Breast Cancer Research and Treatment

, Volume 117, Issue 2, pp 281–288 | Cite as

Kwan’s arm problem scale: psychometric examination in a sample of stage II breast cancer survivors

  • Inger-Lise Nesvold
  • Sophie D. Fosså
  • Bjørn Naume
  • Alv A. Dahl
Clinical Trial


Arm/shoulder problems and lymphedema are common in patients treated for breast cancer. The Kwan’s arm problem scale (KAPS) is a 13 items self-rating form developed for examination of such problems. Since no such testing has been done, we wanted to examine the psychometric properties of the KAPS. At a median of 47 months (range 32–87 months) post-surgery, 256 stage II breast cancer survivors filled in the KAPS. Findings from physical examination of arm/shoulder function, assessment of lymphedema, and established measures of quality of life (QOL), mental distress and fatigue were used to study convergent and discriminant validity. Factor structure and internal consistency were tested in split-half samples. The total KAPS as well as its two subscales showed high internal consistency (α ≥ 0.92). A two factor solution explained 70% of the variance in the total KAPS score. Convergent validity was shown as the total KAPS score explained 32.5% of the variance in abduction of the ipsilateral shoulder. Discriminant validity was shown as the total KAPS score explained only 6.7% of the variance in abduction of the contralateral shoulder. Concurrent validity was confirmed since the total KAPS explained 54.8% of the variance in arm symptom subscale of breast cancer-specific QOL. Area under the curve was 0.80 for problems of using the arm at a cut-off of the total KAPS score of 21.5. The results show that the KAPS has good psychometric properties supported by high reliability and considerable convergent and discriminant validity.


Arm morbidity Breast cancer Kwan’s arm problem scale Lymphedema Patient based rating Shoulder problems 



Center for shared Decision Making and Nursing Research, Rikshospitalet University Hospital has funded the first author during the writing up of this paper.


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Copyright information

© Springer Science+Business Media, LLC. 2008

Authors and Affiliations

  • Inger-Lise Nesvold
    • 1
  • Sophie D. Fosså
    • 2
    • 3
  • Bjørn Naume
    • 4
  • Alv A. Dahl
    • 2
    • 3
  1. 1.Department of Cancer Rehabilitation - Physiotherapy, The Norwegian Radium HospitalRikshospitalet University HospitalOsloNorway
  2. 2.Department of Clinical Cancer Research, The Norwegian Radium HospitalRikshospitalet University HospitalOsloNorway
  3. 3.Faculty Division, The Norwegian Radium HospitalUniversity of OsloOsloNorway
  4. 4.Department of Oncology, The Norwegian Radium HospitalRikshospitalet University HospitalOsloNorway

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