The Frail'BESTest. An Adaptation of the "Balance Evaluation System Test" for Frail Older Adults. Description, Internal Consistency and Inter-Rater Reliability

The Frail'BESTest: an adaptation of the "balance evaluation system test" for frail older adults; Concurrent validity, responsiveness, validity for fall prediction and detection of slower walkers

BACKGROUND

The Frail'BESTest was developed in order to include frail older adults when they are using the BESTest. Recently, psychometrics properties (internal coherence, systems usefulness, complementarity and inter-rater reliability) of the Frail'BESTest were tested. To complete these analyses, this study will aim the assessment of its concurrent validity, responsiveness, predictive validity on falls occurrence, and slower walkers detection.

METHODS

The correlation between the Frail'BESTest and the Gait Speed Test permitted to assess concurrent validity. The variation between the initial test score and the score obtained after the completion of a rehabilitation program was used to evaluate responsiveness with MANOVA analysis and standard response mean (SRM) calculation. Predictive validity was assessed with receiver-operating characteristic curves and area under the curve (AUC) analysis regarding falls occurrence. Slower walkers detection thresholds were computed by receiver-operating characteristic curves for the Frail'BESTest and the Tinetti test.

RESULTS

The concurrent validity of the test was good (r = 0.74; p < 0.001). The Standard Error of measurement was at 2.81 points and the Minimal Detectable Change at 7.79 points for the total score of the Frail'BESTest. The SRM was at 0.41 for the Tinetti test and 0.56 for the Frail'BESTest. The AUC, computed according to fall occurrence, was at 0.71 for the Gait Speed test, 0.673 for the Tinetti test and 0.693 for the Frail'BESTest. Both the Tinetti (AUC = 0.87) and the Frail'BESTest (AUC = 0.88) were found suitable for tracking slower walkers.

CONCLUSION

Concurrent validity and responsiveness of the Frail'BESTest were good. As for the Tinetti and the Frail'BESTest, they were unable to predict efficiently falls occurrence in the tested sample. The Frail'BESTest seems enough sensitive to spot the slower walkers efficiently, using a 15/20 threshold method. The Frail'BESTest was found to be a valid and responsive clinical test, therefore it can be recommended as an outcome measure in clinical practice.

Geriatric Rehabilitation and COVID-19: a Case Report

The COVID-19 infection has particularly affected older adults. Clinical observations in this population highlight major respiratory impairment associated with the development or aggravation of the patient’s frailty state. Mr. P is a 93-year-old frail patient, hospitalized after a COVID-19 infection. The assessment process of this patient has been supported by an innovative multi-systemic tool developed in view of the COVID-19 clinical consequences and a systemic evaluation of motor functions by the Frail’BESTest. This process allowed a mixed clinical picture associated with significant respiratory distress (linked with acute respiratory distress syndrome) and an evident motor frailty. The care plan was developed accordingly, and four assessments were done in the same manner until Mr. P returned home. This case report allows us to see a holistic COVID-19 clinical picture, showing the different axes of clinical reasoning to enhance the rehabilitation process. Furthermore, this case report illustrates the importance of rehabilitation in the COVID-19 context.

Bilan kinésithérapique de Mr P., patient âgé fragile de 93 ans présentant un syndrome de détresse respiratoire aiguë suite à une infection au COVID-19

Mr P. est un patient âgé de 93 ans hospitalisé suite à une infection à COVID-19. La démarche évaluative de ce patient a été réalisée grâce à un bilan multisystémique spécifique COVID-19 et à une évaluation systémique des fonctions motrices. Celle-ci a permis de conclure à un tableau clinique mixte associant une dysfonction respiratoire majeure en lien avec le syndrome de détresse respiratoire aiguë et une fragilité motrice associée. Ce diagnostic soulève donc l’importance d’une évaluation à visée holistique pour cibler le profil des patients COVID-19 et les dysfonctions associées afin d’orienter et déterminer les axes de la prise en soin rééducative pluridisciplinaire.

Indice de factualité (i-FACT)

3.4.