Pictorial Fit‑Frail Scale
The Pictorial Fit-Frail Scale (PFFS) uses simple visual images to assess a person’s level of fitness-frailty. There are acute versions of the PFFS which allow for assessment of a person’s usual state of fitness-frailty and their current (acute) state. Knowing the difference between how someone presents, for example, in the emergency department (their acute state) and what they were like approximately two weeks ago (their usual or pre-acute state) gives an indication of how these states differ and what the care goals of acute treatment may be.
The PFFS assessment can be completed by an individual (self-assessment), a care partner (proxy-assessment), or a healthcare professional (clinical assessment). It is quick to administer, taking less than 2 minutes when assessed by a clinican and less than 5 minutes for self and proxy assessment. The PFFS evaluates a person's ability in 14 different domains. Within each domain, 3 to 6 levels of ability are represented with images and the assessor picks the image that best represents the usual state of the person being assessed. Images make the scale accessible across literacy levels, languages, and cultures. The PFFS visually shows change from one level to another and can facilitate discussion with the patient, and within the care team and their family. The PFFS is comprehensive and captures the multidimensionality of frailty.
There are currently four versions of the PFFS:
1) PFFS: used for self- or proxy-assessment of a person's usual state of fitness-frailty.
2) PFFS-Health Care Professional (HCP): used for clinical assessment (by a health care professional) of a patient's usual state of fitness-frailty.
3) PFFS-Acute: used for self- or proxy-assessment of a patient's current (acute) and usual state of fitness-frailty.
4) PFFS-HCP Acute: used for clinical assessment of a patient's current (acute) and usual state of fitness-frailty.
Scoring the PFFS
For each domain, the level representing least or no impairment (first picture on the left) is scored 0, the next level (second picture from the left) as 1, etc. Scoring for each domain ranges from 2 to 5. Total PFFS scores are calculated by summing the scores across domains. The final summed score could theoretically range from 0 (no frailty; very fit) to 43 (severely frail). We recommend using the continuous PFFS score.
Theou O, Andrew M, Ahip SS, Squires E, McGarrigle L, Blodgett JM, Goldstein J, Hominick K, Godin J, Hougan G, Armstrong JJ, Wallace L, Sazlina SG, Moorhouse P, Fay S, Visvanathan R, Rockwood K. The Pictorial Fit-Frail Scale: Developing a visual scale to assess frailty. Can Geriatr J. 2019;22(2):64-74. doi:10.5770/cgj.22.357
McGarrigle L, Squires E, Wallace LMK, Godin J, Gorman M, Rockwood K, Theou O. Investigating the feasibility and reliability of the Pictorial Fit-Frail Scale. Age and Ageing. 2019;48(6):832-837. doi:10.1093/ageing/afz111
Wallace LMK, McGarrigle L, Rockwood K, Andrew MK, Theou O. Validation of the Pictorial Fit-Frail Scale in a memory clinic setting. International Psychogeriatrics. 2020;32(9):1063-1072. doi:10.1017/S1041610219000905
Ahip SS, Shariff-Ghazali S, Lukas S, Samad AA, Mustapha UK, Theou O, Visvanathan R. Translation, adaptation and pilot testing of the Pictorial Fit-Frail Scale (PFFS) for use in Malaysia – The PFFS-Malay version (PFFS-M) [published online ahead of print, 2021 May 27]. Malaysian Family Physician. 2021;16(2). doi:10.51866/oa1036
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