Inter-Rater Reliability of a Pressure Injury Risk Assessment Scale for Home Care: A Multicenter Cross-Sectional Study

Abstract

Purpose

The aim of the current study was to assess the inter-rater reliability and agreement of the Pressure Injury Primary Risk Assessment Scale for Home Care (PPRA-Home), a risk assessment scale recently developed for Japan-specific social welfare professionals called care managers, to predict pressure injury risk in geriatric individuals who require long-term home care needs.

Methods

A multicenter cross-sectional study was conducted at 30 home-based geriatric support services facilities located at four local districts in Japan. Eligible participants were individuals who needed partial or full assistance for daily living under Japan’s long-term care insurance system (care levels 1–5). The degree of agreement and kappa coefficient were calculated for each item and the total score, after which inter-rater reliability was determined. The effect of the participant’s care level on reliability was also evaluated as secondary analysis.

Results

A total of 96 participants were assessed by 83 care managers (two assessors scored each participant). The degree of agreement and calculated kappa coefficient of the PPRA-Home total score were 59% and 0.72, respectively, with the inter-rater reliability for the total score determined to be “Substantial”. Our subgroup analysis showed that the inter-rater reliability differed according to the participant’s care level. Accordingly, the kappa coefficient for the total score was lower in subgroup “care level 1–3” than in subgroup “care level 4–5” (0.51 and 0.76, respectively).

Conclusion

Our result showed that the PPRA-Home has substantial inter-rater reliability for evaluation of risks of pressure injury development at home care. However, some research focusing on intra-later reliability and validity of the PPRA-Home with adequate sample sizes are required to provide categorical conclusions on whether it can be used for the risk assessment scale in actual clinical settings.

Keywords:

• pressure ulcer
• risk assessment
• reproducibility
• agreement
• geriatrics

Abbreviations

PPRA-Home, Pressure Injury Primary Risk Assessment Scale for Home Care; LTCI, long-term care insurance.

Data Sharing Statement

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Ethics Approval and Consent to Participate

This study was approved by the Institutional Review Board of Sapporo Dermatology Clinic (Number: PRJ Code 21S031). Written informed consent was obtained from all participants. All aspects of this research were in accordance with the principles set forth by the Declaration of Helsinki. There were no major changes in study methods after trial commencement.

Consent for Publication

All authors and their affiliations consented to publication of the study in this journal.

Acknowledgments

The authors thank all the staff, including the manager, nursing stuff, and administrative officer, of our facilities for their valuable cooperation. We also thank Enago (http://www.enago.jp) for their English language editing services.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: MK and YK are employees of ALCARE (Tokyo, Japan) and report this research was supported by funding from ALCARE (Tokyo, Japan). The authors report no other potential conflicts of interest for this work.

Additional information

Funding

This research was supported by funding from ALCARE (Tokyo, Japan).