Adaptation, development, validity, and reliability of the Escala Multidimensional de Fragilidad (EMFRA), and the 5-item FRAIL scale: a study design of the EMFRA project.
Joaquín Pardo-Montero
Resumen
Introduction: The concept of frailty has been investigated in recent years. Currently, frailty in the elderly is understood as the presence of vulnerability to the occurrence of health-related adverse events. It was originally conceived as a construct dependent on the patient’s physical parameters. However, it is currently conceived on the basis of several physical, cognitive, emotional and social influences.
Justification: Currently we do not count with enough tools in Spanish to assess frailty in the elderly, especially integrating multimodal assessments.
Objectives: To develop the Multidimensional Frailty Scale (EMFRA), to cross-culturally adapt the 5-item FRAIL scale, and to explore the validity and reliability of both scales.
Methods: The construction of the EMFRA will begin with a review and synthesis of the literature. Relevant factors will be identified for inclusion in the scale. A translation of the 5-item FRAIL scale will be performed. Content validation of both scales will begin with an expert panel, followed by cognitive interviews with healthcare workers and older adults. Convergent validity with physical performance will be analysed in the Short Physical Performance Battery, global cognitive function, with anxiety and depression levels, level of dependence. The criterion validity of the scales will be explored cross-sectionally with the level of dependence. The time to complete both scales, the floor effect and the ceiling effect will be analysed. The internal consistency, test-retest reliability, standard error of measurement and minimum detectable change of both scales will be studied.
Keywords: Frailty; Instrument development; Validity; Content validity; Convergent validity; Criterion validity; Floor effect; Ceiling effect; Reliability; Internal consistency; Test-retest; Standard error of measurement; Minimum detectable change; Diagnosis; Older adults; Aging.
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Referencias
Aiken, L. R. (1985). Three Coefficients for Analyzing the Reliability and Validity of Ratings. Educational and Psychological Measurement, 45(1), 131–142. https://doi.org/10.1177/0013164485451012
Angulo, J., Assar, M. E., Álvarez-Bustos, A., & Rodríguez-Mañas, L. (2020). Physical activity and exercise: Strategies to manage frailty. Redox Biology, 35. https://doi.org/10.1016/J.REDOX.2020.101513
Apóstolo, J., Cooke, R., Bobrowicz-Campos, E., Santana, S., Marcucci, M., Cano, A., Vollenbroek-Hutten, M., Germini, F., & Holland, C. (2017). Predicting risk and outcomes for frail older adults: An umbrella review of frailty screening tools. Jbi Database of Systematic Reviews and Implementation Reports, 15(4), 1154. https://doi.org/10.11124/JBISRIR-2016-003018
Baztán, J., Molino, J., Alarcón, T., Cristóbal, E., Izquierdo, G., & Manzarbeitia, J. (1993). Índice de Barthel: Instrumento válido para la valoración funcional de pacientes con enfermedad cerebrovascular. Rev Esp Geriatr Gerontol, 28, 32–40.
Bock, J. O., König, H. H., Brenner, H., Haefeli, W. E., Quinzler, R., Matschinger, H., Saum, K. U., Schöttker, B., & Heider, D. (2016). Associations of frailty with health care costs–results of the ESTHER cohort study. BMC Health Services Research, 16(1). https://doi.org/10.1186/S12913-016-1360-3
Boers, M., & Cruz Jentoft, A. J. (2015). A New Concept of Health Can Improve the Definition of Frailty. Calcified Tissue International, 97(5), 429–431. https://doi.org/10.1007/s00223-015-0038-x
Brown, T. A. (2015). Confirmatory factor analysis for applied research. Guilford publications.
Cabañero-Martínez, M. J., Cabrero-García, J., Richart-Martínez, M., & Muñoz-Mendoza, C. L. (2009). The Spanish versions of the Barthel index (BI) and the Katz index (KI) of activities of daily living (ADL): A structured review. Archives of Gerontology and Geriatrics, 49(1), e77-84. https://doi.org/10.1016/j.archger.2008.09.006
Cronbach, L. J. (1951). Coefficient alpha and the internal structure of tests. Psychometrika, 16(3), Article 3. https://doi.org/10.1007/BF02310555
Dent, E., Morley, J. E., Cruz-Jentoft, A. J., Woodhouse, L., Rodríguez-Mañas, L., Fried, L. P., Woo, J., Aprahamian, I., Sanford, A., Lundy, J., Landi, F., Beilby, J., Martin, F. C., Bauer, J. M., Ferrucci, L., Merchant, R. A., Dong, B., Arai, H., Hoogendijk, E. O., … Vellas, B. (2019). Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management. The Journal of Nutrition, Health & Aging, 23(9), 771. https://doi.org/10.1007/S12603-019-1273-Z
Estefania, C. C., & Zalazar-Jaime, M. F. (2018). Entrevistas cognitivas: Revisión, directrices de uso y aplicación en investigaciones psicológicas. Avaliação Psicológica, 17(3), 362–370. https://doi.org/10.15689/ap.2018.1703.14883.09
Faller, J. W., Pereira, D. do N., Souza, S. de, Nampo, F. K., Orlandi, F. de S., & Matumoto, S. (2019). Instruments for the detection of frailty syndrome in older adults: A systematic review. PLoS ONE, 14(4). https://doi.org/10.1371/JOURNAL.PONE.0216166
Ferguson, E., & Cox, T. (1993). Exploratory Factor Analysis: A Users?Guide. International Journal of Selection and Assessment, 1(2), 84–94. https://doi.org/10.1111/j.1468-2389.1993.tb00092.x
Ferrando Piera, P. J., & Anguiano Carrasco, C. (2010). El análisis factorial como técnica de investigación en psicología. Papeles del psicólogo, 31(1), 18–33.
Fried, L. P., Tangen, C. M., Walston, J., Newman, A. B., Hirsch, C., Gottdiener, J., Seeman, T., Tracy, R., Kop, W. J., Burke, G., McBurnie, M. A., & Cardiovascular Health Study Collaborative Research Group. (2001). Frailty in older adults: Evidence for a phenotype. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 56(3), M146-156. https://doi.org/10.1093/gerona/56.3.m146
Gómez-Moreno, S. M., Cuadrado, M. L., Cruz-Orduña, I., Martínez-Acebes, E. M., Gordo-Mañas, R., Fernández-Pérez, C., & García-Ramos, R. (2020). Validation of the Spanish-language version of the Montreal Cognitive Assessment as a screening test for cognitive impairment in multiple sclerosis. Neurologia (Barcelona, Spain), 37(9), 726–734. https://doi.org/10.1016/J.NRL.2019.11.006
González, N., Bilbao, A., Forjaz, M. J., Ayala, A., Orive, M., Garcia-Gutierrez, S., Hayas, C. L., Quintana, J. M., Lópeza, J. M. Q., Gutiérreza, S. G., Rodríguezb, C. L. H., Echenagusia, J. Z., Calzadaa, M. O., Hernándeza, N. G., Larracoecheaa, U. A., Ladislaoa, A. A., Guerrero, I. L., Gonzálezd, A. B., Lampreave, L. A. S., … Rubio, G. N. (2018). Psychometric characteristics of the Spanish version of the Barthel Index. Aging Clinical and Experimental Research, 30(5), 489–497. https://doi.org/10.1007/S40520-017-0809-5
Haley, S. M., & Fragala-Pinkham, M. A. (2006). Interpreting Change Scores of Tests and Measures Used in Physical Therapy. Physical Therapy, 86(5), 735–743. https://doi.org/10.1093/ptj/86.5.735
Herrero, M. J., Blanch, J., Peri, J. M., Pablo, J. D., Pintor, L., & Bulbena, A. (2003). A validation study of the hospital anxiety and depression scale (HADS) in a Spanish population. General Hospital Psychiatry, 25(4), 277–283. https://doi.org/10.1016/S0163-8343(03)00043-4
Herrmann, C. (1997). International experiences with the Hospital Anxiety and Depression Scale-A review of validation data and clinical results. Journal of Psychosomatic Research, 42(1), 17–41. https://doi.org/10.1016/S0022-3999(96)00216-4
Horn, J. L. (1965). A rationale and test for the number of factors in factor analysis. Psychometrika, 30(2), 179–185. https://doi.org/10.1007/BF02289447
Hu, L., & Bentler, P. M. (1998). Fit indices in covariance structure modeling: Sensitivity to underparameterized model misspecification. Psychological Methods, 3(4), 424–453. https://doi.org/10.1037/1082-989X.3.4.424
Izquierdo, I., Olea, J., & Abad, F. J. (2014). Exploratory factor analysis in validation studies: Uses and recommendations. Psicothema, 26(3), 395–400. https://doi.org/10.7334/psicothema2013.349
Kan, G. A. V., Rolland, Y., Bergman, H., Morley, J. E., Kritchevsky, S. B., & Vellas, B. (2008). The I.A.N.A. task force on frailty assessment of older people in clinical practice. The Journal of Nutrition Health and Aging, 12(1), 29–37. https://doi.org/10.1007/BF02982161
Kline, P. (2013). Handbook of phsychological testing. Routledge.
Kojima, G. (2019). Frailty as a Predictor of Emergency Department Utilization among Community-Dwelling Older People: A Systematic Review and Meta-Analysis. Journal of the American Medical Directors Association, 20(1), 103–105. https://doi.org/10.1016/J.JAMDA.2018.10.004
Koo, T. K., & Li, M. Y. (2016). A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research. Journal of Chiropractic Medicine, 15(2), 155–163. https://doi.org/10.1016/j.jcm.2016.02.012
Lee, Y., Kim, E., Yun, J., & Chuck, K. W. (2022). The influence of multiple frailty profiles on institutionalization and all-cause mortality in community-living older adults. Journal of Cachexia, Sarcopenia and Muscle, 13(5), 2322–2330. https://doi.org/10.1002/JCSM.13033
Lloret-Segura, S., Ferreres-Traver, A., Hernández-Baeza, A., & Tomás-Marco, I. (2014). El Análisis Factorial Exploratorio de los Ítems: Una guía práctica, revisada y actualizada. Anales de Psicología, 30(3), 1151–1169. https://doi.org/10.6018/analesps.30.3.199361
Mitnitski, A. B., Mogilner, A. J., & Rockwood, K. (2001). Accumulation of Deficits as a Proxy Measure of Aging. The Scientific World JOURNAL, 1, 323–336. https://doi.org/10.1100/tsw.2001.58
Morley, J. E., Malmstrom, T. K., & Miller, D. K. (2012). A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. The Journal of Nutrition, Health & Aging, 16(7), 601–608. https://doi.org/10.1007/s12603-012-0084-2
Nasreddine, Z. S., Phillips, N. A., Bédirian, V., Charbonneau, S., Whitehead, V., Collin, I., Cummings, J. L., & Chertkow, H. (2005). The Montreal Cognitive Assessment, MoCA: A Brief Screening Tool For Mild Cognitive Impairment. Journal of the American Geriatrics Society, 53(4), 695–699. https://doi.org/10.1111/j.1532-5415.2005.53221.x
O’Caoimh, R., Sezgin, D., O’Donovan, M. R., Molloy, D. W., Clegg, A., Rockwood, K., & Liew, A. (2021). Prevalence of frailty in 62 countries across the world: A systematic review and meta-analysis of population-level studies. Age and Ageing, 50(1), 96–104. https://doi.org/10.1093/ageing/afaa219
O’connor, B. P. (2000). SPSS and SAS programs for determining the number of components using parallel analysis and Velicer’s MAP test. Behavior Research Methods, Instruments, & Computers, 32(3), 396–402. https://doi.org/10.3758/BF03200807
Ofori-Asenso, R., Chin, K. L., Mazidi, M., Zomer, E., Ilomaki, J., Zullo, A. R., Gasevic, D., Ademi, Z., Korhonen, M. J., Logiudice, D., Bell, J. S., & Liew, D. (2019). Global Incidence of Frailty and Prefrailty Among Community-Dwelling Older Adults: A Systematic Review and Meta-analysis. JAMA Network Open, 2(8). https://doi.org/10.1001/JAMANETWORKOPEN.2019.8398
Ojeda, N., Pino, R. D., Ibarretxe-Bilbao, N., Schretlen, D. J., & Pena, J. (2016). [Montreal Cognitive Assessment Test: Normalization and standardization for Spanish population]. Revista de Neurologia, 63(11), 488–496.
Rasiah, J., Cummings, G. G., Gruneir, A., Oelke, N. D., Estabrooks, C., & Holroyd-Leduc, J. (2020). Prefrailty in older adults: A concept analysis. International Journal of Nursing Studies, 108. https://doi.org/10.1016/J.IJNURSTU.2020.103618
Rolfson, D. B., Majumdar, S. R., Tsuyuki, R. T., Tahir, A., & Rockwood, K. (2006). Validity and reliability of the Edmonton Frail Scale. Age and Ageing, 35(5), 526–529. https://doi.org/10.1093/ageing/afl041
Rosas-Carrasco, O., Cruz-Arenas, E., Parra-Rodríguez, L., García-González, A. I., Contreras-González, L. H., & Szlejf, C. (2016). Cross-Cultural Adaptation and Validation of the FRAIL Scale to Assess Frailty in Mexican Adults. Journal of the American Medical Directors Association, 17(12), 1094–1098. https://doi.org/10.1016/J.JAMDA.2016.07.008
The International Classification of Functioning, Disability and Health: ICF. (2001). World Health Organization.
Vermeiren, S., Vella-Azzopardi, R., Beckwée, D., Habbig, A. K., Scafoglieri, A., Jansen, B., Bautmans, I., Bautmans, I., Verté, D., Beyer, I., Petrovic, M., Donder, L. D., Kardol, T., Rossi, G., Clarys, P., Scafoglieri, A., Cattrysse, E., Hert, P. de, & Jansen, B. (2016). Frailty and the Prediction of Negative Health Outcomes: A Meta-Analysis. Journal of the American Medical Directors Association, 17(12), 1163.e1-1163.e17. https://doi.org/10.1016/J.JAMDA.2016.09.010
Veronese, N., Custodero, C., Cella, A., Demurtas, J., Zora, S., Maggi, S., Barbagallo, M., Sabbà, C., Ferrucci, L., & Pilotto, A. (2021). Prevalence of multidimensional frailty and pre-frailty in older people in different settings: A systematic review and meta-analysis. Ageing Research Reviews, 72. https://doi.org/10.1016/J.ARR.2021.101498
Vet, H. C. W. de, Terwee, C. B., Mokkink, L. B., & Knol, D. L. (2011). Measurement in Medicine: A Practical Guide.
von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., Vandenbroucke, J. P., & STROBE Initiative. (2007). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. Annals of Internal Medicine, 147(8), 573–577. https://doi.org/10.7326/0003-4819-147-8-200710160-00010
Vrotsou, K., Machón, M., Rivas-Ruíz, F., Carrasco, E., Contreras-Fernández, E., Mateo-Abad, M., Güell, C., & Vergara, I. (2018). Psychometric properties of the Tilburg Frailty Indicator in older Spanish people. Archives of Gerontology and Geriatrics, 78, 203–212. https://doi.org/10.1016/J.ARCHGER.2018.05.024
Walter, S. D., Eliasziw, M., & Donner, A. (1998). Sample size and optimal designs for reliability studies. Statistics in Medicine, 17(1), 101–110. https://doi.org/10.1002/(sici)1097-0258(19980115)17:1<101::aid-sim727>3.0.co;2-e