The Australia-modified Karnofsky Performance Status (AKPS) scale: a revised scale for contemporary palliative care clinical practice [ISRCTN81117481]

Abernethy, Amy P.; Shelby‐James, Tania; Fazekas, Belinda; Woods, David; Currow, David C.

doi:10.1186/1472-684x-4-7

Cited by 418 publications

(403 citation statements)

References 28 publications

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“…Exclusion criteria included: regular use of any opioid medication in the two weeks before screening; a true hypersensitivity reaction to opioids; a history of substance misuse; use of monoamine oxidase inhibitors in the last two weeks; functional status <50 on the Australianmodified Karnofsky Performance scale (AKPS) [14] (Table 2); a calculated creatinine clearance of less than 15ml/min (as calculated using the MDRD formula [15]); pregnancy; confusion (less than 24/30 on a Mini-Mental State Examination(MMSE) [16]); or unwilling or unable to complete the study measures.…”

Section: Study Participantsmentioning

confidence: 99%

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Once-Daily Opioids for Chronic Dyspnea: A Dose Increment and Pharmacovigilance Study

Currow

McDonald

Oaten

et al. 2011

Journal of Pain and Symptom Management

256

242

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Please note that any alterations made during the publishing process may not appear in this version."NOTICE: this is the authors' version of a work that was accepted for publication in the Journal of Pain and Symptom Management. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Cities. Published Journal Articles (PJAs) Definition: A published journal article (PJA) is the definitive final record of published research that appears or will appear in the journal and embodies all value-adding publisher activities including copy-editing, formatting and (if relevant) pagination. Policy: Elsevier guarantees each PJA's authenticity, we work with others (e.g. national libraries) to preserve them for posterity and in perpetuity, and we invest to drive their usage. We strictly apply an absolute guideline regarding their location: every PJA will reside only on a completely controlled site because this is the only way that we as the publisher can guarantee each PJA's permanence, authenticity and that it is not altered. The continued viability of scholarly journals and their PJAs is also important to the research community. Publishers invest significant time, money and resources to create, maintain and develop both journals' reputations and the publishing process. The distribution of PJAs is therefore also subject to strict guidelines so that journals' ability to recoup the investments required to create them are not compromised. An author may use the PJA for personal use and internal institutional use (see above for definitions of these terms). In the interest of safeguarding the correct scientific record, however, Elsevier does not permit the posting of PJAs (Elsevier-provided PDF or HTML files) on any open websites. This is to ensure that the final published version of an article, which has been edited and peer-reviewed according to the publishing standards of an Elsevier journal, is always recognized as such only via the journal itself, whether in print or electronic format. PJAs may not be used for commercial use or for systematic distribution (see above for definitions of these terms). Tables: 6 References: 25Funding : This study was generously funded by National Health and Medical Research Council grant #480459. 2Archived at Flinders University: dspace.flinders.edu.au Abstract ContextRandomised controlled trials (RCTs) can answer questions of efficacy, but rarely generate a complete safety profile. Long term pharmacovigilance studies complement RCTs. ObjectivesLevel I evidence supports short term efficacy of opioids in reducing refractory dyspnoea. This study aims to determine: the minimum effective daily dose of sustained release morphine to reduce refractory breathlessness; and whether net clinical benefits are sustained safely. MethodsIn a phase II d...

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Section: Study Participantsmentioning

confidence: 99%

“…Other reasons for withdrawal included AKPS [14] falling below 30, a sudden increase in dyspnoea, or participant death.…”

Section: Study Withdrawalmentioning

confidence: 99%

Once-Daily Opioids for Chronic Dyspnea: A Dose Increment and Pharmacovigilance Study

Currow

McDonald

Oaten

et al. 2011

Journal of Pain and Symptom Management

256

242

View full text Add to dashboard Cite

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“…Patients were included in the study if they were aged >18 years, were undergoing treatment with radiotherapy or concurrent radiotherapy and chemotherapy for cure or control of cancer rather than palliation, were able to communicate in English, had adequate cognition to complete the assessments, and had a physical performance status ranging from normal to requiring occasional assistance as demonstrated by a Karnofsky performance status (KPS) of 60 to 100. 19,20 Patients with breast cancer were excluded from the study because of a separate intervention study being conducted at the research location that may have contaminated results.…”

Section: Participants and Settingsmentioning

confidence: 99%

“…Each subscale consists of 4 items, 2 indicative of fatigue and 2 contraindicative (subscale score range, [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. The responder indicates on a scale of 1 to 5 to what extent the statement applies to him or her.…”

Section: Fatiguementioning

confidence: 99%

“…The inter-rater reliability, construct validity, and predictive validity have all been reported to be high. 19,20 their activities over the recent past across 3 activity domains-domestic, leisure/work, and outdoors-which are also compiled into a single summary score (with a range of 15-60 points), with a higher score indicating more frequent activity participation. The FAI has good construct validity, particularly in middle-aged and elderly people, and is reliable.…”

Section: Performance Statusmentioning

confidence: 99%

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A multidimensional examination of correlates of fatigue during radiotherapy

Purcell

Fleming

Bennett

et al. 2009

Cancer

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BACKGROUND: Cancer-related fatigue can be measured as both a unidimensional and a multidimensional construct. Unidimensional fatigue and its symptom correlates have undergone some previous investigation; however, minimal research has considered the differential effect of correlates on individual dimensions of fatigue. The objective of the current study was to investigate cancer-related fatigue in a radiotherapy sample using a multidimensional conceptualization to determine whether correlates of fatigue are consistent across all dimensions or whether each fatigue dimension has its own unique pattern of correlates. METHODS: The study used a prospective cohort design with data collected from radiotherapy patients at 3 time points; before, after, and 6 weeks after radiotherapy treatment. RESULTS: A total of 210 participants were enrolled in the study. Results indicated the following relations. Increased general fatigue was found to be associated with lower performance status, being in a de facto relationship, depression, having treatment to the brain, and reduced vigorous physical activity. Increased physical fatigue was associated with lower performance status, depression, reduced physical activity, reduced productive hours, and nausea. Higher levels of reduced activity were associated with depression, decreased participation in activities of daily living, decreased number of productive hours, and lower performance status. Higher levels of reduced motivation were associated with radiotherapy to the brain, reduced moderate physical activity, and depression. Increased mental fatigue was associated with diagnosis of a brain tumor, anxiety, depression, and sleep problems. CONCLUSIONS: The results of the current study support the recognition of multiple dimensions of fatigue, because each dimension examined had various correlates. These findings further develop our understanding of fatigue and may help clinicians provide more targeted information to people with cancer-related fatigue. Furthermore, these results can guide the development of group or individually tailored interventions that ultimately may reduce the impact of this distressing symptom on people with cancer. Cancer 2010;116:529-37.

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Effect of Regular, Low-Dose, Extended-release Morphine on Chronic Breathlessness in Chronic Obstructive Pulmonary Disease

Ekström

Chang

Louw

et al. 2022

JAMA

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ImportanceChronic breathlessness is common in people with chronic obstructive pulmonary disease (COPD). Regular, low-dose, extended-release morphine may relieve breathlessness, but evidence about its efficacy and dosing is needed.ObjectiveTo determine the effect of different doses of extended-release morphine on worst breathlessness in people with COPD after 1 week of treatment.Design, Setting, and ParticipantsMulticenter, double-blind, placebo-controlled randomized clinical trial including people with COPD and chronic breathlessness (defined as a modified Medical Research Council score of 3 to 4) conducted at 20 centers in Australia. People were enrolled between September 1, 2016, and November 20, 2019, and followed up through December 26, 2019.InterventionsPeople were randomized 1:1:1 to 8 mg/d or 16 mg/d of oral extended-release morphine or placebo during week 1. At the start of weeks 2 and 3, people were randomized 1:1 to 8 mg/d of extended-release morphine, which was added to the prior week’s dose, or placebo.Main Outcomes and MeasuresThe primary outcome was change in the intensity of worst breathlessness on a numerical rating scale (score range, 0 [none] to 10 [being worst or most intense]) using the mean score at baseline (from days −3 to −1) to the mean score after week 1 of treatment (from days 5 to 7) in the 8 mg/d and 16 mg/d of extended-release morphine groups vs the placebo group. Secondary outcomes included change in daily step count measured using an actigraphy device from baseline (day −1) to the mean step count from week 3 (from days 19 to 21).ResultsAmong the 160 people randomized, 156 were included in the primary analyses (median age, 72 years [IQR, 67 to 78 years]; 48% were women) and 138 (88%) completed treatment at week 1 (48 in the 8 mg/d of morphine group, 43 in the 16 mg/d of morphine group, and 47 in the placebo group). The change in the intensity of worst breathlessness at week 1 was not significantly different between the 8 mg/d of morphine group and the placebo group (mean difference, −0.3 [95% CI, −0.9 to 0.4]) or between the 16 mg/d of morphine group and the placebo group (mean difference, −0.3 [95%, CI, −1.0 to 0.4]). At week 3, the secondary outcome of change in mean daily step count was not significantly different between the 8 mg/d of morphine group and the placebo group (mean difference, −1453 [95% CI, −3310 to 405]), between the 16 mg/d of morphine group and the placebo group (mean difference, −1312 [95% CI, −3220 to 596]), between the 24 mg/d of morphine group and the placebo group (mean difference, −692 [95% CI, −2553 to 1170]), or between the 32 mg/d of morphine group and the placebo group (mean difference, −1924 [95% CI, −47 699 to 921]).Conclusions and RelevanceAmong people with COPD and severe chronic breathlessness, daily low-dose, extended-release morphine did not significantly reduce the intensity of worst breathlessness after 1 week of treatment. These findings do not support the use of these doses of extended-release morphine to relieve breathlessness.Trial RegistrationClinicalTrials.gov Identifier: NCT02720822

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The Australia-modified Karnofsky Performance Status (AKPS) scale: a revised scale for contemporary palliative care clinical practice [ISRCTN81117481]

Cited by 418 publications

References 28 publications

Once-Daily Opioids for Chronic Dyspnea: A Dose Increment and Pharmacovigilance Study

Once-Daily Opioids for Chronic Dyspnea: A Dose Increment and Pharmacovigilance Study

A multidimensional examination of correlates of fatigue during radiotherapy

Effect of Regular, Low-Dose, Extended-release Morphine on Chronic Breathlessness in Chronic Obstructive Pulmonary Disease

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