Spanish Electronic and Paper Version of the Comprehensive Frailty Assessment Instrument (CFAI): a Cross-Cultural Adaptation

Frailty is a dynamic and potentially reversible state that precedes and predicts adverse health outcomes. However, there is no instrument available that comprehensively assesses multidimensional frailty with adequate psychometric properties in the Spanish older population. A cross-culturally adaptation of the Comprehensive Frailty Assessment Instrument (CFAI), which has shown adequate psychometric properties in the evaluation of older Belgian population, is proposed. The availability of an electronic version will enhance access to the target population and reduce the workload of healthcare professionals. The process followed the International Test Commission (ITC) guidelines for test adaptation, Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes (PRO) Measures and the recommendations of the ePRO task Force. Iterative Cognitive interviews were conducted with a sample of 10 + 10 older adults selected based on the theoretical relevance of emerging patterns. The reconciliation phase identified minor wording issues. The harmonization committee and cognitive interview reviewers proposed the most significant changes. The issues resolved included recency bias, answers not being understood as expected by experts, wording ambiguity, lack of clarity and form layout. Measurement equivalence between versions was validated. A Spanish cross-culturally adapted version of the CFAI instrument is now available in electronic and paper format. The rigorous application of international guidelines and procedures suggests a high equivalence with the original instrument and retainment of its psychometric properties. Further analysis must confirm this assumption.