Mount Carmel Health Partners Clinical Guidelines Palliative Care | Page 5

Instructions for Use of PPS ( see also definition of terms ) 1 . PPS scores are determined by reading horizontally at each level to find a ‘ best fit ’ for the patient which is then assigned as the

PPS % score .

2 . Begin at the left column and read downwards until the appropriate ambulation level is reached , then read across to the next column and downwards again until the activity / evidence of disease is located . These steps are repeated until all five columns are covered before assigning the actual PPS for that patient . In this way , ‘ leftward ’ columns ( columns to the left of any specific column ) are ‘ stronger ’ determinants and generally take precedence over others .

Example 1 : A patient who spends the majority of the day sitting or lying down due to fatigue from advanced disease and requires considerable assistance to walk even for short distances but who is otherwise fully conscious level with good intake would be scored at PPS 50 %.

Example 2 : A patient who has become paralyzed and quadriplegic requiring total care would be PPS 30 %. Although this patient may be placed in a wheelchair ( and perhaps seem initially to be at 50 %), the score is 30 % because he or she would be otherwise totally bed bound due to the disease or complication if it were not for caregivers providing total care including lift / transfer . The patient may have normal intake and full conscious level .

Example 3 : However , if the patient in example 2 was paraplegic and bed bound but still able to do some self-care such as feed themselves , then the PPS would be higher at 40 or 50 % since he or she is not ‘ total care .’

3 . PPS scores are in 10 % increments only . Sometimes , there are several columns easily placed at one level but one or two which seem better at a higher or lower level . One then needs to make a ‘ best fit ’ decision . Choosing a ‘ half- fit ’ value of PPS 45 %, for example , is not correct . The combination of clinical judgment and ‘ leftward precedence ’ is used to determine whether 40 % or 50 % is the more accurate score for that patient .

4 . PPS may be used for several purposes . First , it is an excellent communication tool for quickly describing a patient ’ s current functional level . Second , it may have value in criteria for workload assessment or other measurements and comparisons . Finally , it appears to have prognostic value .

Copyright © 2001 Victoria Hospice Society

Palliative - 5

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