Nine self-reported items at three months formed a robust frailty scale that tracked survival over follow-up.

A Swedish registry study built a frailty score from nine patient-reported items collected three months after stroke. The score fit best as a general frailty dimension with two related facets: physical functioning and well-being with mental health. Higher frailty scores were linked to higher all-cause mortality over follow-up.

Quick summary

• What the study found: A frailty score derived from patient-reported outcomes showed strong measurement performance, minimal bias by sex and education, modest age-related item bias, and clear prediction of mortality.
• Why it matters: Patient-reported questionnaires can generate a scalable frailty metric that may help track recovery and flag higher-risk patients without clinician rating.
• What to be careful about: Some items functioned differently by age, and the score is unitless and model-based, so cutoffs are not inherently intuitive.

What was found

The journal article Developing and validating a frailty score based on patient-reported outcome 3 months after stroke: A Riksstroke-based study analyzed 19,470 three-month questionnaires from the Swedish Stroke Register.

Nine self-reported items covered function, mood, fatigue, pain, and general health. The items met Mokken Scale Analysis scalability criteria, supporting a strong underlying continuum where higher scores reflect worse recovery and well-being.

Exploratory factor analysis suggested two correlated facets: Physical Functioning and Well-being and Mental Health. A bifactor item response theory model fit best, capturing a dominant general frailty dimension while also representing the two facets.

Higher frailty scores separated survival curves by quartile over about 1,100 days of follow-up. In adjusted Cox regression, each one-unit increase in the frailty score was associated with an approximately 80% higher hazard of death.

What it means

This work supports frailty as something patients can report in a structured way, not only something clinicians rate. That matters because clinician-rated measures can be time-consuming and harder to deploy at scale.

The bifactor result is clinically intuitive: many post-stroke problems cluster together, but physical dependence and subjective well-being still add distinct information. In practice, a single score can summarize overall vulnerability while reminding teams to look at both mobility and mental health burden.

Where it fits

Frailty is often described as reduced physiological and psychological reserve, making stressors harder to tolerate. After stroke, that can show up as dependence in daily activities, persistent fatigue, depressed or anxious mood, pain, and a poorer sense of general health.

Item response theory is a measurement approach that estimates a latent trait from patterns of answers, weighting items by how informative they are. Here, some physical-functioning items were most informative at moderate to high frailty levels.

How to use it

For quality improvement, a patient-reported frailty score at three months could help services compare recovery burden across time and identify groups with persistently worse outcomes. The authors also provide tools for computing scores via a public repository.

For clinical follow-up, the practical move is not “a score replaces judgment,” but “a score prompts triage.” A high score should trigger a quick scan for actionable drivers such as unmet rehabilitation needs, unmanaged pain, treatable mood symptoms, or fatigue that interferes with activity.

Limits & what we still don’t know

Measurement fairness testing found minimal differential item functioning by sex and education, but small-to-moderate age-related bias on several items. That means comparisons across age groups may be slightly distorted for specific questions even if the overall score performs well.

The score is unitless and model-derived, and the paper cautions that scores from different models are not directly comparable. Also, the study links higher scores to mortality, but it does not establish which interventions change the score or whether score reduction improves survival.

Closing takeaway

A nine-item patient questionnaire at three months after stroke can yield a psychometrically strong frailty score that meaningfully predicts mortality. The main value is speed and scale: routine patient-reported outcomes can be converted into a single, interpretable risk signal to guide follow-up and system monitoring.

Data in this article is provided by PLOS.

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