title: The adequacy of the Karnofsky Rating and Global Adjustment to Illness Scale as outcome measures in cancer rehabilitation and continuing care.
abstract: The Karnofsky Patient Performance Rating and the Global Adjustment to Illness Scale (Derogatis) were chosen to rate the physical status and psychosocial adjustment of 857 cancer patients participating in 6 Rehabilitation and Continuing Care (R/CC) programs. Both instruments are reported to have high interrater reliability, and administration is easy, fast, and non-intrusive to the patient. Repeated ratings were taken at hospital admission or initial assessment, discharge and at times of marked change to monitor patient status and to be used as outcome measures to evaluate the programs' impacts. The latter application has not been reported elsewhere. Changes in physical and psychosocial status from program entry to last contact were defined in terms of three outcomes: improvement, no change, deterioration. Adequacy of these ratings as outcome measures is evaluated in terms of generally accepted criteria for outcome measures and the operational experience during the program. The Karnofsky and GAIS instruments are judged favorably in terms of criteria for outcome measures in that they (1) relate to patient health status and the process of medical care; (2) are suitable for cancer patients; and (3) are not restricted to specific sites or complications. Three years' experience has resulted in the identification of difficulties in administration (appropriateness of specific descriptors of adjustment in particular situations or between ethnic or age groups, e.g. the GAIS is not appropriate for use among children) and interpretation of results (due to lack of norms for comparison). Overall, the scales are good measures of outcome. Adaptations of the scales based on their use with different age and ethnic groups might enhance the reliability and validity in this setting. Finally, norms need to be established if results are to be compared among different cancer patient populations.
mesh_terms: D000203:Activities of Daily Living; D001294:Attitude to Health; D006254:Hawaii; D006801:Humans; D009369:Neoplasms / Q000534:rehabilitation*; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D012803:Sick Role; D012917:Social Adjustment