Objective measurement of scarring by multiple assessors: is the tissue tonometer a reliable option?
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.
Corica
Gavin Frank
GF
School of Physiotherapy, Curtin University of Technology, Perth, Western Australia.
Wigger
Nicholas Charles
NC
Edgar
Dale Wesley
DW
Wood
Fiona Melanie
FM
Carroll
Sara
S
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