FRAIL scale predicts rehabilitative outcomes in postacute care setting

A Singapore study has recently validated the use of the FRAIL scale to indicate frailty status and shown its association with rehabilitative outcomes in older adults admitted to the postacute care setting. In addition, the FRAIL scale appears to improve prediction of the rehabilitative progress of prefrail patients.

“Frailty is associated with adverse health outcomes and can be measured using the FRAIL scale,” the researchers said. “A tool to predict rehabilitation outcomes would allow for better risk stratification and allocation of resources.”

In this retrospective cohort study, 560 older adults admitted to a community hospital for rehabilitation were screened using the FRAIL scale.

The researchers then analysed the data to ascertain the relationship between baseline characteristics and frailty status, with rehabilitation outcome measures of absolute functional gain, rehabilitation effectiveness, rehabilitation efficiency, length of stay, and discharge destination.

The combined score of the FRAIL scale revealed a significant negative association with absolute functional gain (p<0.001), rehabilitation effectiveness (p<0.001), and rehabilitation efficiency (p<0.001) and a positive association with increased length of stay (p<0.05) and a need for continued support in increased care settings (p<0.001). [Singapore Med J 2021;doi:10.11622/smedj.2021137]

Individual components of the FRAIL scale (ie, fatigue, ambulation, and loss of weight) showed a robust correlation with rehabilitation effectiveness and efficiency, particularly among prefrail patients.

“As postulated by a previous study, the FRAIL scale has indeed shown to be useful in a population with higher frailty prevalence,” the researchers said. [BMC Musculoskelet Disord 2018;19:14]

“Further, excluding patients with severe cognitive impairment … might influence the accuracy and applicability of estimates in rehabilitative recovery and, hence, the determination of the predictive value of frailty scoring for rehabilitative recovery,” they added.

This was worth noting since severe cognitive impairment had been shown to negatively predict functional recovery in rehabilitation, according to the researchers. [J Am Geriatr Soc 2002;50:679-684]

The current study also agreed with previous findings that frailty correlated with length of stay and discharge disposition. Of note, these studies had utilized other frailty measurements such as the Clinical Frailty Scale and frailty index. [Int J Ther Rehabil 2016;23:33-40; Age Ageing 2012;41:242-246]

Additionally, the finding that the FRAIL scale could help predict the rehabilitative progress of prefrail patients compelled community hospital to take steps in improving the rehabilitative outcomes of these individuals, the researchers said.

The present study, however, was limited by the lack of details on the rehabilitative process, including time spent and type of exercises performed during therapy, and the weak socioeconomic indicators utilized. However, two previous studies did not find any significant relationship between frailty and socioeconomic status. [Geriatr Gerontol Int 2017;17:1444-1454; Aging Med Healthcare 2020;11:39-46]

“Future research might consider focusing on the less frail patients, implementing a frailty-specific inpatient exercise programme, monitoring rehabilitative progress after discharge, utilizing a greater variety of rehabilitation outcome measures, and using more comprehensive indicators of socioeconomic status,” the researchers said.