title: Assessing Upper-Extremity Motion: An Innovative, Objective Method to Identify Frailty in Older Bed-Bound Trauma Patients.
abstract: Despite increasing evidence that assessing frailty facilitates medical decision-making, a quick and clinically simple frailty assessment tool is not available for trauma settings.
  
  
  
  This study examined accuracy and acceptability of a novel wearable technology (upper-extremity frailty [UEF]) to objectively assess frailty status in older adults (65 years or older) admitted to the hospital due to traumatic ground-level falls. Frailty was measured using a validated modified Rockwood questionnaire, the Trauma-Specific Frailty Index (TSFI), as the gold standard. Participants performed a 20-second trial of rapid elbow flexion with the dominant elbow in a supine posture while wearing the UEF system.
  
  
  
  We recruited 101 eligible older adults (age 79 ± 9 years). Parameters of the UEF indicative of slowness, weakness, and exhaustion during elbow flexion were independent predictors of the TSFI score, while adjusted for age, sex, and body mass index. A high agreement (r = 0.72, p < 0.0001) was observed between TSFI score and the UEF model; sensitivity and specificity for predicting the frailty status were 78% and 82%, respectively. Of recruited participants, 57% were not able to walk at the time of measurements, suggesting a limitation for walking-based frailty assessments. Significant correlations were observed between UEF parameters and number of falls within a previous year, with highest correlation observed for elbow flexion slowness (r = -0.41).
  
  
  
  The results suggest that a simple test of 20-second elbow flexion may be practical and sensitive to identify frailty among hospitalized older adults. The UEF test is independent of walking assessments, reflects several frailty markers, and it is practical for bed-bound patients.
authors.affiliation: Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Department of Surgery, University of Arizona, Tucson, AZ; Arizona Center on Aging, Department of Medicine, University of Arizona, Tucson, AZ.
authors.forename: Nima
authors.initials: N
authors.lastname: Toosizadeh
authors.affiliation: Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona, Tucson, AZ.
authors.forename: Bellal
authors.initials: B
authors.lastname: Joseph
authors.affiliation: Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Department of Surgery, University of Arizona, Tucson, AZ; Department of Biomedical Engineering, University of Arizona, Tucson, AZ; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Michelle R
authors.initials: MR
authors.lastname: Heusser
authors.affiliation: Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona, Tucson, AZ.
authors.forename: Tahereh
authors.initials: T
authors.lastname: Orouji Jokar
authors.affiliation: Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Department of Surgery, University of Arizona, Tucson, AZ; Department of Biomedical Engineering, University of Arizona, Tucson, AZ; Arizona Center on Aging, Department of Medicine, University of Arizona, Tucson, AZ.
authors.forename: Jane
authors.initials: J
authors.lastname: Mohler
authors.affiliation: Division of Burns, Trauma, and Critical Care, Department of Surgery, UT-Southwestern Medical Center, Dallas, TX.
authors.forename: Herb A
authors.initials: HA
authors.lastname: Phelan
authors.affiliation: Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Department of Surgery, University of Arizona, Tucson, AZ; Department of Biomedical Engineering, University of Arizona, Tucson, AZ; Arizona Center on Aging, Department of Medicine, University of Arizona, Tucson, AZ; Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX. Electronic address: najafi.bijan@gmail.com.
authors.forename: Bijan
authors.initials: B
authors.lastname: Najafi
mesh_terms: D061725:Accelerometry / Q000295:instrumentation* / Q000379:methods; D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods*; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D034941:Upper Extremity / Q000503:physiopathology*; D014947:Wounds and Injuries / Q000503:physiopathology*