Palliative Performance Scales ( PPSv2 ) continued ... Definition of Terms for PPS
As noted below , some of the terms have similar meanings with the differences being more readily apparent as one reads horizontally across each row to find an overall ‘ best fit ’ using all five columns .
Ambulation The items ‘ mainly sit / lie ,’ ‘ mainly in bed ,’ and ‘ totally bed bound ’ are clearly similar . The subtle differences are related to items in the self-care column . For example , ‘ totally bed ‘ bound ’ at PPS 30 % is due to either profound weakness or paralysis such that the patient not only can ’ t get out of bed but is also unable to do any self-care . The difference between ‘ sit / lie ’ and ‘ bed ’ is proportionate to the amount of time the patient is able to sit up vs need to lie down .
‘ Reduced ambulation ’ is located at the PPS 70 % and PPS 60 % level . By using the adjacent column , the reduction of ambulation is tied to inability to carry out their normal job , work occupation or some hobbies or housework activities . The person is still able to walk and transfer on their own but at PPS 60 % needs occasional assistance .
Activity & Extent of disease ‘ Some ,’ ‘ significant ,’ and ‘ extensive ’ disease refer to physical and investigative evidence which shows degrees of progression . For example in breast cancer , a local recurrence would imply ‘ some ’ disease , one or two metastases in the lung or bone would imply ‘ significant ’ disease , whereas multiple metastases in lung , bone , liver , brain , hypercalcemia or other major complications would be ‘ extensive ’ disease . The extent may also refer to progression of disease despite active treatments . Using PPS in AIDS , ‘ some ’ may mean the shift from HIV to AIDS , ‘ significant ’ implies progression in physical decline , new or difficult symptoms and laboratory findings with low counts . ‘ Extensive ’ refers to one or more serious complications with or without continuation of active antiretrovirals , antibiotics , etc .
The above extent of disease is also judged in context with the ability to maintain one ’ s work and hobbies or activities . Decline in activity may mean the person still plays golf but reduces from playing 18 holes to 9 holes , or just a par 3 , or to backyard putting . People who enjoy walking will gradually reduce the distance covered , although they may continue trying , sometimes even close to death ( eg . trying to walk the halls ).
Self-Care ‘ Occasional assistance ’ means that most of the time patients are able to transfer out of bed , walk , wash , toilet and eat by their own means , but that on occasion ( perhaps once daily or a few times weekly ) they require minor assistance .
‘ Considerable assistance ’ means that regularly every day the patient needs help , usually by one person , to do some of the activities noted above . For example , the person needs help to get to the bathroom but is then able to brush his or her teeth or wash at least hands and face . Food will often need to be cut into edible sizes but the patient is then able to eat of his or her own accord .
‘ Mainly assistance ’ is a further extension of ‘ considerable .’ Using the above example , the patient now needs help getting up but also needs assistance washing his face and shaving , but can usually eat with minimal or no help . This may fluctuate according to fatigue during the day .
‘ Total care ’ means that the patient is completely unable to eat without help , toilet or do any self-care . Depending on the clinical situation , the patient may or may not be able to chew and swallow food once prepared and fed to him or her .
Intake Changes in intake are quite obvious with ‘ normal intake ’ referring to the person ’ s usual eating habits while healthy . ‘ Reduced ’ means any reduction from that and is highly variable according to the unique individual circumstances . ‘ Minimal ’ refers to very small amounts , usually pureed or liquid , which are well below nutritional sustenance .
Conscious Level ‘ Full consciousness ’ implies full alertness and orientation with good cognitive abilities in various domains of thinking , memory , etc . ‘ Confusion ’ is used to denote presence of either delirium or dementia and is a reduced level of consciousness . It may be mild , moderate or severe with multiple possible etiologies . ‘ Drowsiness ’ implies either fatigue , drug side effects , delirium or closeness to death and is sometimes included in the term stupor . ‘ Coma ’ in this context is the absence of response to verbal or physical stimuli ; some reflexes may or may not remain . The depth of coma may fluctuate throughout a 24 hour period .
© Copyright Notice . The Palliative Performance Scale version 2 ( PPSv2 ) tool is copyright to Victoria Hospice Society and replaces the first PPS published in 1996 [ J Pall Care 9 ( 4 ): 26-32 ]. It cannot be altered or used in any way other than as intended and described here . Programs may use PPSv2 with appropriate recognition . Available in electronic Word format by email request to judy . martell @ caphealth . org
Correspondence should be sent to Medical Director , Victoria Hospice Society , 1900 Fort St , Victoria , BC , V8R 1J8 , Canada
Palliative - 6