The Pictorial Fit-Frail Scale-Malay version (PFFS-M): reliability and validity testing in Malaysian primary care

Sally S., Ahip and Sazlina S., Ghazali and Olga, Theou and Azah A., Samad and Sabrina, Lukas and Ummu K., Mustapha and Mark Q., Thompson and Renuka, Visvanathan (2022) The Pictorial Fit-Frail Scale-Malay version (PFFS-M): reliability and validity testing in Malaysian primary care. Family Practice, XX. pp. 1-10. ISSN 1460-2229

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Abstract

Background: This study investigated the reliability and convergent validity of the PFFS-Malay version (PFFS-M) among patients (with varying educational levels), caregivers, and health care professionals (HCPs). PFFS-M cutoffs for frailty severity were developed. Methods: This is a cross-sectional study from 4 primary care clinics where 240 patients aged >60 years and their caregivers were enrolled. Patients were assigned to a nurse or a health care assistant (HCA) for 2 separate PFFS-M assessments administered by HCPs of the same profession, as well as by a doctor during the first visit (inter-rater reliability). Patients were also administered the Self-Assessed Report of Personal Capacity & Healthy Ageing (SEARCH) tool, a 40-item frailty index, by a research officer. The correlation between patients' PFFS-M scores and SEARCH tool scores determined convergent validity. Patients returned 1 week later for PFFS-M reassessment by the same HCPs (test-retest reliability). Caregivers completed the PFFS-M for the patient at both clinic visits. Classification cut-points for the PFFS-M were derived against frailty categories defined through the SEARCH tool. Results: The inter-rater (intraclass correlation coefficient [ICC] = 0.92 [95% CI, 0.90-0.93)] and test-retest (ICC = 0.94 [95% CI, 0.92-0.95]) reliability between all raters was excellent, including by patients' education levels. The convergent validity was moderate (r = 0.637, p < 0.001), including for varying educational background. PFFS-M categories were identified as: 0-3, no frailty; 4-5, at risk of frailty; 6-8, mild frailty; 9-12, moderate frailty; and >13, severe frailty. Conclusion: PFFS-M is a reliable and valid tool with frailty severity scores now established for use of this tool in primary care clinics.

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