Inter-rater reliability assessment of new diabetic foot ulcers (The Diabetic Foot Ulcer Assessment Scale) based on photograph

A diabetic foot wound healing assessment tool: A scoping review

Background

Indonesia faces a challenge in controlling the burden of diabetic foot ulcers, which necessitates a nursing care management approach to optimize the healing of complications by accurately monitoring wound healing progress using wound assessment tools.

Methods

This literature review, which is part of a scoping study framework, searched electronic databases including PubMed, ScienceDirect, EBSCOhost, and Google Scholar to find papers relevant to the Indonesian context. Five papers were chosen from a total of 463 papers discovered.

Results

The diabetic foot ulcer wound assessment tools DFUAS (diabetic foot ulcer assessment scale), DMIST (deep, maceration, infection, size, and tunneling), and MUNGS (maceration, undermining, necrotic, granulation, and symptoms/signs) were identified in the literature review. For leg ulcers, LUMT (leg ulcer measurement tool) and RESVECH 2.0 (Results Expected from Chronic Wound Healing Assessment) were used. DMIST, DFUAS, and MUNGS are used to predict healed and non-healing wounds. LUMT determines the evaluation and documentation of leg ulcers, and RESVECH 2.0 is designed to shorten the duration of chronic wound occurrence. The psychometric properties of the DMIST scale were identified, including reliability, validity, and responsiveness.

Conclusions

Five tools for assessing chronic wounds were identified. The predictive validity and responsiveness of the DMIST tool were supported by a sufficient rating based on evidence quality. This scoping review provides an overview of the measurement properties of available assessment tools for diabetic foot ulcers.

The measurement properties of assessment tools for chronic wounds: A systematic review

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.

Effect of Family Empowerment on HbA1c Levels and Healing of Diabetic Foot Ulcers

Objective. To evaluate the effectiveness of family empowerment through educational interventions against HbA1c level and healing progress of diabetic foot ulcers. Method. A quasi-experimental design was employed involving 33 participants from 4 wound care clinics in Makassar, eastern Indonesia. The intervention group consisted of 17 participants and their families; the control group was composed of 16 participants who received nonstructural education. Family empowerment was measured by the Indonesian version of the Family Empowerment Scale instrument. Glycemic control was evaluated with HbA1c levels, and the wound healing process was evaluated on the Diabetic Foot Ulcers Assessment Scale. Result. After 3 months, Family Empowerment Scale scores improved, particularly in the subdomain of family knowledge (16.59 ± 3.92 vs 13.38 ± 1.26; P = .005) and attitude (3.65 ± 0.93 vs 2.75 ± 0.45; P = .002). After 3 months of intervention, HbA1c decreased (from 10.47 ± 2.44% to 8.81 ± 1.83%), compared with the control group ( P = .048). Meanwhile, an independent t test further revealed that the wound healing process tended to be better with the intervention group (4.71 ± 7.74) compared with the control group (17.25 ± 17.06), with P = .010 at the third month. Conclusion. Family-based education intervention creates family empowerment to control HbA1c levels and accelerate wound healing of diabetic foot ulcer.