Validation of Subjective and Objective Decisional Trees to prescribe exercise using the pace tool in outpatient older...

A tool called PACE, including two decisional trees (SDT for physicians and ODT for exercise professionals), was co-created to integrate PA prescriptions in outpatient geriatric care. The SDT comprised 13 questions from validated questionnaires (FRAIL, FIND, and SARC-F), and the ODT included four geriatric functional tests (30-s chair test, functional reach test, balance, and normal walking speed). SDT and ODT were administered to ninety-seven patients. Cronbach's alpha, confirmatory factor analysis, Pearson's correlation, Kappa, and Tau-B correlation were conducted.

The SDT and ODT demonstrated good internal consistency (α = 0.74-0.86 and α = 0.75, respectively). Concurrent validity showed significant correlations between the SDT and indices of frailty and sarcopenia (r = 0.62-0.90, p < 0.001) and objective functional tests (r = 0.66-0.72, p < 0.001). The ODT showed significant correlations with functional tests (r = 0.65-0.88, p < 0.001). Despite some correlations between the decisional trees (r = 0.48-0.68, p < 0.001), their concordance was limited (kappa = 0.08-0.41). Sub-analyses revealed higher correlations and concordances when the caregiver living with the patient was involved in SDT responses.

The SDT and ODT demonstrated good validity for assessing the functional performance profile of older adults and can be used to prescribe exercise programs using PACE. This study highlights the importance of involving caregivers in the SDT assessment to refine PACE prescriptions.