Validation of a modified FRAX(R) tool for improving outpatient efficiency--part of the "Catch Before a Fall" initiative

Summary We have validated our touch-screen-modifiedFRAX® tool against the traditional healthcare professional-led questionnaire, demonstrating strong concordance between doctor- and patient-derived results. We will use this in outpatient clinics and general practicetoincreaseour capture of the rate of at-risk patients, making valuable use of otherwise wasted patient waiting times. Introduction Outpatient clinics offer an opportunity to collect valuable health information from a captive population. We have previously developed a modified fracture risk assessment (FRAX®) tool, enabling patients to self-assess their osteoporotic fracture risk in a touch-screen computer format and demonstrated its acceptability with patients. We aim to validate the accuracy of our tool against the traditional questionnaire Methods Fifty patients over 50 years of age within the fractureclinic independently completed a paper equivalent of our touch-screen-modified FRAX® questionnaire. Responseswere analysed against the traditional healthcare professional(HCP)-led questionnaire which was carried out afterwards.Correlation was assessed by sensitivity, specificity, Cohen’s kappa statistic and Fisher ’s exact test for each potentialFRAX® outcome of treat measure BMD and lifestyle advice Results The age range was 51 – 98 years. The FRAX® tool was completed by 88 % of patients; six patients lacked confidence in estimating either their height or weight. Following question adjustment according to patient response and feedback, our tool achieved >95 % sensitivity and specificity for the treatment and lifestyle advice groups, and 79 % sensitivity and 100 %specificity in the measure BMD group. Cohen’s kappa value ranged from 0.823 to 0.995 across all groups, demonstrating very good agreement for all. Fisher's exact test demonstrated significant concordance between doctor and pa-tient decisions. Discussion Our modifiedtoolprovidesa simple, accurateandreliable method for patients to self-report their own FRAX®score outside the clinical contact period, thus releasing theHCP from the time required to complete the questionnaireand potentially increasing our capture rate of at-risk patients