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Translation, cross-cultural adaptation and validation of the composite physical function scale in Chinese community-dwelling older adults

BMC Geriatrics volume 25, Article number: 86 (2025) Cite this article

Abstract

Purpose

To translate, cross-culturally adapt and validate the Composite Physical Function (CPF) scale in Chinese community-dwelling older adults.

Methods

The Chinese version of the CPF (C-CPF) was constructed by following Brislin’s guidelines. A cross-sectional study was conducted to evaluate the measurement properties of the C-CPF in 477 eligible older adults. Factor analysis, hypotheses testing, internal consistency and test-retest were performed to evaluate the validity and reliability of the C-CPF.

Results

The C-CPF was consistent with the original version, which consisted of a single dimension with 12 items. It had a Cronbach’s alpha coefficient of 0.901, fold-half reliability of 0.831 and test–retest reliability of 0.994. Structural validity was determined through exploratory factor analysis for a single-factor structure explained 75.391% of the total variance. Confirmatory factor analysis for a modified model provided an average fit index (chi-square/free ratio = 3.596, root mean square error of approximation = 0.099, normal fit index = 0.908, incremental fit index = 0.931, comparative fit index = 0.931 and Tucker–Lewis index = 0.909). Construct validity analysis revealed a significant difference in C-CPF scores amongst older adults in groups of different ages, regular exercise and physical activity habits (P < 0.01). Criterion validity was tested for the correlation between the results of C-CPF and the Senior Fitness Test (r = 0.446, P < 0.01).

Conclusions

The C-CPF scale serves as a valid and practical tool for widespread health screening to measure the level of comprehensive physical function and its decline amongst Chinese older adults. Further research is needed to explore the eligibility of the application of the C-CPF in a broad range of populations.

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Background

Consensus that developing and maintaining functional ability are the essence of healthy ageing for older adults has been growing in recent years [1, 2]. When their physical function is at a high level [3], older adults can perform their daily living activities freely. The decline in their physical function may limit their ability to live independently and necessitate additional assistance and health care [4]. Maintaining physical function evidently plays a crucial role in enabling well-being in older adults and reducing economic burden on their families and society [5].

In older adults, the physical function level is closely related to function abilities, including aerobic endurance, muscle strength and balance. However, the above abilities decline with the increase in age and diseases, and the physical function level of older adults also presents an age-related decrease [6]. In contrast to diseases, the decline in physical function level may not be obvious and perceived in a timely manner. A large proportion of older people do not discover that their physical functions have been severely impaired until their daily lives are extremely restricted. Therefore, older adults must have convenient evaluation tools that can be used for the early screening and detection of physical function decline [7].

Methods for the assessment of physical function can be categorised into objective and subjective measures, with subjective measures being conducive for use on China’s large-scale and -base ageing population due to their lower cost and facileness than objective measures [8, 9]. The Barthel index (BI) is a widely utilised physical function scale [10]. It is applied to assess the ability for activities of daily living (ADL) and suitable for individuals with severe physical dysfunction because of its limited sensitivity [11]. Another related scale, the Lawton and Brody Instrumental ADL scale (LB-IADL) [12], is only used to identify individuals whose physical function level no longer meets the requirements for self-care from a living perspective but not from other advanced aspects, such as the function of sports exercises [13]. The Functional Independence Measure sale [14] is used for patients in hospital with deficits in independent function and has poor sensitivity for patients with mild disabilities [15, 16]. All of these scales focus on physical function related to the ADL of people with disabilities and illnesses.

Self-assessment tools based on physical performance exist in China. They include the Dragon scale for ADL [17] and the Chinese version of the ADL scale [18]. Both were developed on the basis of the BI and Chinese culture, and their main contents remain centred on basic daily living and confined to the level of self-care ability amongst older adults. They cannot reflect advanced and comprehensive physical function and are therefore applicable to people with disabilities and illnesses dwelling in hospitals and rehabilitation institutions [19, 20]. Currently we lack subjective measures of physical function for ordinary older people in China as well as the assessment of advanced aspects of active functioning beyond ADL [21, 22].

In 1998, Rikli [23] developed the Composite Physical Function scale (CPF) by adapting and expanding previously published scales [24, 25] and the National Health Survey Interview. This scale was developed as a specific measurement tool for physical function level amongst the general older adult population. The CPF comprehensively includes ADL, IADL and common sports and concerns low-to-high domains of physical function. Its age-adjusted criteria can predict whether ‘younger’ older adults can maintain physical independence in their later life [26]. This ability is not commonly found in other instruments. The original English version of the CPF scale has been translated into Portuguese [27], Spanish [28] and Danish [29] with good test–retest reliability and validity. These translated versions were fully verified in terms of reliability and validity and have been used for health surveys [30,31,32] to assess the level of physical function in older adults. They serve as early diagnostic tools for identifying older adults at risk of functional impairment in later life and has gradually applied to the older adults with sarcopenia in many countries [32, 33]. In China, the CPF scale has been used to establish the criterion-referenced standards for functional fitness, whereas has not received standard process of translation and validation [34].

Therefore, this study aimed to develop the Chinese version of the CPF (C-CPF) through standard process of translation, cross-cultural adaption and validation. This scale will enrich the evaluation indicators of subjective physical function of ordinary older people in China. It is expected to quickly screen out those at the risk of the loss of physical independence in large-scale surveys. In addition, it could be applied to some specific populations such as elderly patients with sarcopenia when combined with objective indicators such as muscle strength.

Methods

Design and settings

This study was a cross-sectional survey conducted at community health service centres from November 2023 to December 2023. Data collection was completed at the community health service centres in Suzhou.

Study protocol and procedure

The C-CPF was established on the basis of the English version of the CPF by following Brislin’s translation model, which includes translation (forward-translation and back-translation), cross-cultural adaption (first round of expert consultation) and pilot testing. Thereafter, the measurement properties of the C-CPF were assessed in community-dwelling older adults in China together with the Senior Fitness Test (SFT) which served as an objective criterion tool for verifying the criterion validity of the C-CPF. The second round of expert consultation was conducted during the measurements to assess the content validity. The flowchart of the study can be seen in Fig. 1.

Fig. 1
figure 1

Flowchart of the translation and measurement property assessment of the C-CPF

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Participants

Participants were recruited from community health service centres in Suzhou, China, through convenience sampling. Recruitment posters were posted at four community health service centres belonging to the same integrated health care system. The community-dwelling older adults who visited the community health service centres for physical examination or medical services were inquired face-to-face about their willingness to participate in the study.

Inclusion criteria for participants included (1) age ≥ 60 years, (2) community residing, (3) ability to understand researchers’ questions and communicate normally and (4) voluntary participation. The exclusion criteria included illiterate persons who were unable to understand (read and write) Chinese.

Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) require at least 100 and 200 cases, respectively, for sample size consideration [35]. Therefore, in this study, 495 scales were distributed to ensure a sufficient sample size. A total of valid 477 scales were returned and included in the analysis with a valid return rate of 93.6%. Amongst the C-CPF scales, 210 were subjected to EFA and the remaining 267 were subjected to CFA. A total of 51 participants were invited to complete the same C-CPF after 7–14 days to assess test-retest reliability [36].

Formation of the C-CPF

Translation

After obtaining authorisation was obtained from the original authors of the CPF scale through email, the scale was translated strictly in accordance with Brislin’s translation model [37]. (1) Forward translation: The CPF was translated independently by a university English lecturer who had practised for 11 years and nursing professor who had practised overseas for eight years (TL1 and TL2). The research team performed comparison, discussion and integration to establish the C-CPF (Synthesis I). (2) Back translation: The CPF version Synthesis I was translated into English by two experts who had no prior knowledge of the CPF. These experts included a university teacher majoring in English education and a doctor of nursing from the US (B-TL1 and B-TL2). The differences in back-translation were discussed with the two back-translators against the Chinese cultural background to establish the English back-translated version of the CPF (Synthesis II). (3) Check translation: The English back-translated version of the CPF Synthesis II was sent to the original authors to check its appropriateness.

Cross-cultural adaption

Twelve experts were invited to the first round of expert consultation to comment on the accuracy of translation, content relevance of the items and applicability to Chinese culture to establish the cross-cultural adaption of C-CPF. The research team revised and constructed the preliminary C-CPF in accordance with their suggestions for modification.

Pilot test

Thirty older adults who met the inclusion criteria were recruited through convenience sampling at community health centres in Suzhou to participate in the pilot test. The participants filled out the preliminary C-CPF. If they were unable to read the scale, the researcher verbally read out the question of each item and recorded the participant’s responses. After the scale was completed, the researcher inquired the older adults about the clarity and comprehensibility of the content of each item. The preliminary C-CPF was revised and the final version was obtained on the basis of the pilot test results.

Measurement property assessment of C-CPF

The recruited participants were investigated, including the final C-CPF and SFT test to assess the reliability and validity of the C-CPF. Six experts participated in the second round of expert consultation to assess the content validity of the C-CPF on the basis of 1–4 points, which represent ‘not at all relevant’ to ‘completely relevant’.

Measures

General demographic questionnaire

The general demographic questionnaire included gender, age, education, marital status, residence status, chronic disease number, exercise habit and physical activity status.

CPF

This 12-item scale covers basic, instrumental and advanced life activities related to the requirement of different levels of function in daily life. Participants were scored in accordance with their ability to complete the content of the item. Scores of 2, 1 and 0 indicate ‘can be done independently without assistance’, ‘can be done with assistance’ and ‘unable to complete’, respectively. The total scale ranges from 0 to 24 and can be categorised into three levels, including high/advanced functioning (score of 24), moderate functioning (scores of 14–23) and low functioning/at risk (scores of 0–13). Rikli established age-adjusted criteria for moderate function level, which represents the requirements of physical independence, to allow the early prediction of physical independence in later life. It could predict whether older adults will be able to maintain a moderate level of physical function in later life (90 years old) after experiencing an age-related physical function decline [26].

SFT

The SFT is a battery of objective tests established by Rikli [26] for evaluating the physical function of older adults. It has been translated into Chinese [38], Spanish [39] and Portuguese [40] and is widely used around the world with fully validated reliability [26, 41]. SFT consists of the six compulsory indices of a 2 min step test (aerobic endurance), 30 s arm curl and 30 s chair stand (upper and lower extremity muscle strength), back scratch and chair sit-and-reach test (upper and lower body flexibility) and 8 feet up-and-go test (for agility and dynamic balance) and one recommended index of body mass index (BMI).

In this study, the three core indices of the SFT that were most relevant to the daily activities of older adults, including aerobic endurance, upper and lower extremity muscle strength and dynamic balance, were selected for measurement to verify the criterion validity of the C-CPF. Before the test, researchers explain the key points of the each test to the subjects and demonstrate the movements. The testing sequence of SFT was set as 30 s chair stand, 30 s arm curl, 8 feet up-and-go test and 2 min step test. Considering the fatigue of participants, the rest interval between each test was set to be 2 min, and could be adjusted according to participants’ actual feelings. The considerations on safety including the followings: conducting 2 min step test beside a wall with handrails, placing the chair against the wall to prevent it from sliding, and allowing subjects who were physically weak to stop at any time. The scoring criteria for each indicator of the SFT were established in reference to the results of the normative values Xu’s study from our team [42], which was based on a survey of 785 community-dwelling older adults in six districts of Suzhou. The score of the three dimension indicator were added as a sum scores [43] and their correlation with the C-CPF was analysed.

Data collection

Before starting the survey, the two researchers who collected the data received uniform training concerning the standardised measurement of the SFT and an explanation of the scale. All data were collected on the spot and carefully verified in case of doubt.

Statistical analysis

Data analysis was performed by using IBM SPSS 26.0 and AMOS 25.0 software. Participant demographic characteristics and relevant measurement data were expressed in the form of mean ± standard deviation, and count data were expressed in the form of frequencies and percentages. The measurement property assessment of the C-CPF included item analysis, reliability and validity.

Item analysis

The critical ratio decision value (CR) and correlation coefficient methods were used for item analysis to evaluate and screen all the items of the C-CPF. The total scores of participants were ranked from high to low. Participants who scored in the top 27% were regarded as the high group and those who scored in the bottom 27% were regarded as the low group. The CR value of each item was obtained through the two-sample independent t-test. An item can be retained for its good ability to discriminate physical function levels amongst older adults when its CR value was greater than 3 and P value was less than 0.05, otherwise, it should be removed. In addition, the Pearson correlation coefficient method was used to calculate the correlation between each item and total scores of the C-CPF. A high correlation coefficient (r) represents good homogeneity between items and the scale. An item with r less than 0.4 must be deleted. The floor and ceiling effects of the C-CPF were evaluated, and the floor or ceiling effect was considered to exist when more than 15% of participants reached the lowest or highest C-CPF score [36].

Validity assessment

Content validity

The content validity of the scale was examined through expert assessment by calculating the item-level content validity index (I-CVI), scale-level content validity index (S-CVI) and average scale content validity index (S-CVI/Ave). I-CVI > 0.78, S-CVI > 0.80 and S-CVI/Ave > 0.90 are considered to be appropriate [44] when the number of experts is six.

Structural validity

EFA and CFA were performed to verify the construct validity of the C-CPF. For EFA, Kaiser–Meyer–Olkin (KMO) and Bartlett’s spherical tests were used to determine whether the scale was appropriate for factor analysis [45]. When KMO > 0.8, factor analysis can be chosen. EFA uses principal component analysis and maximum variance orthogonal rotation to extract the factor structure with eigenvalue > 1. Each item should have factor loading ≥ 0.4; otherwise, the item must be removed [45]. For CFA, the model fit of the scale was examined by using maximum likelihood estimation. The following metrics were used to assess model fit [46,47,48] chi-square/free ratios (χ2/df) of 1 and 3 indicating desirable and acceptable models, respectively; root mean square error of approximation (RMSEA) of less than 1.0; and other metrics, including comparative fit index (CFI), incremental fit index (IFI), Tucker–Lewis index (TLI) and normal fit index (NFI) greater than 0.9.

Construct validity (hypotheses testing)

The hypotheses testing of construct validity were conducted by using a priori hypotheses recommended by COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) psychometric guidelines. Hypotheses related to age, regular exercise and physical activity habits were formulated on the basis of previous research [49] to explain the differences in total C-CPF scores between subgroups. The hypotheses were as follows: (1) in the comparison of adults aged 60–69 years and older groups (70–79 and 80–89 years), decreasing C-CPF scores are assumed to indicate ageing; (2) older adults who exercise regularly are expected to have higher C-CPF scores than those who do not. (3) in terms of physical activity, older adults who are physically active would receive higher scores than those who are not.

Criterion validity

The SFT, a well-recognised and common tool, was used to assess the criterion validity of the C-CPF. Correlation analysis was selected on the basis of the distribution of C-CPF and SFT data. r > 0.4 suggests the existence of a correlation. Meanwhile, r values of 0.6–0.8 suggest a strong correlation between the C-CPF and SFT.

Reliability assessment

Cronbach’s α coefficient was employed to test the internal consistency reliability of the scale, and Cronbach’s α coefficients of 0.70–0.95 were considered as indicators of good internal consistency [36]. The overall reliability of the scale was tested with Guttman’s fold-half coefficient, and a Guttman’s fold-half coefficient of more than 0.6 indicates that the result is desirable. Moreover, the intraclass correlation coefficient (ICC) was used to evaluate the retest reliability of the scale, and an ICC of more than 0.75 is acceptable [50].

Results

Demographic characteristics of the participants

A total of 477 older adults with complete data were included in the analysis. They included 211 men (44.2%) and 266 women (55.8%). The Participants ranged in age from 60 years to 92 years and had a mean age of 67 (± 6.6) years and mean BMI of 24 (± 2.8) kg/m2. Most of the participants were married (83.2%), lived with their family (90.6%), received high school or above education (41.1%), suffered from 1 to 2 chronic diseases (53.0%) and performed regular exercise (71.5%) and physical activity (84.7%). Further details about the characteristics of all participants are shown in Table 1.

Table 1 Demographic characteristics of participants (n = 477)
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Cross-cultural adaption of the CPF

The research team made some changes to the CPF on the basis of the 12 experts’ opinions and feedback from older adults. Specific modifications that were mainly based on common Chinese contexts are as follows: the units of length measurement ‘block, mile and yard’ in items 3, 6, 8 and 9 were converted into ‘metre’; the unit of weight measurement ‘pound’ in items 7 and 10 was converted into ‘kilogram’; the heavy household activity ‘raking leaves’ in item 11 was revised as ‘hand washing’; and the strenuous activities ‘hiking, digging in garden and moving heavy objects’ in item 12 were concisely revised as ‘running’. The final C-CPF scale is shown in the Appendix (including the Chinese and English versions of the C-CPF.

Item analysis

The CR value method revealed that the CR values ranged from 3.280 to 26.436 (P < 0.01) for all items, indicating that all items of the C-CPF were highly discriminative. In addition, the Pearson correlation coefficients between each item score and the total C-CPF score ranged from 0.637 to 0.843 (P < 0.01), representing good homogeneity. The C-CPF had floor and ceiling effects of 0.4% and 58.4%, respectively.

Validity assessment

Content validity

Six experts generally agreed that the items of the scales and their overall content were in line with the objectives for measurement. The results showed that the C-CPF had I-CVI, S-CVI and S-CI/Ave values of 0.830–1.000, 0.833 and 0.972, respectively.

Structural validity

Bartlett’s spherical test yielded χ2 = 4303.236 and KMO = 0.921, suggesting that the C-CPF was suitable for EFA. One common factor with eigenvalues greater than 1 was extracted through principal component analysis and the maximum variance method. Consequently, the C-CPF was analysed and found to consist of a single dimension in line with the original scale. No double-loading phenomenon was observed, and the factor loading value of each item ranged from 0.511 to 0.964 and the cumulative variance explained a total of 75.391% of the total variance (Table 2). A one-factor initial model was constructed in accordance with the EFA results, and the maximum likelihood method was used for validation factor analysis. The results were acceptable but not highly satisfactory. The initial model was corrected four times in accordance with the modification index, and structural equations were then modified. The modified model fit metrics were χ2/df = 3.596, RMSEA = 0.099, NFI = 0.908, IFI = 0.931, CFI = 0.931 and TLI = 0.909. Although the fit indices of the modified model were close to the standard requirements, they were still unsatisfactory (Fig. 2).

Table 2 Factor loadings of the C-CPF scale (n = 210)
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Fig. 2
figure 2

Standardized single factor structural model of the C-CPF scale (n = 267)

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Construct validity (hypotheses testing)

As we hypothesised, the C-CPF total scores significantly differed amongst the 60–69, 70–79 and 80–89 year groups (P < 0.01). In terms of regular exercise, a significant difference was found between older adults with regular exercise than those without (P < 0.01). The scores for physical activity also differed between older adults with high and low activity levels (P < 0.01). The results of construct validity, including the median of the total C-CPF scores of different groups, are shown in Table 3.

Table 3 Construct validity of the C-CPF (n = 477)
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Criterion validity

Correlation analysis was used to test the correlation between SFT and C-CPF. Given that the total score of the C-CPF was not normally distributed on the basis of the Kolmogorov–Smirnov test, Spearman’s correlation analysis was applied. A moderate correlation was found between the C-CPF and objective measurement data of the SFT amongst older adults (r = 0.446, P < 0.01).

Reliability

The Cronbach’s α coefficient for the C-CPF was 0.901, suggesting that the scale has good internal consistency. The scale had a Guttman’s fold-half coefficient of 0.831 and test–retest reliability of ICC of 0.994 with a 95% confidence interval of 0.989–0.998.

Discussion

The progression from fully functional to disabled is the result of the interaction between individual ageing and the environment that accumulates gradually over time [51]. China has a large population of disabled older adults with an estimated prevalence of approximately 26% [52]. Given that disabled older people have impaired physical function and limited mobility, their demand for medical treatment and care increases [53]. Therefore, the existing healthcare policy in China focuses on meeting the medical and care needs of disabled older adults but pays little attention to older adults with functional decline and integrity loss [54]. Consequently, it cannot prevent and reduce the incidence of physical function disability at the source. A systematic assessment of functional capacity, as the key to predicting the burden of long-term care for older adults, is conducive to the early identification of those at risk of the loss of physical function and adoption of timely and effective measures to delay disability.

Compared with Western countries, China remains in the developmental stage in terms of the establishment of assessment tools centred on the physical function of older adults [55]. Most assessment scales were developed for patients with severe physical dysfunction and only covered the most basic self-care aspects of physical function. Therefore, a practical and easy-to-use physical function assessment tool that is specifically designed to reflect the level of comprehensive physical function for a wide range of community-dwelling older adults is urgently needed [56].

This work is the first study in China to take standardised and rigorous steps for the translation, cross-cultural adaptation and validation of the CPF. On the basis of Brislin’s translation model, the original CPF was forward-translated, back-translated and revised to construct the Chinese version. During this process, the research team could not clarify whether the statement ‘lift and carry’ in items 7 and 10 indicates that a person can lift and walk with a weight or is simply able to lift a weight without walking. They contacted the original authors to clarify this statement and found that the latter meaning was intended. Additionally, the activities and exercise styles listed in items 11 and 12 are seldom performed in the Chinese population. After consultation with experts and older adults and confirmation with the original authors, the research team decided to use ‘washing clothes by hand’ and ‘running’ as replacements to match the behavioural habits of the Chinese population. According to the pilot test revealed that each older adult took 2–5 min for each older adults to complete the scale, and most participants provided feedback that the scale was easy to understand. During data collection, incompletely filled C-CPF or scales with wrong answers were excluded. Scales with more than one unanswered item were defined as incompletely filled. Wrong answers were detected by the research team through verbal communication and verification with the participant. During filling, some older adults encountered difficulties in differentiating between the ability to accomplish a task and the truth of previously performing a task. These individuals tended to make prompt and explicit judgments on the basis of whether they have actually accomplished such tasks in their daily lives. This situation indicated that medical staff should pay attention to whether older adults can read and understand the instructions of the C-CPF to ensure the accuracy of outcomes.

The Cronbach’s alpha coefficient of 0.901, indicated that the C-CPF had a satisfactory internal consistency reliability, and was similar to the result of the Portuguese translated version (0.90). The test–retest reliability of ICC was 0.994, indicating excellent stability over time. It is important to note that this result is the combined outcome of two separate test batches. Initially, we conducted the repeated test on 30 participants, yielding a reliability coefficient of 0.993. However, we later realized that a sample size of 30 was insufficient for robust results. To address this, we performed the exact same test on an additional 21 participants, and the retest reliability improved to 0.997. The results of the two batches showed no significant difference, which may indicate the reliability of the test-retest results for the 51 participants (0.994). A team of experts with rich experience and a high academic level in the field of geriatric care and sports rehabilitation was invited to assess the correlation between the C-CPF and concepts intended for measurement. The results indicated that the C-CPF has good content validity. One common factor, which complied with the single-dimensional structural composition of the original scale, can be extracted from the C-CPF through EFA. Meanwhile, the result of the CFA showed that the one-factor fit model was just average. This finding may be related to the limited sample size. In hypothesis testing, the authors found that the score of the C-CPF showed significant differences amongst older adults with different ages, physical activity levels and regular exercise habits. This finding indicated that the CPF has discriminative power in evaluating physical function.

The above results indicated a necessity to divide C-CPF scores into different levels on the basis of age to establish an age-related standard. They showed that the scores of the C-CPF can be refined into multiple levels, including higher than normal, normal and lower than normal, for an efficient and practical application of the scale. For older adults at high risk for physical function decline, increasing physical activity and exercise in daily life can be recommended to improve physical function.

The results of this work showed that, although the C-CPF did not have a floor effect, it had a significant ceiling effect. This result is consistent with the result of the Portuguese version of the CPF scale (28.1%) [27]. This finding indicated that the C-CPF may not be able to distinguish differences amongst older adults with good physical function. Therefore, combining the C-CPF with objective physical ability tests may be appropriate for the comprehensive evaluation of such older adults. The ceiling effect suggested that the C-CPF may be suitable for populations with slightly low physical function, such as older adults living in nursing homes and hospitals or those who have lacked physical activity and exercise for a long time.

The literature review revealed that the widely used subjective assessment tools for physical function, such as BI and LB-IADL, are simple and cannot reflect advanced life activity abilities. Moreover, these tools have long been developed for a long time, and content covered by their items is inconsistent with the actual life of current older adults. Notably, the physical functioning subscale of the Medical Outcomes Study Short-Form Survey (10 items) [57], the scale published by Siu (six items) [24] and Rosow–Breslau Scale (four items) [25], were used as concurrent validity tools to verify the Portuguese [27] and Danish [29] translated versions of the CPF. However, the above tools evaluated limited item content and did not cover advanced dimensions of physical activity. Therefore, in this study, the SFT was chosen as the criterion validity tool that can objectively and quantitatively reflect the level of the functional fitness of older adults. The total score of the three core dimensions selected from the SFT, including cardiorespiratory endurance, muscular strength and dynamic balance and coordination, which most closely related to the performance of physical functions of older adults, were analysed with the total scores of the C-CPF. The correlation coefficient r of 0.446 met the requirements of the measurement test, suggesting that the C-CPF can effectively reflect the actual level of physical function.

This study has some limitations. Firstly, this study mostly included older adults aged 60–69 years, with fewer older adults aged 80 years and above, which may limit the applicability of the findings to the oldest-old population. More studies are expected to be conducted among the older adults more than 80 years old. Secondly, this study only investigated community-dwelling older adults. Large-sample and multicentred studies involving older adults living in hospital wards and nursing homes could be considered in the future.

Conclusion

The C-CPF scale was developed through a rigorous translation process and cross-cultural adaptation, and its reliability and validity were validated. It is expected to serve as a valid and practical tool for widespread health screening to measure the comprehensive physical function level and its decline in older adults. Such an assessment could help healthcare professionals provides a reference for early intervention in older adults with physical independence loss. Future studies are expected to explore the eligibility of applying the C-CPF in a broad range of populations.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

CPF:

Composite Physical Function scale

BI:

Barthel Index

ADL:

Activities of Daily Living

LB-IADL:

Lawton and Brody Instrumental Activities of Daily Living Scale

SFT:

Senior Fitness Test

EFA:

Exploratory Factor Analysis

CFA:

Confirmatory Factor Analysis

BMI:

Body Mass Index

CR:

Critical Ratio decision value

CVI:

Item-level Content Validity Index

S-CVI:

Scale-level Content Validity Index

S-CVI/Ave:

Average Scale Content Validity Index

KMO:

Kaiser–Meyer–Olkin

RMSEA:

Root Mean Square Error of Approximation

CFI:

Comparative Fit Index

IFI:

Incremental Fit Index

TLI:

Tucker–Lewis Index

NFI:

Normal Fit Index

ICC:

Intraclass Correlation Coefficient

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Acknowledgements

We are grateful to Professor Rikli, who created the original scale. In addition, we acknowledge help from all participants, investigators and experts who assisted with this study.

Funding

This work was supported by the Humanities and Social Sciences Research Project of Soochow University (grant number 21XM2012, LW) and the Research Foundation for Talented Scholars, Soochow University (grant number Q412700114, LW).

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Authors and Affiliations

  1. Cardiovascular Department, First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China

    Jiaying Qi & Hongyan Meng

  2. School of Nursing, Suzhou Medical College of Soochow University, No.1 Shi zi Street, Suzhou, 215006, Jiangsu, China

    Jiaying Qi, Jing Xu, Hui Zhang, Mingshuai Feng, Hongyan Meng & Li Wang

Authors
  1. Jiaying Qi
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  2. Jing Xu
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  3. Hui Zhang
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  6. Li Wang
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Contributions

L.W. and J.Q. conceptualized the study. J.Q. made substantial contributions to formation of the scale and original writing. J.X. contributed to data collection and analysis. H.Z. and M.F. were responsible for the translation process. L.W. and H.M. contributed to study discussion, and reviewed and edited the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Hongyan Meng or Li Wang.

Ethics declarations

Ethics approval and consent to participate

The study was conducted in accordance with the Declaration of Helsinki and approved by the ethics committee (SUDA20231120H02). All participants were fully informed of the research purpose, content and risks before signing consent forms.

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Not applicable.

Competing interests

The authors declare no competing interests.

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Qi, J., Xu, J., Zhang, H. et al. Translation, cross-cultural adaptation and validation of the composite physical function scale in Chinese community-dwelling older adults. BMC Geriatr 25, 86 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12877-025-05743-w

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BMC Geriatrics

ISSN: 1471-2318

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