Toward Remote Assessment of Physical Frailty Using Sensor-based Sit-to-stand Test

Published:February 27, 2021DOI:



      Traditional physical frailty (PF) screening tools are resource intensive and unsuitable for remote assessment. In this study, we used five times sit-to-stand test (5×STS) with wearable sensors to determine PF and three key frailty phenotypes (slowness, weakness, and exhaustion) objectively.

      Materials and methods

      Older adults (n = 102, age: 76.54 ± 7.72 y, 72% women) performed 5×STS while wearing sensors attached to the trunk and bilateral thigh and shank. Duration of 5×STS was recorded using a stopwatch. Seventeen sensor-derived variables were analyzed to determine the ability of 5×STS to distinguish PF, slowness, weakness, and exhaustion. Binary logistic regression was used, and its area under curve was calculated.


      A strong correlation was observed between sensor-based and manually-recorded 5xSTS durations (r = 0.93, P < 0.0001). Sensor-derived variables indicators of slowness (5×STS duration, hip angular velocity range, and knee angular velocity range), weakness (hip power range and knee power range), and exhaustion (coefficient of variation (CV) of hip angular velocity range, CV of vertical velocity range, and CV of vertical power range) were different between the robust group and prefrail/frail group (P < 0.05) with medium to large effect sizes (Cohen's d = 0.50-1.09). The results suggested that sensor-derived variables enable identifying PF, slowness, weakness, and exhaustion with an area under curve of 0.861, 0.865, 0.720, and 0.723, respectively.


      Our study suggests that sensor-based 5×STS can provide digital biomarkers of PF, slowness, weakness, and exhaustion. The simplicity, ease of administration in front of a camera, and safety of 5xSTS may facilitate a remote assessment of PF, slowness, weakness, and exhaustion via telemedicine.


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        • Buigues C.
        • Juarros-Folgado P.
        • Fernández-Garrido J.
        • Navarro-Martínez R.
        • Cauli O.
        Frailty syndrome and pre-operative risk evaluation: a systematic review.
        Arch Gerontol Geriatr. 2015; 61: 309-321
        • Lin H.S.
        • Watts J.N.
        • Peel N.M.
        • Hubbard R.E.
        Frailty and post-operative outcomes in older surgical patients: a systematic review.
        BMC Geriatr. 2016; 16: 157
        • Clegg A.
        • Young J.
        • Iliffe S.
        • Rikkert M.O.
        • Rockwood K.
        Frailty in elderly people.
        Lancet. 2013; 381: 752-762
        • Xue Q.-L.
        The frailty syndrome: definition and natural history.
        Clin Geriatr Med. 2011; 27: 1-15
        • Makary M.A.
        • Segev D.L.
        • Pronovost P.J.
        • et al.
        Frailty as a predictor of surgical outcomes in older patients.
        J Am Coll Surgeons. 2010; 210: 901-908
        • de Vries N.M.
        • Staal J.B.
        • van Ravensberg C.D.
        • et al.
        Outcome instruments to measure frailty: a systematic review.
        Ageing Res Rev. 2011; 10: 104-114
        • Fried L.P.
        • Tangen C.M.
        • Walston J.
        • et al.
        Frailty in older adults: evidence for a phenotype.
        J Gerontol Ser A Biol Sci Med Sci. 2001; 56: M146-156
        • Rockwood K.
        • Song X.
        • MacKnight C.
        • et al.
        A global clinical measure of fitness and frailty in elderly people.
        CMAJ. 2005; 173: 489-495
        • Faller J.W.
        • Pereira D.D.N.
        • de Souza S.
        • et al.
        Instruments for the detection of frailty syndrome in older adults: a systematic review.
        PLoS One. 2019; 14: e0216166
        • Dent E.
        • Kowal P.
        • Hoogendijk E.O.
        Frailty measurement in research and clinical practice: a review.
        Eur J Intern Med. 2016; 31: 3-10
        • Bruyère O.
        • Buckinx F.
        • Beaudart C.
        • et al.
        How clinical practitioners assess frailty in their daily practice: an international survey.
        Aging Clin Exp Res. 2017; 29: 905-912
        • Birkelbach O.
        • Mörgeli R.
        • Spies C.
        • et al.
        Routine frailty assessment predicts postoperative complications in elderly patients across surgical disciplines - a retrospective observational study.
        BMC Anesthesiol. 2019; 19: 204
        • De Lepeleire J.
        • Degryse J.
        • Illiffe S.
        • Mann E.
        • Buntinx F.
        Family physicians need easy instruments for frailty.
        Age Ageing. 2008; 37 (author reply 484-485): 484
        • Guralnik J.M.
        • Simonsick E.M.
        • Ferrucci L.
        • et al.
        A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission.
        J Gerontol. 1994; 49: M85-94
        • Bohannon R.W.
        Test-retest reliability of the five-repetition sit-to-stand test: a systematic review of the literature involving adults.
        J Strength Cond Res. 2011; 25: 3205-3207
        • Teo T.W.L.
        • Mong Y.
        Ng SSM the repetitive five-times-sit-to-stand test: its reliability in older adults.
        Int J Ther Rehabil. 2014; 20: 122-130
        • Wallmann H.W.
        • Evans N.S.
        • Day C.
        • Neellym K.R.
        Interrater reliability of the five-times-sit-to-stand test.
        Home Health Care Mgt Pract. 2013; 25: 13-17
        • Whitney S.L.
        • Wrisley D.M.
        • Marchetti G.F.
        • et al.
        Clinical measurement of sit-to-stand performance in people with balance disorders: validity of data for the five-times-sit-to-stand test.
        Phys Ther. 2005; 85: 1034-1045
        • Millor N.
        • Lecumberri P.
        • Gomez M.
        • Martinez-Ramirez A.
        • Izquierdo M.
        An evaluation of the 30-s chair stand test in older adults: frailty detection based on kinematic parameters from a single inertial unit.
        J Neuroeng Rehabil. 2013; 10: 86
        • Kurlowicz L.
        • Wallace M.
        The mini-mental state examination (MMSE).
        J Gerontol Nurs. 1999; 25: 8-9
        • Yardley L.
        • Beyer N.
        • Hauer K.
        • et al.
        Development and initial validation of the falls efficacy scale-international (FES-I).
        Age Ageing. 2005; 34: 614-619
        • Radloff L.S.
        The CES-D scale: a self-report depression scale for research in the general population.
        Appl Psychol Meas. 1977; 1: 385-401
        • Thiede R.
        • Toosizadeh N.
        • Mills J.L.
        • et al.
        Gait and balance assessments as early indicators of frailty in patients with known peripheral artery disease.
        Clin Biomech (Bristol Avon). 2016; 32: 1-7
        • Lee H.
        • Joseph B.
        • Enriquez A.
        • Najafi B.
        Toward using a smartwatch to monitor frailty in a hospital setting: using a single wrist-wearable sensor to assess frailty in bedbound inpatients.
        Gerontology. 2018; 64: 389-400
        • Toosizadeh N.
        • Mohler J.
        • Najafi B.
        Assessing upper extremity motion: an innovative method to identify frailty.
        J Am Geriatr Soc. 2015; 63: 1181-1186
        • Bohannon R.W.
        • Bubela D.J.
        • Magasi S.R.
        • Wang Y.-C.
        • Gershon R.C.
        Sit-to-stand test: performance and determinants across the age-span.
        Isokinet Exerc Sci. 2010; 18: 235-240
        • Giavarina D.
        Understanding bland altman analysis.
        Biochem Med (Zagreb). 2015; 25: 141-151
        • Bunting K.V.
        • Steeds R.P.
        • Slater L.T.
        • et al.
        A practical guide to assess the reproducibility of echocardiographic measurements.
        J Am Soc Echocardiogr. 2019; 32: 1505-1515
        • Cohen J.
        Statistical Power Analysis for the Behavioral Sciences.
        Taylor & Francis; Elsevier Science, Burlington2013
        • Mandrekar J.N.
        Receiver operating characteristic curve in diagnostic test assessment.
        J Thorac Oncol. 2010; 5: 1315-1316
        • van Lummel R.C.
        • Walgaard S.
        • Maier A.B.
        • et al.
        The instrumented sit-to-stand test (iSTS) has greater clinical relevance than the manually recorded sit-to-stand test in older adults.
        PLoS One. 2016; 11: e0157968
        • Regterschot G.R.
        • Zhang W.
        • Baldus H.
        • Stevens M.
        • Zijlstra W.
        Test-retest reliability of sensor-based sit-to-stand measures in young and older adults.
        Gait Posture. 2014; 40: 220-224
        • Regterschot G.R.H.
        • Folkersma M.
        • Zhang W.
        • et al.
        Sensitivity of sensor-based sit-to-stand peak power to the effects of training leg strength, leg power and balance in older adults.
        Gait Posture. 2014; 39: 303-307
        • Hassani A.
        • Kubicki A.
        • Brost V.
        • Mourey F.
        • Yang F.
        Kinematic analysis of motor strategies in frail aged adults during the timed up and go: how to spot the motor frailty?.
        Clin Interv Aging. 2015; 10: 505-513
        • Gross M.M.
        • Stevenson P.J.
        • Charette S.L.
        • Pyka G.
        • Marcus R.
        Effect of muscle strength and movement speed on the biomechanics of rising from a chair in healthy elderly and young women.
        Gait Posture. 1998; 8: 175-185
        • Yanquez F.J.
        • Peterson A.
        • Weinkauf C.
        • et al.
        Sensor-based upper-extremity frailty assessment for the vascular surgery risk stratification.
        J Surg Res. 2020; 246: 403-410
        • Salzman B.
        Gait and balance disorders in older adults.
        Am Fam Phys. 2010; 82: 61-68
        • Joswig H.
        • Stienen M.N.
        • Smoll N.R.
        • et al.
        Patients' preference of the timed up and go test or patient-reported outcome measures before and after surgery for lumbar degenerative disk disease.
        World Neurosurg. 2017; 99: 26-30
        • Lansbury L.N.
        • Roberts H.C.
        • Clift E.
        • et al.
        Use of the electronic Frailty Index to identify vulnerable patients: a pilot study in primary care.
        Br J Gen Pract. 2017; 67: e751-e756
        • Khalafallah A.M.
        • Huq S.
        • Jimenez A.E.
        • Brem H.
        • Mukherjee D.
        The 5-factor modified frailty index: an effective predictor of mortality in brain tumor patients.
        J Neurosurg. 2020; : 1-9
        • Wu M.
        • Luo J.
        Wearable technology applications in healthcare: a literature review.
        Online J Nurs Inform. 2019; 23
        • Haghi M.
        • Thurow K.
        • Stoll R.
        Wearable devices in medical internet of things: scientific research and commercially available devices.
        Healthc Inform Res. 2017; 23: 4-15
        • Shoultz T.H.
        • Evans H.L.
        Telemedicine and mobile technology.
        in: Itani K.M.F. Reda D.J. Clinical Trials Design in Operative and Non Operative Invasive Procedures. Springer International Publishing, Cham2017: 427-431