Access Keys:
Skip to content (Access Key - 0)

OUTCOME MEASUREMENTS

Musculoskeletal Tumor Society (MSTS) functional classification scale
FUNCTIONAL ASSESSMENT SCALE OF THE MSTS, ACCORDING TO SEVEN PRIMARY FACTORS, 1985
(For the UE surgical management evaluation)
RATINGMOTIONPAIN STABILITYDEFORMITYSTRENGTHFUNCTIONALEMOTIONAL
ACTIVITYACCEPTANCE
Excellent>240?noneno subluxation 90? abduction normalno restrictions enthusiastic
<10? rotation
Good 120-240? modestno subluxation 60? abductionless than normal recreational satisfied
15? rotation restrictions
Fair 60-120?intermittant moderate 30? abduction can overcome partial disability accepts
subluxation 30? rotation gravity
Poor <60? severehabitual >30? abductioncannot overcome total disabilitydislikes
subluxation 40? rotationgravity
FUNCTIONAL ASSESSMENT SCALE OF THE MSTS, ACCORDING TO FIVE PRIMARY FACTORS, 1987
(For the LE surgical management evaluation)
RATINGMOTION{}{*}STRENGTHPAINACTIVITYDEFORMITY
Excellent>905/5None (no Rx)No restrictionNone
Good60-904/5Mild (Rx occassionally) Restrictions in recreational activities Mild
Fair30-<603/5Moderate (Rx weekly)Partial disabilityModerate
Poor<301-2/5 Severe (narcotic or other Rx daily) Total disabilitySevere

      • (% OF TOTAL MOTION OF NORMAL JOINT)
        For an over-all rating of excellent, at least four primary factors had to have had that rating; for an over-all rating of good, at least four primary factors had to have had that rating or excellent, and the over-all rating was not excellent, for an over-all rating of fair, at least four primary factors had to have been rated fair or better, and the over-all rating was not good; and for an over-all rating of poor, at least two primary factors had to have had that rating.
        ISOLS (International Symposium on Limb Salvage) FUNCTIONAL EVALUATION
        (For the UE surgical management evaluation)(maximum 30 points)
        SCOREPAINHAND POSITIONINGDEXTERITYLIFTINGEMOTIONALFUNCTION
        ABILITYACCEPTANCE
        5noneunlimitednormalnormalenthusedno restriction
        4 -----------------------------------------------------------------intermediate-----------------------------------------------------------
        3modestnot above shoulder or loss of finelimitedsatisfiedrecreational
        supination/pronationmovementsrestriction
        2 -----------------------------------------------------------------intermediate-----------------------------------------------------------
        1 moderatenot above waistcannot pinchhelping onlyacceptspartial disability
        0severeflailcannot graspcannot helpdislikestotal disability
        ISOLS (International Symposium on Limb Salvage) FUNCTIONAL EVALUATION
        (For the LE surgical management evaluation)(maximum 30 points)
        SCOREPAINWALKINGSUPPORTS GAIT EMOTIONAL FUNCTION
        ACCEPTANCE
        5noneunlimitednonenormalenthusedno restriction
        4 ---------------------------------------------------------------------intermediate----------------------------------------------------
        3modestlimitedbraceminor cosmeticsatisfied recreational restrictions
        2 ---------------------------------------------------------------------intermediate----------------------------------------------------
        1moderateinside only1 cane/crutchmajor cosmetic/dislikespartial disability
        minor handicap
        0severeunable unaided 2 canes/crutches major handicapdislikestotal disability
        MANKIN-WABER SCORING SYSTEM FOR THE LE
        MANKIN SCORING SYSTEM FOR THE UE
        TESS (Toronto Extremity Salvage Score)
        REINTEGRATION to NORMAL LIVING scale (RNL)
        SHORT FORM-36
        Variables
        Physical function
        Social function
        Emotional role function
        Mental health
        Vitality
        Comfort
        General health
        GRADING SYSTEM (Allan, et al) FOR ANALGESIC USE, INDEPENDENCE, MOBILITY
        Analgesic useIndependenceAmbulation and mobility
        7bedridden
        6wheelchair
        5constant narcoticnonweightbearing, household
        4intermittant narcoticpartial weightbearing, household
        3constant non-narcotic(A) total carenonweightbearing, community
        2intermittant non-narcotic(B) partial assistancepartial weightbearing, community
        1none(C) independent livingno walking aids
        INTERNATIONAL SYMPOSIUM OF LIMB SALVAGE (ISOLS) IMPLANT ROENTGENOGRAPHIC EVALUATION, according to 6 parameters
        Bone remodellingInterface/radiolucent linesAnchorageImplant bodyImplant articulationExtracortical bone bridging
        Excellentno changenocementationno changeno change75-100%
        adequate, no change
        no radiolucent lines
        Goodhypertrophy,<2mm in thickness < entireinadequate cemen-debonding of smalljoint space ­<2mm50-75% and/or
        sclerosislengthtation, no changeparticles, looseradiolucent lines
        Fairfixation area resorp->2mm, incompletestem, plate, PMMAcoupling joint rota-joint space 2-4mm25-50% and/or
        tion <50% + <2cm<2mm, completefx, no stem motiontion, soft tissue<5° varus/valgusradiolucent lines
        <5mm axial migrationdetachment, particlepatellar subluxation
        debonding >1cm
        Karnofsky performance status (including presence of sxs can improve the prognosis accuracy)
        Eastern Cooperative Oncology Group (ECOG) performance status scale
        0normal activity
        1+ sxs, nearly fully able to ambulate
        2bedridden < 50% of the day
        3bedridden ? 50% of the day
        4totally bedridden
        Memorial Symptom Assessment Scale
        Questionaires
        Questionaire on Subjective Well-Being
        State-Trait Anxiety Inventory
        Frankfurt Self-Concept Scales
        Questionaire on Life Goals and Satisfaction with Life
        Prosthesis Evaluation Questionnaire (for amputees)
        Brief Sexual Function Inventory (BSFI)
        Cost-effectiveness for limb salvage
        Considerable recurring costs are incurred by the average amputee far below the average limb salvage pt
        ($9442 +[$7716 to $16,033/yr] vs $22,421/yr)
        O2 consumption determined by Douglas-bag technique
        Gait analysis
        Stride characteristics
        VA-Rancho Footswitch Stride Analyzer (Pathokinesiology Laboratory, Rancho Los Amigos Medical Center, Downey, CA)
        Stereophotgrammetric acquistion of kinematic variables (Elite, BTS, Milan, Italy)
        Muscular strength
        Mean extensor and flexor torque production, maximum contraction isometric testing
        Cybex II isokinetic dynamoneter (Lumex, Ronkonkoma, NY)
        REV 9000 dynamometer (Technogym, Gambettola, Italy)
        Foot-ground reaction forces
        Kistler force-plates (Kistler Instrumente, Winterthur, Switzerland)
        Electromyographic (EMG) data
        8-channel EMG telemetry system (TELEMG, BTS, Milan, Italy)
        DEXA measurement of BMD surrounding megaprostheses has been reported
        REFERENCES
        Abudu A, Carter SR, Grimer RJ: The outcome and functional results of diaphyseal endoprotheses after tumour excision. J Bone Joint Surg 78B:652-7,1996.
        Benedetti MG, Catani F, Donati D, Simoncini L, Giannini S: Muscle performance about the knee joint in patients who had distal femoral replacement after resection of a bone tumor. An objective study with use of gait analysis. J Bone Joint Surg 82A:1619-25,2000.
        Bruckner JD, Cluett JC, Conrad EU, III: Effects of musculoskeletal neoplasms on patient self assessment of health status. Clin Orthop 351:196-202,1998.
        Chang AE, Steinberg SM, Culane M, : Functional and psychosocial effects of multimodality limb-sparing therapy in patients with soft tissue sarcomas. J Clin Oncol 7:1217-28,1989.
        Clohisy DR, Le CT, Cheng EY, Dykes DC, Thompson RC Jr: Evaluation of the feasibility of and results of measuring health-status changes in patients undergoing surgical treatment for skeltal metastases. J Orthop Res 18:1-9,2000.
        Conill C, Verger E, Salamero M: Performance status assessment in cancer patients. Cancer 65:1864-6,1990.
        Cox D: Regression models and life-tables. J Royal Stat Soc Ser B 34:187-220,1972.
        Davis AM, Bell RS, Badley EM, Yoshida K, Williams JI: Evaluating functional outcome in patients with lower extremity sarcoma. Clin Orthop 358:90-100,1999.
        Davis AM, Devlin M, Griffin AM, : Functional outcome in amputation versus limb sparing of patients with lower extremity sarcoma: a matched case-control study. Arch Phys Med Rehabil 80:615-8,1999.
        Davis AM, Wright JG, Williams JI, Bombardier C, Griffin A, Bell RS: Development of a measure of physical function for patients with bone and soft tissue sarcoma. Qual Life Res 5:514-20,1996.
        Eiser C, Cool P, Grimer RJ, : Quality of life in children following treatment for a malignant primary bone tumour around the knee. Sarcoma 1:39-45,1997.
        Enneking WF: Discussion of the functional evaluation system. In Limb Salvage in Musculoskeletal Oncology, pp 622-639. New York, Churchill Livingstone, 1987.
        Enneking WF [editor]: Modification of the system for functional evaluation of surgical management of musculoskeletal tumors. In Bristol-Myers/Zimmer Orthopaedic Symposium. Limb Salvage in Musculoskeletal Oncology, pp.314-26. Edited by W.F. Enneking. New York, Churchill Livingstone, 1987.
        Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ: A system for the functional evaluation of reconstructive procedures after surgical treatment of tumours of the musculoskeletal system. Clin Orthop 286:241-6, 1993.
        Felder-Puig R, Formann AK, Mildner A, Bretschneider W, Bucher B, Windhager R, Zoubek A, Puig S, Topf R: Quality of life and psychosocial adjustment of young patients after treatment of bone cancer. Cancer 83:69-75,1998.
        Grimer RJ, Carter SR, Pynsent PB: The cost-effectiveness of limb salvage for bone tumours. J Bone Joint Surg 79B:558-61,1997.
        Kaplan E, Meier P: Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457-81,1958.
        Kawai A, Backus SI, Otis JC, Healey JH: Interrelationships of clinical outcome, length of resection, and energy cost of walking after prosthetic knee replacement following resection of a malignant tumor of the distal aspect of the femur. J Bone Joint Surg 80A:822-31,1998.
        Lan F, Wunder JS, Griffin AM, Davis AM, Bell RS, White LM, Ichise M, Cole W: Periprosthetic bone remodelling around a prosthesis for distal femoral tumours. J Bone Joint Surg 82B:120-5,2000.
        Lindner NJ, Ramm O, Hillmann A, Roedl R, Gosheger G, Brinkschmidt C, Juergens H, Winkelmann W: Limb salvage and outcome of osteosarcoma. The University of Muenster experience. Clin Orthop 358:83-9,1999.
        Matson SL, Malchow D, Matsen FA, III: Correlations with patients' perspectives of the result of lower-extremity amputation. J Bone Joint Surg 82A:1089-95,2000.
        McClenaghan BA, Krajbich JI, Pirone AM, Koheil R, Longmuir P: Comparative assessment of gait after limb-salvage procedures. J Bone Joint Surg 71A:1178-82,1989.
        O'Leary MP, Fowler FJ, Lenderking WR, Barber B, Sagnier PP, Guess HA, Barry MJ: A brief male sexual function inventory for urology. Urology 46:697-706,1995.
        Portenoy RK, Thaler HT, Kornblith AB, Lepore JM, Friedlander-Klar H, Kiyasu E, Sobel K, Coyle N, Kemeny N, Norton L, : The Memorial Symptom Assessment Scale: an instrument for the evaluation of symptom prevalence, characteristics and distress. Eur J Cancer 30A:1226-36,1994.
        Roila F, Lupatelli M, Sassi M, Basurto C, Bracarda S, Picciafuoco M, Boshetti E, Milella G, Ballatori E, Tonato M, Del Favero A: Intra and interobserver variability in cancer patients' performance status assessed according to Karnofsky and ECOG scales. Ann Oncol 2:437-9,1991.
        Serletti JM, Carras AJ, O'Keefe RJ, : Functional outcome after soft-tissue reconstruction for limb salvage after sarcoma surgery. Plast Reconstr Surg 102:1576-85,1998.
        Sorensen JB, Lee M, Palshof T, Hansen HH: Performance status assessment in cancer patients. An inter-observer variability study. British J Cancer 67:773-5,1993.
        Sugarbaker PH, Barofsky L, Rosenberg SA, Gianola FJ: Quality of life assessment of patients in extremity sarcoma clinical trials. Surgery 91:17-23,1982.
        Verger E, Salamero M, Conill C: Can Karnofsky performance status be transformed to the Eastern Cooperative Oncology Group scoring scale and vice versa? European J Cancer 28A:1328-30,1992.
        Wexler AM, Eilber FR, Miller TA: Therapeutic and functional results of limb salvage to treatt sarcomas of the forearm and hand. J Hand Surg 13A:292-6,1988.
        Yates JW, Chalmer B, McKegney FP: Evaluation of patients with advanced cancer using the Karnofsky performance status. Cancer 45:2220-4,1980.
Content

Download: PDF | EPUB

Famous Quote
"The great use of life is to spend it for something that outlasts it." William James
Figures
Related Content

Resources for OUTCOME MEASUREMENTS and related topics on OrthopaedicsOne.