Validation of the Human Activity Profile Questionnaire in Patients after Allogeneic Hematopoietic Stem Cell Transplantation

Chronic graft-versus host disease (cGVHD) associated morbidity and mortality remain major barriers for successful allogeneic hematopoietic stem cell transplantation (alloHSCT) Currently no reliable measures are established to monitor cGVHD activity changes for use in clinical trials The Human Activity Profile (HAP) patient self-report was proposed by the National Institutes of Health (NIH) cGVHD consensus project as an independent measure of patients' functional status that could also indirectly reflect improvement of cGVHD but that has not been validated in an alloHSCT patient population One hundred seventy-six patients (median age 44 years [range 18-72 years] after alloHSCT were evaluated with a German translation of the HAP, the NIH criteria-based cGVHD activity assessment, the Lee cGVHD Symptom-Scale FACT-BMT SF36 Berlin Social Support Scale 24 Item Adjective Measure (24 AM) Hospital Anxiety and Depression Scale and the NCCN-Distress-Thermometer Enrollment occurred a median of 286 (range 85-4003) days after alloHSCT Follow-up surveys were conducted at 1 2 3 5 8 and 12 months after the baseline survey Although 117 patient had cGVHD am time of enrollment (mild n = 33 moderate n = 50 or severe n = 34) 59 patients were included into the study in the absence of cGVHD between days 85 and 395 after transplantation The maximum activity score (MAS) and adjusted activity score (AAS) of the HAP correlated inversely with grading of cGVHD severity (mild moderate or severe) (r = 0 25 for MAS and 0 24 for AAS) Lung manifestations of cGVHD correlated with AAS (r = 0 17) but not with MAS HAP scores cor related with subscales from other instruments measuring physical domains especially the physical functioning scale of the SF36 Performance was improved by use of an HSCT modified HAP scoring system that excluded activities prohibited within the first year after alloHSCT No significant correlation of the HAP was found with personality age sex, symptom burden or social functioning or social well-being Moreover the HAP displayed a higher sensitivity to change of cGVHD activity compared to the SF36 and the FACT-BMT In addition steroid myopathy correlated with both HAP scores but not the SF36 The HAP is a simple and valid questionnaire for the evaluation of the physical activity in patients after alloHSCT with the advantage of detecting changes in cGVHD status independently of other quality-of life measures and with a superior sensitivity compared to the SF36 Biol Blood Marrow Transplant 16 1707-1717 (2010) (C) 2010 American Society for Blood and Marrow Transplantation