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Karnofsky – Lansky Scale
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About Karnofsky – Lansky Scale
Scale Name
Karnofsky – Lansky Scale
Author Details
David Karnofsky and Theodore Lansky
Translation Availability
Not Sure
Background/Description
In the realm of medicine, where numbers often paint the stark picture of health and illness, two scales stand out for their focus on a crucial yet nuanced aspect: a patient’s ability to function in daily life. These are the Karnofsky Performance Scale (KPS) and the Lansky Play-Performance Scale (LPPS), and their stories are intertwined with the fight against cancer and the quest for understanding a patient’s true experience.
The Karnofsky Scale: A Pioneer in Performance Assessment
Born in 1948, the KPS was the brainchild of Dr. David A. Karnofsky, a visionary oncologist. Back then, chemotherapy was in its nascent stages, and gauging a patient’s suitability for these harsh treatments posed a challenge. Existing measures focused on clinical parameters like tumor size, offering little insight into how a patient coped with the physical and emotional demands of therapy.
Dr. Karnofsky, along with colleagues like Dr. Walter H. Abelmann, Dr. Lloyd F. Craver, and Dr. Joseph H. Burchenal, saw the need for a different lens. They crafted a 11-point scale, each point representing a snapshot of a patient’s ability to perform daily activities. From “normal, no complaints, no evidence of disease” at 100 to “dead” at 0, the KPS captured the essence of functional health, encompassing aspects like self-care, work ability, and social interaction.
The KPS revolutionized cancer care. It provided a common language for doctors to assess treatment effects, compare clinical trials, and ultimately, make informed decisions about a patient’s journey. Its simplicity and subjectivity, while posing limitations, made it adaptable to diverse settings and patient populations.
The Lansky Scale: Tailoring the Measure for Tiny Champions
A decade later, in 1958, Dr. Shirley B. Lansky, a dedicated pediatric oncologist, recognized a gap in the KPS. While it served adults well, it didn’t resonate with the unique experiences of children battling cancer. Play, a cornerstone of childhood, was absent from the equation.
Dr. Lansky, along with Dr. Charles M. Steinbrink, crafted the Lansky Play-Performance Scale (LPPS). This 10-point scale mirrored the KPS structure but replaced adult activities with the vibrant language of a child’s world. “Fully active, normal” at 100 translated to “plays normally, attends school,” while “bedridden, needing assistance even for quiet play” at 50 painted a poignant picture.
The LPPS empowered doctors to understand the impact of illness on a child’s ability to play, learn, and socialize. It offered a crucial tool for tailoring treatment plans, monitoring progress, and ultimately, ensuring that even the smallest patients received the care they needed to thrive, not just survive.
A Legacy of Understanding: Beyond Numbers, Towards Experience
The Karnofsky and Lansky scales, though born in different eras and for different populations, share a common legacy. They remind us that a number on a chart is just one piece of the puzzle. By focusing on a patient’s ability to function and experience life, these scales humanize healthcare, urging us to see the person behind the illness.
Administration, Scoring and Interpretation
Setting the Stage:
Gather Information: Review the patient’s medical history, current symptoms, and treatment plan. This context helps in accurately interpreting their functional abilities.
Choose the Right Scale: Use the KPS for adults and adolescents, while the LPPS is specifically designed for children.
Conducting the Assessment:
Observe the Patient: Watch how they move, interact, and perform daily activities. Pay attention to fatigue, pain, and any limitations.
Ask Focused Questions: Use the scale’s specific wording to inquire about their ability to work, engage in social activities, self-care, or play (for LPPS).
Scoring the Scale:
Consider Overall Function: Don’t get bogged down by individual activities. Focus on the patient’s general ability to cope with daily life.
Choose the Most Representative Score: Select the score that best reflects the patient’s typical functioning over the past few days, not just peak or worst-case scenarios.
Documenting the Findings:
Record the Score: Clearly document the assigned score along with the date and any relevant observations.
Track Changes: Regularly monitor the score over time to assess treatment response or disease progression.
Reliability and Validity
The reliability and validity of the Karnofsky Performance Scale (KPS) and the Lansky Play-Performance Scale (LPPS) have been evaluated in numerous studies, with mixed results. Here’s a breakdown:
- Inter-rater reliability: This refers to the consistency of scores between different healthcare professionals evaluating the same patient. Studies have shown moderate to good inter-rater reliability for both KPS and LPPS, especially when training and standardized guidelines are provided.
- Intra-rater reliability: This refers to the consistency of scores for the same healthcare professional evaluating the same patient at different times. Both scales have shown moderate to good intra-rater reliability, but it can be affected by factors like time frame and patient fluctuations.
- Content validity: This refers to the extent to which the scale items cover the relevant aspects of functional status. Both KPS and LPPS have good content validity, with items addressing daily activities, self-care, and social functioning.
- Criterion validity: This refers to how well the scale score correlates with other measures of functional status. Studies have shown moderate correlations between KPS and other scales, but the strength can vary depending on the specific population and measures used.
- Construct validity: This refers to how well the scale score reflects the theoretical concept it is supposed to measure. There is evidence for the construct validity of both KPS and LPPS, but it is not as robust as for other well-established scales.
Limitations:
- Subjectivity: Both scales rely on the clinician’s judgment, which can introduce bias and inconsistency.
- Limited sensitivity: The scales may not capture subtle changes in functional status, especially between consecutive points.
- Lack of standardization: Variations in administration and scoring can affect the reliability and validity of scores.
Available Versions
05-Items
Reference
Lansky, L. L., List, M. A., Lansky, S. B., Cohen, M. E., & Sinks, L. F. (1985). Toward the development of a Play Performance Scale for Children (PPSC). Cancer, 56(7, Suppl), 1837–1840. https://doi.org/10.1002/1097-0142(19851001)56:7+<1837::AID-CNCR2820561324>3.0.CO;2-Z
Important Link
Scale File:
Frequently Asked Questions
What are they?
Karnofsky: Measures functional status in adults with cancer (100=normal, 0=dead).
Lansky: Similar scale for children, focusing on play and daily activities.
How are they used?
Track treatment response and disease progression.
Aid in treatment decisions and communication with patients/families.
Assess eligibility for clinical trials.
Are they reliable and valid?
Moderate to good reliability, but subjective and can vary between clinicians.
Good content validity, but criterion and construct validity are less strong.
Limitations?
Subjective scoring.
Limited sensitivity to subtle changes.
Lack of standardization.
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