title: Evaluation of the internal and external responsiveness of the Pressure Ulcer Scale for Healing (PUSH) tool for assessing acute and chronic wounds.
abstract: OBJECTIVE
  To examine the internal and external responsiveness of the Pressure Ulcer Scale for Healing (PUSH) tool for assessing the healing progress in acute and chronic wounds.
  
  
  BACKGROUND
  It is important to establish the responsiveness of instruments used in conducting wound care assessments to ensure that they are able to capture changes in wound healing accurately over time.
  
  
  METHODS
  Prospective longitudinal observational study.
  
  
  METHODS
  The key study instrument was the PUSH tool. Internal responsiveness was assessed using paired t-testing and effect size statistics. External responsiveness was assessed using multiple linear regression. All new patients with at least one eligible acute or chronic wound, enrolled in the Nurse and Allied Health Clinic-Wound Care programme between 1 December 2012 - 31 March 2013 were included for analysis (N = 541).
  
  
  RESULTS
  Overall, the PUSH tool was able to detect statistically significant changes in wound healing between baseline and discharge. The effect size statistics were large. The internal responsiveness of the PUSH tool was confirmed in patients with a variety of different wound types including venous ulcers, pressure ulcers, neuropathic ulcers, burns and scalds, skin tears, surgical wounds and traumatic wounds. After controlling for age, gender and wound type, subjects in the 'wound improved but not healed' group had a smaller change in PUSH scores than those in the 'wound healed' group. Subjects in the 'wound static or worsened' group had the smallest change in PUSH scores. The external responsiveness was confirmed.
  
  
  CONCLUSIONS
  The internal and external responsiveness of the PUSH tool confirmed that it can be used to track the healing progress of both acute and chronic wounds.
authors.affiliation: School of Nursing, The University of Hong Kong, Hong Kong.
authors.forename: Edmond P H
authors.initials: EP
authors.lastname: Choi
authors.affiliation: Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong.
authors.forename: Weng Yee
authors.initials: WY
authors.lastname: Chin
authors.affiliation: School of Nursing, The University of Hong Kong, Hong Kong.|Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong.
authors.forename: Eric Y F
authors.initials: EY
authors.lastname: Wan
authors.affiliation: Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong.
authors.forename: Cindy L K
authors.initials: CL
authors.lastname: Lam
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D036262:Empirical Research; D005260:Female; D006723:Hong Kong; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014945:Wound Healing / Q000502:physiology*; D014947:Wounds and Injuries / Q000451:nursing / Q000503:physiopathology*
keywords: acute wound; chronic wound; nursing; responsiveness; wound assessment