Cross-cultural adaptation and validation of the Sinhala version of the PRISMA 7 scale (PRISMA 7SV)

Abstract Background PRISMA-7 is a seven-item, simple tool developed to detect frailty among older adults. Objectives To translate, culturally adapt, and validate the PRISMA 7 frailty scale among Sinhala conversant older adults. Methods This cross-sectional study validated the Sinhala version of PRISMA 7 frailty scale (PRISMA 7SV) among Sinhala-conversant older adults in Sri Lanka after standard forward and backward translation and cultural adaptation of the content. After a pilot study, the final version of PRISMA 7SV was administered to a group of older adults (purposive sampling) attending medical clinics in a tertiary health care setting in Colombo. The Fried phenotype was used as the reference standard to detect frailty phenotype. PRISMA 7SV score 3 was used as the cut point to define frailty and the agreement between the reference standard and PRISMA 7SV was assessed. Reliability of the questionnaire was assessed and the optimum cut point to define frailty in the local population was determined by ROC analysis. Results The mean (SD) age of the subjects (n = 118) was 81.9(7.3) years. Although male sex and polypharmacy are generally associated with frailty, no significant sex- or medication-related differences were observed in this cohort. Frailty was strongly and significantly associated with advanced age (≥85 years) compared with 85 years (p = 0.0001). The agreement between the reference standard and PRISMA 7SV was high (Kappa 0.69, p 0.001). According to PRISMA 7SV, 53 were frail, and compared to those non-frails (n = 65), they were older, had higher comorbidity and poor physical performance (p 0.05 for all). The overall Cronbach’s alpha of PRISMA 7SV was 0.71 (p 0.001) and the area under ROC curve was 0.87 (p 0.001) The best cut point in ROC curve was 3 and this was associated with 0.80 sensitivity and 0.90 specificity. Additionally, 66 (55.1%) are on polypharmacy, defined as taking five or more drugs. Discussion and Conclusions PRISMA 7SV has satisfactory psychometric properties to be used as a screening tool to detect frailty among Sinhala conversant older adults in Sri Lanka.