THE PALLIATIVE PERFORMANCE SCALE IN NEUROLOGICAL PATIENTS: LIMITATIONS, EVALUATION DISCREPANCIES, AND COMPLEMENTARY TOOLS IN HOME-BASED PALLIATIVE CARE

• DOI: https://doi.org/10.22533/at.ed.1813622607055

• Palavras-chave: Palliative care; functional assessment; neurological diseases; Palliative Performance Scale; assessment instruments.

• Keywords: Palliative care; functional assessment; neurological diseases; Palliative Performance Scale; assessment instruments.

• Abstract:

  The Palliative Performance Scale (PPS) is widely used in palliative care for functional assessment and prognostic prediction. Its original validation, however, was conducted predominantly in an oncological context, and its applicability in patients with chronic and progressive neurological diseases remains a subject of debate. Objective: To analyze the limitations of the PPS in the context of neurological diseases, discuss the causes and implications of interobserver discrepancies, and justify the use of complementary instruments to enhance functional assessment in this patient population. Method: Integrative literature review with searches in PubMed/MEDLINE, LILACS, SciELO, and the Cochrane Library, covering the period 1996–2026. Studies on the validation and prognostic accuracy of the PPS, systematic reviews, meta-analyses, and palliative care guidelines for neurological diseases were included. Forty-three studies were included after screening. Results: The PPS demonstrates superior prognostic accuracy in oncology compared to neurological diseases, in which trajectories of decline are nonlinear and marked by prolonged functional plateaus. The domains of consciousness, oral intake, and ambulation are frequently misapplied in neurological patients, leading to overestimation or underestimation of the score, with implications for determining care modalities and therapeutic proportionality. Conclusion: The PPS, when applied in isolation to neurological patients, may be insufficient to capture functional complexity and the actual burden of care. Combining it with specific instruments—FAST for dementia, ALSFRS-R for ALS, and the Barthel Index for quantifying dependency—is strongly recommended to enhance functional assessment, improve care equity, and support evidence-based clinical decision-making.