Clinical Global Impression of Change in Physical Frailty: development of a measure based on clinical judgment |
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Authors: | Studenski Stephanie Hayes Risa P Leibowitz Ruth Q Bode Rita Lavery Laurie Walston Jeremy Duncan Pamela Perera Subashan |
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Institution: | From the Department of Medicine, Geriatrics Division, University of Pittsburgh, Pittsburgh, Pennsylvania;;Global Health Outcomes Research Department, Eli Lilly and Company, Indianapolis, Indiana;;Audie Murphy Veterans Affairs, San Antonio, Texas;;Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;;Department of Medicine, Johns Hopkins University, Baltimore Maryland;;Department of Health Services Administration, School of Health Professions, University of Florida, Gainesville, Florida;and;Center on Aging and;Department of Preventive Medicine, University of Kansas, Kansas City, Kansas. |
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Abstract: | Objectives: To expand the ability to assess physical frailty by developing a Clinical Global Impression of Change in Physical Frailty (CGIC-PF) instrument. Design: Qualitative and quantitative instrument development. Setting: Academic centers. Participants: Six expert panel members, 46 clinicians, 24 patients, and 12 caregivers. Measurements: Literature review and structured group processes with experts, clinicians, and consumers were used to generate an initial list of domains and indicators. Structured interviews with clinical experts in the area of frailty were used to establish relevance and feasibility of measurement of domains. Interrater reliability was assessed through a Web-based study. Geriatricians pilot tested the feasibility of the baseline CGIC-PF with 10 patients. Results: The CGIC-PF includes six intrinsic domains (mobility, balance, strength, endurance, nutrition, and neuromotor performance) and seven consequences domains (medical complexity, healthcare utilization, appearance, self-perceived health, activities of daily living, emotional status, and social status). Each domain has two to four clinical indicators. Change is scored on a 7-point scale from markedly worse to markedly improved. Average interrater reliability of the CGIC-PF for the Web-based cases was 0.97. Geriatricians completed a baseline CGIC-PF on their own patients in 10 minutes or less. Conclusion: The CGIC-PF is a structured assessment of change in physical frailty with defined content and process. It has strong face validity, reliability, and feasibility for use in clinical research. It may be useful as one criterion of change and as an anchor for change in other measures. |
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Keywords: | frailty clinical global impression of change measurement aging |
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