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German translation, cross-cultural adaptation and diagnostic test accuracy of three frailty screening tools

PRISMA-7, FRAIL scale and Groningen Frailty Indicator

Deutsche Übersetzung, interkulturelle Adaptation und diagnostische Testgenauigkeit von drei Frailty Screening Fragebögen

PRISMA-7, FRAIL Skala und Groningen Frailty Indicator

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Abstract

Background

Routine screening for frailty could be used to timely identify older people with increased vulnerability und corresponding medical needs.

Objective

The aim of this study was the translation and cross-cultural adaptation of the PRISMA-7 questionnaire, the FRAIL scale and the Groningen Frailty Indicator (GFI) into the German language as well as a preliminary analysis of the diagnostic test accuracy of these instruments used to screen for frailty.

Methods

A diagnostic cross-sectional study was performed. The instrument translation into German followed a standardized process. Prefinal versions were clinically tested on older adults who gave structured in-depth feedback on the scales in order to compile a final revision of the German language scale versions. For the analysis of diagnostic test accuracy (criterion validity), PRISMA-7, FRAIL scale and GFI were considered the index tests. Two reference tests were applied to assess frailty, either based on Fried’s model of a Physical Frailty Phenotype or on the model of deficit accumulation, expressed in a Frailty Index.

Results

Prefinal versions of the German translations of each instrument were produced and completed by 52 older participants (mean age: 73 ± 6 years). Some minor issues concerning comprehensibility and semantics of the scales were identified and resolved. Using the Physical Frailty Phenotype (frailty prevalence: 4%) criteria as a reference standard, the accuracy of the instruments was excellent (area under the curve AUC >0.90). Taking the Frailty Index (frailty prevalence: 23%) as the reference standard, the accuracy was good (AUC between 0.73 and 0.88).

Conclusion

German language versions of PRISMA-7, FRAIL scale and GFI have been established and preliminary results indicate sufficient diagnostic test accuracy that needs to be further established.

Zusammenfassung

Hintergrund

Die Verwendung von Routine-Screenings auf Frailty könnte helfen, ältere Menschen erhöhter Vulnerabilität und entsprechendem Versorgungsbedarf frühzeitig zu identifizieren.

Ziel

Das Ziel dieser Studie war die Übersetzung und interkulturelle Adaptation des PRISMA-7-Fragebogens, der FRAIL-Skala und des Groningen Frailty Indicators (GFI) in die deutsche Sprache, verbunden mit einer ersten Analyse der diagnostischen Testgenauigkeit dieser Messinstrumente im Screening auf Frailty.

Methoden

Es wurde eine diagnostische Querschnittsstudie durchgeführt. Die Übersetzung der Fragebögen in die deutsche Sprache folgte einem standardisierten Prozess. Präfinale Versionen wurden mit älteren Menschen klinisch erprobt. Die Teilnehmenden gaben ein vertieftes, strukturiertes Feedback zu den Fragebögen. Dieses Feedback wurde zur finalen Überarbeitung der deutschen Fragebogen-Versionen genutzt. Für die Analyse der diagnostischen Testgenauigkeit (Kriteriumsvalidität) galten PRISMA-7, FRAIL-Skala und GFI als Index-Tests. Zur Bestimmung der Frailty wurden zwei Referenz-Tests erhoben, die entweder auf Frieds Modell eines physischen Frailty-Phänotyps oder dem Modell der Defizitakkumulation, ausgedrückt in einem Frailty-Index, basierten.

Ergebnisse

Es wurden präfinale deutsche Versionen der Fragebögen erstellt und von 52 älteren Teilnehmenden beantwortet (mittleres Alter: 73 ± 6 Jahre). Kleinere Probleme hinsichtlich der Verständlichkeit und Semantik der Fragebögen konnten identifiziert und gelöst werden. Wenn der physische Frailty-Phänotyp (Frailty-Prävalenz: 4 %) als Referenzstandard verwendet wurde, war die Testgenauigkeit der Fragebögen exzellent (AUC >0,90). Wurde der Frailty-Index (Frailty Prävalenz: 23 %) als Referenzstandard verwendet, war die Testgenauigkeit gut (AUC zwischen 0,73 und 0,88).

Schlussfolgerungen

Deutschsprachige Versionen von PRISMA-7, der FRAIL-Skala und dem GFI wurden erstellt. Die ersten Ergebnisse weisen auf eine ausreichende diagnostische Testgenauigkeit hin, die weiter untersucht werden sollte.

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Acknowledgements

The authors would like to thank all participants for participating in this study. We further acknowledge the support in data acquisition by Isabelle Stickdorn, Katharina van Baal, Caren Horstmannshoff and the staff of the physiotherapy clinic “Hand drauf” in Bochum. We further thank the colleagues of the expert committees, namely Lena Wulff, Anika Schmitt, Esther Hoolt, Johann Wulff, Ina Bergmann, Rachel Seidenglanz, Christopher Hamley and Jana Zimmermann. Finally, we acknowledge the helpful, patient and constructive support by Nardi Steverink, Michel Raîche and John Morley.

Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

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Authors and Affiliations

  1. Department für Angewandte Gesundheitswissenschaften, Studienbereich Physiotherapie, Hochschule für Gesundheit, Gesundheitscampus 6–8, 44801, Bochum, Germany

    Tobias Braun, Christian Grüneberg & Christian Thiel

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  1. Tobias Braun
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  2. Christian Grüneberg
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  3. Christian Thiel
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Corresponding author

Correspondence to Tobias Braun.

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Conflict of interests

T. Braun, C. Grüneberg and C. Thiel declare that they have no competing interests.

All studies described in this manuscript were carried out in accordance with national law and the Helsinki Declaration from 1964 (in its current revised form). This study was approved by the Ethical Review Board of the German Confederation for Physiotherapy (registration number 2014-02). All participants provided written informed consent.

Additional information

Author contributions Study concept and design: TB, CG, CT. Acquisition of data: TB. Analysis of data: TB. Interpretation of data: TB, CG, CT. Drafting the manuscript: TB. Manuscript revision for important intellectual content: CG, CT. Final approval of the version to be published: TB, CG, CT.

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Braun, T., Grüneberg, C. & Thiel, C. German translation, cross-cultural adaptation and diagnostic test accuracy of three frailty screening tools. Z Gerontol Geriat 51, 282–292 (2018). https://doi.org/10.1007/s00391-017-1295-2

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