A Wrist-Worn Sensor-Derived Frailty Index Based on an Upper-Extremity Functional Test in Predicting Functional Mobility in Older Adults

Abstract

<b><i>Introduction:</i></b> Preoperative frailty is an independent risk factor for postoperative complications across surgical specialties. Functional mobility such as gait, timed up and go (TUG), and 5 times sit-to-stand (5-STS) are popular preoperative frailty measurements but are not suitable for patients with severe mobility impairment. A wrist-worn sensor-derived frailty index based on an upper-extremity functional test (20-s repetitive elbow flexion-extension task; UEFI) was developed previously; however, its association with functional mobility remained unexplored. We aimed to investigate the predictive power of the UEFI in predicting functional mobility. <b><i>Methods:</i></b> We examined correlation between the UEFI and gait speed, TUG duration, and 5-STS duration in 100 older adults (≥ 65 years) using multivariate regression analysis. The UEFI was calculated using slowness, weakness, exhaustion, and flexibility of the sensor-based 20-s repetitive elbow flexion-extension task. <b><i>Results:</i></b> The UEFI was a significant predictor for gait speed and TUG duration and 5-STS duration (all <i>R</i> ≥ 0.60; all <i>p</i> &#x3c; 0.001) with the variance (adjusted <i>R</i>^<i>2</i>) of 35–37% for the dependent variables. The multivariate regression analysis revealed significant associations between the UEFI and gait speed (β = −0.84; 95% confidence interval [95% CI] = [−1.19, −0.50]; <i>p</i> &#x3c; 0.001) and TUG duration (β = 16.2; 95% CI = [9.59, 22.8]; <i>p</i> &#x3c; 0.001) and 5-STS duration (β = 33.3; 95% CI = [23.6, 43.2]; <i>p</i> &#x3c; 0.001), found after accounting for confounding variables (e.g., age and fear of falling scale). <b><i>Conclusions:</i></b> Our findings suggest that the UEFI can be performed with a wrist-worn sensor and has been validated with other established measures of preoperative frailty. The UEFI can be applied in a wide variety of patients, regardless of mobility limitations, in an outpatient setting.