Cross-sectoral inter-rater reliability of the clinical frailty scale – a Danish translation and validation study

Abstract

Background Focus on frailty status has become increasingly important when determining care plans within and across health care sectors. A standardized frailty measure applicable for both primary and secondary health care sectors is needed to provide a common reference point. The aim of this study was to translate the Clinical Frailty Scale (CFS) into Danish (CFS-DK) and test inter-rater reliability for key health care professionals in the primary and secondary sectors using the CFS-DK. Methods The Clinical Frailty Scale was translated into Danish using the ISPOR principles for translation and cultural adaptation that included forward and back translation, review by the original developer, and cognitive debriefing. For the validation exercise, 40 participants were asked to rate 15 clinical case vignettes using the CFS-DK. The raters were distributed across several health care professions: primary care physicians (n = 10), community nurses (n = 10), hospital doctors from internal medicine (n = 10) and intensive care (n = 10). Inter-rater reliability was assessed using intraclass correlation coefficients (ICC), and sensitivity analysis was performed using multilevel random effects linear regression. Results The Clinical Frailty Scale was translated and culturally adapted into Danish and is presented in this paper in its final form. Inter-rater reliability in the four professional groups ranged from ICC 0.81 to 0.90. Sensitivity analysis showed no significant impact of professional group or length of clinical experience. The health care professionals considered the CFS-DK to be relevant for their own area of work and for cross-sectoral collaboration. Conclusion The Clinical Frailty Scale was translated and culturally adapted into Danish. The inter-rater reliability was high in all four groups of health care professionals involved in cross-sectoral collaborations. However, the use of case vignettes may reduce the generalizability of the reliability findings to real-life settings. The CFS has the potential to serve as a common reference tool when treating and rehabilitating older patients.

Association between Clinical Frailty Scale score and hospital mortality in adult patients with COVID-19 (COMET): an international, multicentre, retrospective, observational cohort study

“…However, it is likely that this bias was limited as there are several studies indicating sufficient interrater reliability of the CFS. [29][30][31][32] Although there is still some variability in interrater agreement, the CFS is prognostically relevant. 30 The present study showed an important direction for future research.…”

Translation of the updated clinical frailty scale 2.0 into Danish and implications for cross-sectoral reliability

“…In our inter-rater reliability study on CFS-DK 1.2 we found little variance among raters when rating CFS levels 4 and 5, the threshold at which the term “frail” is included in headings [ 1 ]. However, a recent study on older (≥ 80 years of age) patients in intensive care units found high variance among raters when differentiating these two levels using the CFS version 1.2 [ 9 ].…”

“…We consider the differences between CFS 1.2 and 2.0 versions to be minor and that the results of our recent inter-rater reliability study on CFS-DK 1.2 are likely still applicable to the 2.0 version [ 1 ]. The inter-rater reliability study used clinical vignettes to describe individuals in their habitual state, and raters were introduced to the CFS 1.2 (including an explanation of the abbreviation IADL and the importance of scoring the subject according to habitual health state) before they rated the vignettes.…”

“…The previous version of the Clinical Frailty Scale (CFS 1.2) was recently translated into Danish and published alongside results from a cross-sectoral inter-rater reliability study among primary care physicians, community nurses, and hospital doctors [ 1 ]. We found excellent inter-rater reliability across these four groups of health care professionals, supporting the notion that the CFS has the potential to serve as a common reference tool when treating and rehabilitating older patients.…”

Prevention of AcuTe admIssioN algorithm (PATINA): study protocol of a stepped wedge randomized controlled trial

“…Such changes may be subtle signs of health deterioration, and not just ageing processes. Additionally, the ‘PATINA decision tool’ includes validated health assessment scales and information on risk factors of acute disease, such as functional level (Barthel-20) [ 33 ], frailty (Clinical Frailty Scale) [ 34 , 35 ], Brief Geriatric Assessment [ 36 ], medications, falls tendency, weight, mental state, dehydration, and more. Further, the tool supports and covers areas of health care, which nurses in Denmark are obligated to assess regularly, e.g.…”