title: Objective measurement of scarring by multiple assessors: is the tissue tonometer a reliable option?
abstract: Depending on the patient population, the incidence of scarring is as great as 75% after burns. Skin pliability and functional recovery are affected negatively by hypertrophic scarring. Therapists use various treatment strategies to improve scar outcomes. However, a simple, objective, clinically useful method of measuring scar response to treatment eludes us. This study examines the inter-rater reliability and validity of scar pliability measures using the modified tissue tonometer (MTT). Twenty-four patients were tested by two blinded, randomly allocated raters. The MTT was used to assess scar pliability with a standardized, repeated-measures design. One normal and up to three scar points were assessed for each subject. One subject was excluded from the data analyses. Concerning inter-rater reliability, the intraclass correlation coefficient for averaged measures between measurers was 0.957, and the standard error of measurement was 0.025 mm. For validity, a significant difference (P = .0000) between scar (2.64 +/- 0.5 mm) and normal tissue (3.23 +/- 0.46 mm) measurements was demonstrated. Scar pliability scores between raters are extremely reliable and reproducible using the MTT. It can differentiate between injured and uninjured tissue. Hence, it provides clinicians with a reliable, transportable, and objective tool to document scar outcomes. The MTT provides a standardized method to longitudinally measure scar tissue pliability after burn injury.
authors.affiliation: School of Physiotherapy, Curtin University of Technology, Perth, Western Australia.
authors.forename: Gavin Frank
authors.initials: GF
authors.lastname: Corica
authors.forename: Nicholas Charles
authors.initials: NC
authors.lastname: Wigger
authors.forename: Dale Wesley
authors.initials: DW
authors.lastname: Edgar
authors.forename: Fiona Melanie
authors.initials: FM
authors.lastname: Wood
authors.forename: Sara
authors.initials: S
authors.lastname: Carroll
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002056:Burns / Q000150:complications* / Q000628:therapy; D002921:Cicatrix / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry / Q000295:instrumentation*; D008875:Middle Aged; D015588:Observer Variation; D018583:Pliability; D015203:Reproducibility of Results; D016037:Single-Blind Method