There is substantial overlap between patients with COPD identified as frail using the FFP or SPPB measures and both identify patients with multidimensional health challenges.
Studies have shown that patients diagnosed with frailty in addition to COPD have diminished physical and mental health, are prone to a higher rate of hospital readmission and mortality, and are at risk for not receiving disease-modifying treatments compared with patients with COPD without frailty.
While comprehensive geriatric assessment is considered the gold standard approach to identifying frailty, the two most common frailty measures used to evaluate patients with COPD are the Fried Frailty Phenotype (FFP) and Short Physical Performance Battery (SPPB). Although there is an overlap between these two evaluation tools, a comparative examination of their characteristics, including their predictive value in relation to survival time in patients with COPD, has not been studied.
Frailty Measures Have Not Been Directly Compared in COPD
To fill this knowledge gap, Lisa Jane Brighton, PhD, MSc, BSc, and colleagues developed a cohort study to examine these two frailty classification matrices, which was published in the International Journal of Chronic Obstructive Pulmonary Disease. The FFP and SPPB identify people living with frailty, and their varying predictive properties may have important implications for their use and interpretation. “Around one in five people with COPD are thought to be living with frailty. Identifying these individuals for the purposes of clinical care and further research is important, and yet little is known about the properties of commonly used frailty instruments in this population,” Dr. Brighton says. “Both the Fried Frailty Phenotype and Short Physical Performance Battery are good measures to identify potential frailty in people with COPD: a group who has increased mortality risk and multidimensional health challenges.”
Participants for the study were recruited from community respiratory and pulmonary rehabilitation assessment clinics between November 2011 and January 2015. After determining eligibility based on age, diagnosis, and current health standing, 714 participants were included. Of these, 421 (59%) were male, and the mean age was 69.9. The mean survival time was 2,270 days (95% CI, 2,185-2,355). The classification of frail or not frail, as determined by FFP and SPPB, matched in 572 (80.1%) cases, showing moderate agreement (Kappa=0.469; standard error [SE]=0.038; P<0.001; Figure).
BMI, Comorbidities & Exercise Capacity Tied to Survival
The disease and health characteristics observed during the study among frail versus not frail participants were compared using t-, Mann–Whitney U, and Chi-Square tests. Overall, there were many similarities between the participants identified as frail by FFB and SPPB. Those identified as frail using FFB reported significantly worse anxiety and worse Chronic Respiratory Disease Questionnaire (CRQ) dyspnea compared with those participants deemed not frail according to FFB.
The researchers noted that SPPB scores, which are rated on a total scale of 0 to 12 with a score of equal to or less than 7 indicating a person who is living with frailty, were similar to FFB assessments. However, as the cut-off score increased, the SPPB showed significant differences in anxiety (≤8 only) and CRQ dyspnea (≤8 and ≤9) between those with and without frailty.
The predictive value of FFB and SPPB for mortality was examined with multivariable Cox regression. For both measurements, more people with frailty died by the end of the study than people deemed non-frail. In the FFP group, 71.7% (N=134) with frailty versus 45.9% (N=242) without frailty died, and in the SPPB group, 72.2% (N=122) with frailty versus 46.6% (N=254) without frailty died. Univariate Cox regression analysis showed that BMI, comorbidities, and exercise capacity were also related to survival.
According to Dr. Brighton and colleagues, frailty is being recognized as a significant prognostic tool in the treatment of respiratory care. “Given varying resources and equipment available across settings (e.g., handgrip dynamometers), it is helpful to know that there is substantial overlap between those identified as frail using the FFP or SPPB measure and that both measures identify people experiencing multidimensional health challenges,” the study authors wrote. “Decisions driven by pragmatic considerations can now be made with an understanding of the different emphases of each measure.”
Dr. Brighton shares, “It would be helpful for future research to explore the properties of other common frailty measures to check how they perform in people with COPD and other chronic lung conditions (e.g., the FRAIL scale, and the Clinical Frailty Scale). More research is also needed to understand how we can best provide the support that meets the additional multidimensional needs of people with both COPD and frailty.”
