Background

Chronic wounds are an increasing problem in the aging population, patients experience a lower health-related quality of life and the care for these patients is associated with high costs. Thorough wound assessments facilitate objective monitoring of wound status and progress. A wound assessment tool can guide clinicians in these wound assessments and in recording wound progress or deterioration.

Objective

Systematically identify assessment tools for chronic wounds, investigate their measurement properties, and summarize the data per assessment tool.

Design

Systematic review

Methods

The databases Medline (PubMed interface), Embase, CINAHL, and CENTRAL were systematically searched until May 2020 (updated in February 2021). Studies reporting the development and/or the evaluation of measurement properties of assessment tools for chronic wounds were included. The “Consensus-based Standards for the selection of health Measurement Instruments” risk of Bias checklist was applied to evaluate the methodological quality of the included studies. Each reported measurement property was rated against criteria for good measurement properties. The evidence was summarized and the quality of the evidence was graded using a modified Grades of Recommendation, Assessment, Development, and Evaluation approach. Study selection, data extraction and quality appraisal were conducted independently by two reviewers and double-checked by a third reviewer.

Results

Twenty-seven studies describing the measurement properties of fourteen assessment tools for chronic wounds were included. None of the studies reported a content validity evaluation by a relevance study or a comprehensiveness study in professionals. Six articles reported the development or revision of an existing assessment tool. The reported measurement properties included: structural validity (5 studies), reliability (18 studies), hypotheses testing for construct validity (18 studies) and responsiveness (7 studies). Internal consistency, cross-cultural validity / measurement invariance and measurement error were not reported. If criterion validity was assessed, the results were allocated to hypotheses testing for construct validity as no ‘gold standard’ is available.

Conclusions

Fourteen assessment tools for chronic wounds were identified. Construct validity (by hypotheses testing) and responsiveness of the Pressure Ulcer Scale for Healing version 3.0 were supported by sufficient ratings based on moderate to high level quality of evidence. Reliability of the (Revised) Photographic Wound Assessment Tool had a sufficient rating based on moderate quality of evidence. The ratings of the measurement properties of the other wound assessment tools were either insufficient or indeterminate, or a sufficient result was supported by low to very low quality of evidence.

Registration number in PROSPERO: CRD42020183920

Tweetable abstract: “A systematic review giving a clear overview of the measurement properties of available assessment tools for chronic wounds.”

中文翻译：

---

慢性伤口评估工具的测量特性：系统评价

背景

慢性伤口在老龄化人口中是一个日益严重的问题，患者的健康相关生活质量较低，并且对这些患者的护理与高成本相关。彻底的伤口评估有助于对伤口状态和进展进行客观监测。伤口评估工具可以指导临床医生进行这些伤口评估并记录伤口进展或恶化。

目标

系统地确定慢性伤口的评估工具，调查其测量特性，并总结每个评估工具的数据。

设计

系统审查

方法

系统检索了 Medline（PubMed 界面）、Embase、CINAHL 和 CENTRAL 数据库，直至 2020 年 5 月（2021 年 2 月更新）。研究报告了慢性伤口评估工具的测量特性的开发和/或评估。应用“基于共识的健康测量仪器选择标准”偏差检查表风险评估纳入研究的方法学质量。每个报告的测量属性都根据良好测量属性的标准进行评级。对证据进行总结，并使用修改后的推荐、评估、制定和评价方法对证据的质量进行分级。研究选择、数据提取和质量评估由两名评价员独立进行，并由第三名评价员复核。

结果

包括描述 14 种慢性伤口评估工具的测量特性的 27 项研究。没有一项研究报告了通过相关性研究或专业人士的全面性研究进行的内容有效性评估。六篇文章报告了现有评估工具的开发或修订。报告的测量属性包括：结构有效性（5 项研究）、可靠性（18 项研究）、结构有效性的假设检验（18 项研究）和反应性（7 项研究）。没有报告内部一致性、跨文化有效性/测量不变性和测量误差。如果评估了标准效度，则将结果分配给假设检验结构效度，因为没有“金标准”可用。

结论

确定了 14 种慢性伤口评估工具。压力溃疡愈合量表 3.0 版的结构效度（通过假设检验）和反应性得到了基于中等至高水平证据质量的足够评级的支持。基于中等质量的证据，（修订后的）摄影伤口评估工具的可靠性具有足够的评级。其他伤口评估工具的测量属性评级要么不充分，要么不确定，或者足够的结果得到低到极低质量的证据的支持。

PROSPERO 注册号：CRD42020183920

Tweetable 摘要：“一项系统综述，清楚地概述了可用的慢性伤口评估工具的测量特性。”