Using the Short Physical Performance Battery for Frailty Screenings Among Community-Dwelling Older Adults: An ROC Analysis

Frailty is a highly prevalent and adverse syndrome among older adults, and there are many different assessments for screening both frailty (robust + pre-frail vs. frail) and frailty process (robust vs. pre-frail + frail). Previous studies have suggested that the Short Physical Performance Battery (SPPB) can be used as a quick screening tool for frailty, demonstrating excellent agreement when compared to Fried’s phenotype as a criterion. However, to the best of our knowledge, no study has assessed the SPPB’s diagnostic accuracy using the FRAIL questionnaire as the criterion. In this cross-sectional study, we compared frailty (SPPB ≤ 8) and frailty process (SPPB ≤ 10) classifications for 371 community-dwelling older adults (≥60 yrs) by the SPPB to the FRAIL questionnaire using McNemar tables and a receiver operator characteristic analysis. The SPPB and the FRAIL questionnaire significantly differed in their appraisal of both frailty and frailty process (p < 0.001). For frailty, the SPPB scored a sensitivity of 62.9%, a specificity of 78.6%, and an area under the curve of 0.78. In addition, for the frailty process, the SPPB scored a sensitivity of 77.6%, a specificity of 55.3%, and an area under the curve of 0.70. The SPPB demonstrated limited diagnostic accuracy compared to the criterion FRAIL questionnaire. Our findings indicate that the SPPB should not be the sole method of assessing frailty among older adults. To address the complexity of frailty, clinicians should attempt to implement multiple assessments that combine biological, social, and functional aspects of frailty. Pre-registered on ClinicalTrials.gov (NCT05778604).