Chang S K, Hawes K A
Prog Clin Biol Res. 1983;120:429-43.
The Karnofsky Patient Performance Rating and the Global Adjustment to Illness Scale (Derogatis) were chosen to rate the physical status and psychosocial adjustment of 857 cancer patients participating in 6 Rehabilitation and Continuing Care (R/CC) programs. Both instruments are reported to have high interrater reliability, and administration is easy, fast, and non-intrusive to the patient. Repeated ratings were taken at hospital admission or initial assessment, discharge and at times of marked change to monitor patient status and to be used as outcome measures to evaluate the programs' impacts. The latter application has not been reported elsewhere. Changes in physical and psychosocial status from program entry to last contact were defined in terms of three outcomes: improvement, no change, deterioration. Adequacy of these ratings as outcome measures is evaluated in terms of generally accepted criteria for outcome measures and the operational experience during the program. The Karnofsky and GAIS instruments are judged favorably in terms of criteria for outcome measures in that they (1) relate to patient health status and the process of medical care; (2) are suitable for cancer patients; and (3) are not restricted to specific sites or complications. Three years' experience has resulted in the identification of difficulties in administration (appropriateness of specific descriptors of adjustment in particular situations or between ethnic or age groups, e.g. the GAIS is not appropriate for use among children) and interpretation of results (due to lack of norms for comparison). Overall, the scales are good measures of outcome. Adaptations of the scales based on their use with different age and ethnic groups might enhance the reliability and validity in this setting. Finally, norms need to be established if results are to be compared among different cancer patient populations.
选用卡氏患者功能状态评分表及疾病整体适应量表（德罗加蒂斯）对参与6个康复与持续护理（R/CC）项目的857名癌症患者的身体状况和社会心理适应情况进行评分。据报道，这两种工具都具有较高的评分者间信度，且使用简便、快速，对患者无侵扰性。在患者入院或初次评估、出院时以及病情显著变化时进行重复评分，以监测患者状况，并用作评估项目影响的结果指标。后一种应用在其他地方尚未见报道。从项目开始到最后一次接触期间，身体和社会心理状况的变化根据三种结果来界定：改善、无变化、恶化。根据普遍认可的结果指标标准以及项目期间的实际操作经验，评估这些评分作为结果指标的充分性。卡氏评分表和GAIS工具在结果指标标准方面得到了积极评价，因为它们（1）与患者健康状况和医疗护理过程相关；（2）适用于癌症患者；（3）不限于特定部位或并发症。三年的经验发现了在使用过程中存在的管理困难（例如，特定适应情况描述符在特定情况或不同种族或年龄组之间的适用性，如GAIS不适用于儿童）和结果解释困难（由于缺乏比较规范）。总体而言，这些量表是良好的结果测量工具。根据不同年龄和种族群体的使用情况对量表进行调整，可能会提高其在这种情况下的信度和效度。最后，如果要在不同癌症患者群体之间比较结果，就需要建立规范。
