Abstract

BackgroundThe Karnofsky Performance Status (KPS) is a gold standard scale. The Thorne-modified KPS (TKPS) focuses on community-based care and has been shown to be more relevant to palliative care settings than the original KPS. The Australia-modified KPS (AKPS) blends KPS and TKPS to accommodate any setting of care.MethodsPerformance status was measured using all three scales for palliative care patients enrolled in a randomized controlled trial in South Australia. Care occurred in a range of settings. Survival was defined from enrollment to death.ResultsRatings were collected at 1600 timepoints for 306 participants. The median score on all scales was 60. KPS and AKPS agreed in 87% of ratings; 79% of disagreements occurred within 1 level on the 11-level scales. KPS and TKPS agreed in 76% of ratings; 85% of disagreements occurred within one level. AKPS and TKPS agreed in 85% of ratings; 87% of disagreements were within one level. Strongest agreement occurred at the highest levels (70–90), with greatest disagreement at lower levels (≤40). Kappa coefficients for agreement were KPS-TKPS 0.71, KPS-AKPS 0.84, and AKPS-TKPS 0.82 (all p < 0.001). Spearman correlations with survival were KPS 0.26, TKPS 0.27 and AKPS 0.26 (all p < 0.001). AKPS was most predictive of survival at the lower range of the scale. All had longitudinal test-retest validity. Face validity was greatest for the AKPS.ConclusionThe AKPS is a useful modification of the KPS that is more appropriate for clinical settings that include multiple venues of care such as palliative care.

Highlights

  • The Karnofsky Performance Status (KPS) is a gold standard scale

  • The Thornemodified KPS (TKPS) concentrated on the community setting, though, limiting the scale's utility in the varied clinical settings encountered in palliative care including inpatient hospice, acute inpatient care, and nursing home care

  • The categories in the Australia-modified KPS (AKPS) are less directive of the expected location of care; as much of the original KPS and TKPS language as possible has been maintained in order to reduce confusion and the need for extensive retraining for clinicians already familiar with the earlier versions

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Summary

Introduction

The Karnofsky Performance Status (KPS) is a gold standard scale. The Karnofsky Performance Scale (KPS) has been used as an assessment tool for performance status in oncology since 1948 [4]. It is commonly regarded as the gold standard measurement of performance status in cancer[2,3]. The KPS scale assesses three dimensions of health status – activity, work and self-care – and can be administered by any healthcare professional for a quick assessment of general functioning and survival [5]. In an evaluation of predictive validity, Mor et al found significant correlation between KPS at initial interview and survival time (r = 0.30, P < 0.001) [6]. When KPS is low it is a sensitive predictor of poor prognosis, but when high it is a poor cross-sectional indicator of prognosis [2]

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