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Assessing physical functioning: a systematic review of quality of life measures developed for use in palliative care

Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, mjordhoy{at}online.no, The Cancer Unit, Department of Internal Medicine, Innlandet Hospital Trust -Gjøvik, Norway

Gerd Inger Ringdal

Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, marit.jordhoy{at}sykehuset-innlandet.no

Jorunn L. Helbostad

Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim

Line Oldervoll

Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim

Jon Håvard Loge

Palliative Care Unit, The Cancer Center, Ulleval University Hospital, Oslo, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim

Stein Kaasa

Palliative Medicine Unit, Department of Radiotherapy and Oncology, University Hospital of Trondheim and Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim

Background: Physical decline is experienced by all palliative care patients and affects most aspects of life. Physical functioning (PF) is therefore a crucial domain for quality of life (Qol) assessments. The purpose of this study was to review how PF assessments are performed in Qol instruments developed for palliative care Methods: For identification of instruments, Medline searches up to April 2005 were performed using the terms (palliative care OR end of life care OR terminal care) AND quality of life AND (assessment OR instrument OR questionnaire). A total of 1326 hits were screened. Named QoL instruments were extracted from 240 abstracts and 46 relevant reports. Items assessing PF were then identified and classified according to activity domains as described by the WHO International Classification of Functioning Disability and Health. Results: Of 224 different instruments detected, 39 were identified as developed for palliative care. Of these, 11 included original PF assessments. Two were comprehensive performance status measures made for staff assessment, 9 were multidimensional tools including 2—7 PF items. The content and phrasing of items varied considerably. All instruments included some aspects of self-care, whereas the coverage of mobility, domestic, work — and leisure activities was inconsistent. Interpretation: Despite its importance, PF assessment seems to be a minor part of palliative care QoL instruments. Clear definitions and conceptualization of PF are needed, as well as a consensus on relevant aspects to include in improved instruments. Performance scales already developed should be further explored with regard to content, validity and psychometric properties. Palliative Medicine 2007; 21: 673—682

Key Words: palliative care • quality of life assessment • physical functioning

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