonastandardclinicalinterview[6],andcanalsobereliablyusedretrospectively[7].Ithasbeenintroducedasaseven-pointscale,rangingfromveryfittoseverelyfrail,withavisualchartthataccompaniedadescriptionforeachpointofthescale[6].Later,itwasexpandedfroma7-pointscaletothepresent9-pointscale[8]andrecentlywasfurtherrevisedwithminoreditstotheleveldescriptionsandtheircorrespondinglabels[9].Ithasbeenlargelyusedtoassesstheoverallleveloffitnessorfrailtyinhospitalized[10,11,12,13,14],institutionalized[15,16,17]andcommunity-dwelling[6,7]olderadultsandinelderlypatientsadmittedtointensivecareunits[18,19,20]orevaluatedatemergencydepartments[21,22,23].Asfrailtyhasbeenassociatedwithmortality[6,10,11],lengthofhospitalization[24,25,26],degreeandtimeofrecovery[12,27],re-admission[11,25,28],andfutureneedforinstitutionalization[6,24,29],thereisaneedfortoolsthatcanbeusedpracticallyandquicklytodetectfrailty[30].InordertoavoidmisclassificationduetodifferencesincultureorhowsomeoneperceivestheEnglishversionindividually[31],CFShasbeentranslatedinseverallanguages[30,31,32,33,34,35,36].TryingtopromotetheadequateuseofthisscaleinGreeceweaimedtodevelopavalidandreliableversionoftheCFStotheGreeklanguage.MethodsSample,toolsanddatacollectionAprospectivestudywasconductedamongpatientsolderthan65 yearsold,consecutivelyadmittedthroughtheemergencydepartmentofGeneralandOncologicalHospitalofKifissia“AgioiAnargyroi”fromSeptember2020toJanuary2021.Onadmission,afteracomprehensivegeriatricassessment(CGA)thatrequirestheevaluationofphysical,cognitive,affective,social,financial,andenvironmentalcomponents[37],patients’demographiccharacteristics(age,gender,educationallevel,maritalstatus),medicalhistory(comorbidities),medicationuse(numberandtypeofmedications)andreasonofadmissionwererecorded.CharlsonCo-morbidityIndex(CCI),whichincludesmostmajormedicalcomorbidities[38],wasused,formeasuringco-morbidity,whileactivitiesofdailylivingwereevaluatedusingBarthelIndex[39].CognitivestatuswasassessedbyusingtheGlobalDeteriorationScale,a7-pointscalerangingfromnocognitivedecline(stage1)toveryseverecognitivedecline-severedementia(stage7)thatcanbebrokendownintothreegroups(nocognitivedecline,mildcognitiveimpairment,andsevere-veryseverecognitiveimpairment)[40].BothBarthelIndexandGlobalDeteriorationScalewereestimatedforthebaselinestatusofthepatients,whennotaffectedbyacuteillness.Informationregardingdemographiccharacteristics,medicalandmedicationhistoryandfunctionalstatuswereobtainedbyaskingeitherthepatientsortheircaregivers,whenpatientswerenotabletocommunicate.Aftertheinitialassessment,CFSwasscoredforeachpatient(CFS1).Inordertoevaluateinter-raterreliability,asecondCFSassessmentwasperformedbyanotherexaminerwhodidnotknowtheother’sscore(CFS2).CFSwasalsore-assessedbytheinitialexaminer,toevaluatetest-retestreliability,atleast2weekslater,afterinterrogationoftheentirepatients’record(CFS3).CFS1,CFS2andCFS3werescoredaccordingtothebaselinefunctionofthepatient,beforetheonsetofacuteillnessprecipitatinghospitaladmission.Beforestartingthisstudy,thetwoexaminersunderwenttrainingregardingtheassessmentoffrailtybyusingCFS.Theresearchprotocolwasapprovedbytheinstitutionalethicalandscientificcommittee.Aninformedwrittenconsentwasobtainedfromthepatientsorfromtheirfamilymembers.ObtainingtheGreekversionofCFSAfterobtainingpermissionfromtheoriginalauthors,twoindependenttranslationsoftheClinicalFrailtyScale,fromEnglishintoGreek,weredonebyatranslationagencyandbyamedicaldoctorwithcertifiedexcellentknowledgeoftheEnglishlanguage.Thetwoversionswerecomparedandaconsensus-basedchoiceofanappropriatetranslationwasperformedbytheauthors.Then,theGreekversionofCFSwasretranslatedintoEnglishbyaprofessionaltranslatorandadoctorwhosenativelanguagewasGreekandlivesinEngland.Thetwoback-translatorswereblindedtotheoriginalquestionnaire.Theauthorscomparedthetwoback-translatedversionswiththeoriginalandthedifferenceswereresolvedbyagreementbetweentheauthors,aimingtoimprovetheGreektranslatedversion.TheGreekversionwasthenfurtherassessedbysixmedicaldoctorswhosenativelanguageisGreekandtheircommentswereusedtofurthermodifythescaleandobtainthedefiniteGreekversion(Fig. 1). Fig.1ClinicalFrailtyScaleinGreeklanguageFullsizeimageValidityandreliabilityoftheGreekversionofCFSThe“known-group”constructvalidityoftheCFSwasdeterminedbyexamininghypothesizedrelationshipsbetweensociodemographicandhealth-relatedvariablesandtheleveloffitnessorfrailtyaccordingtoCFS.Specifically,itwasexpectedthatthepresenceoffrailtywouldbeassociatedwitholderage,higherCCI,mobilityproblems,fallsinpreviousmonths,socialwithdrawal,swallowingproblemsandthedegreeofcognitiveimpairment.CriterionconcurrentvaliditywasassessedbyexaminingtheassociationbetweenCFSandBarthelIndex.CFS1andCFS2scoreswereusedfortheevaluationofinter-rater,andCFS1andCFS3scoreswereusedfortheevaluationoftest-retestreliabilityrespectively.StatisticalanalysisAllanalyseswereperformedbyusingSPSSv22.0.ForassessingthedistributionofevaluatedcontinuousvariablestheKolmogorov–Smirnovtestwasused.Thecontinuousvariables:age,CCI,andnumberofmedicationshadnon-Gaussiandistributionandareexpressedasmedianandinterquartilerange.Categoricalvariablesareexpressedaspercentages.Patientswhowerescored1–3atCFSweregroupedasnon-frailandpatientswhowerescored≥4weregroupedasfrail.ConstructvaliditywasevaluatedbyusingknowngroupscomparisontotesthowwelltheCFSdiscriminatesbetweensubgroupsofthestudysamplethatdifferedinage,CCI,mobility,balance,sociability,swallowingabilityandthedegreeofcognitiveimpairment.Testfortrendswasusedforcomparisons.Whenplevelwas