Spanish linguistic validation, validity and reliability testing of Frail´BESTest in institutionalized frail people older than 60 years old with mild cognitive impairment

AIM: The primary purpose of this study is to validate linguistically the Frail Best test and then to identify the reliability and validity of this instrument that detects static and dynamic balance problems in institutionalized older fragile people with mild cognitive impairment. TASKS: Frail'BESTest it is an assessment tool validated that aims to identify disorder systems underlying postural control responsible for poor functional balance in Frail individuals. It has 26 items, 23 test that evaluate performance of 6 balance systems: A: anticipations, B: reactions, C: locomotion, D: sensorial orientation, E: biomechanical constraints and F: asymmetric gait. Each one of these sub-systems include different test or criteria are included. All test or criteria are scored dichotomously assigning 0 for negative results or 1 for positive. The maximum and best possible score for Frail'BESTest it is 26 and minimum 0. A. Proactive motor control anticipatory maximum score is 5 and minimum 0 (represents 19% of the Frail’BESTtest score). B. Reactive motor control - reactions- maximum score is 2 and minimum 0 (represents 8% of the Frail’BEST test score). C. Locomotion and gait maximum score is 6 and minimum 0 (represents 23% of the Frail’BESTtest score). D. Static postural control maximum score is 3 and minimum 0 (represents 12% of the Frail’BESTtest score). E. Biomechanical restrictions maximum score is 6 and minimum 0 (represents 23% of the Frail’BESTtest score). F. Gait symmetry maximum score is 4 and minimum 0 (represents 15% of the Frail’BESTtest score), EQUIPMENT: Minimum equipment is require 1) foam (mean density 55 kg/m3) for the “sensorial orientation” section 2) a 15-cm-high rehabilitation step for the “anticipations” section. 3) Stopwatch, 4) Instruction tools (paper or tablet), 5) Ruler, 6) Chair with armrests TEST SUPERVISION/CONDUCTION Motor assessments are immediately score by the physiotherapist or exercise physiologist that are supervising and conducting the test. TIME NEEDED TO COMPLETE THE TEST Frail’BESTest is feasible. Based on previous publications an experienced testers, 10 minutes are necessary to complete the test in frail participants. This Cross-sectional study consists of five phases. PHASE 1 [Ph1] [T0] Consist on the linguistic validation and it will be carried out the transcultural adaptation of Frail'BESTest in a population sample (named group A), which will be make up of 30 individuals over 60 years of age, community living independently in their houses, cognition preserve (scoring > or = to 27 with Mini Mental State Examination, MMSE), who have a preserve physical functional status (score less than 2 or equal to 2 on Fried Phenotype), and able to stand up still, without assistive devices for 10s or over (Group A). A Physical therapist or exercise Physiologists will give instruction to participants. They will be ask if they understand the instructions and it will be confirm with the execution of the test whether they perform as plann and safe. It is anticipate being conduct over 4 weeks period. Week one begins with first participant at Ph1, PHASE 2 [Ph2] [T0 and T1] consist on reliability. Starts 1 weeks after the end of Ph1. Two subgroups (Group B and Group C) of institutionalized frail aged participants (scoring 3 or more in FRIED TEST), n=30 with mild cognitive impairment (scoring 24-26 at MMSE) (named Group B) and 30 without mild cognitive impairment (scoring = or >27 at MMSE) (named group C) will be test. We will examine between raters reliability and test-retest reliability. To examine reliability between testers, at baseliene Test (T0) two different physiotherapist will be testing at the same time. To examine test-retest reliability, the first 30 participants from group B, called Group B1 will be test at baseline (T0) and on a second occasion during the 7 days following baseline test (T1). Participants will maintain usual activities of geriatric institution or nursing home these days. Week one begins with first participant at Ph1., Ph2 length it is arround 7 weeks. ans Phase 2 it is anticipate being conduct over an accumulative time of 12 weeks. That is Ph1 4wks+1wk +Ph2 7wks) PHASE 3 [Ph3] [T0] consisting on construct validity. Ph3 starts together Ph1 for Group A. and together Ph2 for Group B and Group C. The three subsamples are: 1) non-institutionalized people over 60 years old, cognitively intact and highly functioning (Group A) n=30, 2) Institutionalized elderly with mild cognitive impairment and frailty (Group B) n= 210 3) Cognitively intact and fragile institutionalized older people (Group C). n= 30 Each participant will be test at baseline only once (T0). Week one begins with first participant at Ph1. Ph3 length it is arround 22 weeks. Testing the whole sample (270 participants) It is anticipate being conduct over an accumulative time of 34 weeks. (That is Ph1 4wks+1wk +Ph2 7wks+ Ph3 22wks) PHASE 4 [Ph4] [T3] consisting on predictive falls/concurrent validity. Will take part participants from Group B and Group C, Ph4 starts the day after Ph3. Week one begins with first participant at Ph1. Ph4 length it is arround 26 weeks .P4 it is anticipate being conduct over an accumulative time of 60 weeks. (That is Ph1 4wks+1wk +Ph2 7wks+ Ph3 22wks +Ph4 26wks). Each participant from Group B and Group C will take part and after baselinte test day (T0) they will be follow up for 6 months (T3) for outcomes related with falls and their consequences. During P4 articipants will maintain usual activities of the geriatric institution or nursing home. PHASE 5 [Ph5] [T4] consisting on predictive deaths/concurrent validity. Will take part participants from Group B and Group C, Week one begins with first participant at Ph1. Ph5 length it is arround 26 weeks .P5 it is anticipate being conduct over an accumulative time of 86 weeks. (That is Ph1 4ws+1w +Ph2 7ws+ Ph3 22ws +Ph4 26ws+ Ph426ws). Ph5 starts the day after baseline test (Ph2 or Ph3) and together Ph4, for 12 months (T4). It is anticipate being conduct over an accumulative time of 86 weeks. Week one begins with first participant at Ph1.Each participant from Group B and Group C will take part and after baseline test day he/she will be follow up for 12 months, (T4) or until death. During the follow up time time or until the outcome, each participants will maintain usual activities of the geriatric institution or nursing home. Detailed information about FrailBESTest administration and testing procedure has been obtained from Kubicki A, and Kubicki A, Brika M, Coquisart L, Basile G, Laroche D, Mourey F. The Frail'BESTest. An Adaptation of the "Balance Evaluation System Test" for Frail Older Adults. Description, Internal Consistency and Inter-Rater Reliability. Clin Interv Aging. 2020 Jul 30;15:1249-1262. doi: 10.2147/CIA.S247332. PMID: 32801673; PMCID: PMC7398746. Kubicki A, Laroche D, Coquisart L, Basile G, Brika M, Mourey F. The Frail'BESTest: an adaptation of the "balance evaluation system test" for frail older adults; Concurrent validity, responsiveness, validity for fall prediction and detection of slower walkers. Eur Rev Aging Phys Act. 2021 Oct 28;18(1):22. doi: 10.1186/s11556-021-00276-8. PMID: 34711173; PMCID: PMC8555199. A. Kubicki, F. Mourey, Rehabilitación geriátrica: enfoque sistémico, Volume , Issue, /2016, Pages , ISSN 1293-2965, http://dx.doi.org/10.1016/S1293-2965(15)76057-3 (http://www.sciencedirect.com/science/article/pii/S1293-2965(15)76057-3).