Monitoring healing of pressure ulcers: a review of assessment instruments for use in the spinal cord unit.
METHODS
Review.


OBJECTIVE
To identify the pressure ulcer healing assessment instrument that is the best choice for use in spinal cord injury rehabilitation.


METHODS
Articles were retrieved from PubMed. Inclusion criteria were written in English, published up to December 2008 and describing instruments evaluated in more than one study. Search terms were pressure ulcer, wound healing, severity of illness index, reproducibility of results, sensitivity and specificity. Articles describing pressure ulcer staging scales and articles not describing clinimetric properties of an instrument were excluded. Validity, reliability, responsiveness and feasibility for routine clinical use were described of all instruments evaluated in two or more studies.


RESULTS
Eleven instruments were described. Clinimetric information was incomplete for all instruments. Clinimetric information was most complete and promising for two instruments: 'ruler length and width' and the 'Sessing' scale. The ruler method showed good intra-rater and inter-rater reliability and good concurrent validity. The 'Sessing' scale has a moderate concurrent validity but was not tested for its responsiveness.


CONCLUSIONS
Further study of the clinimetric properties of pressure ulcer assessment instruments is necessary before the best instrument can be selected.
van Lis
M S
MS
Bovenij Ziekenhuis, Department of Rehabilitation, Amsterdam and Rehabilitation Centre, Amsterdam, The Netherlands.
van Asbeck
F W A
FW
Post
M W M
MW
D006801:Humans; D008991:Monitoring, Physiologic / Q000379:methods*; D017063:Outcome Assessment, Health Care / Q000379:methods; D003668:Pressure Ulcer / Q000209:etiology / Q000503:physiopathology*; D015203:Reproducibility of Results; D013119:Spinal Cord Injuries / Q000150:complications / Q000534:rehabilitation; D014945:Wound Healing / Q000502:physiology*