Aging; Frailty; Functional capacities; Screening; Validity; Gerontology; Geriatrics and Gerontology
Abstract :
[en] [en] METHODS: A tool called PACE, including two decisional trees (SDT for physicians and ODT for exercise professionals), was co-created to integrate PA prescriptions in outpatient geriatric care. The SDT comprised 13 questions from validated questionnaires (FRAIL, FIND, and SARC-F), and the ODT included four geriatric functional tests (30-s chair test, functional reach test, balance, and normal walking speed). SDT and ODT were administered to ninety-seven patients. Cronbach's alpha, confirmatory factor analysis, Pearson's correlation, Kappa, and Tau-B correlation were conducted.
RESULTS: The SDT and ODT demonstrated good internal consistency (α = 0.74-0.86 and α = 0.75, respectively). Concurrent validity showed significant correlations between the SDT and indices of frailty and sarcopenia (r = 0.62-0.90, p < 0.001) and objective functional tests (r = 0.66-0.72, p < 0.001). The ODT showed significant correlations with functional tests (r = 0.65-0.88, p < 0.001). Despite some correlations between the decisional trees (r = 0.48-0.68, p < 0.001), their concordance was limited (kappa = 0.08-0.41). Sub-analyses revealed higher correlations and concordances when the caregiver living with the patient was involved in SDT responses.
CONCLUSIONS: The SDT and ODT demonstrated good validity for assessing the functional performance profile of older adults and can be used to prescribe exercise programs using PACE. This study highlights the importance of involving caregivers in the SDT assessment to refine PACE prescriptions.
Disciplines :
Geriatrics
Author, co-author :
Ruiz, F-J-M; Département des Sciences de l'Activité Physique, Groupe de Recherche en Activité Physique Adapté, Université du Québec à Montréal, Pavillon des Sciences Biologiques, 141 President-Kennedy Ave, Montreal, QC, SB-4615H3C 3P8, Canada ; Research Center, l'Institut Universitaire de Gériatrie de Montréal, CIUSSS du Centre-Sud de-l'Île-de-Montréal, Montreal, Québec, Canada
Kergoat, M-J; Research Center, l'Institut Universitaire de Gériatrie de Montréal, CIUSSS du Centre-Sud de-l'Île-de-Montréal, Montreal, Québec, Canada ; Department of Medicine, Université de Montréal, Montreal, QC, Canada
Andriamampionona, F; Research Center, l'Institut Universitaire de Gériatrie de Montréal, CIUSSS du Centre-Sud de-l'Île-de-Montréal, Montreal, Québec, Canada ; Department of Medicine, Université de Montréal, Montreal, QC, Canada
Brodeur, C; Research Center, l'Institut Universitaire de Gériatrie de Montréal, CIUSSS du Centre-Sud de-l'Île-de-Montréal, Montreal, Québec, Canada ; Department of Medicine, Université de Montréal, Montreal, QC, Canada
Beauchet, O; Research Center, l'Institut Universitaire de Gériatrie de Montréal, CIUSSS du Centre-Sud de-l'Île-de-Montréal, Montreal, Québec, Canada ; Department of Medicine, Université de Montréal, Montreal, QC, Canada
Tannou, T; Research Center, l'Institut Universitaire de Gériatrie de Montréal, CIUSSS du Centre-Sud de-l'Île-de-Montréal, Montreal, Québec, Canada ; Department of Medicine, Université de Montréal, Montreal, QC, Canada
Buckinx, Fanny ; Université de Liège - ULiège > Département des Sciences de l'activité physique et de la réadaptation ; Département des Sciences de l'Activité Physique, Groupe de Recherche en Activité Physique Adapté, Université du Québec à Montréal, Pavillon des Sciences Biologiques, 141 President-Kennedy Ave, Montreal, QC, SB-4615H3C 3P8, Canada ; Research Center, l'Institut Universitaire de Gériatrie de Montréal, CIUSSS du Centre-Sud de-l'Île-de-Montréal, Montreal, Québec, Canada
Aubertin-Leheudre, M; Département des Sciences de l'Activité Physique, Groupe de Recherche en Activité Physique Adapté, Université du Québec à Montréal, Pavillon des Sciences Biologiques, 141 President-Kennedy Ave, Montreal, QC, SB-4615H3C 3P8, Canada. aubertin-leheudre.mylene@uqam.ca ; Research Center, l'Institut Universitaire de Gériatrie de Montréal, CIUSSS du Centre-Sud de-l'Île-de-Montréal, Montreal, Québec, Canada. aubertin-leheudre.mylene@uqam.ca
Language :
English
Title :
Validation of Subjective and Objective Decisional Trees to prescribe exercise using the pace tool in outpatient older adults.
Publication date :
18 September 2025
Journal title :
European Geriatric Medicine
ISSN :
1878-7649
eISSN :
1878-7657
Publisher :
Springer Science and Business Media Deutschland GmbH, Switzerland
R.L. Reed et al. The relationship between muscle mass and muscle strength in the elderly J Am Geriatr Soc 39 6 555 561 1:STN:280:DyaK3M3ksFWisQ%3D%3D 1805811 10.1111/j.1532-5415.1991.tb03592.x
M.V.C. Pisciottano et al. The relationship between lean mass, muscle strength and physical ability in independent healthy elderly women from the community J Nutr Health Aging 18 5 554 558 1:STN:280:DC%2BC2cjos1Wrtg%3D%3D 24886744 10.1007/s12603-013-0414-z
S.E. Howlett A.D. Rutenberg K. Rockwood The degree of frailty as a translational measure of health in aging Nat Aging 1 8 651 665 37117769 10.1038/s43587-021-00099-3
M. Izquierdo et al. International exercise recommendations in older adults (ICFSR): expert consensus guidelines J Nutr Health Aging 25 7 824 853 1:STN:280:DC%2BB2cvmtlGnsw%3D%3D 34409961 12369211 10.1007/s12603-021-1665-8
J. Gianoudis C.A. Bailey R.M. Daly Associations between sedentary behaviour and body composition, muscle function and sarcopenia in community-dwelling older adults Osteoporos Int 26 2 571 579 1:STN:280:DC%2BC2M7js1ahsQ%3D%3D 25245026 10.1007/s00198-014-2895-y
J. Gianoudis C.A. Bailey R.M. Daly Associations between sedentary behaviour and body composition, muscle function and sarcopenia in community-dwelling older adults Osteoporos Int 26 2 571 579 25245026 10.1007/s00198-014-2895-y
J. Harvey S. Chastin D. Skelton Prevalence of sedentary behavior in older adults: a systematic review Int J Environ Res Public Health 10 12 6645 6661 24317382 3881132 10.3390/ijerph10126645
G. Bernardelli et al. Adapted physical activity to promote active and healthy ageing: the PoliFIT pilot randomized waiting list-controlled trial Aging Clin Exp Res 31 4 511 518 30019265 10.1007/s40520-018-1002-1
L.P. Fried et al. Frailty in older adults: evidence for a phenotype J Gerontol: Ser A 56 3 M146 M157 1:STN:280:DC%2BD3M7osFejuw%3D%3D 10.1093/gerona/56.3.M146
J.G. Quicke et al. Is long-term physical activity safe for older adults with knee pain? A systematic review Osteoarthritis Cartilage 23 9 1445 1456 1:STN:280:DC%2BC2Mfmslejtg%3D%3D 26003947 10.1016/j.joca.2015.05.002
J.S. Thornton et al. Physical activity prescription: a critical opportunity to address a modifiable risk factor for the prevention and management of chronic disease: a position statement by the Canadian Academy of Sport and Exercise Medicine Br J Sports Med 50 18 1109 1114 27335208 10.1136/bjsports-2016-096291
Fortin M-P, Kergoat M-J, Cloutier C (2020), Les cliniques externes spécialisées de gériatrie - Recommandations sur la dotation en ressources humaines. Montréal
F. Lobelo I.G. de Quevedo The evidence in support of physicians and health care providers as physical activity role models Am J Lifestyle Med 10 1 36 52 26213523 10.1177/1559827613520120
Wyman MF, Shiovitz-Ezra S, Bengel JJCpoa (2018) Ageism in the health care system: Providers, patients, and systems. pp 193–212
S. Deslauriers et al. Effects of waiting for outpatient physiotherapy services in persons with musculoskeletal disorders: a systematic review Disabil Rehabil 43 5 611 620 31304824 10.1080/09638288.2019.1639222
F. Dijkstra et al. Facilitators and barriers to enhancing physical activity in older patients during acute hospital stay: a systematic review Int J Behav Nutr Phys Act 19 1 99 1:STN:280:DC%2BB2MblvVWqsA%3D%3D 35908056 9338465 10.1186/s12966-022-01330-z
A. Manas et al. Unsupervised home-based resistance training for community-dwelling older adults: a systematic review and meta-analysis of randomized controlled trials Ageing Res Rev 69 34022464 10.1016/j.arr.2021.101368 101368
M. Kotsani et al. A simple questionnaire as a first-step tool to detect specific frailty profiles: the Lorraine frailty-profiling screening scale J Nutr Health Aging 24 7 730 738 1:STN:280:DC%2BB38fgsVajsg%3D%3D 32744569 10.1007/s12603-020-1420-6
I. Piffer et al. Ability of emergency department physicians using a functional autonomy-assessing version of the triage risk screening tool to detect frail older patients who require mobile geriatric team consultation J Nutr Health Aging 24 6 634 641 1:STN:280:DC%2BB38rntVOntQ%3D%3D 32510117 10.1007/s12603-020-1378-4
M. Pinquart Correlates of subjective health in older adults: a meta-analysis Psychol Aging 16 3 414 426 1:STN:280:DC%2BD3Mrgs1CitA%3D%3D 11554520 10.1037/0882-7974.16.3.414
S.M. Hunt J. McEwen The development of a subjective health indicator Sociol Health Illn 2 3 231 246 10.1111/j.1467-9566.1980.tb00213.x
J.M. Guralnik et al. Validation and use of performance measures of functioning in a non-disabled older population: MacArthur studies of successful aging Aging Clin Exp Res 6 410 419 1:STN:280:DyaK2M3mslyhtg%3D%3D 10.1007/BF03324272
A.T. Balachandran et al. Validity, reliability, and measurement error of a sit-to-stand power test in older adults: a pre-registered study Exp Gerontol 145 33347922 10.1016/j.exger.2020.111202 111202
L.P. Carvalho et al. A systematic approach for prescribing posthospitalization home-based physical activity for mobility in older adults: the PATH study J Am Med Dir Assoc 20 10 1287 1293 30872083 10.1016/j.jamda.2019.01.143
E. Peyrusque et al. Implementation, feasibility, and acceptability of MATCH to prevent iatrogenic disability in hospitalized older adults: a question of geriatric care program? Healthcare (Basel) 10.3390/healthcare11081186 37108022
M. Cesari et al. A self-reported screening tool for detecting community-dwelling older persons with frailty syndrome in the absence of mobility disability: the FiND questionnaire PLoS ONE 9 7 24999805 4084999 10.1371/journal.pone.0101745 e101745
J.E. Morley T.K. Malmstrom D.K. Miller A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans J Nutr Health Aging 16 7 601 608 1:STN:280:DC%2BC38fjtl2hsQ%3D%3D 22836700 10.1007/s12603-012-0084-2
S.N. Voelker et al. Reliability and concurrent validity of the SARC-F and its modified versions: a systematic review and meta-analysis J Am Med Dir Assoc 22 9 1864 1876.e16 34144049 10.1016/j.jamda.2021.05.011
R.F. DeVellis C.T. Thorpe Scale development: Theory and applications Sage publications
L.S. McAllister K.M. Palombaro Modified 30-second sit-to-stand test: reliability and validity in older adults unable to complete traditional sit-to-stand testing J Geriatr Phys Ther 43 3 153 158 30807554 10.1519/JPT.0000000000000227
P.H.S. Figueiredo et al. The reliability and validity of the 30-seconds sit-to-stand test and its capacity for assessment of the functional status of hemodialysis patients J Bodyw Mov Ther 27 157 164 34391227 10.1016/j.jbmt.2021.02.020
R.W. Bohannon F.J.P. Tudini Unipedal balance test for older adults: a systematic review and meta-analysis of studies providing normative data Physiotherapy 104 4 376 382 30017097 10.1016/j.physio.2018.04.001
F. Lauretani et al. Short-physical performance battery (SPPB) score is associated with falls in older outpatients Aging Clin Exp Res 31 10 1435 1442 30515724 10.1007/s40520-018-1082-y
M.V. Rosa M.R. Perracini N.A. Ricci Usefulness, assessment and normative data of the functional reach test in older adults: a systematic review and meta-analysis Arch Gerontol Geriatr 81 149 170 30593986 10.1016/j.archger.2018.11.015
Arsh A et al (2021) Reliability of modified functional reach test in the assessment of balance function in people with spinal cord injury: a systematic review. pp 1–12
Y.M. Rolland et al. Reliability of the 400-m usual-pace walk test as an assessment of mobility limitation in older adults J Am Geriatr Soc 52 6 972 976 15161464 10.1111/j.1532-5415.2004.52267.x
J. Gunawan C. Marzilli Y. Aungsuroch Establishing appropriate sample size for developing and validating a questionnaire in nursing research Belitung Nurs J 7 5 356 360 37496511 10367972 10.33546/bnj.1927
White M (2022) Sample size in quantitative instrument validation studies: a systematic review of articles published in Scopus, 2021. Heliyon 8(12)
S.M. Arafat et al. Cross cultural adaptation and psychometric validation of research instruments: a methodological review J Behav Health 10.5455/jbh.20160615121755
D.J. Mundfrom D.G. Shaw T.L. Ke Minimum sample size recommendations for conducting factor analyses Int J Test 5 2 159 168 10.1207/s15327574ijt0502_4
M. Tavakol R. Dennick Making sense of Cronbach's alpha Int J Med Educ 2 53 55 28029643 4205511 10.5116/ijme.4dfb.8dfd
K.S. Taber The use of Cronbach’s alpha when developing and reporting research instruments in science education Res Sci Educ 48 6 1273 1296 10.1007/s11165-016-9602-2
M. Gagnon et al. Validity of the mini-mental state examination as a screening instrument for cognitive impairment and dementia in French elderly community residents Neuroepidemiology 9 3 143 150 1:STN:280:DyaK3czosVKhsw%3D%3D 2402325 10.1159/000110764
T.-Y. Chen et al. Caregiver involvement in the use of assistive devices by frail older persons Occup Ther J Res 20 3 179 199 10.1177/153944920002000303
M. van Dijk et al. Can in-hospital or post discharge caregiver involvement increase functional performance of older patients? A systematic review BMC Geriatr 20 1 362 32962653 7510152 10.1186/s12877-020-01769-4
L.F. Tan et al. Screening for frailty and sarcopenia among older persons in medical outpatient clinics and its associations with healthcare burden J Am Med Dir Assoc 18 7 583 587 28242192 10.1016/j.jamda.2017.01.004
R.D. Adelman et al. Caregiver burden: a clinical review JAMA 311 10 1052 1060 1:CAS:528:DC%2BC2cXksVaisbk%3D 24618967 10.1001/jama.2014.304
C.F. Olsen A. Bergland Reliability of the Norwegian version of the short physical performance battery in older people with and without dementia BMC Geriatr 17 1 124 28599623 5466771 10.1186/s12877-017-0514-4
S.Y. Lee et al. SPPB reference values and performance in assessing sarcopenia in community-dwelling Singaporeans - Yishun study BMC Geriatr 21 1 213 33781211 8008740 10.1186/s12877-021-02147-4
E. Freiberger et al. Performance-based physical function in older community-dwelling persons: a systematic review of instruments Age Ageing 41 6 712 721 22885845 10.1093/ageing/afs099
S.P. Sayers et al. Concordance and discordance between two measures of lower extremity function: 400 meter self-paced walk and SPPB Aging Clin Exp Res 18 2 100 106 16702778 10.1007/BF03327424
J.M. Pritchard et al. Measuring frailty in clinical practice: a comparison of physical frailty assessment methods in a geriatric out-patient clinic BMC Geriatr 17 1 264 1:STN:280:DC%2BC1M3gs1Ontg%3D%3D 29132301 5683585 10.1186/s12877-017-0623-0
E.M. Reijnierse et al. The association between parameters of malnutrition and diagnostic measures of sarcopenia in geriatric outpatients PLoS ONE 10 8 26284368 4540413 10.1371/journal.pone.0135933 e0135933
R. Roubenoff Exercise, sarcopenia, cognition, and mood Nestle Nutr Workshop Ser Clin Perform Programme 6 151 159 16969973 10.1159/000061864
R. Pavasini et al. Short physical performance battery and all-cause mortality: systematic review and meta-analysis BMC Med 14 1 215 28003033 5178082 10.1186/s12916-016-0763-7
D.H. Paterson D.E.R. Warburton Physical activity and functional limitations in older adults: a systematic review related to Canada's physical activity guidelines Int J Behav Nutr Phys Act 7 1 38 20459782 2882898 10.1186/1479-5868-7-38
L.A. Schaap A. Koster M. Visser Adiposity, muscle mass, and muscle strength in relation to functional decline in older persons Epidemiol Rev 35 1 51 65 23221972 10.1093/epirev/mxs006
A.A.O. Leopoldino et al. Influence of frailty status on pain, disability, and quality of life in older adults with acute low back pain: results from the back complaints in the elders (BACE-Brazil) study Can J Aging 40 3 367 375 1:STN:280:DC%2BB38fltFGgsQ%3D%3D 32792030 10.1017/S0714980820000288
M. Thompson A. Medley Forward and lateral sitting functional reach in younger, middle-aged, and older adults J Geriatr Phys Ther 30 2 43 48 18171486 10.1519/00139143-200708000-00002
N. Martínez-Velilla et al. Effect of exercise intervention on functional decline in very elderly patients during acute hospitalization JAMA Intern Med 179 1 28 30419096 10.1001/jamainternmed.2018.4869
