Web-based software applications for frailty assessment in ...

For example, an electronic frailty index calculation in the Electronic Medical ... Fried LP, Walston J. Frailty and failure to thrive. Skiptomaincontent Advertisement SearchallBMCarticles Search DownloadPDF Research OpenAccess Published:18December2021 Web-basedsoftwareapplicationsforfrailtyassessmentinolderadults:ascopingreviewofcurrentstatuswithinsightsintofuturedevelopment RileyChang1,HilaryLow1,2,AndrewMcDonald1,3,GracePark3,4&XiaoweiSong1,2,5  BMCGeriatrics volume 21,Article number: 723(2021) Citethisarticle 752Accesses Metricsdetails AbstractBackgroundAcrucialaspectofcontinuedseniorcareistheearlydetectionandmanagementoffrailty.Developingreliableandsecureelectronicfrailtyassessmenttoolscanbenefitvirtualappointments,aneedespeciallyrelevantinthecontextoftheCOVID-19pandemic.Anemergingefforthastargetedweb-basedsoftwareapplicationstoimproveaccessibilityandusage.Theobjectivesofthisscopingreviewaretoidentifyandevaluateweb-basedfrailtyassessmenttoolscurrentlyavailableandtoidentifychallengesandopportunitiesforfuturedevelopment.MethodsWeconductedareviewwithliterature(e.g.,usingMEDLINEdatabases)andGooglesearches(lastupdatedonOctober10,2021).Eachoftheidentifiedwebapplicationswereassessedbasedoneightfeaturedcategoriesandassignedaratingscoreaccordingly.ResultsTwelveweb-basedfrailtyassessmentapplicationswerefound,chieflyprovidedbytheUSA(50%)orEuropeancountries(41%)andfocusedonfrailtygradingandoutcomepredictionforspecificpatientgroups(59%).CategoriesthatscoredwellamongtheapplicationsincludedtheUserInterface(2.8/3)andtheCost(2.7/3).Othercategorieshadameanscoreof1.6/3orlower.TheleastdevelopedfeaturewasDataSaving.ConclusionsWeb-basedapplicationsrepresentaviableoptionforremotefrailtyassessmentsandmultidisciplinaryintegratedcareofolderadults.Despitetheavailableweb-basedfrailtyassessmentsontheInternet,manymissedcertainneededfeaturesforprofessionaluseinhealthcaresettings.Thissituationcallsforfullycomprehensiveweb-basedapplications,takingintoconsiderationanumberofkeyfunctionslinkinggraphicaluserinterfaceandfunctionalities,andpayingspecialattentiontosecuredatamanagement. PeerReviewreports BackgroundFrailtyisamultidimensionalstateofincreasedvulnerabilitywithagethatcanleadtoincreasedriskofmanyadverseoutcomes,includinghospitalizationandmortality[1,2].Frailtycanbeoperationalizedinmanyways,althoughnoneofthemhaveprovidedadefinitediagnosis[2,3,4,5,6].Thephenotypicapproachcategorizesthephysicalpresentationoffrailtybasedonfiveclinicalfeaturesincludingweakness,slowwalkingspeed,unintentionalweightloss,exhaustion,andlowphysicalactivity[7,8].Thedeficitaccumulationbasedfrailtyindexestimatestheproportionalpresentationofhealthproblemsofawiderangeofhealthdomains[6,9].Bothapproacheshavegainedpopularityandbeenwidelyusedinclinicalandepidemiologicalstudies[10].Ongoingeffortsarebeingmadetoenablefrailty-informedcareofolderadultsinvolvingmultidisciplinarycareteams[10].Forsuchintegratedcare,earlydetectionandmanagementoffrailtyiskey[10].EmergingdatahavealsohighlightedtherelationshipbetweenfrailtyandtheCOVID-19deathsandotheradverseeffectsinolderadults,whoaremorelikelytohavecomorbiditiesofmultipleorgansystemsandtoencounterothermedicalandsocialchallenges[11,12,13].Followingthephysicaldistancingguidelines,virtualizedapproachesarebeingincreasinglyadoptedtocontinueseniorcareandfrailtymanagement,whilereducingin-personappointments[14,15].Besidesthepandemic,someolderadultsmayalsobebesetbytransportationrelatedissuesthatpreventeasyaccesstoprimarycare(e.g.mobilityproblems,lackofcaregiverabilitytodrive,nodriver'slicense,remotearea)[16,17],increasingtheneedforreliablevirtualassessments.Web-basedhealthassessmentshavepotentialtobenefitvirtualappointmentsandfrailtydetection,astheyallowcareprovidersofdifferentsettingstofeasiblyaccessassessmentdataandbetterunderstandtheleveloffrailtyanditschangesinindividualpatientsindevelopingoptimizedcareplans(e.g.interventionstrategiesanddischargecare).Aswell,thepotentiallarge-scaledatasharingovertheInternetcanbenefitdemographicalresearchinpromotingthehealthofolderadultsinagingpopulations.Ingeneral,web-basedapplicationscanalsobeavailableforfreeoratalowcost,moretimeefficient,andallowautomaticcalculationsleadingtoimmediateresults[18,19,20,21].Itisanticipatedthatwiththeneedformaintainingphysicaldistancing,reliableweb-basedassessmentswillbeindemandforfuturefrailtyassessments.Frailtyassessmentshavetraditionallyreliedonmanualdataentryandprocessing,whichcanbetime-consuminganderror-prone[21,22].Recentresearchhasenabledcomputerizedsolutions.Forexample,anelectronicfrailtyindexcalculationintheElectronicMedicalRecords(EMR)systemhasallowedforfrailtymeasuresinprimarycareformillionsofolderpatientsintheUKandseveralotherEuropeancountries[23,24].Morerecently,acomputerizedfrailtymeasurenamedtheelectronicfrailtyindex(eFI)hasbeenconstructedbasedontheelectronicComprehensiveGeriatricAssessment(eCGA,amultidisciplinarydiagnosticassessmentthatevaluatesmanydomainsofolderadults’healthandcareneeds)[25,26].BeingavailableintheEMRsystemandasstandalonesoftwarethatrunsonpersonalcomputers[25],theeFI-CGAistime-efficientandcost-effective.Evenso,accessingtheEMRfromhomecanbecumbersome,anddownloading/installingthestandaloneversionupgradescanbeinconvenient.ThisisespeciallytrueforhealthprofessionalswhohavenoaccesstoanEMR,includingthosewhocareforolderadultsinemergency,acutecare,andlong-termcaresettings.Motivatedtodevelopaweb-basedsoftwaretoolforreliablefrailtyassessment,weconductedathoroughsearchandevaluationofthecurrentlyavailablewebapplicationsinthefield.Thepurposeofthisstudyistoprovideinsightstoguidefutureweb-basedfrailtyassessmentsoftwaredevelopment,includingtheweb-basedeFI-CGA.Ourspecificobjectiveswereto:1)understandwhatwebapplicationsexistforfrailtyassessment;2)describetheusabilityoftheseapplications;and3)evaluatethechallengesandopportunitiesoffutureweb-basedfrailtyassessments.Whereapplicable,thePreferredReportingItemsforSystematicReviewsandMeta-AnalysesforScopingReviewsguidelines(PRISMA-Scr)wereapplied[27]toallowabroadscopeontheconceptofweb-basedfrailtyassessmentswasobtained.MethodsInformationsourcesThestudyusedtheelectronicMEDLINEdatabase,andtheGooglesearchengine.TheMEDLINE-basedliteraturesearchwasconductedtoextractinformationfrompeer-reviewedresearchliterature.Additionaldatabases(EMBASE,whichcapturesmoreinternationalpublications,andCINAHL, whichcapturesmorepublicationsaimedatnursingandalliedhealthprofessions)weresearchedtoverifythewebsitesfound,withbroadercoverageofthehigh-qualityresearchfromthesearches.Consideringthenatureofweb-basedsoftwareapplications,forwhichmanydevelopersdonotpublishjournalarticlesontheirweb-basedtools,aGooglesearchwasconductedinadditiontothetraditionalliteraturesearchbydirectlyidentifyingthewebsiteslinkingtothesoftwareapplications.Tworesearchers(RCandHL)conductedeachofthesearchesindependently,whichweremostrecentlyupdatedonOctober10,2021(Fig. 1).Fig.1FlowdiagramshowingsearchesonGoogleandMEDLINEFullsizeimageSearchtermsThesearcheswereperformedbasedonthreesetsofkeywords:Set1:"online"or"web-based"or"website-based";Set2:"geriatric"or"frailty"or“olderadult”;andSet3:"assessment"or"softwaretool"or"application"or“calculator”.Fortheliteraturesearch,thethreesetsofkeywordswerecombinedwithadditionalcontrolledvocabulary,whichincluded“Internet”,“geriatrics”,“aged”,“frailty”,“mobileapplication”,“user-computerinterface”,“geriatricassessment”,and“riskassessment”(Additionalfile1).FortheGooglesearch,theindividualtermsinsets1through3werecombinedoneonone,creating36uniquesearchinputs(Additionalfile2).A“*”signwasusedtorepresentdifferentsuffixesofthesamewordinthesearchinputs/stringwhereapplicable.SearchmethodsandselectionofsourcesofevidenceThesearchstrategyconsistedofastandardliteraturesearchsupplementedbya websitesearch.Theprocesswasdevelopedwiththeconsultationandhelpofexperiencedlibrarians.LiteraturesearchusingMEDLINEWeincludedstudiespublishedfromtheinceptionofthedatabasetoOctober10,2021.Articletitlesandabstractswerescreenedtoincludepublicationsdiscussingfrailtyassessment.Namesofspecificfrailtyrelatedweb-basedassessmentswerethenextractedfromtheserelevantarticles.WebsitesearchusingGoogleTominimizetheselectionandcustomizationimpactoftheGooglesearchengine,allpersonalaccountswereloggedoutofpriortoeachsearch,andthehistory,cookies,andcachewerecleared.Foreachuniquesearchinputterm,thefirst50non-advertisementresultswereretrieved,whichsufficientlycoveredallrelevantmaterials.Thisyieldedatotalof1800initialresults(Fig.1).Allinitialwebsitetitlesandpreviewsweresequentiallyscreenedtoincludewebsitesrelatedtofrailtyassessment.Theresultingwebsiteswerethenfullyscannedtoensuretheyeitherhostedawebapplicationonfrailtyassessmentorincludedadirectexternallinktosuchawebapplication(Fig.1).Anadditionalcheckofeachoftheindividualwebapplicationswasconductedtoensuretheassessmentremainsavailableonlineandmeetstheselectioncriteriaasspecifiedbelow.Finally,theresultsfromthesesearcheswerecombined,yieldingafinallistofwebapplicationsforfurtherevaluationandanalysis(Fig.1).SelectioncriteriaWeb-basedfrailtyassessmentswereincludediftheymetthefollowinginclusioncriteria:(1)relatedtofrailty,(2)hadafillableformfordatacollection,(3)hostedonawebdomain,(4)focusedonolderadults,and(5)interfacedinEnglish.Theexclusioncriteriawere:(1)notavailableonline,(2)onlydisplayedanon-fillablePDFversionorconductedacalculation(i.e.,asimplecalculatorthatdoesnotspecify/assessanyitem),and(3)notaccessibleforresearchuseoranyindependentapplication(e.g.,assessmentsbuiltintoanEMRsystemorimbeddedwithinaresearchproject).AssessmentcharacteristicsselectedanddatachartingprocessConsideringthecommonfeaturesofwebapplications,eachapplicationwasevaluatedapplyingIEEErecommendationsforscoringthatconsistedofacomprehensivelistofsoftwarecriteria[28,29,30,31,32,33,34]ofatotalof13categories(Table 2).Theseincludeduserfriendlyinterface,effectivedatasaving,completenessofhealthdomaininclusion(Additionalfile3),completenessofhealthiteminclusion,thecostofusage,resultsinterpretationavailability,instructionsandtrainingavailability,remoteaccess,andconductancepossibility(Table2,toppanel);andtimeefficiencyofassessment,algorithmefficiency,security,environmentalrequirements,andbrowserrequirements(Table2,bottompanel).Thecategorieswererelevanttofrailtyandwidespreadapplicationpotential(e.g.promotingdigitalhealthandbenefitingvirtualhealthassessment)andreflectedthepopulations,concepts,andcontextsofinterestinthisreview[27].Foreachwebapplicationidentified,anassessmentscorewasassignedusingaratinggraderangingfrom0to3foragivencategory,withhigherscoresmeaningbetterperformance(Table2).Foracategorythatcouldnotbeadequatelyevaluated(i.e.missedbeingreportedbymostwebsites),thecategorywasnotpresentedinthesummedupscore.Theevaluationandscoringwereconductedindependentlybytworesearchers(RCandHL).Anydiscrepancieswereresolvedthroughdiscussionsbetweentheresearchersandconsensuseswereachieveduponthemajorityvoteinvolvingadditionalresearchers(AM,XS).ResultsCharacteristicsofassessmentsThefinalsetofresultsconsistedoftwelveweb-basedfrailtyassessmentapplications,allofwhichweredevelopedoverthepastsixyears(2015–2021).ThemajorityofthewebapplicationswereprovidedbytheUSA(50%)orEuropeancountries(41%),withafocusonfrailtygradingandoutcomepredictionforspecificpatientgroups(59%).EachofthewebapplicationsissummarizedbelowanddescribedwithmoredetailsinTable 1.Table1Web-basedfrailtyassessmentsFullsizetableReleasedin2015,theQxMDprovidedwebEdmontonFrailScaleconsistsof11itemsovermultiplehealthdomains.Itprovidesasimplewaytoassessfrailtyinolderadultsandcanbecompletedin5 minonaverage.Alsoreleasedin2015,theMyelomaFrailtyScoreCalculatoraidsintheprognosisofelderlymyelomapatients,throughassessing31itemsonage,comorbidities,cognitive,andphysicalfunctions,whichcanbesavedinaPDFdocumentalongwiththecalculatedscore.Inthefollowingyear,theJohnsHopkinsFrailtyAssessmentCalculatorwasreleasedtoassessthefive-itemfrailtyphenotype[8].Afreetrialislimitedto5calculations;unlimitedcalculationsandguidebookanddatabaseaccesscanbeobtainedwithanannualsubscription. TheGeriatric8(G8)HealthStatusScreeningToolwasupdatedin2017,foridentifyingoldercancerpatientswhomaybenefitfromaCGAthroughassessingphysicalandneuropsychologicalhealth.FreeaccountscandownloadaPDFassessment;asubscriptionleadstounlimiteddownloadsandtheabilitytoaddnotestothePDF. TheLiverFrailtyIndexwasalsoreleasedin2017toassessphysicalfrailtyinpatientswithchronicliverdiseaseand/orcirrhosis.Itassessesthreeperformance-baseditems:gripstrength,chairstands,andbalance,withdetailedinstructionsincludingdiagramsforuse.Alsoreleasedin2017,theQFrailtyRiskCalculatorassessesolderadults’riskofdevelopingfrailtyinvolving40+deficitsover10healthdomains.Thesoftwareestimatesthefrailtydegrees(e.g“mild”or“severe”),andthetwo-yearhospitalizationanddeathrisks. TheFrailtyRiskCalculatorwasreleasedin2018.Utilizingsocialandclinicalvariables,thistoolestimatestheprobabilityofhospitalizationordeathwithinthenextyearforolderadults.Alsoreleasedin2018,theSeniorHealthCalculatorusestheCGAitemstoproduceadeficitaccumulationbasedFI.Fiftyitemsonmedicalhistory,functionalstatus,performancetests,andnutritionalstatusareassessed,andFIcalculationcanbebasedonlyonthefirsttwodomains.Theinputdata,FI,andsummarymaybesavedorprintedasPDF. TheModifiedFrailtyIndexwasrecentlyupdatedin2019andassessesthemorbidityandmortalityrisksinoldergeneralsurgerypatientsbasedontheFI.FreeaccountscandownloadaPDFassessment;asubscriptionleadstounlimiteddownloadsandaddingnotestothePDF. TheMyelodysplasticsyndromes(MDS)SpecificFrailtyIndexwasreleasedin2020andevaluatesfrailtyinpatientswithmyelodysplasticsyndrome.Seventeenitemsareincludedtocalculateafrailtyscaleratio,compositescore,andestimatedsurvivaloutcome.Usersmaymanuallycopy/pastetheinputandoutputtothelocalcomputer. TheCumulativeIllnessRatingScale-Geriatric(CIRS-G)isanassessmentthatquantifiesthediseaseburdeninolderadults.Ituses14multiple-choicecomorbiditiestoproduceafrailtyscore.Withafreeaccount,userscancopyassessmentinputsandresultstothelocalcomputer.In2021,theFrailtyGroupCalculatorwasreleased.Itassesses21itemsfromtheCharlsonComorbidityIndex,GeriatricNutritionalRiskIndex,andactivitiesofdailylivingtoproduceafrailtyscore.Thewebsiteincludesadetaileddescriptionofalltermsused(Table1).SynthesisofresultsEightfeaturecategoriescouldbeappliedtoscoringthesewebapplications(i.e.,assigninga0through3toeachcategory),making24themaximumpossiblesum-upscorethatawebapplicationcouldreceiveforhighperformance(Table2).Figure 2showsthecategoricalandsum-upscoresofeachwebapplication.ThetwocategoriesthatscoredwithhighvaluesamongtheapplicationswereUserInterfaceandCost(2.75/3and2.67/3,respectively),whereastheothercategorieshadameanscoreof1.67orlower(Fig. 2).ThecategorywiththelowestscorewasDataSaving,withonly4assessmentsnotscoringa0,asmostofthewebapplicationspermittednoorveryprimitivedatasavingordataloading.Table2EvaluationcategoriesandcriteriaFullsizetableFig.2Graphcomparingthetotalscoresofeachassessment.*Thescoringwasbasedonthecategoriesasgiveninthelegends.Additionalcategories(timeefficiency,security,algorithmefficiency,environmentalandbrowserrequirements)couldnotbescoredduetolimitedinformationfromtheapplicationsunderevaluationFullsizeimageDiscussionWeconductedthisstudytounderstandwhatfrailtyassessmenttoolsarecurrentlyavailableonlineandtoevaluatetheirusabilityconsideringalargenumberoffeaturecategories.Tothebestofourknowledge,thisisthefirstattempttoidentifyandsummarizeweb-basedfrailtyassessmentapplicationsinascopingreview.Thisisalsothefirstknownstudythatcomprehensivelyevaluatestheapplicabilityandlimitationsofwebapplications.Theresearchhasallowedustogenerateimportantinsightsintosuccessfulfuturedevelopmentofonlinesoftwaretoolsinsupportofearlydetectionandmanagementoffrailty.Theassessmentsunderevaluationshowedseveralessentialmeritsandhavemultipleadvantages.Mostapplicationshaveimplementedahighlyfriendlyuserinterface.Onecrucialbenefitofhavingaweb-basedassessmentistheconvenienceandeaseofcompletingtheassessmentwithsimpleselectionsandmouseclicks[20,23].Forexample,thewebapplicationsrealizeduserinterfacefunctionalitybyemployingradiobuttonselectionforthebinary“yesorno”questions,whichismoretimeconservativethanusingadrop-downmenuortextbox.Mostapplicationsalsoappearedtobehighlycostefficient.Makingassessmentsavailableforfreecanhelpmaximizethepotentialforadoptionandimpact.Havingeasilyaccessiblefrailtyassessmentswillencourageuseandscaleuptheeffortoffrailtymanagement.Despitethesebeneficialqualities,severalimportantareasmaybeimprovedinfuturedevelopmentofweb-basedfrailtytools.Forexample,theassessmentpagesoftenlackedclearandcomprehensiveinstructionsortrainingmaterials.Includingsufficientmaterialsoftrainingandeducationcanbecrucialforpotentialuserstoaccuratelyandeffectivelycompletetheassessments,especiallyregardingthespecificsofsomeperformanceitems(e.g.specificversionofthe“sittostand”test).Similarargumentscanapplytoincludinghelpfulmaterialsforresultsinterpretation.Eventhoughanassessmentcanyieldascoreorafrailtyrating,thesenumberswouldneedinterpretationwithcontext.Addingthisinformationcanhelptheuserunderstandtheassessmentoutcomemoreaccurately,benefitingpatientcareplanning.Itisalsoworthnotingthattheexistingwebapplicationscommonlyincludedlimitedoptionsfordatasavingandretrieval.Althoughcopyingofthecompletedassessmentandtheassociatedscoringmightbeallowedbysome,workingwiththedataorevenreloadingthesavedassessmentsforprocessing/editingweretypicallyunmanageable.Inthecontextofvirtualhealthappointments,thisfeatureisneededinscenarioswhereanassessmentmustbecompletedovermorethanonesessionduetotimerestrictions,interruptedInternetconnections,orotherdisruptionsthathealthcareprofessionalsmayexperience[35].Further,amajorityoftheassessmentsconsideredonlyalimitednumberofhealthdomainsand/ortotalitems.Becausefrailtyiscommonlyrecognizedasamultidimensionalsyndromecharacterizedbythelossofphysiologicalreserveinmultiplehealthsystems[6,9]frailtyassessmentscanhaveimprovedprecisionrelatingtheoutcomeswhenawiderangeofhealthdomainsanditemsareconsidered,foracomprehensiveoverviewofpatients’health.Forexample,ithasbeenrecommendedthata deficitaccumulation-basedfrailtyindexincludesnolessthan30individualitemswhenpossible[36,37].Ourstudyhasseverallimitations.TheliteraturesearchlargelyusedtheMEDLINEdatabases.Althoughappliedathoroughsearchstrategy wasappliedandcheckedagainstadditionaldatabasestoincreasecoverageofhighqualityresearch,theliteraturesearchesyieldedonlyalimitednumberofthewebsites.Thissituationisdeterminedbythegenerallackofresearchpublicationsforwebapplicationsonfrailty.WhensupplementedbytheGooglesearch,morewebsiteshostingsuchwebapplicationswereretrieveddirectly,regardlessofwhetherifanyscientificpublicationswereassociatedwiththem.Whilethesearchstrategyhasproperlytargetedtheresearchtopicathand,itisstillpossiblethatsomewebapplicationsthatareonlyavailablefromlessprominentresourcesmayhavebeenoverlooked.Likewise,frailtyassessmentsthatareelectronicbutnotweb-based,suchastheEMRdataanalysesoffrailtywithintheUKandseveralothercountries[23,38],andthefrailtyassessmentwithintheEMRs[26],werenotincluded.Otherusefulbutnonweb-basedassessmentsthatmayhavebeenexcludedcanincludethosethatareeimbeddedinspecificclinicalprogramsorresearchinvestigationssuchasInterRAI,awell-establishedglobalinitiative,inwhichawide-rangeofembeddedfunctionaltoolsaredeveloped,includingfrailtyscales[39].Asprogram-imbeddedtoolsarenotreadilyidentifiableoraccessibleviaInternetdomains,theyarenotalwayssearchablefollowingaconsistentapproach(e.g.,theonedescribedinthemethodology),andapplyingpriorknowledgeabouttheseembeddedtoolsinthesearchwouldlikelyleadtocertainadditions,butinthemeantime,inconsistentinclusions.Also,whileusinganonlinesearchenginetosupplementthestandardliteraturesearchhasmeritforamoreadequatewebsiteidentification,itisacknowledgedthatthecommercialaspectofasearchenginecanpotentiallycompromiseanunbiasedsearch.Inaddressingthislimitation,ourstrategyhasallowedtheexclusionofallresultslabeledasadvertisements,theclean-upofallpersonalaccounts,andthescanningofasufficientnumberof results,avoidingthepossibilityoflimitingthesearchtoretrievingonlytothe“mostpopular”resultsdisplayedfirst.Further,asthestudyfocusedistheavailability,accessibility,functionality,andusabilityofthewebapplications,wehaveincludedallfrailtyconceptualizationandoperationalizationapproachesfound;i.e.,thecontentvalidityandpsychometricsofthefrailtyassessmentsthemselvesbaseduponthewebapplicationsdevelopedwerenotconsiderationsforexclusion[40].Also,severalcategoriesoftheevaluation(timeefficiency,security,algorithmefficiency,environmentalrequirements,andbrowserrequirements)werenotassessable,duetothelackofdataprovidedbythewebapplicationsunderreview.Informationontheseaspectscanbefundamentalinsoftwareappraisal[25,28,30,31,32,33,34],andweencouragefuturedevelopmentstotaketheseintoconsiderationwithsoftwareimplementationandreporthowtheseaspectsareaddressed.Despitetheselimitations,ourstudycontributestotheresearchfieldandisrelevanttoadvancingearlydetectionandmanagementoffrailty.Wehaveappliedtheestablishedsoftwareevaluationapproaches[28,29,30,31,32,33,34]foran insightfulunderstandingoftheavailablewebapplications,highlightingtheimportantfeaturestoconsiderforinclusioninfuturedevelopment,includingourongoingeffortinadvancingafullyfunctionalweb-basedeFI-CGA(https://efi-cga.ca/).Creatingrobustweb-basedfrailtyassessmentspresentsopportunitiesformorewidelyaccessiblefrailtymonitoringandmanagement.Inthisregard,standalonesoftwaretoolsarelimitedbytheneedtomanuallydownloadandinstallsoftwareandanyneededupdates.Standaloneapplicationscanalsorestricteffectivedatasharing,asdataisonlysavedlocallyontheuser’scomputer.Similarly,assessmentsembeddedinEMRsystemsareonlyaccessiblefromcertainlocations(e.g.,familyphysicianclinics),restrictingaccessibilitybyhealthprofessionalswhocareforolderadultsinacuteandlong-termsettings,andlimitingindividualizedintegratedcare.Webfrailtyassessmentsmayallowforamuch-requiredcontinuityofcareforpatients,particularlyforfrailolderadultswithcomplexmedicalneeds,asshownbytheabilitytopredicthospitaloutcomesfromfrailtymeasures[18,19,20,21,41,42,43].Anothermajoradvantageofweb-basedfrailtyassessmentsisthepotentialofincreasingtheefficiencyofdatamanagementandlarge-scaleinformationsharing.InCanada,andperhapsinsomeothercountries,thelackofinteroperabilityofEMRsystemsrepresentsamajorbarriertoaunifiedelectronichealthsolution[44].TakingtheEMRbasedeFI-CGAasanexample,vendorsofdifferentEMRsystemshaveautomatedtheassessmentindifferentways,makingitdifficulttointegratemeasurementsandoutputs[25].AwebapplicationcanprovideasolutionthroughtheuniversallyaccessibleInternet,whichismeaningfulforpromotingeffortsinprovidingbettercareforpeoplein theagingsociety.TheCOVID-19pandemicanditsconsequenceshavealsohighlightedthevalueofweb-basedassessments,withhealthcareprovidersneedingflexiblehealthassessmentstoaccommodatephysicaldistancingrestrictions[15].Forinstance,wehaveseenanincreasingnumberofrequestssincethebeginningofthepandemicforobtainingacopyofthestandaloneeFI-CGAsoftwaretool[25].Havingweb-basedassessmentswouldallowforfrailtymanagementtocontinueduringtimesoflimitedcontact,astheycanbereadilyaccessed.OneconcernrelatedtovirtualhealthappointmentsmaybetheabilityofolderadultstousethenecessarytechnologiessuchastheInternetorvideocallplatforms.However,throughoutthecourseofthepandemic,manypatientsorproviderswhomayhavebeendeemedas“technologically limited”haveadaptedandbecomeproficientinusingvideocallsforotheractivitiessuchasexercise,socializing,andlearning[43].Whileaninitiallearningcurveisexpected,thereisagenerallypositiveperspectivetowardsvirtualcareapplyingcomputerizedtechnologieswithinthenewgenerationofolderadults[45].Aforeseeablechallengetowidespreadadoption ofweb-basedfrailtyassessmentsisthepatientprivacyanddatasecurityconcerns.Giventhattherearemanyhealthcaresystemsalreadyusingexternaldataplatformsincludingtherapydeliveryandpatientmonitoring,itisanticipatedthatwithsufficientprecautionsandregulations,perhapsonedaythesamecanbedoneforfrailty.Eventhoughpreviouseffortstoexpandvirtualcaremetwithsomeresistance[43],theCOVID-19pandemichas“kickstarted”thisexpansion.Asdifferentaspectsofvirtualhealthcareadvance,itisimportantthatfrailtyassessmentsadvanceconcurrently–ifweexpectfrailtyidentificationandmanagementtohaveamorecentralroleinolderadults’healthcare,asrecommended[10,46],wemustensureitevolvesasthehealthcaresystemdoes.Theprocessmaytaketimeandeffort,andthepresentstudyaimstoaidthetransitionbyhighlightingthecurrentlyavailableweb-basedfrailtyassessmentsandprovidinginsightsondevelopingwebapplicationsforuseinvirtualcare.ConclusionsTakentogether,web-basedapplicationsrepresentaviableoptionforremotefrailtyassessmentsandmultidisciplinaryintegratedcareofolderadults.PresentedfollowingthePRISMA-ScR,thisscopingreviewhasshownthatdespitetheavailabilityofweb-basedfrailtyassessmentsontheInternet,manylackcertainfeaturesneededforprofessionaluseinhealthcaresettings.Thissituationcallsforfullycomprehensiveweb-basedapplications,takingintoaccountanumberofkeyfunctionslinkingthefrontandbackendsandpayingspecialattentiontosecuredatamanagement.Itisanticipatedthathavingreliableandeffectiveweb-basedhealthapplicationswillpromoteremoteassessmentsasanaspectofvirtualcareascommonpracticeinthefuture. 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Consentforpublication Notapplicable. Competinginterests Theauthorsdeclarethattheyhavenocompetinginterests. AdditionalinformationPublisher’sNoteSpringerNatureremainsneutralwithregardtojurisdictionalclaimsinpublishedmapsandinstitutionalaffiliations.SupplementaryInformation Additionalfile1.Searchtermsandcontrolledvocabularyfortheliteraturesearchusingtheelectronicdatabases.Additionalfile2.GoogleSearchStringsforWebsites.Additionalfile3.Healthdomainsandexamples.Additionalfile4.Web-basedapplicationsandassociatedscoresassignedduringanalysis.Rightsandpermissions OpenAccessThisarticleislicensedunderaCreativeCommonsAttribution4.0InternationalLicense,whichpermitsuse,sharing,adaptation,distributionandreproductioninanymediumorformat,aslongasyougiveappropriatecredittotheoriginalauthor(s)andthesource,providealinktotheCreativeCommonslicence,andindicateifchangesweremade.Theimagesorotherthirdpartymaterialinthisarticleareincludedinthearticle'sCreativeCommonslicence,unlessindicatedotherwiseinacreditlinetothematerial.Ifmaterialisnotincludedinthearticle'sCreativeCommonslicenceandyourintendeduseisnotpermittedbystatutoryregulationorexceedsthepermitteduse,youwillneedtoobtainpermissiondirectlyfromthecopyrightholder.Toviewacopyofthislicence,visithttp://creativecommons.org/licenses/by/4.0/.TheCreativeCommonsPublicDomainDedicationwaiver(http://creativecommons.org/publicdomain/zero/1.0/)appliestothedatamadeavailableinthisarticle,unlessotherwisestatedinacreditlinetothedata. ReprintsandPermissionsAboutthisarticleCitethisarticleChang,R.,Low,H.,McDonald,A.etal.Web-basedsoftwareapplicationsforfrailtyassessmentinolderadults:ascopingreviewofcurrentstatuswithinsightsintofuturedevelopment. BMCGeriatr21,723(2021).https://doi.org/10.1186/s12877-021-02660-6DownloadcitationReceived:23July2021Accepted:15November2021Published:18December2021DOI:https://doi.org/10.1186/s12877-021-02660-6SharethisarticleAnyoneyousharethefollowinglinkwithwillbeabletoreadthiscontent:GetshareablelinkSorry,ashareablelinkisnotcurrentlyavailableforthisarticle.Copytoclipboard ProvidedbytheSpringerNatureSharedItcontent-sharinginitiative KeywordsComprehensivegeriatricassessmentDigitalhealthFrailtyassessmentsWeb-basedsoftwareWebapplications DownloadPDF Advertisement BMCGeriatrics ISSN:1471-2318 Contactus Submissionenquiries:[email protected] Generalenquiries:[email protected]