Data Sheet 1_Assessing frailty in older adults: discriminative properties of physical activity questionnaires.pdf

IntroductionFrailty is prevalent among older adults and is a growing public health concern. Physical activity questionnaires are pragmatic tools for screening; however, their discriminative capacity remains uncertain. This study aimed to determine the discriminative performance and optimal cut-offs of the International Physical Activity Questionnaire–Short Form (IPAQ-SF) and the Physical Activity Scale for the Elderly (PASE) for identifying frailty states (non-frail, pre-frail, and frail) in a clinically derived cohort of older adults. MethodsThe study enrolled 289 older adults who were assessed using a demographic form, the FRAIL Scale, the IPAQ-SF, and the PASE. Frailty discrimination was evaluated via receiver operating characteristic analysis (ROC); optimal thresholds were identified using the Youden index, diagnostic indices (sensitivity, specificity, accuracy, predictive values) were computed, micro-/macro- area under the curves (AUC) were reported, and scale AUCs were compared using the DeLong test. ResultsParticipants had a mean age of 72.5 ± 7.0 years, and 56.7% were women. Frailty prevalence was 31.1% non-frail, 29.4% pre-frail, and 39.4% frail. For IPAQ-SF, AUCs were 0.45 (non-frail), 0.40 (pre-frail), and 0.67 (frail); for PASE, AUCs were 0.39 (non-frail), 0.50 (pre-frail), and 0.65 (frail). Macro−/micro-AUCs were 0.51/0.53 for IPAQ-SF and 0.51/0.52 for PASE. No significant differences were found between the two instruments across the frailty categories (DeLong test, p > 0.05). At optimal cut-offs (IPAQ-SF ≤ 322.5; PASE ≤ 63.6), both questionnaires showed moderate agreement with the FRAIL Scale (κ = 0.46–0.48), whereas agreement between the instruments was only low-to-moderate (κ = 0.32, McNemar p = 0.015). ConclusionIPAQ-SF and PASE demonstrated limited ability to discriminate frailty status in older adults, with moderate accuracy in identifying frail individuals and poor discrimination between the non-frail and pre-frail groups. The IPAQ-SF showed slightly higher specificity, whereas the PASE demonstrated higher sensitivity, indicating that they capture distinct aspects of physical activity behavior but cannot be used interchangeably.引言 衰弱（Frailty）在老年人群中高发，已成为日益严峻的公共卫生问题。体力活动问卷是用于筛查的实用工具，但其判别效能仍不明确。本研究旨在明确国际体力活动问卷短卷（International Physical Activity Questionnaire–Short Form, IPAQ-SF）与老年体力活动量表（Physical Activity Scale for the Elderly, PASE）在临床来源的老年队列中识别衰弱状态（非衰弱、衰弱前期及衰弱）的判别性能与最佳截断值。 方法 本研究纳入289名老年受试者，采用人口学问卷、FRAIL量表、IPAQ-SF及PASE进行评估。通过受试者工作特征曲线分析（Receiver Operating Characteristic Analysis, ROC）评估衰弱判别效能，采用尤登指数（Youden Index）确定最佳阈值，计算诊断指标（灵敏度、特异度、准确率、预测值），报告微观/宏观曲线下面积（Area Under the Curve, AUC），并通过德龙检验（DeLong Test）比较不同量表的AUC差异。 结果 受试者平均年龄为72.5±7.0岁，其中女性占比56.7%。衰弱患病率分布为：非衰弱者31.1%、衰弱前期者29.4%、衰弱者39.4%。IPAQ-SF的AUC分别为0.45（非衰弱）、0.40（衰弱前期）、0.67（衰弱）；PASE的AUC分别为0.39（非衰弱）、0.50（衰弱前期）、0.65（衰弱）。IPAQ-SF的宏观/微观AUC分别为0.51/0.53，PASE为0.51/0.52。德龙检验显示，两种工具在各衰弱分类中的判别效能无显著差异（p>0.05）。在最佳截断值（IPAQ-SF ≤322.5；PASE ≤63.6）下，两种问卷与FRAIL量表均表现出中等程度的一致性（κ=0.46~0.48），而两种工具之间的一致性仅为低至中等程度（κ=0.32，麦克内马尔检验p=0.015）。 结论 IPAQ-SF与PASE对老年人群衰弱状态的判别能力有限：仅在识别衰弱个体时具有中等准确率，而在区分非衰弱与衰弱前期人群时判别效能较差。IPAQ-SF的特异度略高，而PASE的灵敏度更高，提示二者捕捉的体力活动行为特征存在差异，不可互换使用。