Validity and reliability of a pressure ulcer monitoring tool for persons with spinal cord impairment

Abstract

Objective

The purpose was to provide support for validity and reliability of the spinal cord impairment pressure ulcer monitoring tool (SCI-PUMT) to assess pressure ulcer (PrU) healing.

Design

Expert panels developed a 30-item pool, including new items and items from two established PrU healing tools, to represent potential variables for monitoring PrU healing. Subjects were prospectively assessed weekly for each variable over a 12-week period.

Setting

Data collection was conducted on a cohort of inpatients and outpatients in one Spinal Cord Injury/Disorders Center in the Veterans’ Health Administration.

Subjects

A convenience sample of Veterans (n = 66) with spinal cord impairment (SCI) was recruited. Eligible subjects had at least one PrU (n = 167) and a history of SCI for longer than 1 year.

Interventions

Not applicable.

Outcome Measure

A change in PrU volume was calculated using VeV Measurement Documentation software and a digital imaging camera.

Results

Content validity was established for a pool of items designed to gauge PrU healing. Exploratory factor analysis (construct validity) identified a parsimonious set of seven items for inclusion in the SCI-PUMT to assess PrU healing. The SCI-PUMT was found to explain 59% of the variance of the volume across the study. Inter-rater reliability was 0.79 and intra-rater reliability ranged from 0.81 to 0.99 among research assistants. Similar levels of reliability were subsequently established among registered nurses, who used the SCI-PUMT in the clinical setting.

Conclusions

The final version of the SCI-PUMT was determined to be valid, reliable, and sensitive in detecting PrU healing over time in Veterans with SCI.

Keywords:

• Pressure ulcer
• Decubitus ulcer
• Pressure sore
• Bedsore
• Spinal cord injuries

Acknowledgments

We appreciate the research acumen of Audrey L. Nelson, PhD, RN, FAAN (retired), former Director of the Tampa HSR&D and RR&D Research Center of Excellence. We also greatly appreciate Barbara Bates-Jensen, PhD, RN for providing us permission to incorporate two elements of the BWAT into the SCI-PUMT. In addition, we are grateful to Mary Reeder, BIS, Automation Clerk, Tampa HSR&D/R&D Research Center of Excellence, and the RN Research Assistants who collected data for the study: Francis Hernandez RN, Stephanie McGovern RN, Olivia Monteso-Smithson RN, Suk Tomlinson RN, and Linda Smith, RN, and; Valerie Keller for assistance with manuscript formatting and submission.