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- Title
A Critical Appraisal of the Application of Frailty and Sarcopenia in the Spinal Oncology Population.
- Authors
MacLean, Mark A.; Charles, Antoinette J.; Georgiopoulos, Miltiadis; Phinney, Jackie; Charest-Morin, Raphaële; Goodwin, Rory; Laufer, Ilya; Fehlings, Michael G.; Shin, John; Dea, Nicholas; Rhines, Laurence D.; Sahgal, Arjun; Gokaslan, Ziya; Stephens, Byron; Disch, Alexander C.; Kumar, Naresh; O'Toole, John; Sciubba, Daniel M.; Netzer, Cordula; Goldschlager, Tony
- Abstract
Study Design: Systematic review and clinimetric analysis. Objectives: Frailty and sarcopenia predict worse surgical outcomes among spinal degenerative and deformity-related populations; this association is less clear in the context of spinal oncology. Here, we sought to identify frailty and sarcopenia tools applied in spinal oncology and appraise their clinimetric properties. Methods: A systematic review was conducted from January 1st, 2000, until June 2022. Study characteristics, frailty tools, and measures of sarcopenia were recorded. Component domains, individual items, cut-off values, and measurement techniques were collected. Clinimetric assessment was performed according to Consensus-based Standards for Health Measurement Instruments. Results: Twenty-two studies were included (42 514 patients). Seventeen studies utilized 6 frailty tools; the three most employed were the Metastatic Spine tumor Frailty Index (MSTFI), Modified Frailty Index-11 (mFI-11), and the mFI-5. Eight studies utilized measures of sarcopenia; the three most common were the L3-Total Psoas Area (TPA)/Vertebral Body Area (VBA), L3-TPA/Height2, and L3-Spinal Muscle Index (L3-Cross-Sectional Muscle Area/Height2). Frailty and sarcopenia measures lacked or had uncertain content and construct validity. Frailty measures were objective except the Johns-Hopkins Adjusted Clinical Groups. All tools were feasible except the Hospital Frailty Risk Score (HFRS). Positive predictive validity was observed for the HFRS and in select studies employing the mFI-5, MSTFI, and L3-TPA/VBA. All frailty tools had floor or ceiling effects. Conclusions: Existing tools for evaluating frailty and sarcopenia among patients undergoing surgery for spinal tumors have poor clinimetric properties. Here, we provide a pragmatic approach to utilizing existing frailty and sarcopenia tools, until more clinimetrically robust instruments are developed.
- Subjects
DISEASE risk factors; PREDICTIVE validity; SARCOPENIA; FRAILTY; UNITS of measurement
- Publication
Global Spine Journal, 2025, Vol 15, p47S
- ISSN
2192-5682
- Publication type
Academic Journal
- DOI
10.1177/21925682231207325