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Evaluating a Pragmatic Strength Alternative for Frailty Measurement and Assessing Its Predictive Capacity Against

Kylie E Riggles1, Hannah F Brubeck1, Adrienne D Tanus1

  • 1VA Puget Sound Health Care System, Seattle, Washington.

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Summary
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Frailty instruments in rheumatoid arthritis predict poor health outcomes, with varying performance. The chair sit-to-stand measure showed good predictive ability for falls and composite outcomes.

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Area of Science:

  • Rheumatology
  • Gerontology
  • Clinical Epidemiology

Background:

  • Rheumatoid arthritis (RA) is linked to premature frailty, increasing the risk of adverse health outcomes.
  • Assessing frailty is crucial for managing RA patients and predicting their prognosis.
  • Existing frailty instruments may vary in their effectiveness within the RA population.

Purpose of the Study:

  • To compare the performance of four frailty instruments in rheumatoid arthritis (RA) patients.
  • To evaluate the predictive ability of these instruments for adverse health outcomes.
  • To assess a pragmatic alternative measure using chair sit-to-stand (STS) for frailty assessment.

Main Methods:

  • Four frailty instruments were used: Fried Frailty Phenotype with STS (Fried-STS), Fried Frailty Phenotype with hand grip strength (Fried-HGS), VA-Frailty Index (VA-FI), and FRAIL Scale (FRAIL).
  • Outcomes assessed at 1-year included falls, hospitalization days, and a composite of fall, hospitalization, or death.
  • Regression models adjusted for age and sex analyzed the association between frailty measures and outcomes.

Main Results:

  • Categorization of frailty status differed significantly across the four instruments.
  • Agreement between instruments was generally poor, except between Fried-STS and Fried-HGS.
  • Frailty assessed by Fried-STS, Fried-HGS, and FRAIL predicted falls, while VA-FI predicted hospitalization days.
  • Fried-STS, VA-FI, and FRAIL predicted a composite outcome of fall, hospitalization, or death.

Conclusions:

  • All assessed frailty measures demonstrated predictive value for adverse health outcomes in RA.
  • Phenotypic and patient-reported measures (Fried-STS, FRAIL) were effective in predicting falls.
  • The deficit accumulation model (VA-FI) was associated with hospitalization days.
  • The Fried-HGS measure was less effective in predicting poor outcomes compared to other instruments, including Fried-STS.