Appraisal of the Karnofsky Performance Status and proposal of a simple algorithmic system for its evaluation

BACKGROUND: For over 60 years, the Karnofsky Performance Status (KPS) has proven itself a valuable tool with which to perform measurement of and comparison between the functional statuses of individual patients. In recent decades conditions for patients have changed, and so too has the KPS undergone several adjustments since its initial development. DISCUSSION: The most important works regarding the KPS tend to focus upon a variety of issues, including but not limited to reliability, validity and health-related quality of life. Also discussed is the question of what quantity the KPS may in fact be said to measure. The KPS is increasingly used as a prognostic factor in patient assessment. Thus, questions regarding if and how it affects survival are relevant. In this paper, we propose an algorithm which uses a minimum of two and a maximum of three questions to facilitate an adequate and efficient evaluation of the KPS. SUMMARY: This review honors the original intention of the discoverer and gives an overview of adaptations made in recent years. The proposed algorithm suggests specific updates with the goal of ensuring continued adequacy and expediency in the determination of the KPS

Poor Performance Status is Associated with Increased Mortality in Patients with Cirrhosis

Background & Aims Functional status (a patient’s ability to perform activities that meet basic needs, fulfill usual roles, and maintain health and well being) has been linked to outcomes in patients with cirrhosis and can be measured by the Karnofsky performance status (KPS) scale. We investigated the association between KPS score and mortality in patients with cirrhosis. Methods We used the United Network for Organ Sharing database to perform a retrospective cohort study of patients listed for liver transplantation in the United States between 2005 and 2015. We used Cox proportional hazards and competing risk regression analyses to examine the association between KPS and mortality and transplantation. Results Of 79,092 patients, 44% were in KPS category A (KPS 80%–100%), 43% were in category B (KPS 50%–70%), and 13% were in category C (KPS 10%–40%). Between 2005 and 2015, the proportion of patients in category A decreased from 53% to 35%, whereas the proportions in categories B and C increased from 36% to 49% and from 11% to 16%, respectively. KPS was associated with mortality: compared to patients in KPS category A, the KPS B adjusted hazard ratio [HR] was 1.14 (95% confidence interval [CI], 1.11–1.18) and the KPS C adjusted HR was 1.63 (95% CI, 1.55–1.72). KPS was also associated with liver transplantation; compared to patients in KPS category A, the KPS B adjusted HR was 1.08 (95% CI, 1.06–1.11) and the KPS C adjusted HR was 1.35 (95% CI, 1.30–1.40). In competing risk analysis, only the relationship between KPS and mortality maintained significance and directionality. These relationships were most pronounced in patients without hepatocellular carcinoma. Conclusions Among patients with cirrhosis listed for liver transplantation, poor performance status, based on the KPS scale, is associated with increased mortality. In this population, performance status has decreased over time

Evaluation of fatigue-related kinesiophobia and associated factors in individuals with lung cancer with and without respiratory comorbidity

Aim: To investigate fatigue-related kinesiophobia and associated factors in individuals with lung cancer. Methods: A total of 52 individuals were included in the study and the individuals were divided into two groups, each consisting of 26 individuals. Charlson comorbidity index, Brief Fatigue Inventory, modified Medical Research Council dyspnea scale, Tampa Kinesiophobia Scale-Fatigue are applied as data collection tools. Results: The individuals in the study had similar demographic characteristics. There was no difference between the groups in the study in terms of fatigue-related kinesiophobia. There was a difference between the pain and performance status of the individuals in the study in activities of daily living (p<0.05). Conclusion: At the end of this study, it was observed that individuals with lung cancer with respiratory comorbidity had worse pain, fatigue and performance values in activities of daily living, while kinesiophobia values related to fatigue were similar

Comparison of content and psychometric properties for assessment tools used for brain tumor patients : a scoping review

Funding Information: This study was supported by Riga Stradiņš University internal grant. Publisher Copyright: © 2021, The Author(s).Aims: To determine the most frequently utilized functional status assessment instruments for patients with brain tumors, compare their contents, using the International Classification of Functioning, Disability and Health (ICF), and their psychometric properties. Methods: A scoping review was conducted to explore possible assessment instruments and summarize the evidence. A systematic literature search was performed for identification of the frequently used functional assessment tool in clinical trials in PubMed, ScienceDirect, and ProQuest databases. The content of most used instruments was linked to the ICF categories. The psychometric qualities of these assessment tools were systematically searched and analyzed. Results: Nine most used assessment tools in clinical trials were identified. The most frequently used assessment instrument is the Karnofsky Performance Scale, which is developed for a general assessment of oncological patients. Out of four self-assessment tools, two were disease-specific (EORTC QLQ-BN20 and FACT-Br), EORTC QLQ-C30 has been shown good psychometric properties in patients with brain tumors as well as in patients with various oncological diseases, similar to the SF-36, it is used in patients with brain tumors as well as in patients with various diseases. The Functional Independence Measure and the Barthel Index were two objective assessment tools that described functioning, but two were neuropsychological tests (MMSE and Trial Making Test). Two hundred eighty-three meaningful concepts were identified and linked to 102 most relevant second-level categories covering all components of the ICF. Forty-nine studies reporting psychometric properties of those nine assessment tools were identified, indicating good reliability and validity for all the instruments. Conclusion: Nine most frequently utilized functional status assessment instruments for patients with brain tumors represent all components of the ICF and have good psychometric properties. However, the choice of the tool depends on the clinical question posed and the aim of its use.publishersversionPeer reviewe

Die Bedeutung einer detaillierten geriatrischen Funktionsbeurteilung älterer Krebspatienten

Für ältere Krebspatienten ist der Erhalt oder die Wiedererlangung ihrer Fähigkeit, sich selbst zu versorgen, von großer Wichtigkeit. Welche Instrumente sind geeignet, um dies zu messen? In der geriatrischen und onkologischen Versorgung sind verschiedene Instrumente zur Beurteilung des funktionellen Status etabliert, die jedoch in der Vergangenheit nur unzureichend miteinander verglichen wurden. Patienten und Methoden: Im Rahmen einer prospektiven Kohortenstudie haben wir 483 Patienten eingeschlossen, 198 ältere Patienten mit Krebs, 156 jüngere Patienten mit Krebs und 129 ältere Patienten mit gutartigen Erkrankungen. Der Funktionsstatus wurde anhand des Eastern Cooperative Oncology Group Performance-Status (ECOG-PS), der Aktivitäten des täglichen Lebens (ADL) und der instrumentellen Aktivitäten des täglichen Lebens (IADL) beurteilt. Die Ergebnisse wurden dahingehend verglichen, Patienten mit Einschränkungen im funktionellen Status zu erfassen. Zusammenfassung: Die relative Häufigkeit von Krebspatienten mit Einschränkungen bei ECOG-PS, ADL und IADL stieg von 25,7 %, 13,5 % und 17,9 % bei den unter 60-Jährigen auf 50,0 %, 47,1 % und 66,7 % bei den 80-Jährigen und älteren. Die Ergebnisse bei älteren Patienten mit Krebs waren mit denen bei älteren Patienten mit gutartigen Erkrankungen vergleichbar. Bei älteren Krebspatienten wiesen 20,7 % der Patienten mit gutem ECOG-PS Einschränkungen bei den Aktivitäten des täglichen Lebens (ADL) und 21,6 % bei den instrumentellen Aktivitäten des täglichen Lebens (IADL) auf. Von den Patienten ohne Einschränkungen bei den Aktivitäten des täglichen Lebens (ADL) hatten 34,7 % einen schlechten ECOG-PS, und von den Patienten ohne Einschränkungen bei den instrumentellen Aktivitäten des täglichen Lebens (IADL) hatten 26,0 % einen schlechten ECOG-PS. Der Behandlungsansatz (kurativ vs. palliativ) ist signifikant mit funktionellen Einschränkungen verbunden

Las interfaces entre apoyo social, calidad de vida y depresión en usuarios elegibles para cuidados paliativos

Objective: Analyzing the relationship between social support, quality of life and depression in patients eligible for palliative care at Primary Health Care of a municipality in the interior of Minas Gerais, Brazil. Method: A correlational cross-sectional study carried out with patients treated in six primary health care units. Data were submitted to descriptive statistical analysis, tests for differences between averages and medians, and correlation tests. The significance level was 0.05. Results: The sample consisted of 115 participants, and it was identified that the higher the social support, the better the global quality of life (p<0.001) and functional quality of life (p=0.035); the greater the presence of physical symptoms, the lower the level of social support (p=0.012) and the higher the level of depression (p<0.001); the higher the symptoms of depression, the worse the global quality of life (p<0.001), functional quality of life (p<0.001) and the lower the levels of social support (p<0.001). Conclusion: Levels of quality of life, social support and depression of patients eligible for palliative care are influenced by socioeconomic factors such as marital status, gender, age, income, education and presence of a caregiver.Objetivo: Analisar a relação entre apoio social, qualidade de vida e depressão em pacientes elegíveis para cuidados paliativos atendidos na Atenção Primária à Saúde de um município no interior de Minas Gerais, Brasil. Método: Estudo transversal correlacional, realizado com pacientes atendidos em seis unidades da atenção primária à saúde. Os dados foram submetidos à análise estatística descritiva, testes de diferenças entre médias e medianas e testes de correlação. O nível de significância adotado foi 0,05. Resultados: A amostra foi composta por 115 participantes, e identificou-se que quanto maior o apoio social, melhor é a qualidade de vida global (p<0,001) e funcional (p=0,035); quanto maior a presença de sintomas físicos, menor o nível de apoio social (p=0,012) e maior o nível de depressão (p<0,001); quanto maiores os sintomas de depressão, pior é a qualidade de vida global (p<0,001), funcional (p<0,001) e menores os níveis de apoio social (p<0,001). Conclusão: Os níveis de qualidade de vida, apoio social e depressão de pacientes elegíveis para cuidados paliativos são influenciados por fatores socioeconômicos, tais como estado conjugal, sexo, idade, renda, escolaridade e presença de cuidador.Objetivo: Analizar la relación entre apoyo social, calidad de vida y depresión en pacientes elegibles para cuidados paliativos atendidos en la Atención Primaria a la Salud de un municipio en el interior de Minas Gerais, Brasil. Método: Estudio transversal correlacional, realizado con pacientes atendidos en seis unidades de atención primaria a la salud. Los datos fueron sometidos al análisis estadístico descriptivo, pruebas de diferencias entre medias y medianas y pruebas de correlación. El nivel de significancia adoptado fue 0,05. Resultados: La muestra fue compuesta por 115 participantes, y se identificó que cuanto mayor el apoyo social, mejor es la calidad de vida global (p<0,001) y funcional (p=0,035); cuanto mayor sea la presencia de síntomas físicos, menor el nivel de apoyo social (p=0,012) y mayor el nivel de depresión (p<0,001); cuanto mayores los síntomas de depresión, peor es la calidad de vida global (p<0,001), funcional (p<0,001) y menores los niveles de apoyo social (p<0,001). Conclusión: Los niveles de calidad de vida, apoyo social y depresión de pacientes elegibles para cuidados paliativos son influenciados por factores socioeconómicos, tales como estado conyugal, sexo, edad, renta, escolaridad y presencia de cuidador

Association Between Sarcopenia and Functional Status in Liver Transplant Patients

OBJECTIVES: A growing body of evidence shows that frailty and functional performance predict liver transplant outcomes. The Organ Procurement and Transplant Network uses the Karnofsky Performance Status scale to adjust for transplant center case mix in assessing quality measures. This study explores the strength of the relationship between Karnofsky Performance Status scores and objective measures of frailty. MATERIALS AND METHODS: This observational study includes 136 adult, first-time liver transplant recipients at UMass Memorial (2006-2015) who had 2 abdominal computed tomography scans available (at \u3c /= 90 days pretransplant and \u3e /= 7 days before that). We analyzed the relationship between Karnofsky Performance Status and muscle wasting using absolute and change in psoas muscle size and quality pretransplant. RESULTS: The mean age was 55 years, mean Model for End-Stage Liver Disease was 22, and 34% of patients were women. In the study group, 50% of patients had sarcopenia pretransplant and 71.3% demonstrated declined lean psoas area at an average rate of 11% per month. Patients who experienced muscle wasting at a rate of \u3e /= 1% per month had 2.83 times the risk (95% confidence interval, 1.18-6.80) of being severely impaired/disabled pretransplant. The risk increased by 2.32-fold (95% confidence interval, 1.44-3.75) for every standard deviation decrease in pretransplant lean psoas area. CONCLUSIONS: Provider-assessed physical health status moderately correlates with objective measures of frailty

The аssessment of the quality of life of gynecological patients

Quality of Life (QOL) research in Healthcare Service practice is of great importance in various fields of medicine. The assessment of QOL is carried out not only for the analysis of statistics, but also with the aim of improving and optimizing medical organizations activities, developing and standardizing of treatment guidelines, studying the effectiveness of treatment methods in QOL measurements, examining new treatment methods, identifying risk groups for diseases and promotion of preventive measures. A review of the literature dealing with the main modern methods for studying the QOL of patients is presented. Special aspects of the application of methods for assessing the QOL of patients depending on diseases and their role in the study of the effectiveness of treatment are considered. The issues of studying the QOL of patients in gynecological practice are clarified. The paper presents studies estimating the QOL of patients with various gynecological pathologies: uterine myoma, pelvic organ prolapse, endometriosis, climacteric syndrome. Despite the high prevalence of gynecological diseases among the population, currently there is a limited number of developed specific questionnaires on gynecological nosologies. The analysis of the available literature showed that the assessment of the QOL of patients in gynecology was done mainly after surgical treatment. QOL of outpatient clinic patients was assessed only in some studies