The Association Of Performance Status And Disease Severity In Patients With Chronic Graft-Versus-Host Disease

Publication date: Available online 8 September 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Cody Andrews, Sean Smith, Maggi Kennel, Steve Schilling, Claire Kalpakjian

Abstract

Objective

Determine the relationship between functional status and degree of specific organ involvement, physical performance, and subjective well-being Chronic graft-versus-host disease (cGVHD) after allogeneic hematopoietic stem cell transplantation

Design

Observational cohort.

Setting

Outpatient clinic.

Participants

Adult patients (N = 121) with cGVHD with 634 assessments.

Interventions

Not applicable.

Main Outcome Measure(s)

Karnofsky Performance Status (KPS). Skin, fascia/joints, lungs, upper and lower extremity range of motion, liver, eye, mucosal, and gastrointestinal involvement were measured using the National Institutes of Health GVHD scale. Physical performance was assessed with the 2-Minute Walk test and hand grip strength. Subjective measures were the Patient Health Questionnaire 9 (PHQ-9) and Lee Symptom Burden (LSB) scale.

Results

Myofascial (p<.001) and lung (p=.001) involvement, 2-Minute Walk test (p<.001), LSB (p<.001) and PHQ-9 (p=.03) had the largest associations with KPS with liver (p=.05) and hand grip strength (p<.001) more modest associations with KPS.

Conclusions

Patients with cGVHD experience multifactorial impairment in function associated with potentially modifiable symptoms physiatrists have the expertise to address to enhance function. More research is needed to determine rehabilitation interventions to mitigate the impact of cGVHD on function.

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