Objective Measures of Physical Performance in Chronic GVHD: PediatricsDavid A. Jacobsohn, M.D.

Kimberly E. Thormann, M.A., CPNP

Children’s Memorial Hospital

Chicago, IL

Why Measure Impact?

• Improved understanding of the impact of chronic GVHD will contribute to better supportive care.

• Information on disease impact can enhance the evaluation of new therapies.

• Information on disease and treatment impact can promote evidence-based decision-making.

How Do We Measure Impact?

• Symptoms scales: – What problems are they having?

• Patient/proxy-reported outcomes – Performance: What are they doing?– Health-related quality of life: How are they

doing? • Functional capacity:

– End organ function (e.g., PFTs)– Physical capacity: What can they do?

Functional Performance: Physical

• Objective measures

– 2 minute walk distance

– Grip strength

• Clinician-reported

– Lansky/Karnofsky Performance Status

• Self-reported

– Activities Scale for Kids (ASK)

– Child Health Ratings Inventories (CHRIs)

2 Minute Walk Distance

• 50 foot gait path marked with tape at start and finish

• Stopwatch or watch with second hand to time 2 minutes

• Lap counter

• Tape measure or other device to measure the distance in feet covered in the final partial lap

Grip Strength—Hand Dynamometer

• Hand dynamometer selected based on hand size

• Evaluated with patient seated, shoulder adducted and in neutral position with elbow at 90 degrees

• Forearm neutral position

• Wrist 0–30 degrees extension

• Record three trials for dominant hand

Clinician-Reported Measures

• Lansky/Karnofsky Scale

– Mixture of performance, health status, and impairment measures

Score Lansky Performance Status Scale Definitions

(circle from 0–100)

Karnofsky Performance Status Scale Definitions (circle from 0–100)

100 Fully active, normal Normal; no complaints; no evidence of disease

90 Minor restrictions in physically strenuous activityAble to carry on normal activity; minor signs or symptoms of disease

80 Active, but tires more quicklyNormal activity with effort; some signs or symptoms of disease

70Both greater restriction of and less time spent in play activity

Cares for self; unable to carry on normal activity or to do active work

60Up and around, but minimal active play; keeps busy with quieter activities

Requires occasional assistance but is able to care for most personal needs

50Gets dressed but lies around much of the day, no active play but able to participate in all quiet play and activities

Requires considerable assistance and frequent medical care

40 Mostly in bed; participates in quiet activities Disabled; requires special care and assistance

30 In bed; needs assistance even for quiet playSeverely disabled; hospital admission is indicated although death not imminent

20Often sleeping; play entirely limited to very passive activities

Very sick; hospital admission necessary; active supportive treatment necessary

10 No play; does not get out of bed Moribund; fatal processes progressing rapidly

0 Unresponsive Dead