Richard L. Heinrich

Karnofsky performance status revisited: reliability, validity, and guidelines.

Little research has been conducted documenting the reliability and validity of the Karnofsky Performance Status (KPS) scale, and guidelines based on empirical data do not exist to govern its use. Two hundred ninety-three cancer patients completed a questionnaire that assesses their physical and psychosocial difficulties. Physicians rated patients on the KPS and a subsample of 75 patients was used to evaluate interrater reliability. Analyses were conducted to evaluate the interrater reliability and construct validity of the KPS. The KPS was shown to have good reliability and validity. Detailed examination of the reliability data suggested areas in which physicians err in their judgments. Multiple regression techniques were used to empirically identify seven behaviorally based questions that would be helpful in predicting KPS scores. The seven variables included weight loss, weight gain, reduced energy, difficulty walking, driving, grooming, and working part time. An interview approach with behaviorally based guidelines is presented using these variables to obtain relevant data and make more accurate KPS ratings. With the approach suggested and the guidelines presented, oncologists may train themselves to use the KPS in a standard way, which should increase reliability and validity of the KPS and has implications for patients and research studies that use KPS as a stratifying variable.

CAncer rehabilitation evaluation system–short form (CARES-SF). A cancer specific rehabilitation and quality of life instrument

The CAncer Rehabilitation Evaluation System (CARES) (CARES Consultants, Santa Monica, CA) a rehabilitation and quality of life instrument with well‐documented reliability and validity, has been shortened. This report describes the development and psychometric properties of the new instrument, the CAncer Rehabilitation Evaluation System—Short Form (CARES‐SF). The data from four existing samples of cancer patients demonstrate that the CARES‐SF is highly related to the CARES (r = 0.98), has excellent test‐retest reliability (86% agreement), concurrent validity with related measures, and acceptable internal consistency of summary scales (alpha = 0.85 to 0.61). In a new sample of breast cancer patients evaluated at three points in time (1 month, 7 months, and 13 months after diagnosis) the instrument appears to be sensitive to change and is highly related to the Functional Living Index—Cancer (FLIC), an existing quality of life instrument. The authors conclude that the CARES‐SF has excellent potential as a quality of life instrument for use in clinical trials.

Assessing problems of cancer patients: Psychometric properties of the Cancer Inventory of Problem Situations.

Evaluated the psychometric properties of the Cancer Inventory of Problem Situations (CIPS), a cancer-specific survey instrument designed to assess day-to-day problems and rehabilitation needs of cancer patients. A heterogeneous group of 479 cancer patients participated in the research. The substructure of the CIPS was investigated using factor-analytic techniques. The CIPS was factored into 31 clinically useful subscales. Further analyses led to five higher order factors representing the physical, psychosocial, medical interaction, marital, and sexual problem areas characteristic of cancer and its treatment. Internal consistency of all the scales was high (mean alpha = .81). The test-retest reliability and validity of the instrument were also studied in a sample of 120 patients. Analyses of items, subscales, higher order factors, and total CIPS scores suggest excellent reliability. The pattern of correlations of the CIPS with other measures (psychological distress; physical, marital, and sexual functioning; and quality of life) provided preliminary evidence of concurrent, discriminant, and convergent validity. The CIPS appears to have sound psychometric properties and fills an important gap in the assessment of cancer patients for both clinical and research purposes.

The Psychosocial Impact of Cancer on the Elderly: A Comparison with Younger Patients

This report examines the psychosocial impact of cancer in 240 men according to age using a recently developed cancer‐specific survey instrument. Overall, younger patients experienced more frequent or severe psychosocial and treatment‐related problems than the older patients, especially in relation to work and chemotherapy. In addition, younger patients experienced more difficulty dealing with the health care setting. The authors conclude that the elderly cancer patient experiences less psychosocial disruption from cancer than do younger individuals. J Am Geriatr Soc 33:429, 1985

Living with Cancer: The Cancer Inventory of Problem Situations.

With the recent improvement in cancer therapy, patients are living for extended periods of time. There is little information on the day-to-day problems that these patients experience. The paucity of such information is due to the absence of instruments specifically designed to document these problems. The authors have developed an instrument, The Cancer Inventory of Problem Situations (CIPS), and present a study of 84 cancer patients using the CIPS. Preliminary evaluation of the instrument in this small and heterogeneous group of patients demonstrates that cancer has a significant, extensive impact on psychosocial and physical functioning. Cancer patients have moderate to severe problems in personal care, activity management, involvement with the health care system, work, and interpersonal interactions.

Rehabilitation needs and breast cancer: The first month after primary therapy

SummaryBreast cancer is the most common neoplasm in occidental women, yet very little information is available about the rehabilitation needs of these patients. This report reviews in detail the physical, psychological, social, and financial problems identified by fifty women during the first month after primary surgical treatment. The most frequently reported problems were physical and psychological. Patients undergoing modified radical mastectomy (MRM) are compared with patients receiving segmental mastectomy and primary radiotherapy (SM). There were few differences between the two surgical treatment groups; however, patients in the MRM group reported more difficulty with clothing and body image, while the SM group had more disruption of recreation and social activities. Information about the rehabilitation problems of patients with this common neoplasm should be helpful to patients and to the members of the health care team who are helping them recover.

Signal detection and threshold measures to loud tones and radiant heat in chronic low back pain patients and cohort controls.

Abstract Eleven chronic low back pain (CLBP) and 11 age‐ and sex‐matched control subjects were tested during two separate sessions for the perception of radiant heat and uncomfortably loud tones. Following the determination of a subjects pain threshold (PT) for radiant heat, a standard signal detection methodology was used to present 26 trials each of 4 stimulus levels. The stimuli were rated on a 9‐point scale ranging from ‘nothing’ to ‘very strong pain.’ A similar procedure was used for the tone stimuli with the 9‐point scale ranging from ‘nothing’ to ‘very strongly uncomfortable.’ It was found that the CLBP group had both higher heat pain and tone discomfort thresholds than the control group. For radiant heat only, the CLBP group had poorer discrimination as determined by P(I). The results are discussed within the framework of the hypervigilance and adaptation theories of pain perception.

Signal detection and threshold measures for chronic back pain patients, chronic illness patients, and cohort controls to radiant heat stimuli.

Three distinct subject populations consisting of 15 chronic low back pain patients, 11 chronic respiratory patients, and 11 nonpatient controls were studied using a standard radiant heat signal detection methodology. Following determination by ascending limits of each subjects stimulus detection and faint pain thresholds, 26 randomized trials at each of five stimulus levels were administered. Subjects rated each stimulus on a 6-point subjective rating scale ranging from no pain to severe pain. Results indicated that the chronic low back pain patients and chronic respiratory patients had higher radiant heat pain thresholds than the controls, and the chronic low back pain patients had a discrimination deficit for mildly painful stimuli. These results fit the predictions of an adaptation model of pain perception in chronic pain patients as opposed to a hypochondriasis model.

The chronic illness problem inventory: problem-oriented psychosocial assessment of patients with chronic illness.

Two studies are presented which describe the development of a problem-oriented psychosocial screening instrument for use in health care settings. Reliability and validity data are presented on the Chronic Illness Problem Inventory (CIPI) which demonstrate its ability to document accurately patients specific problems in areas of physical limitations, psychosocial functioning, health care behaviors and marital adjustment. A study is also presented which compares the problems of patients with three distinct chronic illnesses: pain, obesity, and respiratory ailments. Results indicate a significantly greater severity of problems for pain patients and especially patients with multiple pain complaints. Problem areas common to all three illness groups are discussed in the context of providing better comprehensive treatment for chronically ill patients.

Comparing physical and behavior therapy for chronic low back pain on physical abilities psychological distress and patients perceptions

A treatment-outcome study was conducted to study the impact of behavior and physical therapy on components of the chronic low back pain syndrome. Eighteen patients received behavior therapy and 15 patients received physical therapy. All patients had at least a 6-month history of seeking treatment for chronic low back pain. Prior to treatment patients were assessed in four principal areas of functioning: (1) physical abilities; (2) current physical functioning; (3) psychological and psychosocial functioning; and (4) pain intensity and pain perception. Treatments were conducted in a group (five to eight patients) outpatient setting. Both behavior therapy and physical therapy groups met for 10-weekly sessions, each lasting 2 hr. Behavior therapy was designed to address the environmental, social, and emotional components of the low back pain syndrome as well as the depression and decreased activity that result from chronic low back pain. Physical therapy was based upon traditional rehabilitation theory and was designed to improve low back function. Patients were reevaluated at posttreatment, 6 months, and 1 year. The results showed a general improvement for patients in both groups and a few treatment-specific differences in outcome measures.