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Australia-modified Karnofsky Performance Scale and physical activity in COPD and lung cancer: an exploratory pooled data analysis
  1. Carlo Barbetta1,
  2. Victoria Allgar2,
  3. Matthew Maddocks3,
  4. Catarina Ribeiro4,
  5. Andrew Wilcock5,
  6. David C Currow6,
  7. Jane Phillips7 and
  8. Miriam J Johnson8,9
  1. 1 Respiratory Department, Ospedale Santa Maria degli Angeli, Pordenone, Italy
  2. 2 Hull York Medical School/Health Sciences, York University, York, UK
  3. 3 London, UK
  4. 4 Cicely Saunders Institute of Palliative Care and Rehabilitation, London, London, UK
  5. 5 Palliative Medicine, University of Nottingham, Nottingham, UK
  6. 6 Faculty of Heath, University of Technology Sydney, Sydney, New South Wales, Australia
  7. 7 Faculty of Health, University of Technology, Sydney, Sydney, Northern Territory, Australia
  8. 8 Hull York Medical School, Hull, UK
  9. 9 The University of Hull, UK
  1. Correspondence to Professor Miriam J Johnson, HYMS, Hull York Medical School, Hull YO10 5DD, UK; miriam.johnson{at}


Objectives Patient-relevant measures of functional status are required in chronic obstructive pulmonary disease (COPD) and lung cancer in clinical practice and research. We explored the relationship between the Australia-modified Karnofsky Performance Scale (AKPS) and measures of functional capacity and physical activity in these patient groups.

Methods Pooled clinical trial data were analysed to explore the relationship between AKPS and average daily steps (ADS), 6 min walk distance (6MWD), and body mass index, airflow obstruction, dyspnoea and exercise score (COPD group). Receiver operator characteristic curves were produced to compare sensitivity and specificity of cut-offs (no dependency >70, high dependency <60) and area under the curve (AUC).

Results Seven clinical trials included people with COPD (n=79) and lung cancer (n=150). To detect an AKPS of >70, the optimal ADS cut-points were COPD, 3342 steps (AUC 0.88, 95% CI 0.79 to 0.97, sensitivity 82%, specificity 76%), and lung cancer, 3380 steps (AUC 0.72, 95% CI 0.64 to 0.81, sensitivity 61%, specificity 74%), and for 6MWD (COPD only) 242 m (AUC 0.72, 95% CI 0.63 to 0.81, sensitivity 73%, specificity 34%).

Conclusions An AKPS score is strongly related to ADS in people with COPD and lung cancer. The AKPS may be useful in clinical practice and research to indicate levels of physical activity where ADS and 6 min walk test are not possible. Longitudinal data are needed to confirm these findings.

  • physical activity
  • chronic obstructive pulmonary disease
  • lung cancer
  • performance status
  • outcome measurement
  • functional independence

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  • Contributors Concept and design: MJJ, MM and DCC; data pooling: CR and CB; analysis: VA and CB; first draft of the manuscript: CB. All authors contributed substantially to data interpretation and manuscript drafts and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.