Comparative Study of Frailty Phenotype and Short Physical Performance Battery for Frailty Assessment in Chronic Obstructive Pulmonary Disease

Aim and background: Frailty is a multidimensional syndrome of physical and cognitive impairments predisposing patients to increased risk of hospitalizations and poorer health-related quality of life.We conducted this study with the aim of comparing the frailty phenotype (FP) and short physical performance battery (SPPB) methods for the assessment of frailty in chronic obstructive pulmonary disease (COPD).Materials and methods: This is a descriptive cross-sectional study conducted in 150 stable COPD patients.Frailty was assessed using the FP and SPPB methods, followed by a comparative evaluation of the two methods.Results: The prevalence of frailty was 51.33% (n = 77) by the FP method and 21.33% (n = 32) by SPPB.Frail patients in both groups had the lowest post-bronchodilator forced expiratory volume in 1 second (FEV1) (%) (p < 0.0001).The median St. George's Respiratory Questionnaire (SGRQ) score was highest in the Frail group by the FP method [43.21 (32.116-58.338)]and pre-frail group by SPPB [43.47 (30.913-59.02)](p = 0.007).The association between FP and SPPB was significant but with poor inter-rater kappa agreement (0.196, p = 0.0001).Frailty phenotype method showed a significant positive correlation, whereas SPPB had a significant negative correlation with duration of dyspnea (r = 0.3; r = -0.269),frequency of exacerbations (r = 0.498; r = -0.548),mMRC score (r = 0.525; r = -0.408),CAT score (r = 0.478; r = -0.52)and pack-years of smoking (r = 0.301; r = -0.278).Six-minute walk test (6MWT) distance had a significant association with frailty (p < 0.0001) by both methods.Conclusion: Frailty phenotype is a more sensitive method of frailty assessment in COPD compared to SPPB and correlates better with the severity of the disease.However, both methods showed a significant positive correlation with distance covered in 6MWT.Clinical significance: The FP and SPPB both identified a group of stable COPD patients with frailty.Our study underscores the importance of early identification and timely intervention to prevent deconditioning of muscular and cardiovascular systems which can otherwise progress to frailty.