Instructions: Module 73 - TheMeasurementGroup.com

Citation: Huba, G. J., Melchior, L. A., Staff of The Measurement Group, Cherin, D., and HRSA/HAB's SPNS Cooperative Agreement Steering Committee (1996). Module 73: Karnofsky and Disease Stage Scale. Available: www.TheMeasurementGroup.com. Culver City, California: The Measurement Group.

Source Citation: KARNOFSKY PERFORMANCE STATUS SCALE (KPS): Karnofsky, D. A., Abelmann, W. H., Craver, L. F., and Burchenal (1948). The use of nitrogen mustards in the palliative treatment of cancer. Cancer, 1, 634-656.

This module should be completed only by a knowledgeable health-care provider; it should not be distributed to nor filled in by the patient.

Answer questions by either filling in a circle, or writing a number or letter in a square box. If the answer goes in a square box, you must use a CAPITAL LETTER or number that does not touch the sides of the box. Print only one letter or number in each box. If the letters or numbers that you print touch the sides of the boxes, or if you do not clearly print the information, the computer will "kick out" the form and we will need to return it to you to be completed correctly. If the question asks for the answer to be filled in a circle, make sure that the circle is completely darkened. Only darken one circle for each question unless the instructions specifically tell you to darken as many as apply for that question.

ID Letters/ID Numbers. These boxes are provided for entering the unique identifier your site is using to track client information. The four boxes on the left are to be used for letters, while the ten boxes on the right are reserved for numbers. You may use letters, numbers, or a combination of letters and numbers, for identification purposes. If you use a combination of letters and numbers, however, please use the letters first in your alphanumeric sequence (for example, if your unique identifier is MD-1479, the letters "M" and "D" would be entered in the first two of the four boxes reserved for letters and the numbers "1", "4", "7", and "9" would be entered into the first four of the ten boxes reserved for numbers). If you are unsure about a client’s unique identifier, check with your project director.

Site. This is a code to identify your project in the cross-cutting evaluation. It should be pre-printed on the form. Site codes are 3 letters.

Sub-Provider. This field may be used to designate specific sites or providers within your project. If appropriate, enter the code for the service provider agency doing the activity. Provider codes can be up to 3 letters.

Date. Enter the numbers representing today’s date (the date of the activity or on which services were provided) in these boxes. Enter the month as a number from 01 to 12 corresponding to January through December. Enter the day as a two-digit number (01 to 31). Enter the last two digits of the current year (for example, "96" for 1996). Make sure that if a month or day is less than 10, you place a "0" before the number.

Staff Code. Each staff member should be assigned a unique number code (up to 3 digits). Make sure that each new staff member has a unique code. Do not reassign any staff codes that have been previously assigned. Enter the 3-digit code for the staff who provided the services. If the staff code is less than 3 digits, place "0"s before the number. For example, 3 is "003."

Client Gender. Use your observations to determine if client is male or female. If the client is biologically male, darken the circle next to "Male." If the client is biologically female, darken the circle next to "Female." Ask him or her if necessary.

1. In general, how would you rate the patient’s overall health; would you say that it is: Darken the bubble next to the description that corresponds to how you would rate the patient’s current overall health. The scale ranges from a rating of "Excellent" to "Terrible." If you observe the patient to be in excellent health, darken the bubble next to "Excellent." If you observe the patient to be in good health, darken the bubble next to "Good." If you observe the patient to be in moderate health, darken the bubble next to "Fair." If you observe the patient to be in very bad health, darken the bubble next to "Very Bad." And, if you observe the patient to be in the worst possible health, darken the bubble next to "Terrible." If you don’t know or are unsure as to how the patient should be rated in terms of his/her health, darken the bubble next to "Don’t Know."

HIV-Disease Progression Curve. Darken the bubbles corresponding to any signs that the patient is currently manifesting.

Along the figure are positioned vertical lines corresponding to clusters of signs commonly manifested by persons who have contracted HIV. Signs range from the point of Transmission to M. avium (mycobacterium avium intracellulare) and CMV (cytomegalovirus). The clusters are positioned along the curve roughly corresponding to the time continuum at which they normally occur in the progression of HIV disease. Darken each bubble corresponding to an illness currently manifested by the patient. For example: if the patient currently has candida vaginitis as well as tuberculosis, the bubbles next to "Candida vaginitis" and "Tuberculosis" would be darkened: (Note that there are several signs which can manifest at a number of different points during the progression of the disease. These signs are marked with an asterisk "*".

In the table below are listed the signs, their working definitions, and abbreviations (if any) that appear as part of the clusters along the HIV-Disease Progression Curve. The signs are listed in the order in which they appear along the curve. Working definitions are drawn from the AIDS and HIV glossary produced by the CDC and from the Encyclopedia of Medicine published by the American Medical Association (1989). These definitions are not meant to be complete or for purposes of diagnosis; they are only characteristics that can be superficially observed by the person doing the rating and to aid him/her in the completion of this module.

Sign	Abbreviation (If Any)	Working Definition
Transmission	*	The point at which HIV is contracted by an individual
Acute retroviral syndrome	*	Presents like infectious mononucleosis; marked by headache, anorexia, malaise, sweating, inflammation of the pharynx and pathology of the spleen and lymph
Seroconversion	*	The point after which an individual has been exposed to the AIDS virus (i.e., after transmission) and where his/her antibody status changes from negative to positive (i.e., the point at which an individual tests positive for HIV)
Peripheral generalized lymphadenopathy	*	Characterized by swollen, firm, and, possibly, tender lymph nodes; also commonly associated with an enlarged spleen
Candida vaginitis	*	Yeast infection of the vagina; characterized by a thick, white, "cottage cheese" discharge and/or associated itching/burning/redness in the vaginal area
Idiopathic Thrombocytopenic Purpura	ITP	Autoimmune disease characterized by destruction of the blood’s platelets resulting in spontaneous bruising
Pneumococcal pneumonia	*	Inflammation of the lungs due to infection by the pneumococcus virus; characterized by fever, chills, shortness of breath, pain w/breathing and cough that produces yellow-green sputum
HIV-associated dementia	*	Caused by HIV or other opportunistic infections (e.g., CMV); manifested by chronic intellectual impairment--particularly loss of memory, thinking ability, and emotional control; results in complete degradation of the client’s personality
Kaposi’s sarcoma	*	Characterized by painless nodules ranging in color from pink to purple (manifested due to masses of rapidly growing small blood vessels); can be present externally on skin as well as internally
Lymphoma	*	Hodgkins or non-Hodgkins; cancer of the lymphoid tissue present in the spleen and/or lymph nodes; characterized by persistent lymph-node swelling, weight loss, and sometimes, fever
Oral hairy leukoplakia	*	Characterized by a whitish, slightly-raised lesion that appears on the side of the cheeks, gums or tongue; thought to be related to the Epstein-Barr virus
Thrush	*	A white, patchy/plaquey yeast infection of the mouth or throat; deposits usually found on tongue, cheeks and palate; can cause severe discomfort
Tuberculosis	TB	Bacterial infection of the lungs; characterized by pain w/breathing and shortness of breath
Candida esophagitis	*	Yeast infection of the esophagus (i.e., food tube or gullet); often results in pain w/swallowing and weight loss
Cryptococcosis	*	Acquired via the respiratory tract; common symptoms include: meningitis w/headache, blurred vision, confusion, depression, agitation, and slurred speech
Herpes simplex	*	Characterized by a painful rash consisting of itching, burning small blisters (or cold sores) in or around the penis/vagina or anus
Pneumocystis carinii pneumonia	PCP	Infection of the lungs characterized by fever, dry cough, and shortness of breath
Toxoplasmosis	*	Symptoms are similar to mononucleosis (which is characterized by fever, enlarged, swollen, and tender lymph nodes, brain abscess); may also have retinitis (inflammation of the retina in the eye); commonly spread via cat boxes and droppings as well as ingestion of raw/undercooked meat from infected animals
Wasting		Also known as "wasting syndrome"; characterized by involuntary weight loss of more than 10% of the client’s baseline body weight; also associated with chronic diarrhea and/or weakness and fever for more than 30 days
Cytomegalovirus	CMV	Virus related to the herpes family; may occur w/wo any symptoms; if present, symptoms include: aches, fever, mild sore throat, weakness, and/or enlarged lymph nodes
Mycobacterium avium intracellulare	M. Avium MAI	A tuberculosis-like or related illness caused by a bacteria that produces throughout the body (e.g., lungs, muscle, skin, bones) cavities filled with a cheesy material; symptoms commonly include: prolonged wasting, fever, fatigue, and enlarged spleen

2a. Enter CD4-Cell Count (/CU MM) ê . In the boxes provided, enter the person’s most recent CD4- (T4- or t-helper-) cell count per cubic millimeter of blood. The cell count must be entered into the boxes provided and not on the actual y-axis.

2b. Enter (estimate if needed) the number of years since initial exposure and infection. In the boxes provided, estimate and enter the amount of time in years that have elapsed between when the client first contracted the AIDS virus and the present. Enter the amount of time as two digits and round all time to the nearest whole number. For example, if the amount of time is 1.5 years, enter "02." Note that time = "0" would mean that the time for transmission was the present. The number of years must be entered into the boxes provided and not on the actual x-axis.

3. The Karnofsky Rating Scale. On this scale is recorded the client’s current performance status (or level of functioning) as indicated by the clients ability to perform common tasks. The scale ranges from 0 to 100% with a rating of 0% equal to the client being dead and a rating of 100% equal to the client being normal and manifesting no signs of disease. Darken the one bubble next to the description most suited to the client’s highest level of functioning.

According to the Scale, individuals who score at 100% exhibit normal activity. Those who score at 80% are symptomatic but ambulatory and can care for themselves. Those who rate at 60% are ambulatory more than 50% of the time but occasionally need assistance. Persons who rate at 30% are ambulatory 50% or less of time and tend to need nursing care. Last, persons who rate at 10% are bedridden and may need hospitalization.