1. Objective Measures of Physical Performance in Chronic GVHD: Adults Lynn H. Gerber, M.D. National Institutes of Health Bethesda, MD

2. Background Impairment Measures: –Grip strength –Range of motion Objective/observed Anatomically/physiologically based

3. Background Functional Limitations/Disabilities –Performance measures or measures of perceptions of ability to perform –Objective/observed Walk distance –Patient self-report Human Activity Profile (HAP)

4. Skill Development Impairment Measure: Grip Strength –Hydraulic Hand Dynamometer Seated Shoulder adducted and in neutral Elbow at 90 degrees Forearm neutral Wrist 0–30 degrees extension Record 3 trials for the dominant hand

5. Skill Development Hydraulic Hand Dynamometer –Zero after each measure –Record reading from indicator needle –As an outcome measure in clinical trials, the three measures may be averaged and compared to table of norms for age and gender

6. Skill Development 2 Minute Walk Distance –50 foot gait path marked at start/finish –Stopwatch or watch with second hand to time 2 minutes –Lap counter –Tape measure or other device to measure the distance in feet covered in the final partial lap

7. Skill Development 2 Minute Walk Distance –Patient encouraged to walk as quickly as possible, no running –Patient given start (on mark etc) –Told to stop at exactly 2 minutes –Must touch marker at each end –Patient given 1 min warning –Patient given “15 seconds left” warning –Record total distance traveled including the partial lap

8. Skill Development Karnofsky Performance Status Scale –Clinician administered –Mixture of performance, health status, and impairment measures

9. Karnofsky Performance Status Scale 100% - Normal; no complaints; no evidence of disease. Able to work. 90% - Able to carry on normal activity; minor symptoms. Able to work. 80% - Normal activity with effort; some symptoms. Able to work. 70% - Cares for self; unable to carry on normal activity. Independent; not able to work. 60% - Disabled; dependent. Requires occasional assistance; cares for most needs. 50% - Moderately disabled; dependent. Requires considerable assistance and frequent care. 40% - Severely disabled; dependent. Requires special care and assistance. 30% - Severely disabled. Hospitalized, death not imminent. 20% - Very sick. Active supportive treatment needed. 10% - Moribund. Fatal processes are rapidly progressing.