Screening for Sarcopenia with a Self-Reported Cartoon Questionnaire: Combining SARC-F with Finger-Ring Test

Objectives No pictorial questionnaire is available for screening sarcopenia. We aimed to develop a self-reported cartoon questionnaire based on the SARC-F and the Finger-Ring test and to compare its diagnostic accuracy with the SARC-F and the SARC-F combined with calf circumference (SARC-CalF). Design A diagnostic accuracy study. Setting Urban communities in Chengdu, China. Participants Older adults aged >= 60 years. Methods We established a multidiscipline team to design this pictorial questionnaire, entitled Self-Reported Cartoon SARC-CalF (cSARC-CalF). We used the Asian Working Group for Sarcopenia (AWGS) criteria as the "gold standard" of sarcopenia. We performed sensitivity/specificity analyses of the three tools (cSARC-CalF, SARC-CalF, and SARC-F) and applied the receiver operating characteristics (ROC) curves and the area under the ROC curves (AUC) to compare the diagnostic accuracy of the three tools. Results We included 1,009 participants. Using the Youden Index method, the cutoff of the cSARC-CalF for identifying sarcopenia was set as >= 11 points. Both the cSARC-CalF and the SARC-CalF showed better sensitivity but similar specificity than the SARC-F for identifying sarcopenia (sensitivity: 33.3%, 41.4%, and 23.0%; specificity: 90.1%, 85.9%, and 88.1%). The AUCs of the cSARC-CalF, SARC-CalF, and SARC-F were 0.74 (95% CI, 0.71 - 0.77), 0.79 (95% CI, 0.76 - 0.81), and 0.67 (95% CI, 0.64 - 0.70), respectively. The difference in AUCs between cSARC-CalF and SARC-F and the difference in AUCs between SARC-CalF and SARC-F was statistically significant (p=0.012 and p<0.001, respectively). However, the difference in AUCs between cSARC-CalF and SARC-CalF was not significant (p=0.109). Conclusion The cSARC-CalF showed a better overall diagnostic accuracy than the SARC-F and a similar overall diagnostic accuracy as the SARC-CalF in Chinese community-dwelling older adults. It may serve as a new tool for screening sarcopenia; however, it needs to be validated in other populations.