Diagnostic accuracy of the FRAIL scale plus functional measures for frailty screening: a cross-sectional study

Ángel Rodríguez-Laso; Iñaki Martín-Lesende; Alan Sinclair; Sandrine Sourdet; Matteo Tosato; Leocadio Rodríguez-Mañas

doi:10.3399/BJGPO.2021.0220

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Figure 1. Recommended frailty screening algorithm in primary care. CGA = comprehensive geriatric assessment. SPPB = Short Physical Performance Battery.

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Table 1. Characteristics of the sample for the cross-sectional analysis (n = 362)

Category	Variable	n (%)^a
Age, years, median (IQR)		79 (77–82)
Sex, female		213 (58.8)
City	Getafe (Spain)	116 (32.0)
	Toulouse (France)	93 (25.7)
	Rome (Italy)	78 (21.5)
	Cracow (Poland)	48 (13.3)
	Birmingham (UK)	27 (7.5)
Charlson Comorbidity Index score, median (IQR)		4 (4–5)
Barthel index score, median (IQR)		100 (95–100)
Lawton and Brody scale score, median (IQR)		8 (7–8)
Frail according to frailty phenotype^b		54 (14.9)
Frail or prefrail according to frailty phenotype^b	Total	276 (76.2)
Frail or prefrail according to frailty phenotype^b	Missing	4 (1.1)
Number of items of the frailty phenotype^b	0	82 (22.7)
	1	112 (30.9)
	2	104 (28.7)
	3	33 (9.1)
	4	17 (4.7)
	5	1 (0.3)
	Missing	13 (3.6)
Frailty index score, median (IQR)		0.16 (0.12–0.22)
Frail according to frailty index		55 (15.2)
Number of items of the FRAIL scale	0	209 (57.7)
	1	85 (23.5)
	2	38 (10.5)
	3	25 (6.9)
	4	4 (1.1)
	5	1 (0.3)
SPPB score, median (IQR)		10 (9–11)
Gait speed, m/s	Total, median (IQR)	1 (0.9–1.3)
Gait speed, m/s	Missing	18 (5.0)
Worsening of dependence in basic activities of daily living	Total	46 (16.7)^c
Worsening of dependence in basic activities of daily living	Missing	87 (24.0)
Worsening of dependence in instrumental activities of daily living	Total	47 (17.1)^c
	Missing	87 (24.0)
Deaths	Total	2 (0.8)^d
Deaths	Missing	107 (29.6)

^aUnless otherwise stated. ^bThese numbers do not match because of the possibility of assigning an individual with missing items to the frail or frail+ prefrail categories. ^c N = 275. ^d N = 255. IQR = interquartile range. SPPB = Short Physical Performance Battery.

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Table 2. Prevalence and diagnostic accuracy for frailty of different cut-offs of the FRAIL scale

FRAIL scale	Prevalence (95% CI)	Sensitivity (95% CI)		Specificity (95% CI)		% of positives who were not frail (95% CI)
		Fried's frailty phenotype	Frailty index	Fried's frailty phenotype	Frailty index	Fried's frailty phenotype	Frailty index
≥3	8.3(5.4 to 11.1)	37.0(23.7 to 50.3)	23.6(12.0 to 35.2)	96.8(94.8 to 98.7)	94.5(91.9 to 97.0)	33.3(15.4 to 51.2)	56.7(37.8 to 75.5)
≥2	18.8(14.7 to 22.8)	66.7(53.7 to 79.7)	40.0(26.6 to 53.4)	89.6(86.2 to 93.0)	85.0(81.0 to 89.0)	47.1(34.9 to 59.2)	67.6(56.2 to 79.1)
≥1	42.3(37.2 to 47.4)	83.3(73.1 to 93.6)	74.5(62.7 to 86.4)	64.9(59.6 to 70.3)	63.5(58.1 to 68.9)	70.6(63.3 to 77.9)	73.2(66.1 to 80.3)

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Table 3. Prevalence and diagnostic accuracy for frailty of different SPPB scores in individuals with a FRAIL score ≥1

SPPB score	Prevalence (95% CI)	Sensitivity (95% CI)		Specificity (95% CI)		% of positives who were not frail (95% CI)
		Fried's frailty phenotype	Frailty index	Fried's frailty phenotype	Frailty index	Fried's frailty phenotype	Frailty index
	0.6(0.0 to 1.3)	3.7(0.0 to 8.9)	3.6(0.0 to 8.7)	100.0	100.0	0.0	0.0
<2	0.8(0.0 to 1.8)	5.6(0.0 to 11.9)	3.6(0.0 to 8.7)	100.0	99.7(99.0 to 100.0)	0.0	33.3(0.0 to 100.0)
<3	1.1(0.0 to 2.2)	7.4(0.2 to 14.6)	5.5(0.0 to 11.7)	100.0	99.7(99.0 to 100.0)	0.0	25.0(0.0 to 100.0)
<4	1.9(0.5 to 3.4)	11.1(2.5 to 19.8)	7.3(0.2 to 14.4)	99.7(99.0 to 100.0)	99.0(97.9 to 100.0)	14.3(0.0 to 49.2)	42.9(0.0 to 92.3)
<5	3.0(1.3 to 4.8)	18.5(7.8 to 29.2)	10.9(2.4 to 19.4)	99.7(99.0 to 100.0)	98.4(96.9 to 99.8)	9.1(0.0 to 29.3)	45.5(10.4 to 80.5)
<6	5.5(3.2 to 7.9)	31.5(18.7 to 44.3)	21.8(10.6 to 33.1)	99.0(97.9 to 100.0)	97.4(95.6 to 99.2)	15.0(0.0 to 32.1)	40.0(16.5 to 63.5)
<7	7.2(4.5 to 9.9)	38.9(25.5 to 52.3)	23.6(12.0 to 35.2)	98.4(97 to 99.8)	95.8(93.5 to 98.0)	19.2(3.0 to 35.5)	50.0(29.4 to 70.6)
<8	10.2(7.1 to 13.4)	46.3(32.6 to 60.0)	30.9(18.3 to 43.5)	96.1(93.9 to 98.3)	93.5(90.7 to 96.3)	32.4(16.6 to 48.3)	54.1(37.2 to 70.9)
<9	15.7(12.0 to 19.5)	55.6(41.9 to 69.2)	40.0(26.6 to 53.4)	91.2(88.1 to 94.4)	88.6(85.0 to 92.2)	47.4(34.0 to 60.7)	61.4(48.4 to 74.4)
<10	24.6(20.1 to 29.0)	68.5(55.7 to 81.3)	56.4(42.8 to 69.9)	83.1(78.9 to 87.3)	81.1(76.7 to 85.5)	58.4(48.0 to 68.9)	65.2(55.1 to 75.3)
	32.3(27.5 to 37.2)	72.2(59.9 to 84.6)	67.3(54.5 to 80.1)	74.7(69.8 to 79.6)	73.9(69.0 to 78.9)	66.7(58.0 to 75.3)	68.4(59.8 to 76.9)
<12	38.4(33.4 to 43.4)	75.9(64.1 to 87.7)	72.7(60.6 to 84.9)	68.2(63.0 to 73.4)	67.8(62.5 to 73.0)	70.5(62.8 to 78.2)	71.2(63.6 to 78.8)

Percentages refer to the total sample (n = 362), not only to individuals with a FRAIL score ≥1. SPPB = Short Physical Performance Battery.

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Table 4. Prevalence and diagnostic accuracy for frailty of different gait speeds in individuals with a FRAIL score ≥1

Gait speed, m/s	Prevalence (95% CI)	Sensitivity (95% CI)		Specificity (95% CI)		% of positives who were not frail (95% CI)
		Fried's frailty phenotype	Frailty index	Fried's frailty phenotype	Frailty index	Fried's frailty phenotype	Frailty index
<0.6	6.7(4.1 to 9.4)	36.0(22.2 to 49.8)	24.5(12.0 to 37.0)	98.3(96.8 to 99.8)	96.2(94.1 to 98.4)	21.7(3.5 to 40.0)	47.8(25.7 to 69.9)
<0.7	9.6(6.5 to 12.8)	40.0(25.9 to 54.1)	24.5(12.0 to 37.0)	95.5(93.2 to 97.9)	92.8(89.9 to 95.8)	39.4(21.8 to 57.0)	63.6(46.3 to 81.0)
<0.8	16.4(12.4 to 20.3)	52.0(37.7 to 66.3)	34.7(20.9 to 48.5)	89.7(86.2 to 93.2)	86.7(82.8 to 90.6)	53.6(40.1 to 67.0)	69.6(57.2 to 82.1)
<0.9	23.7(19.2 to 28.2)	62.0(48.1 to 75.9)	57.1(42.8 to 71.5)	82.9(78.5 to 87.2)	81.9(77.5 to 86.3)	61.7(50.9 to 72.5)	65.4(54.9 to 76.0)
<1	33.0(28.0 to 38.1)	74.0(61.4 to 86.6)	69.4(56.0 to 82.8)	74.0(68.9 to 79.0)	73.0(67.9 to 78.1)	67.3(58.5 to 76.0)	69.9(61.3 to 78.5)
<1.1	36.3(31.1 to 41.4)	80.0(68.5 to 91.5)	71.4(58.3 to 84.5)	71.2(66.0 to 76.5)	69.6(64.3 to 74.9)	67.7(59.4 to 76.1)	71.8(63.7 to 79.8)
<1.2	39.5(34.3 to 44.7)	82.0(71.0 to 93.0)	73.5(60.7 to 86.3)	67.8(62.4 to 73.2)	66.2(60.8 to 71.7)	69.6(61.8 to 77.5)	73.3(65.8 to 80.9)
<1.3	41.5(36.3 to 46.8)	82.0(71.0 to 93.0)	75.5(63.0 to 88.0)	65.4(59.9 to 70.9)	64.2(58.6 to 69.7)	71.1(63.6 to 78.7)	73.9(66.6 to 81.3)
<1.4	42.1(36.8 to 47.4)	82.0(71.0 to 93.0)	75.5(63.0 to 88.0)	64.7(59.2 to 70.2)	63.5(57.9 to 69.0)	71.5(64.1 to 79.0)	74.3(67.1 to 81.5)
<1.5	42.4(37.1 to 47.7)	82.0(71.0 to 93.0)	75.5(63.0 to 88.0)	64.4(58.9 to 69.9)	63.1(57.6 to 68.7)	71.7(64.3 to 79.1)	74.5(67.3 to 81.7)

Percentages refer to the total sample (n = 342), not only to individuals with a FRAIL score ≥1.

Supplementary Data

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