Palliative Performance Scale

VICTORIA HOSPICE PALLIATIVE PERFORMANCE SCALE, VERSION 2 (PPSv2)1


PPS Level Ambulation Activity and Evidence of Disease Self-Care Intake Conscious Level
100% Full Normal activity & work
No evidence of disease
Full Normal Full
90% Full Normal activity & work
Some evidence of disease
Full Normal Full
80% Full Normal activity & work with effort
Some evidence of disease
Full Normal or reduced Full
70% Reduced Unable to do normal activity & work
Significant disease
Full Normal or reduced Full
60% Reduced Unable to do hobby or house work
Significant disease
Occasional assistance necessary Normal or reduced Full or confusion
50% Mainly sitting or lying Unable to do any work
Extensive disease
Considerable assistance required Normal or reduced Full or drowsy or confusion
40% Mainly in bed Unable to do most activity
Extensive disease
Mainly assistance Normal or reduced Full or drowsy +/- confusion
30% Totally bed bound Unable to do any activity
Extensive disease
Total care Reduced Full or drowsy +/- confusion
20% Totally bed bound Unable to do any activity
Extensive disease
Total care Minimal to sips Full or drowsy +/- confusion
10% Totally bed bound Unable to do any activity
Extensive disease
Total care Mouth care only Drowsy or coma
0% Death bound - - - -
Instructions: PPS level is determined by reading left to right to find a ‘best horizontal fit.’ Begin at left column reading downwards until current ambulation is determined, then, read across to next and downwards until each column is determined. Thus, ‘leftward’ columns take precedence over ‘rightward’ columns. Also, see definitions of terms below.

DEFINITION OF TERMS FOR PPS

As noted below, some of the terms have similar meanings with the differences being more readily apparent as one reads horizontally across each row to find an overall ‘best fit’ using all five columns.

Ambulation

(use item Self-Care to help decide the level)

  • Full - no restrictions or assistance
  • Reduced ambulation - degree to which the patient can walk and transfer with occasional assistance
  • Mainly sit/lie vs Mainly in bed - the amount of time that the patient is able to sit up or needs to lie down
  • Totally bed bound - unable to get out of bed or do self-care

Activity & Evidence of Disease

(use Ambulation to help decide the level)

  • Activity - refers to normal activities linked to daily routines (ADL), housework and hobbies/leisure
  • Job/work - refers to normal activities linked to both paid and unpaid work, including homemaking and volunteer activities
  • Both include cases in which a patient continues the activity but may reduce either the time or effort involved

Evidence of Disease

  • No evidence of disease - Individual is normal and healthy with no physical or investigative evidence of disease
  • ‘Some’, ‘significant’, and ‘extensive’ disease - refers to physical or investigative evidence which shows disease progression, sometimes despite active treatments

Example 1: Breast cancer

  • Some = a local recurrence
  • Significant = one or two metastases in the lung or bone
  • Extensive = multiple metastases (lung, bone, liver or brain), hypercalcemia or other complication

Example 2: AIDS

  • Some = may mean the shift from HIV to AIDS
  • Significant = progression in physical decline, new or difficult symptoms & laboratory findings with low counts
  • Extensive = one or more serious complications with or without continuation of active antimicrobials, etc.

Self-Care

  • Full - able to do all normal activities such as transfer out of bed, walk, wash, toilet and eat without assistance
  • Occasional assistance - requires minor assistance from several times a week to once every day, for the activities
  • Considerable assistance - requires moderate assistance every day for some of the activities noted above (getting to the bathroom, cutting up food, etc.)
  • Mainly assistance - requires major assistance every day, for most of the activities noted above (getting up, washing face and shaving, etc.). Can usually eat with minimal or no help. This may fluctuate with level of fatigue
  • Total care - always requires assistance for all care. May or may not be able to chew and swallow food

Intake

  • Normal - eats normal amounts of food as when healthy
  • Normal or reduced - highly variable; ‘reduced’ means intake is less than normal amounts when healthy
  • Minimal to sips - very small amounts, usually pureed or liquid, and well below normal intake
  • Mouth care only - no oral intake

Conscious Level

  • Full - fully alert and orientated, with normal (for the patient) cognitive abilities (thinking, memory, etc. )
  • Full or confusion - level of consciousness is full or may be reduced. If reduced, confusion denotes delirium or dementia which may be mild, moderate or severe, with multiple possible etiologies
  • Full or drowsy +/- confusion - level of consciousness is full or may be markedly reduced; sometimes included in the term stupor. Implies fatigue, drug side effects, delirium or closeness to death
  • Drowsy or coma +/- confusion - no response to verbal or physical stimuli; some reflexes may or may not remain. The depth of coma may fluctuate throughout a 24 hour period. Usually indicates imminent death

SOURCES/REFERENCES

Anderson F, Downing GM, Hill J, Casorso L, Lerch N. Palliative Performance Scale (PPS): a new tool. J Palliat Care 1996;21(1):5-11.

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