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Background the Pictorial Fit-Frail Scale (PFFS) was designed as a simple and practical approach to the identification of frailty. Objectives To investigate the feasibility and reliability of this visual image-based tool, when used by patients, caregivers and healthcare professionals (HCPs) in clinical settings. Design observational study. Setting three outpatient geriatric healthcare settings. Subjects patients (n  = 132), caregivers (n  = 84), clinic nurses (n  = 7) and physicians (n  = 10). Methods the PFFS was administered to all patients. Where available, HCPs and caregivers completed the scale based on the patients' health. In the geriatric day hospital, the PFFS was completed on admission and administered again within 7–14 days. Time and level of assistance needed to complete the scale were recorded. Intraclass correlation coefficients (ICCs) and 95% confidence intervals (CIs) were used to assess test−retest and inter-rater reliability. Results mean time to complete the scale (minutes:seconds ± SD) was 4:30 ± 1:54 for patients, 3:13 ± 1:34 for caregivers, 1:28 ± 0:57 for nurses and 1:32 ± 1:40 for physicians. Most patients were able to complete the scale unassisted (64%). Mean patient PFFS score was 11.1 ± 5.3, mean caregiver score was 13.2 ± 6.3, mean nurse score was 10.7 ± 4.5 and mean physician score was 11.1 ± 5.6; caregiver scores were significantly higher than patient (P  < 0.01), nurse (P  < 0.001) and physician (P  < 0.01) scores. Test−retest reliability was good for patients (ICC = 0.78, [95%CI = 0.67–0.86]) and nurses (ICC = 0.88 [0.80–0.93]). Inter-rater reliability between HCPs was also good (ICC = 0.75 [0.63–0.83]). Conclusion the PFFS is a feasible and reliable tool for use with patients, caregivers and HCPs in clinical settings. Further research on the validity and responsiveness of the tool is necessary. [ABSTRACT FROM AUTHOR]