Clinical Global Impression of Change in Physical Frailty: development of a measure based on clinical judgment.
OBJECTIVE
To expand the ability to assess physical frailty by developing a Clinical Global Impression of Change in Physical Frailty (CGIC-PF) instrument.


METHODS
Qualitative and quantitative instrument development.


METHODS
Academic centers.


METHODS
s Six expert panel members, 46 clinicians, 24 patients, and 12 caregivers.


METHODS
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.


CONCLUSIONS
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.
Studenski
Stephanie
S
Department of Medicine, Geriatrics Division, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. studenskis@msx.dept-med.pitt.edu
Hayes
Risa P
RP
Leibowitz
Ruth Q
RQ
Bode
Rita
R
Lavery
Laurie
L
Walston
Jeremy
J
Duncan
Pamela
P
Perera
Subashan
S
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D002983:Clinical Competence; D004185:Disability Evaluation; D005240:Feasibility Studies; D005260:Female; D016330:Frail Elderly / Q000523:psychology; D015577:Geriatric Assessment / Q000379:methods*; D005853:Geriatrics / Q000379:methods / Q000592:standards; D006801:Humans; D007600:Judgment; D008297:Male; D008603:Mental Health; D009752:Nutritional Status; D015588:Observer Variation; D010807:Physical Endurance; D004856:Postural Balance; D011594:Psychometrics; D011597:Psychomotor Performance; D036301:Qualitative Research; D012647:Self-Assessment; D011795:Surveys and Questionnaires