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Abstract Number: 1288

Predictors of Frailty Identified by the Short Physical Performance Battery and Associations with Patient-reported Outcomes

Patricia Katz1, Jinoos Yazdany2, Laura Trupin3, Stephanie Rush2, Cristina Lanata3, Lindsey Criswell4 and Maria Dall'Era5, 1University of California, San Francisco, Novato, CA, 2University of California, San Francisco, San Francisco, CA, 3UCSF, San Francisco, CA, 4Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center, University of California San Francisco, San Francisco, CA, 5Division of Rheumatology, University of California, San Francisco, CA

Meeting: ACR Convergence 2020

Keywords: functional status, Patient reported outcomes, physical activity, Systemic lupus erythematosus (SLE)

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Session Information

Date: Sunday, November 8, 2020

Session Title: SLE – Diagnosis, Manifestations, & Outcomes Poster II: Comorbidities

Session Type: Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Frailty, defined as a generalized vulnerability to stressors, has emerged as a relevant concept in SLE1, although its origins are in geriatrics.  As defined by the Fried Frailty Phenotype (FFP)2, frailty is an aggregate of 5 constructs: weight loss, exhaustion, low physical activity, slowness, and weakness.  Other means of identifying frailty have been suggested that may be easier to implement in clinical settings, including a shorter performance-based method, the Short Physical Performance Battery (SPPB)3.  We examined the prevalence of frailty using the SPPB in a well-characterized SLE cohort.

Methods: Data are from the California Lupus Epidemiology Study (CLUES), a longitudinal cohort of individuals with rheumatologist-confirmed SLE.  Data are collected annually through in-person research visits and structured interviews.  At one visit, the SPPB was administered to a subset of the cohort.  SPPB consists of balance tests, time to complete 5 chair stands, and gait speed over 4 meters.  Scores range from 0 – 12; a score of < 10 identifies frailty.  Differences in participant characteristics for frail/not frail were examined using t-tests or chi-square analyses.  Multivariate logistic regression analyses identified independent predictors of frailty, including age, sex, race/ethnicity, l, obesity, SLE duration, SLE disease activity, and steroid use.  Separate models were constructed to include either physician-assessed (SLE Disease Activity Index, SLEDAI) or patient-reported disease activity (Systemic Lupus Activity Questionnaire).  The impact of frailty on patient-reported outcomes (PROs) was examined with multiple regression analyses.

Results: Among the 150 individual who completed the SPPB, mean age was 45 ± 14 years, disease duration 15 ± 10 years, 89% were female, 41% Asian, 25% Hispanic, 26% white non-Hispanic, and 8% African American.  The proportion of individuals classified as frail was 48% (Table 1). Factors associated with frailty in bivariate analyses were low income, obesity, physical inactivity, and patient-reported disease activity (Table 1).  In multivariate analysis, only race/ethnicity remained a significant independent predictor of frailty (Hispanic only when adjusting for SLEDAI, Hispanic and African America when adjusting for SLAQ).  In post-hoc analyses, obesity and inactivity were found to be significantly more common among Hispanics and African Americans (p< .01, not shown). Frailty was associated with worse scores on most PROs, even after adjusting for race/ethnicity, income, obesity, and physician-assessed disease activity (Table 3).

Conclusion: Using the SPPB, nearly half of this sample was identified as frail.  A previous study using the FFP found 20% prevalence of frailty and 50% pre-frailty.  Racial/ethnic differences were noted, but may be due to greater prevalence of obesity and inactivity among Hispanics and African Americans.  Patient-reported outcomes were consistently worse among individuals classified as frail, even after adjusting for covariates.  Interventions aimed at reducing inactivity may reduce frailty among individuals with SLE.

1 Katz P. Lupus Sci Med 2017;4:e000186
2 Fried L. J Gerontol 2001; 56:M146
3 Guralnik J. J Gerontol 1994; 49:M85


Disclosure: P. Katz, None; J. Yazdany, Eli Lilly, 1, Astra Zeneca, 1; L. Trupin, None; S. Rush, None; C. Lanata, None; L. Criswell, None; M. Dall'Era, Janssen, 5, AstraZeneca, 5.

To cite this abstract in AMA style:

Katz P, Yazdany J, Trupin L, Rush S, Lanata C, Criswell L, Dall'Era M. Predictors of Frailty Identified by the Short Physical Performance Battery and Associations with Patient-reported Outcomes [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/predictors-of-frailty-identified-by-the-short-physical-performance-battery-and-associations-with-patient-reported-outcomes/. Accessed February 25, 2021.
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