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Clinical Global Impression of Change in Physical Frailty: Development of a Measure Based on Clinical Judgment
Author(s) -
Studenski Stephanie,
Hayes Risa P.,
Leibowitz Ruth Q.,
Bode Rita,
Lavery Laurie,
Walston Jeremy,
Duncan Pamela,
Perera Subashan
Publication year - 2004
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2004.52423.x
Subject(s) - inter rater reliability , reliability (semiconductor) , medicine , clinical global impression , content validity , scale (ratio) , physical therapy , applied psychology , psychology , clinical psychology , gerontology , rating scale , psychometrics , developmental psychology , alternative medicine , power (physics) , physics , pathology , quantum mechanics , placebo
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.