Standardized Assessment of Global activities in the Elderly scale in adult cardiac surgery patients

Jessica Spence; Jackie Bosch; Edward Chongsi; Shun Fu Lee; Lehana Thabane; Pablo Mendoza; Emilie Belley-Côté; Richard Whitlock; Kate Brady; William F McIntyre; Andre Lamy; P J Devereaux

doi:10.1016/j.bja.2021.05.037

Standardized Assessment of Global activities in the Elderly scale in adult cardiac surgery patients

Br J Anaesth. 2021 Oct;127(4):539-546. doi: 10.1016/j.bja.2021.05.037. Epub 2021 Jul 28.

Authors

Affiliations

¹ Department of Anesthesia and Critical Care, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evaluation, and Impact, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada. Electronic address: spencej@phri.ca.
² Population Health Research Institute, Hamilton, ON, Canada; School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.
³ Population Health Research Institute, Hamilton, ON, Canada.
⁴ Department of Health Research Methods, Evaluation, and Impact, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada.
⁵ Department of Health Research Methods, Evaluation, and Impact, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada; Department of Medicine (Cardiology), McMaster University, Hamilton, ON, Canada.
⁶ Department of Health Research Methods, Evaluation, and Impact, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada; Department of Surgery (Cardiac Surgery), McMaster University, Hamilton, ON, Canada.

PMID: 34330417
DOI: 10.1016/j.bja.2021.05.037

Abstract

Background: Different instruments have been used to assess ability to perform everyday functional activities, such as activities of daily living (ADL) and instrumental activities of daily living (IADL). No measures of functional activity have been validated in cardiac surgery. We assessed the reliability and validity of the Standardized Assessment of Global activities in the Elderly (SAGE) scale.

Methods: We undertook an observational sub-study of VISION Cardiac Surgery. Patients were assessed post-discharge after cardiac surgery using SAGE and comparator measures to determine convergent validity. A blinded independent assessor administered SAGE by phone within 7 days to determine test-retest reliability. We sought to demonstrate a correlation of ≥0.5 between SAGE and each corresponding measure. We also sought to define the SAGE score corresponding to severe functional disability, defined using the World Health Organisation Disability Assessment Schedule (WHODAS).

Results: There were 152 patients included. Inter-rater reliability was excellent (intra-class correlation coefficient=0.99; 95% confidence interval [CI], 0.98-0.99). Convergent validity was evident, ranging from adequate for the overall SAGE score (0.54; 95% CI, 0.42-0.65) to very good for the SAGE mobility sub-score (0.80; 95% CI, 0.73-0.85). SAGE was initially poorly correlated with the IADL index (-0.24) but increased to -0.60 after post-hoc adjustment of SAGE scoring. A SAGE score ≥7 was associated with severe functional disability and occurred in 42/152 (27.6%) of patients.

Conclusion: These results demonstrate the reliability and validity of the SAGE scale as a measure of global function in patients discharged home after cardiac surgery.

Clinical trial registration: NCT01842568.

Keywords: Standardized Assessment of Global activities in the Elderly; activities of daily living; cardiac surgery; cognition; outcomes assessment; validation study.

Publication types

Comparative Study
Observational Study
Validation Study

MeSH terms

Activities of Daily Living*
Aged
Cardiac Surgical Procedures / methods*
Cross-Sectional Studies
Disability Evaluation*
Female
Humans
Male
Middle Aged
Observer Variation
Patient Discharge
Reproducibility of Results
Surveys and Questionnaires*

Associated data

ClinicalTrials.gov/NCT01842568