Article

OBJECTIVE: To
characterize the performance of common clinician- and self-report measures of
function in assessing community-dwelling people with metastatic breast cancer.
DESIGN: Cross-sectional study. SETTING: A tertiary medical center outpatient
cancer clinic. PARTICIPANTS: A consecutive sample of community-dwelling patients
(N=163) with stage IV breast cancer. INTERVENTIONS: Not applicable. MAIN OUTCOME
MEASURES: Medical Outcomes Study 36-Item Short-Form Physical Functioning (PF-10)
and Role Physical subscales; the Older Americans Resource Study (OARS) activities
of daily living (ADL) and instrumental ADL subscales; Karnofsky Performance Scale
(KPS); and the FIM Total and FIM Mobility scores. RESULTS: With the exception of
the PF-10 and Role Physical subscales, which demonstrated floor effects, ceiling
effects were detected in all the measures and were particularly persistent in the
OARS ADL subscale. Instrument and item score distributions varied markedly across
KPS-defined subgroups with FIM Mobility, FIM Total, and OARS subscale score
distributions deviating least from the normal in the lowest performing (KPS
40-50) participants. Correlations between self-reported (Role Physical subscales,
PF-10, OARS ADL subscales) and the clinician-rated (KPS and FIM scales) scales
were moderate to high (r=.55-.82); however, clinician-reported scores were more
consistently associated with the presence of physical impairments. CONCLUSIONS:
In this population with stage IV breast cancer, ceiling effects limit the
discriminatory capacity of the common functional scales assessed in this study.
Instruments and items, particularly when ADL based, tend to perform better at
lower levels of function (KPS 40-50) and less well at higher levels.
Clinician-rated outcomes may have greater capacity to discriminate the presence
of physical impairments.

Langue : ANGLAIS