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

Figures & data

Table 1 Definition and Scoring Rule of Pressure Injury Primary Risk Assessment Scale for Home Care

Descriptions	Definitions	Scoring Rules
Spontaneous body turning	Unable to spontaneously move or turn over in bed.	1=yes. 0=no.
Body type	Body shape is identified as skinny or boney.	1=yes. 0=no.
Mobility	Reduced joint mobility, and bending/stretching joints of knee or elbow is difficult.	1=yes. 0=no.
Food intake	Daily food intake is reduced (total amount of eating or eating frequency can be considered).	1=yes. 0=no.
Skin moisture	Skin is occasionally moist with sweat (degree of moisture is not considered).	1=yes. 0=no.
Using diapers	Constantly has usage of diapers for elderly people.	1=yes. 0=no.
Edema	Swelling in the lower legs (degree of swelling is not considered).	1=yes. 0=no.
Using head-of-bed elevation	Usually using Head-of-bed elevation when raising upper body from a spine position (Degree of elevation is not considered).	1=yes. 0=no.

Table 2 Assessor Characteristics

Characteristics	Overall (n=83)
Age in years, n (%)
<40	10 (12)
40–49	34 (41)
50–59	18 (22)
≥60	21 (25)
Gender, n (%)
Male	15 (18)
Female	68 (82)
Years of experience as a care manager, n (%)
<5	27 (33)
≥5 and <10	29 (35)
≥10	27 (33)
Professional background, n (%)^a
Certified care worker	67 (50)
Certified social worker	15 (11)
Home attendant	26 (20)
RN or LPN	8 (6)
Others	17 (13)

Note: ^aThe 83 assessors had 133 professional licenses.

Abbreviations: RN, registered nurse; LPN, licensed practical nurse.

Table 3 Participant Characteristics

Characteristics	Overall (n=96)
Age in years, mean (SD)	84 (9.7)
Gender, n (%)
Male	28 (29)
Female	68 (71)
Living arrangement, n (%)^a
Alone	19 (20)
With others	76 (80)
Care level, n (%)^a
Level 1	19 (20)
Level 2	21 (22)
Level 3	18 (19)
Level 4	24 (25)
Level 5	12 (13)
Functional disability, n (%)^a
Rank J	14 (15)
Rank A	43 (45)
Rank B	28 (29)
Rank C	10 (11)
Cognitive impairment, n (%)^a
Independent/Rank 1	29 (31)
Rank 2	44 (46)
Rank 3	15 (16)
Rank 4/M	7 (7)

Note: ^aMissing data were excluded from this table.

Abbreviation: SD, standard deviation.

Table 4 Inter-Rater Reliability and Agreement of the Pressure Injury Primary Risk Assessment Scale for Home Care

Descriptions	Observed Agreement (95% CI)	Kappa Statistic (95% CI)	Inter-Rater Reliability
Spontaneous body turning	88% (79–93%)	0.68 (0.51–0.85)	Substantial agreement
Body type	90% (81–95%)	0.77 (0.63–0.91)	Substantial agreement
Mobility	89% (80–94%)	0.74 (0.60–0.88)	Substantial agreement
Food intake	84% (75–91%)	0.66 (0.50–0.82)	Substantial agreement
Skin moisture	80% (71–87%)	0.58 (0.42–0.75)	Moderate agreement
Using diapers	85% (76–91%)	0.65 (0.48–0.82)	Substantial agreement
Edema	83% (74–90%)	0.66 (0.51–0.81)	Substantial agreement
Using head-of-bed elevation	93% (85–97%)	0.82 (0.69–0.95)	Almost perfect agreement
Total score	59% (49–69%)	0.72 (0.44–0.98)	Substantial agreement

Abbreviation: CI, confidence interval.

Table 5 Subgroup Analysis for Inter-Rater Reliability and Agreement of Each Item and Total Score of the Pressure Injury Primary Risk Assessment Scale for Home Care

Subgroup	Observed Agreement (95% CI)	Kappa Statistic (95% CI)	Inter-Rater Reliability
Care needs level
Care level 1–3 (n=58)
Spontaneous body turning	88% (76–95%)	0.40 (0.00–0.82)	Fair agreement
Body type	91% (79–97%)	0.76 (0.55–0.96)	Substantial agreement
Mobility	93% (82–98%)	0.80 (0.61–0.99)	Substantial agreement
Food intake	86% (74–93%)	0.70 (0.51–0.89)	Substantial agreement
Skin moisture	82% (70–91%)	0.62 (0.40–0.83)	Substantial agreement
Using diapers,	82% (70–91%)	0.64 (0.44–0.84)	Substantial agreement
Edema	85% (72–92%)	0.68 (0.48–0.87)	Substantial agreement
Using head-of-bed elevation	93% (83–98%)	0.63 (0.28–0.98)	Substantial agreement
Total score	60% (47–73%)	0.51 (0.03–0.98)	Moderate agreement
Care level 4–5 (n=36)
Spontaneous body turning	86% (70–95%)	0.72 (0.50–0.95)	Substantial agreement
Body type	87% (70–96%)	0.75 (0.52–0.98)	Substantial agreement
Mobility	80% (63–91%)	0.61 (0.32–0.89)	Substantial agreement
Food intake	83% (67–93%)	0.61 (0.36–0.87)	Substantial agreement
Skin moisture	75% (57–87%)	0.49 (0.21–0.78)	Moderate agreement
Using diapers,	91% (76–98%)	0.62 (0.21–1.00)	Substantial agreement
Edema	81% (63–91%)	0.61 (0.35–0.87)	Substantial agreement
Using head-of-bed elevation	92% (76–98%)	0.83 (0.65–1.00)	Almost perfect agreement
Total score	56% (38–73%)	0.76 (0.38–1.00)	Substantial agreement
Functional disability
Rank J, A (n=57)
Spontaneous body turning	88% (75–95%)	0.31 (0.00–0.79)	Fair agreement
Body type	93% (82–98%)	0.81 (0.63–0.99)	Almost perfect agreement
Mobility	91% (80–97%)	0.76 (0.55–0.96)	Substantial agreement
Food intake	85% (74–93%)	0.71 (0.52–0.89)	Substantial agreement
Skin moisture	82% (70–91%)	0.64 (0.44–0.84)	Substantial agreement
Using diapers,	84% (72–93%)	0.67 (0.47–0.87)	Substantial agreement
Edema	86% (74–93%)	0.70 (0.51–0.89)	Substantial agreement
Using head-of-bed elevation	95% (84–99%)	0.81 (0.60–1.00)	Almost perfect agreement
Total score	63% (49–75%)	0.62 (0.26–1.00)	Substantial agreement
Rank B, C (n=38)
Spontaneous body turning	87% (72–95%)	0.75 (0.54–0.95)	Substantial agreement
Body type	85% (68–94%)	0.71 (0.47–0.94)	Substantial agreement
Mobility	84% (69–94%)	0.69 (0.46–0.92)	Substantial agreement
Food intake	82% (65–91%)	0.57 (0.28–0.86)	Moderate agreement
Skin moisture	77% (60–88%)	0.49 (0.20–0.78)	Moderate agreement
Using diapers,	87% (72–95%)	0.54 (0.16–0.92)	Moderate agreement
Edema	79% (63–90%)	0.59 (0.34–0.84)	Moderate agreement
Using head-of-bed elevation	92% (78–98%)	0.84 (0.67–1.00)	Almost perfect agreement
Total score	51% (35–67%)	0.72 (0.38–1.00)	Substantial agreement
Cognitive impairment
Independent/Rank 1, 2 (n=73)
Spontaneous body turning	85% (74–92%)	0.53 (0.28–0.79)	Moderate agreement
Body type	91% (81–96%)	0.79 (0.64–0.95)	Substantial agreement
Mobility	92% (83–97%)	0.81 (0.67–0.96)	Almost perfect agreement
Food intake	85% (75–92%)	0.67 (0.49–0.85)	Substantial agreement
Skin moisture	86% (76–93%)	0.71 (0.55–0.88)	Substantial agreement
Using diapers,	88% (78–99%)	0.72 (0.55–0.89)	Substantial agreement
Edema	85% (75–92%)	0.70 (0.54–0.86)	Substantial agreement
Using head-of-bed elevation	92% (83–97%)	0.77 (0.60–0.95)	Substantial agreement
Total score	62% (50–73%)	0.69 (0.32–1.00)	Substantial agreement
Rank 3, 4, M (n=22)
Spontaneous body turning	91% (69–98%)	0.82 (0.58–1.00)	Almost perfect agreement
Body type	86% (64–96%)	0.68 (0.34–0.99)	Substantial agreement
Mobility	77% (54–91%)	0.50 (0.12–0.89)	Moderate agreement
Food intake	77% (54–91%)	0.50 (0.12–0.89)	Moderate agreement
Skin moisture	60% (37–78%)	0.14 (0.00–0.57)	Slight agreement
Using diapers,	77% (54–91%)	0.35 (0.01–0.65)	Fair agreement
Edema	77% (54–91%)	0.52 (0.15–0.89)	Moderate agreement
Using head-of-bed elevation	95% (75–99%)	0.90 (0.72–1.00)	Almost perfect agreement
Total score	45% (25–67%)	0.71 (0.36–1.00)	Substantial agreement

Abbreviation: CI, confidence interval.