Validation of the Pictorial Fit-Frail Scale in a Thoracic Surgery Clinic

Objective: Examine feasibility and construct validity of Pictorial Fit-Frail scale (PFFS) for the first time in older surgical patients. Background: The PFFS uses visual images to measure health state in 14 domains and has been previously validated in outpatient geriatric clinics. Methods: Patients ≤65 year-old who were evaluated in a multidisciplinary thoracic surgery clinic from November 2020 to May 2021 were prospectively included. Patients completed an in-person PFFS and Vulnerable Elders Survey (VES-13) during their visit, and a frailty index was calculated from the PFFS (PFFStrans). A geriatrician performed a comprehensive geriatric assessment (CGA) either in-person or virtually, from which a Frailty Index (FI-CGA) and Frailty Questionnaire (FRAIL) scale were obtained. To assess the validity of the PFFS in this population, the Spearman rank correlations (rspearman) between PFFStrans and VES-13, FI-CGA, FRAIL were calculated. Results: All 49 patients invited to participate agreed, of which 46/49 (94%) completed the PFFS so a score could be calculated. The majority of patients (59%) underwent an in-person CGA and the reminder (41%) a virtual CGA. The cohort was mainly female (59.0%), with a median age of 77 (range: 67-90). The median PFFStrans was 0.27 (interquartile range [IQR] 0.12-0.34), PFFS was 11 (IQR 5-14), and 0.24 (IQR 0.13-0.32) for FI-CGA. We observed a strong correlation between the PFFStrans and FI-CGA (rspearman = 0.81, P < 0.001) and a moderate correlation between PFFStrans and VES-13 and FRAIL score (rspearman = 0.68 and 0.64 respectively, P < 0.001). Conclusions: PFFS had good feasibility and construct validity among older surgical patients when compared to previously validated frailty measurements.