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Concordance of Barthel Index, ECOG-PS, and Palliative Performance Scale in the assessment of functional status in patients with advanced medical diseases
  1. C Hernández-Quiles1,
  2. M Bernabeu-Wittel1,
  3. L M Pérez-Belmonte2,
  4. P Macías-Mir3,
  5. D Camacho-González3,
  6. B Massa4,
  7. M Maiz-Jiménez2 and
  8. M Ollero-Baturone1
  9. on behalf of PALIAR investigators
    1. 1Internal Medicine Department, Hospital Universitario Virgen del Rocio, Seville, Spain
    2. 2Internal Medicine Department, Hospital de la Axarquía, Málaga, Spain
    3. 3Internal Medicine Department, Hospital de Antequera, Málaga, Spain
    4. 4Internal Medicine Department, Hospital de Villajoyosa, Alicante, Spain
    1. Correspondence to Dr Carlos Hernández-Quiles, Internal Medicine Department, Hospital Universitario Virgen del Rocio, Avenida Manuel Siurot, s/n, Sevilla, 41013 Spain; quiles_es{at}


    Objective Analysing most relevant clinical features and concordance between different functional scales in patients with advanced medical diseases (PAMD).

    Methods Cross-sectional multicentre study that included PAMD (heart, lung, kidney, liver, and neurological diseases) in hospital settings from February 2009 to October 2010. We analysed clinical, biological and functional features in performing activities of daily living (ADL) by medians of Barthel Index (BI); additionally we assessed their performance status by medians of Eastern Cooperative Oncology Group-Performance Status (ECOG-PS) and Palliative Performance Scale (PPS) scores. We evaluated the concordance of these instruments in assessing functional impairment by κ and intraclass correlation coefficient tests.

    Results 1847 patients were included (average age 79 years, 50.1% men). Most common symptoms were dyspnoea (62.31%), asthenia (23%) and delirium (20.14%). Functional assessment showed a high prevalence of severe or total impairment in performing basic ADL by medians of used instruments (BI median=35 (IQR=70), and 52.1% of patients with severe–total impairment; ECOG-PS median=2 (IQR 30), and 44% of patients with severe–total impairment; and PPS median=50 (IQR 30), and 32% of patients with severe–total impairment). Concordance among these instruments was acceptably good (κ indexes ranging from 0.653 to 0.745 (p<0.0001)).

    Conclusions PAMD represent a population with severe functional impairment, which requires a multidisciplinary approach for proper management. Assessment of functional ability in this population by BI, ECOG-PS, and PPS showed good concordance.

    • Chronic diseases
    • multimorbidity
    • polypathology
    • polypathological patient
    • functional status
    • performance status

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    • Collaborators Researcher from the PALIAR project: Máximo Bernabeu-Wittel (Hospital Virgen del Rocío (Sevilla)), José Murcia-Zaragoza (Hospital de La Vega Baja (Alicante)), Manuel Ollero-Baturone (Hospital Virgen del Rocío (Sevilla)), Belén Escolano Fernández (Hospital de la Serranía (Málaga)), Guadalupe Jarava Rol (Hospital de la Serranía (Málaga)), Carlos Hernández Quiles (Hospital Virgen del Rocío (Sevilla)), Miguel Oliver (Hospital de Sanlúcar de Barrameda (Cádiz), Jesús Díez-Manglano (Hospital Royo Villanova (Zaragoza)), Susana Sanz Baena (Hospital de la Cruz Roja San José y Santa Adela (Madrid)), Bosco Barón-Franco (Hospital Juan Ramón Jiménez (Huelva)), Luis Miguel Pérez Belmonte (Hospital de la Axarquía (Málaga)), Lourdes Moreno-Gaviño (Hospital Virgen del Rocío (Sevilla)), Javier Galindo-Ocaña (Hospital Virgen del Rocío (Sevilla)), Pilar Macías Mir (Hospital de Antequera (Málaga)), Dionisio Camacho González (Hospital de Antequera (Málaga)), Dolores Nieto Martín (Hospital Virgen del Rocío (Sevilla)), Julia Praena Segovia (Hospital Virgen del Rocío (Sevilla)), Beatriz Massa (Hospital de Villajoyosa (Alicante)), María Maiz-Jiménez (Hospital de la Serranía (Málaga)), Nieves Ramírez-Duque (Hospital Virgen del Rocío (Sevilla)), Antonia Mora-Rufete (Hospital General Universitario de Elche (Alicante)), Antonio Fernández-Moyano (Hospital San Juan de Dios del Aljarafe (Sevilla)), Antonio Alemán (Hospital Morales Meseguer (Murcia)), Purificación Sánchez López (Hospital de Torrecárdenas (Almería)), Juan Bosco López-Sáez (Hospital Universitario de Puerto Real (Cádiz)), Manuel Bayón Sayago (Hospital Virgen Macarena (Sevilla)), Felipe Díez (Hospital de Torrecárdenas (Almería)), Ferrán Masanés (Hospital Clínic (Barcelona)), Carmen Ramos-Cantos (Hospital de la Axarquía (Málaga)), Diana Mendoza Giraldo (Hospital Virgen del Rocío (Sevilla)), Guillermo Ternavasio (Hospital Universitario de Salamanca), Patricia González-Ruano (Hospital Cantoblanco-La Paz (Madrid)), José Ángel García García (Hospital Nuestra Señora de Valme (Sevilla)), Rafael Castillo Rubio (Hospital de la Malva-Rosa (Valencia)), Mónica Loring (Hospital de la Axarquía (Málaga)), Sandra Gómez Lesmes (Hospital Universitario de Salamanca), Sergio Serrano Villar (Hospital Clínico San Carlos (Madrid)), Ignacio Novo Valeiro (Hospital Universitario de Salamanca), Laura de la Higuera (Hospital Virgen del Rocío (Sevilla)), Mª Ángeles Soria-López (Clínica Virgen de la Vega (Murcia)), Begoña González Gisbert (Hospital Pare Jofré (Valencia)), Lola Joya (Hospital de Leganés (Madrid)), Agustín Urrutia de Diego (Hospital Germans Trias i Pujol (Barcelona)), Hernán Llorente Cancho (Hospital Universitario de Salamanca), Manuel Rincón Gómez (Hospital Virgen del Rocío (Sevilla)), Marian Polvorosa (Hospital Universitario de Salamanca), Eva González Escoda (Hospital San Vicente Raspbeig (Alicante)), Manuel García Gutiérrez (Hospital Virgen del Rocío (Sevilla)), Manuel Cassani Garza (Hospital San Juan de Dios del Aljarafe (Sevilla)), Lucia Alvela (Hospital Universitario de Salamanca), Mª Paz Pérez Gutiérrez (Hospital Clínico Universitario de Valladolid), J.Manuel Machín-Lázaro (Hospital Universitario de Guadalajara), Dolores Navarro Hidalgo (Hospital Infanta Margarita (Córdoba)), Leyre Díez (Hospital de la Paz (Madrid)), Marta Muniesa (Hospital San Juan de Dios de Pamplona), Miriam Zubiaga (Complejo Asistencial de Burgos), Auxiliadora Fernández (Hospital Virgen del Rocío (Sevilla)), Luis Feliu-Mazaria (Hospital General de Palma de Mallorca), Gustavo Tolchinski (Hospital Municipal de Badalona), Roberto Riera Hortelano (Hospital San Agustín de Avilés), Pilar Retamar (Hospital Virgen Macarena (Sevilla)), Pilar Giner (Hospital San Cecilio (Granada)), Manuel Francisco Fernández-Miera (Hospital Marqués de Valdecilla (Santander)), Natala Castro Iglesias (Hospital Universitario de Salamanca)), Aurelio Fuertes-Martín (Hospital Universitario de Salamanca), Alberto Ruiz-Cantero (Hospital de la Serranía (Málaga)), Miguel Ángel García Ordóñez (Hospital de Antequera (Málaga)), Carlos Sanromán y Terán (Hospital de la Axarquía (Málaga)), Anastasi Martín Pérez (Hospital Sant Joan Despí (Barcelona)), Francesc Formiga (Hospital de Bellvitge (Barcelona)), Alfonso López-Soto (Hospital Clínic (Barcelona)), Carmen Martínez Velasco (Hospital San Juan de Dios de Pamplona), Miguel Angel Cuervo (Equipo de Cuidados Paliativos de Badajoz).

    • Contributors CH-Q, MB-W and MO-B have planned, conducted and reported this study. LMP-B, PM-M, DC-G, BM and MM-J have collaborated by recruiting patients for the study.

    • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval This study was approved by the ethics committee of Hospitales Universitarios Virgen del Rocio.

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

    • Data sharing statement No additional data are available.