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Table 1 Results of COnsensus‐based Standards for the selection of health Measurement Instruments (COSMIN) Checklist

From: Psychometric properties of multicomponent tools designed to assess frailty in older adults: A systematic review

Frailty assessment tool Study reference Internal consistency Reliability Measurement error Content validity Structural validity Hypotheses testing Cross-cultural validity Criterion validity Responsiveness Comments
9-Item Frailty Measure Ravaglia et al. [25] 0 0 0 4 - 2 0 0 0 Structural Validity: Not rated according to COSMIN guidance as the tool is based on a formative model.
Brief Clinical Instrument to Classify Frailty Rockwood et al. [26] 0 0 0 0 0 2 0 - 0 Criterion Validity: Study reports assessment of criterion validity however this is rated as part of construct validity (hypothesis testing) according to COSMIN guidance.
Kenig et al. [27] 0 0 0 0 0 1 0 0 0 Hypothesis Testing: Important methodological flaws in the design of the study noted; diagnosis of frailty via the detection of deficits in two or more domains of the Geriatric Assessment (GA) has limited theoretical grounding. No reliability or validity data for GA in this context.
Brief Frailty Index Freiheit et al. [28] 0 0 0 2 0 2 0 0 0  
British Frailty Index Kamaruzzaman et al. [29] - 0 0 0 0 0 0 1 0 Internal Consistency: Not rated according to COSMIN guidance as the tool is based on a formative model.
Criterion Validity: The criterion employed cannot be considered a reasonable gold standard. Correlations or AUC of ROC not calculated.
Care Partners-Frailty Index-Comprehensive Geriatric Assessment (CP-FI-CGA) Goldstein et al. [30] 0 0 0 2 0 2 0 1 0 Criterion Validity: The criterion employed cannot be considered as a reasonable gold standard.
Clinical Frailty Scale Rockwood et al. [31] 0 1 0 4 0 2 0 1 0 Reliability: Tool not administered by independent raters when assessing inter-rater reliability.
Criterion Validity: The criterion employed cannot be considered as a reasonable gold standard.
Rockwood et al. [32] 0 0 0 0 0 1 0 1 0 Criterion Validity: The criterion employed cannot be considered as a reasonable gold standard.
Criterion Validity and Hypothesis Testing: Important methodological flaws in the design of the study noted; measurement properties of comparator instrument (Phenotype of frailty-Referred to as Frail-CHS) significantly altered from original. No reliability or validity data for amended version.
Mitiniski et al. [33] 0 0 0 0 0 1 0 0 0 Construct Validity: Important methodological flaws in the design of the study noted; measurement properties of comparator instrument (Phenotype of Frailty) significantly altered from original. No reliability or validity data for amended version.
Clinical Global Impression of Change in Physical Frailty Studenski et al. [34] 0 1 0 2 0 0 0 0 0 Reliability: Inter-rater reliability assessed using case scenarios. Small sample size (n = 24) for pilot testing. Likely selection bias in the focus group; all patients and carers selected by first author (all carers were female). Likely selection bias for participants of pilot test as the testing physicians chose two patients who they deemed to be frail to be tested.
Comprehensive Assessment of Frailty (CAF) Sundermann et al. [35] 0 0 0 1 - 2 0 0 0 Content validity: Some aspects of content validity explored however there was limited assessment of whether all items are relevant for the study population and limited information regarding the theoretical foundation of the tool.
Structural validity: Not rated according to COSMIN guidance as the tool is based on a formative model.
Sundermann et al. [36] 0 0 0 0 0 2 0 0 0  
Sundermann et al. [37] 0 0 0 0 0 2 0 0 0  
Continuous Composite Measure of Frailty Buchman et al. [38] 0 0 0 2 0 2 0 1 1 Criterion Validity: The criterion employed cannot be considered as a reasonable gold standard. Measurement properties of comparator instrument (Phenotype of Frailty) significantly altered from original. No reliability or validity data for amended version.
Responsiveness: The time interval between measurements was not adequately described.
EASY-Care Two-step Older persons Screening (Easycare TOS) Van Kempen et al. [39] 0 1 0 0 0 2 0 1 0 Reliability: Small sample size (n = 19) for reliability calculations.
Criterion Validity: The criterion employed cannot be considered as a reasonable gold standard.
Van Kempen et al. [40] 0 0 0 1 0 0 0 0 0 Content Validity: An assessment of whether all items are relevant for the purpose of the measurement instrument was competed however limited information available regarding other aspects of content validity.
Edmonton Frail Scale Rolfson et al. [41] - 1 0 0 0 0 0 0 0 Internal Consistency: Not rated according to COSMIN guidance as the tool is based on a formative model.
Reliability: Small sub sample size (n = 18) for reliability calculations.
Haley et al. [42] 0 0 0 0 0 2 0 0 0  
Graham et al. [43] 0 0 0 0 0 1 0 0 0 Hypothesis Testing: Important methodological flaws in the design of the study noted; tertile split was performed for reasons of sample size equality and not theoretically or empirically justified.
Evaluative Index for Physical Frailty De Vries et al. [44] 0 1 0 2 0 1 0 0 0 Reliability and Hypothesis testing: Small sample (n = 24)
Frailty Index-Comprehensive Geriatric Assessment (FI-CGA) Jones et al. [45] 0 2 0 2 0 2 0 0 0  
Jones et al. [46] 0 0 0 0 0 2 0 1 0 Criterion Validity: The criterion employed cannot be considered as a reasonable gold standard.
Pilotto et al. [47] 0 0 0 0 0 2 0 0 0  
FORECAST Sundermann et al. [35] 0 0 0 0 0 2 0 0 0  
Sundermann et al. [36] 0 0 0 0 0 2 0 0 0  
Frailty Index Mitnitski et al. [48] 0 0 0 0 0 2 0 0 0  
Frailty Index based on Primary Care Data. Drubbel et al. [49] 0 0 0 2 0 2 0 1 0 Criterion Validity: The criterion employed cannot be considered as a reasonable gold standard.
Drubbel et al. [50] 0 0 0 2 0 2 0 0 0  
Frailty Index for Elders (FIFE) Tocchi et al. [51] - 0 0 1 - 0 0 0 0 Internal Consistency & Structural Validity: Not rated according to COSMIN guidance as the tool is based on a formative model.
Content Validity: Important methodological flaws in the design of the study noted; during item generation process potential variables excluded solely on the basis of information available in the parent data set.
Frail Non-
Disabled Instrument (FiND)
Cesari et al. [52] 0 0 0 1 0 1 0 1 0 Content Validity, Hypothesis Testing and Criterion Validity: Important methodological flaws in the design of the study noted; Analysis of agreement between FiND and Phenotype of Frailty is flawed as FiND includes 2/5 of the Phenotype of Frailty items. This significantly affects the interpretation of the data.
Frailty Screening Tool Doba et al. [53] 0 0 0 1 - 1 0 0 0 Structural Validity: Not rated according to COSMIN guidance as the tool is based on a formative model.
Content validity & Hypothesis Testing: Important methodological flaws in the design of the study noted; potential selection bias due to the exclusion of those older adults who had chronic comorbid illness. Potential underrepresentation of frailest adults due to the exclusion of participants from analysis whom were unable to engage in a final assessment. No clarity regarding the definition of ’cognitive change’ item.
Groningen Frailty Indicator (GFI) Bielderman et al. [54] - 0 0 4 - 2 0 1 0 Internal Consistency and Structural Validity: Not rated according to COSMIN guidance as the tool is based on a formative model.
Criterion Validity: The criterion employed cannot be considered as a reasonable gold standard.
Daniels et al. [55] 0 0 0 0 0 2 0 1 2 Criterion Validity: The criterion employed cannot be considered as a reasonable gold standard.
Drubbel et al. [49] 0 0 0 0 0 2 0 1 0 Criterion Validity: The criterion employed cannot be considered as a reasonable gold standard.
Hoogendijk et al. [56] 0 0 0 0 0 2 0 1 0 Criterion Validity: The criterion employed cannot be considered as a reasonable gold standard.
Kenig et al. [27] 0 0 0 0 0 1 0 0 0 Hypothesis Testing: Important methodological flaws in the design of the study noted; diagnosis of frailty via the detection of deficits in two or more domains of the Geriatric Assessment has limited theoretical grounding. No reliability or validity data for GA in this context.
Metzelthin et al. [57] - 0 0 0 - 3 0 1 0 Internal Consistency and Structural Validity: Not rated according to COSMIN guidance as the tool is based on a formative model.
Criterion Validity: The criterion employed cannot be considered as a reasonable gold standard.
Peters et al. [58] - 0 0 0 - 3 0 0 0 Internal Consistency and Structural Validity: Not rated according to COSMIN guidance as the tool is based on a formative model.
Schuurmans et al. [59] 0 0 0 0 0 2 0 0 0  
Smets et al. [60] 0 0 0 0 0 2 0 1 0 Criterion Validity: The criterion employed cannot be considered as a reasonable gold standard.
Steverink et al. [61] - 1 0 1 0 2 0 0 0 Internal Consistency: Not rated according to COSMIN guidance as the tool is based on a formative model.
Reliability: Limited information regarding basic inter-rater reliability calculations given. No further reliability calculations completed.
Content Validity: Limited assessment of whether all items are relevant for the study population. Limited information due to source being a poster presentation abstract.
Tegels et al. [62] 0 0 0 0 0 2 0 0 0  
Guilley Frailty Instrument Guilley et al. [63] 0 0 0 0 0 2 0 0 0  
Inactivity and Weight Loss Chin et al. [64] 0 0 0 2 0 2 0 0 0  
Chin et al. [65] 0 0 0 0 0 2 0 0 0  
INTER-FRAIL Study Questionnaire De Bari et al. [66] 0 0 0 2 0 2 0 0 0  
KLoSHA Frailty Index Jung et al. [67] 0 0 0 4 - 2 0 1 0 Structural Validity: Not rated according to COSMIN guidance as the tool is based on a formative model.
Criterion Validity: The criterion employed cannot be considered as a reasonable gold standard.
Marigliano–Cacciafesta Polypathological Scale Amici et al. [68] 0 0 0 0 0 1 0 1 0 Hypothesis testing and Criterion Validity: Important methodological flaws in the design of the study noted; analysis consists purely of correlations with limited theoretical justification.
Criterion Validity: The criterion employed cannot be considered as a reasonable gold standard.
Phenotype of Frailty Esrund et al. [2] 0 0 0 0 0 2 0 0 0  
Fried et al. [13] 0 0 0 0 0 2 0 0 0  
Kenig et al. [27] 0 0 0 0 0 1 0 0 0 Hypothesis Testing: Important methodological flaws in the design of the study noted; diagnosis of frailty via the detection of deficits in two or more domains of the Geriatric Assessment has limited theoretical grounding. No reliability or validity data for GA in this context.
Kim et al. [69] 0 0 0 0 0 0 0 1 0 Criterion Validity: The criterion employed cannot be considered as a reasonable gold standard. No calculations of sensitivity and specificity.
Kulminski et al. [70] 0 0 0 0 0 0 0 1 0 Criterion Validity: The criterion employed cannot be considered as a reasonable gold standard. Scoring changed from ordinal to continuous however only relative risk ratios were compared. No correlations or AUC of ROC calculated.
Predictive Physical Frailty Score Carriere et al. [71] 0 0 0 0 - 2 0 0 0 Structural Validity: Not rated according to COSMIN guidance as the tool is based on a formative model.
Prognostic Risk Score Pijpers et al. [72] 0 0 0 0 - 2 0 0 0 Structural Validity: Not rated according to COSMIN guidance as the tool is based on a formative model.
Self-Report Screening Tool for Frailty De Souto Barreto et al. [73] 0 0 0 0 0 2 0 0 0  
SHARE Frailty Instrument Romero-Ortuno et al. [74] 0 0 0 4 - 2 0 1 0 Structural Validity: Not rated according to COSMIN guidance as the tool is based on a formative model.
Criterion Validity: The criterion employed cannot be considered as a reasonable gold standard.
Romero-Ortuno et al. [75] 0 0 0 0 0 2 0 1 0 Criterion Validity: The criterion employed cannot be considered as a reasonable gold standard.
Romero-Ortuno et al. [76] 0 0 0 0 0 2 0 0 0  
Romero-Ortuno et al. [77] 0 0 0 0 0 2 0 0 0  
Romero-Ortuno et al. [78] 0 0 0 0 0 2 0 1 0 Criterion Validity: The criterion employed cannot be considered as a reasonable gold standard.
SHARE Frailty Instrument 75+ (SHARE-FI75+) Romero-Ortuno et al. [79] - 0 0 4 - 2 0 0 0 Internal Consistency & Structural Validity: Not rated according to COSMIN guidance as the tool is based on a formative model.
SOF Frailty Criteria Bilotta et al. [80] 0 0 0 0 0 2 0 0 0  
Ensrud et al. [81] 0 0 0 0 0 2 0 1 0 Criterion Validity: The criterion employed cannot be considered as a reasonable gold standard.
Strawbridge Frailty Measure Strawbridge et al. [82] 0 0 0 1 0 0 0 0 0 Content validity: No assessment of whether all items are relevant for the target population and no assessment of whether all items together comprehensively reflect the measurement of frailty.
Matthews et al. [83] 0 0 0 0 0 2 0 0 0  
The Comprehensive Frailty Assessment Instrument De Witte et al. [84] - 0 0 4 - 0 0 0 0 Internal Consistency & Structural Validity: Not rated according to COSMIN guidance as the tool is based on a formative model.
De Witte et al. [85] - 0 0 0 0 2 0 1 0 Internal consistency: Not rated according to COSMIN guidance as the tool is based on a formative model.
Criterion Validity: The criterion employed cannot be considered as a reasonable gold standard.
The Frailty Trait Scale Garcia-Garcia et al. [86] 0 0 0 2 0 2 0 1 0 Criterion Validity: The criterion employed cannot be considered as a reasonable gold standard.
The FRAIL Scale Lopez et al. [87] 0 0 0 0 0 2 0 0 0  
Tilburg Frailty Indicator (TFI) Andreasen et al. [88] 0 0 0 0 0 0 1 0 0 Cross-Cultural Validity: Sample size less than 5 times the number of items included on the scale (5* 15 = 75, actual sample size included; 34)
Daniels et al. [55] 0 0 0 0 0 2 0 1 2 Criterion Validity: The criterion employed cannot be considered as a reasonable gold standard.
Gobbens & van Assen [89] 0 0 0 0 0 2 0 0 0  
Gobbens et al. [90] 0 0 0 1 0 0 0 0 0 Content Validity: An assessment of whether all items are relevant for the purpose of the measurement instrument was competed however there was limited information regarding other aspects of content validity.
Gobbens et al. [91] 0 2 0 2 0 2 0 0 0  
Gobbens et al. [92] 0 0 0 0 0 2 0 0 0  
Gobbens et al. [93] 0 0 0 0 0 2 0 0 0  
Metzelthin et al. [57] - 0 0 0 - 3 0 1 0 Internal Consistency and Structural Validity: Not rated according to COSMIN guidance as the tool is based on a formative model.
Criterion Validity: The criterion employed cannot be considered as a reasonable gold standard.
Uchmanowicz et al. [94] - 0 0 0 0 0 1 0 0 Internal Consistency: Not rated according to COSMIN guidance as the tool is based on a formative model.
Cross Cultural Validity: Multiple-group confirmatory factor analysis not performed.
WHIOS Multicomponent Measure Woods et al. [95] 0 0 0 0 0 2 0 0 0  
  1. Key: 4: Excellent, 3: Good, 2: Fair, 1: Poor, 0: No information, − : Not rated
  2. AUC Area Under Curve, ROC Receiver Operating Curve