Abstract
Background:
Pressure ulcers are a common secondary condition that occur post-spinal cord injury (SCI). These ulcers come at tremendous personal and societal cost. There are a number of scales that can be used to identify those who are at risk.
Objectives:
This review critically evaluates risk assessment scales designed for identifying and predicting skin ulcers. Specifically, studies on the psychometric properties and utility for individuals with SCI were assessed.
Methods:
The MedLine, CINHAL, Embase, HaPI, Psycinfo, Sportdiscus and Cochrane databases were searched to identify studies. To be included, the scale needed to have at least one study, published in a peer-reviewed journal, which examined its psychometric properties with a sample of individuals with SCI.
Results:
Seven scales were included in this review: Abuzzese, Braden, Gosnell, Norton, SCIPUS, SCIPUS-A and Waterlow. None of the tools reported reliability data with this population. Validity evidence ranged from poor to adequate across scales. Most were readily available, quick to administer and had minimal respondent burden; however, the SCIPUS-A and SCIPUS, two scales developed specifically for individuals with SCI, required laboratory blood testing.
Conclusion:
Although the SCIPUS-A and SCIPUS show promise, utility issues and limited psychometric testing suggest that these tools cannot be recommended at this time. While the Braden scale has the best combined validity and utility evidence, more specific testing with individuals with SCI is required for it and all other scales included in the review.
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References
Noreau L, Proulx P, Gagnon L, Drolet M, Laramee MT . Secondary impairments after spinal cord injury: a population-based study. Am J Phys Med Rehabil 2000; 79: 526–535.
McKinley WO, Jackson AB, Cardenas DD, DeVivo MJ . Long-term medical complications after traumatic spinal cord injury: a regional model systems analysis. Arch Phys Med Rehabil 1999; 80: 1402–1410.
Langemo DK, Melland H, Hanson D, Olson B, Hunter S . The lived experience of having a pressure ulcer: a qualitative analysis. Adv Skin Wound Care 2000; 13: 225–235.
Hopkins A, Dealey C, Bale S, Defloor T, Worboys F . Patient stories of living with a pressure ulcer. J Adv Nurs 2006; 56: 345–353.
Bennett G, Dealey C, Posnett J . The cost of pressure ulcers in the UK. Age Ageing 2004; 33: 230–235.
Langemo DK . Quality of life and pressure ulcers: what is the impact? Wounds 2005; 17: 3–7.
Günnewicht BR . Pressure sores in patients with acute spinal cord injury. J Wound Care 1995; 4: 452–454.
Chen Y, Devivo MJ, Jackson AB . Pressure ulcer prevalence in people with spinal cord injury: age-period-duration effects. Arch Phy Med Rehabil 2005; 86: 1208–1213.
Allman RM . Epidemiology of pressure sores in different populations. Decubitus 1989; 2: 30–33.
Pancorbo-Hidalgo PL, Garcia-Fernandez FP, Lopez-Medina IM, Alvarez-Nieto C . Risk assessment scales for pressure ulcer prevention: a systematic review. J Adv Nurs 2006; 54: 94–110.
Houle RJ . Evaluation of seat devices designed to prevent ischemic ulcers in paraplegic patients. Arch Phys Med Rehabil 1969; 50: 587–594.
Redelings MD, Lee NE, Sorvillo F . Pressure ulcers: more lethal than we thought? Adv Skin Wound Care 2005; 18: 367–372.
Krause JS, Vines CL, Farley TL, Sniezek J, Coker J . An exploratory study of pressure ulcers after spinal cord injury: relationship to protective behaviors and risk factors. Arch Phys Med Rehabil 2001; 82: 107–113.
Salzberg CA, Byrne DW, Cayten CG, van Niewerburgh P, Murphy JG, Viehbeck M . A new pressure ulcer risk assessment scale for individuals with spinal cord injury. Am J Phys Med Rehabil 1996; 75: 96–104.
Salzberg AC, Byrne DW, Kabir R, van Niewerbugh P, Cayten CG . Predicting pressure ulcers during initial hospitalisation for acute spinal cord injury. Wounds: a Compendium of Clinical Research and Practice 1999; 11: 45–57.
Krause JS, Broderick L . Patterns of recurrent pressure ulcers after spinal cord injury: identification of risk and protective factors 5 or more years after onset. Arch Phys Med Rehabil 2004; 85: 1257–1264.
Garber S, Biddle A, Click C, Cowell JF, Gregorio-Torres TL, Hansen NK . Pressure ulcer prevention and treatment following spinal cord injury: a Clinical Practice Guideline for Health Care Professionals. J Spinal Cord Med 2000; 24: S40–S101.
Nixon J, McGough A . Principles of patient assessment: screening for pressure ulcers and potential risk. In: Morison MJ (ed). The Prevention and Treatment of Pressure Ulcers. Mosby: Toronto, ON, 2001, pp 55–74.
Messick S . Validity of psychological assessment: validation of inferences from Persons' responses and performances as scientific inquiry into score meaning. Am Psychol 1995; 50: 741–749.
Atkinson G, Nevill AM . Statistical methods for assessing measurement error (reliability) in variables relevant to sports medicine. Sport Med 1998; 26: 217–238.
Streiner DL, Norman GR . Health Measurement Scales: A Practical Guide to Their Development, 3rd ed. Oxford University Press: New York, 2003.
Byrne DW, Salzberg CA . Major risk factors for pressure ulcers in the spinal cord disabled: a literature review. Spinal Cord 1996; 34: 255–263.
Shrout PE, Fleiss JL . Intraclass correlations: uses in assessing rater reliability. Psychol Bull 1979; 86: 420–428.
Fitzpatrick R, Davey C, Buxton MJ, Jones DR . Evaluating patient-based outcome measures for use in clinical trials. Health Technol Assess 1998; 2: i–iv, 1–74.
Andresen EM . Criteria for assessing the tools of disability outcomes research. Arch Phys Med Rehabil 2000; 81 (12 Suppl 2): S15–S20.
McDowell I, Newell C . Measuring Health. A Guide to Rating Scales and Questionnaires. Oxford University Press: New York, 1996.
Abruzzese RS . Early assessment and prevention of pressure sores. In: Lee BY (ed). Chronic Ulcers of the Skin. McGraw Hill: New York, 1985, pp 1–19.
Bergstrom N, Demuth PJ, Braden BJ . A clinical trial of the braden scale for predicting pressure sore risk. Nurs Clin North Am 1987; 22: 417–428.
Gosnell DJ . An assessment tool to identify pressure sores. Nurs Res 1973; 22: 55–59.
Norton D, Maclaren R, Exton-Smith AN . An investigation of Geriatric Nursing Problems in Hospital: National Corporation for the Care of Old People. Churchill Livingstone: Edinburgh, Scottland, 1962.
Waterlow J . Pressure sores: a risk assessment card. Nurs Times 1985; 81: 49–55.
Wellard S, Lo SK . Comparing Norton, Braden and Waterlow risk assessment scales for pressure ulcers in spinal cord injuries. Contemp Nurse 2000; 9: 155–160.
Ash D . An exploration of the occurrence of pressure ulcers in a British spinal injuries unit. J Clin Nurs 2002; 11: 470–478.
Portney LG, Watkins MP . Foundations of Clinical Research. Applications to Practice. Appleton & Lange: Stamford, CN, 1993.
Pringle M, Ward P, Chilvers C . Assessment of the completeness and accuracy of computer medical records in four practices committed to recording data on computer. Br J Gen Pract 1995; 45: 537–541.
Keast D, Parslow N, Houghton P, Norton L, Fraser C . Best practices for the prevention and treatment of pressure ulcers: Update 2006. Wound Care Can 2006; 4: 31–43.
Acknowledgements
Salary support for Dr Miller was provided by the Canadian Institutes of Health Research. Mr Mortenson's work was supported by a Strategic Training Fellowship in Rehabilitation Research from the Canadian Institutes of Health Research Musculoskeletal and Arthritis Institute, the Canadian Occupational Therapy Foundation and graduate fellowships from the Canadian Institutes of Health Research and the Michael Smith Foundation for Health Research. Funding for this project was provided by the Rick Hansen Man in Motion Research Foundation and the Ontario Neurotrauma Foundation.
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Mortenson, W., Miller, W. & the SCIRE Research Team. A review of scales for assessing the risk of developing a pressure ulcer in individuals with SCI. Spinal Cord 46, 168–175 (2008). https://doi.org/10.1038/sj.sc.3102129
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DOI: https://doi.org/10.1038/sj.sc.3102129
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