Adaptação transcultural da Palliative Performance Scale – PPS versão2 (PPSv2) para a língua portuguesa falada no Brasil

Abstract

Objectives: To carry out the cross-cultural adaptation of the Palliative Performance Scale (PPSv2) to Brazilian Portuguese. Methods: The study was conducted between 2018 and 2024, divided into two stages, the first prototypical and intended for the development of the test version, and the second psychometric, comprising statistical analyses. Data collection occurred between July 2022 and February 2024. The PPSv2 was translated, back-translated, and reviewed by experts, and applied to 328 individuals with neoplasms followed at the General Oncology Outpatient Clinic of the Pedro Ernesto University Hospital (HUPE), of the Rio de Janeiro State University, and at the outpatient clinic and inpatient unit of Hospital do Câncer HC IV, a palliative care unit of the Brazilian National Cancer Institute (INCA). Test-retest and inter-rater reliability and internal consistency were assessed using Cohen’s kappa and Cronbach’s α, respectively. Associations with the Karnofsky Performance Status (KPS-BR) and activities of daily living (ADLs) were analyzed using Spearman and Kendall tests, respectively; survival was evaluated using Kaplan-Meier curves and Cox regression. For data capture and collection, the Research Electronic Data Capture – REDCap tool was used, and data analysis was performed using IBM SPSS Statistics Premium GrandPack 29. Results: A total of 328 individuals composed the sample: 200 recruited at HC IV and 128 at HUPE. Of the total, 52.4% were women and 45.1% declared white skin color. The mean (±SD) and median (IQR) ages were 61.47 (±13.77) and 64 (54–72) years, respectively, ranging from 23 to 93 years. At HC IV, the mean (±SD) and median (IQR) ages were 58.86 (±14.37) and 60.50 (49–68.25) years, respectively; at HUPE, 61.47 (±11.71) and 67 (60–73) years, respectively. The mean and median education levels were 7.89 (±4.64) and 8 (4–11) years, respectively, ranging from 0 to 24 years. At HC IV, education levels were 7.63 (±4.59) and 7.5 (4–11) years, respectively; at HUPE, 8.3 (±4.69) and 8 (4–11) years, respectively. There were significant differences between groups with different education levels (ρ < 0.001). Test-retest and inter-rater reliabilities showed kappa values of 0.814 and 0.343, respectively; internal consistency was α = 0.964. There was a positive association with KPS-BR (ρ = 0.935) and a negative association with ADLs (ρ = −0.743). Among the 328 participants, 134 had scores of 20%–40%, 92 had scores of 50%–70%, and 102 had scores of 80%–100%. Among the participants, 109 died within 154 days. Lower scores were associated with shorter survival. Conclusion: The PPSv2-BR demonstrated high reliability test-retest and validity for use in the Brazilian population, establishing itself as an effective instrument for assessing the functional performance of individuals with advanced neoplasms in palliative care. A strong association was observed between lower initial scores and shorter survival time, reinforcing its applicability in the development of prognoses, risk stratification, and support for clinical and therapeutic decision-making. It is a promising tool for multidisciplinary clinical practice.