Differences in Characteristics Between Physical Frailty Assessments in Chronic Obstructive Pulmonary Disease: A Multicenter Cross-Sectional Observational Study

Abstract

Purpose

Assessment for frailty is important as it enables timely intervention to prevent or delay poor prognosis in chronic obstructive pulmonary disease (COPD). The aims of this study, in a sample of outpatients with COPD, were to (i) assess the prevalence of physical frailty using the Japanese version of the Cardiovascular Health Study (J-CHS) criteria and the Short Physical Performance Battery (SPPB) and the degree of agreement between the findings of the two assessments and (ii) identify factors associated with the disparity in the results obtained with these instruments.

Patients and Methods

This was a multicenter cross-sectional study of individuals with stable COPD enrolled in four institutions. Frailty was assessed using the J-CHS criteria and the SPPB. Weighted Cohen’s kappa (k) statistic was performed to investigate the magnitude of agreement between the instruments. We divided participants into two groups depending on whether there was agreement or non-agreement between the results of the two frailty assessments. The two groups were then compared with respect to their clinical data.

Results

A total of 103 participants (81 male) were included in the analysis. The median age and FEV₁ (%predicted) were 77 years and 62%, respectively. The prevalence of frailty and pre-frail was 21% and 56% with the J-CHS criteria and 10% and 17% with the SPPB. The degree of agreement was fair (k = 0.36 [95% CI: 0.22–0.50], P<0.001). There were no significant differences in the clinical characteristics between the agreement group (n = 44) and the non-agreement group (n = 59).

Conclusion

We showed that the degree of agreement was fair with the J-CHS criteria detecting a higher prevalence than the SPPB. Our findings suggest that the J-CHS criteria may be useful in people with COPD with the aim of providing interventions to reverse frailty in the early stages.

Keywords:

• cardiovascular health study
• Short Physical Performance Battery
• chronic lung disease
• physical function

Data Sharing Statement

Data used to support the findings of this study are included within the manuscript in Tables 1–4. Raw data are available from the corresponding author upon reasonable request.

Acknowledgments

The authors are grateful to the staff physical therapists and all the staff who acquired data for study. In addition, we are grateful to Dr Sue Jenkins, Institute for Respiratory Health and Physiotherapy Department, Sir Charles Gairdner Hospital, for her help in reviewing our manuscript. Finally, we thank Dr Shuntaro Sato, Clinical Research Center, Nagasaki University Hospital, Nagasaki, for his support with statistical analysis.

Author Contributions

YT and RK contributed significantly to conception and design, or analysis and interpretation of data; and have been involved in drafting and reviewing the manuscript. MH and YY contributed significantly to analysis and interpretation of data and have been involved in drafting and revised it critically for important intellectual content. All authors contributed to data analysis, drafting or revising the article, have agreed on the journal to which the article will be submitted, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

The study design, collection and analysis of the data, and preparation of the manuscript were not funded by any public, commercial, or not-for-profit sectors.