International urology and nephrology · 2013
Routine use of an abbreviated 4-item scale to assess dependence in essential activities of daily living amongst elderly hemodialysis patients: a validation study.
СтатьяВалидационное исследованиеНазвание и аннотация: Перевод в очереди
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Farrokhi Farhat, Jassal Sarbjit V
Аннотация
BACKGROUND: Poor functional status is associated with reduced survival and poor outcomes in older dialysis patients. The Geriatric Nephrology Advisory Group recommends routine evaluation of functional status on all older patients; however, assessments can be time consuming and burdensome to clinical care providers. The objective of this study was to validate an abbreviated 4-item self-report screening tool for use in elderly hemodialysis patients.
METHODS: The functional dependence of community-dwelling hemodialysis patients, aged ≥65 years, was measured by trained evaluators. The accuracy of a 4-item self-report activities of daily living (ADL) score was compared against formal evaluation by the Barthel Index and the outcomes using agreement statistics and Cox regression analysis.
RESULTS: The cohort included 167 patients with a mean age of 74.8 ± 5.9 years (57 % males). The 4-item scale correctly identified 83 % of the patients dependent in ≥1 ADL. Those incorrectly identified as independent on the abbreviated scale were uniformly unable to climb stairs without assistance. The sensitivity and specificity, and coefficient for agreement between the 4-item scale and the Barthel Index were 83.2, 100 and 0.78 %, respectively. The positive and negative predictive values of the 4-item scale were 100 and 76.9 %, respectively. Using the 4-item scale, the presence of severe disability was predictive of increased mortality (HR 12.5; 95 % CI 2.5-65.0; P = 0.03).
CONCLUSIONS: The 4-item scale is a simple, valid screening test for disability which can be used in the elderly population on dialysis as a screening tool. Difficulties with stair climbing may be overlooked using this score.
METHODS: The functional dependence of community-dwelling hemodialysis patients, aged ≥65 years, was measured by trained evaluators. The accuracy of a 4-item self-report activities of daily living (ADL) score was compared against formal evaluation by the Barthel Index and the outcomes using agreement statistics and Cox regression analysis.
RESULTS: The cohort included 167 patients with a mean age of 74.8 ± 5.9 years (57 % males). The 4-item scale correctly identified 83 % of the patients dependent in ≥1 ADL. Those incorrectly identified as independent on the abbreviated scale were uniformly unable to climb stairs without assistance. The sensitivity and specificity, and coefficient for agreement between the 4-item scale and the Barthel Index were 83.2, 100 and 0.78 %, respectively. The positive and negative predictive values of the 4-item scale were 100 and 76.9 %, respectively. Using the 4-item scale, the presence of severe disability was predictive of increased mortality (HR 12.5; 95 % CI 2.5-65.0; P = 0.03).
CONCLUSIONS: The 4-item scale is a simple, valid screening test for disability which can be used in the elderly population on dialysis as a screening tool. Difficulties with stair climbing may be overlooked using this score.