# 125 The Palliative Performance Scale (PPS)

FAST FACTS AND CONCEPTS #125 PDF


Author(s): L Scott Wilner MD and Robert Arnold MD

Background Accurate prognostic information is important for patients, families and physicians. This Fast Fact reviews the Palliative Performance Scale; see Fast Fact #124 The Palliative Prognostic Score for another prognostic tool used in palliative care patients.

The Palliative Performance Scale (PPS) uses five observer-rated domains correlated to the Karnofsky Performance Scale (100-0). The PPS is a reliable and valid tool and correlates well with actual survival and median survival time for cancer patients. It has been found useful for purposes of identifying and tracking potential care needs of palliative care patients, particularly as these needs change with disease progression. Large validation studies are still needed, as is analysis of how the PPS does, or does not, correlate with other available prognostic tools and commonly used symptom scales.

PALLIATIVE PERFORMANCE SCALE (PPS)

%

Ambulation

Activity Level

Evidence of Disease

Self-Care

Intake

Level of Consciousness

Estimated Median Survival

in Days

(a) (b) (c)

100

Full

Normal

No Disease

Full

Normal

Full

N/A

N/A

108

90

Full

Normal

Some Disease

Full

Normal

Full

80

Full

Normal with Effort

Some Disease

Full

Normal or Reduced

Full

70

Reduced

Can't do normal job

or work

Some Disease

Full

As above

Full

145

60

Reduced

Can't do hobbies or housework

Significant Disease

Occasional Assistance

Needed

As above

Full or Confusion

29

4

50

Mainly sit/lie

Can't do any work

Extensive Disease

Considerable Assistance

Needed

As above

Full or Confusion

30

11

41

40

Mainly

in Bed

As above

Mainly Assistance

As above

Full or Drowsy or Confusion

18

8

30

Bed Bound

As above

Total Care

Reduced

As above

8

5

20

Bed Bound

As above

As above

Minimal

As above

4

2

6

10

Bed Bound

As above

As above

Mouth Care Only

Drowsy or Coma

1

1

0

Death

-

-

-

--

     

 

  1. Survival post-admission to an inpatient palliative unit, all diagnoses (Virik 2002).
  2. Days until inpatient death following admission to an acute hospice unit, diagnoses not specified (Anderson 1996).
  3. Survival post admission to an inpatient palliative unit, cancer patients only (Morita 1999).

References

  1. Anderson F, Downing GM, Hill J. Palliative Performance Scale (PPS): a new tool. J Palliat Care. 1996; 12(1): 5-11.
  2. Morita T, Tsunoda J, Inoue S, et al. Validity of the Palliative Performance Scale from a survival perspective. J Pain Symp Manage. 1999; 18(1):2-3.
  3. Virik K, Glare P. Validation of the Palliative Performance Scale for inpatients admitted to a palliative care unit in Sydney, Australia. J Pain Symp Manage. 2002; 23(6):455-7.

Fast Facts and Concepts are edited by Drew A Rosielle MD, Palliative Care Center, Medical College of Wisconsin. For more information write to: drosiell@mcw.edu. More information, as well as the complete set of Fast Facts, are available at EPERC: www.eperc.mcw.edu.

Version History: This Fast Fact was originally edited by David E Weissman MD and published in November 2004. Current version re-copy-edited in April 2009.

Copyright/Referencing Information: Users are free to download and distribute Fast Facts for educational purposes only. Wilner LS, Arnold R. The Palliative Performance Scale. Fast Facts and Concepts. November 2004; 125. Available at: http://www.eperc.mcw.edu/EPERC/FastFactsIndex/ff_125.htm.

Disclaimer: Fast Facts and Concepts provide educational information. This information is not medical advice. Health care providers should exercise their own independent clinical judgment. Some Fast Facts cite the use of a product in a dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is used.

ACGME Competencies: Medical Knowledge, Patient Care

Keywords: Prognosis