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BACKGROUND/RATIONALE:
Pressure ulcers are a high risk, high volume, high cost problem for persons with spinal cord impairment (SCI). Currently, there is significant variation in practice related to pressure ulcer assessment and monitoring. The investigators analyzed published tools and identified the following limitations: Tools (1) lack established validity, reliability and/or sensitivity for persons with SCI; (2) are designed predominantly for use in elderly populations; (3) are applicable to acute rather than chronic wounds; (4) contain abbreviated assessment variables or are too lengthy to be practical in busy clinical settings; and (5) omit important clinical characteristics that are unique to assessing and monitoring pressure ulcers in persons with SCI.
OBJECTIVE(S):
The purpose of this study is to develop a valid, reliable, and sensitive tool to assess pressure ulcer healing in persons with SCI. The tool will be named the "SCI Pressure Ulcer Monitoring Tool" (SCI-PUMT).
METHODS:
This 3-year, prospective, longitudinal study is being conducted at the Tampa V.A. Hospital. Data collection is conducted at baseline and weekly data for 3 months. Data collection includes interviews, direct observation, and digital imaging. An individual ulcer (Stages II-IV) is considered as the unit of analysis for this study. Multiple ulcers in one patient are considered as independent observations. Repeated measurements of the same ulcer are considered dependent. A sample size of 125 is needed to detect an R2 difference (targeted effect size) of 0.055, with alpha 0.05 and power 0.80. Approximately 150 ulcers will be required after adjusting for 20% attrition. Factor analysis will be used to establish construct validity for a reduced set of items (the SCI-PUMT) that reflect the underlying process of healing in SCI patients. Additional analysis will be conducted to evaluate the sensitivity of the new tool to reflect changes in pressure ulcer healing over time and determine the internal consistency reliability of the tool. Once the SCI-PUMT is validated and finalized, 26 SCI staff nurses will be trained in the use of the tool. After 2 months of using the tool in clinical practice, 3 SCI nurses will be selected to examine the inter- and intra-rater reliability of the tool.
FINDINGS/RESULTS:
Descriptive statistics will be reported for demographic characteristics and ulcer characteristics. Content validity index of the experts will be computed to establish the content validity. Exploratory factor analysis will be performed to establish the construct validity. Since volume and area are more sensitive to change over time, these outcome measures will be used to assess the ability of the SCI-PUMT to monitor healing using digital imaging. Mixed regression analysis will be used to determine the sensitivity of the SCI-PUMT to measure healing. Reliability of the SCI-PUMT will be established by computing the intra-class correlation (ICC) and Cronbach's alpha.
The Research Plan was initiated 1/1/06 - Project findings are pending.
IMPACT:
Findings will be shared with the National Center for Patient Safety, SCI Strategic Healthcare Group, Paralyzed Veterans of America, National Consortium of Spinal Cord Injury Medicine Clinical Practice Guidelines, and the SCI Quality Enhancement Research Initiative. Findings from this study will be useful to (1) establish the validity, sensitivity, and reliability of an SCI-specific tool to monitor pressure ulcer healing; and (2) improve communication among treatment teams regarding timely clinical management decisions and discharge planning.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases, Health Services and Systems
DRE:
Quality of Care, Rehabilitation
Keywords:
Cost, Screening, Spinal cord injury
MeSH Terms:
none
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