Karnofsky Performance Scale

What is the Karnofsky Performance Scale?

The Karnofsky performance scale is a tool developed in the 1940s by the oncologist David Karnofsky as a way to assess the impacts of cancer on the functional status and the patient's ability to complete daily activities. Since then, it has been used for anyone afflicted with medical conditions that may affect their capabilities and quality of life.

The scale operates by observing a patient's physical ability to complete certain tasks or activities, like light housework or office work, and using the rating key to assign scores to each activity. Practitioners then calculate the scores to form a total performance status score that reflects the patient's ability. The score may also be used as a way to determine how a patient's symptoms are impacting their quality of life and identify whether the patient requires further institutional or hospital care to support them.

For patients experiencing more detrimental outcomes due to their health, this instrument may provide information regarding the patient's life expectancy and prompt palliative care plans or end-of-life care plans that suit their personal needs. Implementing this instrument in palliative settings allows patients to maintain their independence for longer and provides them more time to make calculated decisions before functional impairment progresses.

This instrument is a widely used tool that assists healthcare practitioners in forming care plans, as well as a monitoring tool to see what aspects of the plan need adjustment. Health practitioners involved in hospice care, hospital admission, palliative care, and other medical institutions will benefit from the predictive value of the Karnofsky Performance Scale.

How to use the Karnofsky Performance Scale

Answer some guide questions first

Using the Karnofsky Performance Scale is easy since you do not have to make any calculations. All you need to do is to indicate which part of the scale your patient belongs to.

But how do you determine that? The only way to find out is to do comprehensive examinations of your patient to see the impact of their medical condition(s) on their health and capabilities.

To help you with this, you can answer some of these guide questions:

1. Did your patient lose or gain weight because of their condition(s)?
2. Do they have less energy and are constantly fatigued?
3. Do they have a hard time walking, running, or just moving around in general?
4. Are they having difficulty with their work or are they rendered unable to work at all?
5. Are they having difficulty with domestic activities like cooking, cleaning, etc.?
6. Are they having difficulty bathing and grooming themselves?

These are just some questions that you can think about and answer to help you rate your patient. Our version of the Karnofsky Performance Scale has a comments box for you to detail what influenced your decision to rate them the way you did. You may even indicate the answers to the sample guide questions there.

Pick the rating

Now, the easy part. After you have had your patient undergo a comprehensive examination and you have answered the sample guide questions (or questions you made for yourself), it's time to indicate your rating. All you need to do is tick the radio button for the rating that best describes your patient when you are engaging with this scale.

The scale comes in the form of an eleven-item index arranged by severity, from normal to dead. Here are the items arranged as such:

• 100 = Normal no complaints; no evidence of disease.
• 90 = Able to carry on normal activity; minor signs or symptoms of disease.
• 80 = Normal activity with effort; some signs or symptoms of disease.
• 70 = Cares for self; unable to carry on normal activity or to do active work.
• 60 = Requires occasional assistance, but is able to care for most of his personal needs.
• 50 = Requires considerable assistance and frequent medical care.
• 40 = Disabled; requires special care and assistance.
• 30 = Severely disabled; hospital admission is indicated although death not imminent.
• 20 = Very sick; hospital admission necessary; active supportive treatment necessary.
• 10 = Moribund; fatal processes progressing rapidly.
• 0 = Dead.

Determine what goes into your care plan for the patient

The Karnofsky Performance Scale includes score range designations. You may refer to the following:

• 100 to 80 = The patient is able to carry on doing normal activities, they can work, and no special care is needed.

• 70 to 50 = The patient is unable to work. They are able to live at home and care for most personal needs, but a varying amount of assistance might be needed for a more physically strenuous activity.

• 40 to 10 = The patient is unable to independently care for themselves, and requires considerable assistance with special care or hospital care. Their disease may progress rapidly and shorten the patient's lifespan. In this instance, patient's may be encouraged to seek palliative treatment and begin considering end of life plans.

• 0 = The fatal processes of the disease progressed rapidly, leading to death of the patient.

If you designate a rating between 10 and 70 for your patient, you should work on a care plan for them. The scale itself may not help you determine the specifics of your plan, so you must refer to other tools/instruments used and findings received during the comprehensive examination of the patient. The designations for 70 to 50, as well as 40 to 10, should help you frame your decisions.

When does one typically use the Karnofsky Performance Scale?

The Karnofsky Performance Scale is best used during a patient's treatment stages. This is because while the scale is a clinical evaluation tool, it is essentially a monitoring tool to track any changes in the patient's ability and condition.

Before your patient undergoes any treatment, such as cancer chemotherapy or active support treatment, it would be best to generate a Karnofsky score. Doing so will set a baseline for the patient's current capabilities and pre-disease performance status, which can later be referenced in a comparative therapeutic trial.

The next time that would be best is when the patient is undergoing treatment to monitor how it affects them. This is so changes can be made just in case you determine the treatment can be adjusted for the patient's personal needs. This scale may also be used to assess how the disease progression has impacted the patient's capabilities, which can inform further treatment or implementation of special care.

Once your patient has finished treatment, this scale can also be used to check how far the patient has come or if things have worsened. Using this post-treatment opens up opportunities to evaluate the implemented treatment plan and what post-treatment care can be provided to the patient.

Who can use the Karnofsky Performance Scale?

Given the main purpose the Karnofsky Performance Scale was created, oncologists are the ones who use it the most, but the following healthcare professionals may also use this:

• Palliative care specialists: Individuals involved in palliative treatment may use the Karnofsky performance status scale to identify a patient's ability and current performance status. In doing so, they may be able to determine the needs of patients living with serious illnesses, such as breast cancer or lung cancer. This can then inform effective care plans that enhance the quality of life for these patients, allowing them to carry on normal activities to the best of their ability.
• Physicians: Health professionals such as doctors, pediatricians, or other medical personnel may use the scale to assess the patient's physical capabilities. Following assessment, they may refer to specialized care for patients requiring more frequent medical care, such as institutional or hospital care.
• Nurses: Nurses involved in caring for patients in hospital care may use the scale to detect any changes in the patient's ability to complete normal activity. This may involve detecting any minor signs of functional impairment, which can then be reported and used to devise treatment.

Anyone specializing in treating patients with serious medical illnesses like cancer can use this, and by extension, this means that the people who use this scale are highly-trained and have had enough experience since they will rate patients based on the comprehensive examinations conducted on them.

Benefits of the Karnofksy Performance Scale

Time-saving gives the professional some time

The Karnofsky Performance Scale is one of the easiest assessments to accomplish given that the healthcare professional using it only needs to do one thing: tick the rating they believe best represents the current state of their patient.

The version we have here adds a comment box for healthcare professionals to write on just in case they want to record their thoughts on the rating they gave.

Frames treatment decisions

Since this scale has score ranges and specific designations for each range, the Karnofsky Performance Scale can help professionals frame what needs to go into a patient's treatment plan. Does the patient require constant support for certain activities of daily living? Are they disabled because of their condition and require special care? These are two of the many questions you can answer using this scale to assess your patient.

Streamlines communication

Given that this scale was meant for patients with serious medical issues, it is likely that these patients are cared for by several professionals. Using this scale should help establish a baseline for all professionals to refer to when conducting their examinations and applying their parts of the treatment plan.

With the comments box we added, professionals can record their reasonings for others to remember. Directives can also be indicated so that other professionals know what they should do or consider doing.

Monitors the patient and disease progression

The scale is a valuable monitoring tool because it can track a patient's progress, from before being treated to after being treated. It can help you track if the patient is getting better or worse if the disease is progressing and taking its toll on the patient, and if the treatment plan is working or needs some tweaking.

Leveraging this care plan template and clinical evaluation template can fortify your practice and increase client achievements. Additionally, utilizing these tools can streamline your workflow, ensuring a higher standard of care for your patients.