Australia-modified Karnofsky Performance Scale and physical activity in COPD and lung cancer: an exploratory pooled data analysis

Carlo Barbetta, Victoria Allgar, Matthew Maddocks, Catarina Ribeiro, Andrew Wilcock, David C. Currow, Jane Phillips, Miriam J. Johnson*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objectives: Patient-relevant measures of functional status are required in chronic obstructive pulmonary disease (COPD) and lung cancer in clinical practice and research. We explored the relationship between the Australia-modified Karnofsky Performance Scale (AKPS) and measures of functional capacity and physical activity in these patient groups. Methods: Pooled clinical trial data were analysed to explore the relationship between AKPS and average daily steps (ADS), 6 min walk distance (6MWD), and body mass index, airflow obstruction, dyspnoea and exercise score (COPD group). Receiver operator characteristic curves were produced to compare sensitivity and specificity of cut-offs (no dependency >70, high dependency <60) and area under the curve (AUC). Results: Seven clinical trials included people with COPD (n=79) and lung cancer (n=150). To detect an AKPS of >70, the optimal ADS cut-points were COPD, 3342 steps (AUC 0.88, 95% CI 0.79 to 0.97, sensitivity 82%, specificity 76%), and lung cancer, 3380 steps (AUC 0.72, 95% CI 0.64 to 0.81, sensitivity 61%, specificity 74%), and for 6MWD (COPD only) 242 m (AUC 0.72, 95% CI 0.63 to 0.81, sensitivity 73%, specificity 34%). Conclusions: An AKPS score is strongly related to ADS in people with COPD and lung cancer. The AKPS may be useful in clinical practice and research to indicate levels of physical activity where ADS and 6 min walk test are not possible. Longitudinal data are needed to confirm these findings.

Original languageEnglish
JournalBMJ Supportive and Palliative Care
Early online date11 Jul 2019
Publication statusE-pub ahead of print - 11 Jul 2019


  • chronic obstructive pulmonary disease
  • functional independence
  • lung cancer
  • outcome measurement
  • performance status
  • physical activity

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