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Baker BG, Pieri A. Assessment of Patient-Reported Outcomes for Closed-Incision Negative Pressure Therapy with Wide-Coverage Dressings in Simple Mastectomy and Immediate Implant-Based Breast Reconstruction. Adv Wound Care (New Rochelle) 2024. [PMID: 38695108 DOI: 10.1089/wound.2023.0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024] Open
Abstract
Objective: A new configuration of closed-incision negative pressure therapy (ciNPT) dressings now covers the incision and a broader area of peri-incisional tissues. We have implemented these ciNPT dressings following simple mastectomy (SM) or skin-sparing mastectomy with implant-based reconstruction (IBR). This study assesses patient-reported outcomes of this new protocol. Approach: Patients underwent SM or IBR for breast cancer. ciNPT with wide-coverage dressings were placed over the entire breast, and -125 mmHg was applied for 14 days. Upon dressing removal, patients rated their experience using the Wound-Q™ Suction Device Scale and recorded their satisfaction on a Likert scale ranging 1-5. Results: Thirteen SM patients and 12 IBR patients were included in the study. The median age was 62 years, and SM patients were significantly older (p < 0.01). Patients rated the ciNPT device highest on items relating to its function and appearance, and lowest on noise and interference with sleep and physical activity. The overall mean score for the combined cohort was 64.8/100. The mean score for SM patients (74.8 ± 19.9) was significantly greater than for IBR patients (53.9 ± 9.6, p < 0.01). The mean overall patient satisfaction rating was 3.92 on a 5-point scale; 4.0 in the SM group and 3.8 in the IBR group. Innovation: This study is the first to report on the patient experience with these newly available wide-coverage ciNPT dressings. Conclusion: Overall, the dressing was well-tolerated by patients, and satisfaction was high. The positive reception of ciNPT with wide-coverage dressings supports continued use at our hospital.
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Affiliation(s)
| | - Andrew Pieri
- Royal Victoria Infirmary, Newcastle Upon Tyne, UK
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2
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Simonsen NV, Klassen AF, Rae C, Mundy LR, Poulsen L, Pusic AL, Fan KL, Sørensen JA. The WOUND-Q Function and Symptoms Scales for Chronic Lower Extremity Wounds: A Validation Study. Adv Wound Care (New Rochelle) 2024. [PMID: 38775456 DOI: 10.1089/wound.2024.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024] Open
Abstract
Objective: Determine the validity and reliability of the LIMB-Q scales, Function, and Symptoms in patients with chronic lower extremity wounds. Approach: Cognitive debriefing interviews with people with current or previous wounds were conducted to examine content validity. Scales were field-tested in an international sample of people with chronic lower extremity wounds sourced from an online platform (i.e., Prolific). Psychometric properties were examined using the Rasch Measurement Theory analysis. A test-retest reproducibility study was performed, and construct validity was examined. Results: Content validity was established after 10 cognitive interviews. A total of 233 people with lower extremity wounds (age 19-80 years, mean 39.3) participated in the field test. All 25 items tested demonstrated good fit to the Rasch model with ordered thresholds. One item had a fit residual outside ±2.5, but no items had significant χ2 values after Bonferroni adjustment. Reliability was high with the person separation index, Cronbach alpha, and intraclass correlation coefficient values >0.8. Strong correlations were found between the Function and Symptoms scales and EQ-5D dimensions measuring similar constructs as well as the EQ-5D global score. All hypotheses for construct validity were confirmed. Innovation: Patient-reported outcome measures are an important component of patient-centered care, as they capture the patient's perspective in a rigorous and reproducible way. Adding these two scales to the WOUND-Q provides a means to measure function and symptoms associated with lower extremity wounds. Conclusion: These new WOUND-Q scales can be used to measure outcomes important to patients with lower extremity wounds in clinical settings and research studies.
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Affiliation(s)
- Nina Vestergaard Simonsen
- Research Unit for Plastic Surgery, Department of Plastic Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Charlene Rae
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Lily R Mundy
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Lotte Poulsen
- Research Unit for Plastic Surgery, Odense University Hospital, University of Southern Denmark, Denmark
| | - Andrea L Pusic
- Department of Surgery and Patient-Reported Outcomes, Value & Experience (PROVE) Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Maryland, USA
| | - Kenneth L Fan
- Department of Plastic and Reconstructive Surgery, MedStar, MedStar Plastic and Reconstructive Surgery, Washington, USA
| | - Jens Ahm Sørensen
- Research Unit for Plastic Surgery, Department of Plastic Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark
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Gallo L, Rae C, Voineskos S, Simonsen NV, Pusic AL, Poulsen L, Sørensen JA, Klassen AF, Cano SJ. Further psychometric evaluation of the WOUND-Q: A responsiveness study. Wound Repair Regen 2024; 32:451-463. [PMID: 38656503 DOI: 10.1111/wrr.13179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/19/2024] [Accepted: 03/28/2024] [Indexed: 04/26/2024]
Abstract
The WOUND-Q is a modular patient-reported outcome measure (PROM) with 13 scales measuring constructs across 4 domains (i.e., wound characteristics, health related quality of life, experience of care and wound treatment). The psychometrics of the WOUND-Q were previously assessed and the 13 scales evidenced good validity and reliability. However, the responsiveness (i.e., ability to detect clinical change) of the WOUND-Q has yet to be assessed. The objective of this study was to evaluate responsiveness for 9 WOUND-Q scales that assess outcomes, in a sample of people 18 years of age or older with chronic wounds that were present for at least 3 months. This study conducted a 4 month follow-up of 421 participants who completed the WOUND-Q as part of a previous psychometric study. Participants completed an online survey answering questions about their current wound state (e.g., number, type, size, smell, drainage), anchor questions about change, as well as the WOUND-Q scales that they had completed in their initial assessment. Pre-defined hypotheses were tested with a 75% acceptance threshold indicating sufficient evidence of responsiveness. Minimally important differences (MIDs) were also calculated using both anchor-based and distribution-based methods. Of 390 invited participants, 320 provided responses, ranging in age from 19 to 84 years. Acceptance of hypotheses ranged from 60% to 100%, with only the Symptom scale not meeting the 75% threshold. The findings of this study provide evidence that the WOUND-Q can validly measure clinical change in patients with chronic wounds.
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Affiliation(s)
- Lucas Gallo
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Charlene Rae
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Sophocles Voineskos
- Division of Plastic, Reconstructive & Aesthetic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Nina Vestergaard Simonsen
- Department of Plastic Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Andrea L Pusic
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lotte Poulsen
- Department of Plastic Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Jens Ahm Sørensen
- Department of Plastic Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Stefan J Cano
- Modus Outcomes (a Division of Thread), Cheltenham, UK
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Marangi GF, Mirra C, Gratteri M, Cogliandro A, Salzillo R, Segreto F, Federico G, Romano FD, Rossi C, Persichetti P. Switching from Galenic to Advanced Dressings or Vacuum Assisted Closure Therapy Can Improve Quality of Life of Patients with Chronic Non-Responsive Pressure Skin Ulcers: Preliminary Data with Italian Translation of WOUND-Q. Adv Wound Care (New Rochelle) 2024; 13:131-139. [PMID: 37551983 DOI: 10.1089/wound.2022.0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Abstract
Objective: A few studies have focused on the quality of life (QoL) of patients with chronic non-responsive pressure skin ulcers. The aim of this study was to assess how correct treatment (advanced wound care [AWC] dressings alone or vacuum assisted closure [VAC] therapy alone) changes the QoL of these patients. Approach: One hundred six patients with chronic non-responsive pressure skin ulcers, who had previously used galenic dressings, applied without proper therapeutic indication, were included in this study. We administered the WOUND-Q, at time 0 and after 1 month of appropriate therapy, to assess patient-reported outcome measures. Group 1 consisted of 30 patients treated with advanced dressings, Group 2: 22 patients treated with VAC therapy, and Group 3: 30 patients continuing conventional galenic dressings (Control group). Statistical analysis allowed us to analyze QoL changes over time and to compare WOUND-Q Group 1 and 2 deltas with those of Group 3. The study followed the STROBE statement. Results and Innovation: In all the scales evaluated (Assessment, Drainage, Smell, Life impact, Psychological, Social, Sleep and Dressing), there were significant improvements in mean values for Groups 1 and 2. Kruskal-Wallis tests with Dunn's multiple-comparisons tests and Brown-Forsythe and Welch Analysis of Variance tests demonstrated significant differences between deltas of Group 1 and Group 2 compared with those of Group 3 for most scales analyzed. Conclusions: Administration of the WOUND-Q demonstrated that the application of advanced dressings alone or VAC therapy alone positively affects the QoL of patients with chronic nonresponsive pressure wounds, in comparison with galenic dressings alone. The WOUND-Q has been shown to be a valid tool in studying changes in QoL of these patients.
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Affiliation(s)
- Giovanni Francesco Marangi
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Carlo Mirra
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Marco Gratteri
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Annalisa Cogliandro
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Rosa Salzillo
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Francesco Segreto
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Gaetano Federico
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Fara Desiree Romano
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Caterina Rossi
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Paolo Persichetti
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
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Tsangaris E, van Haren EL, Poulsen L, Squitieri L, Hoogbergen MM, Cross K, Sørensen JA, van Alphen TC, Pusic A, Klassen AF. Identifying health-related quality of life concepts to inform the development of the WOUND-Q. J Wound Care 2024; 33:28-38. [PMID: 38197277 DOI: 10.12968/jowc.2024.33.1.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
OBJECTIVE The impact of hard-to-heal wounds extends beyond traditional clinical metrics, negatively affecting a patient's health-related quality of life (HRQoL). Yet treatment outcomes are seldom measured from the patient's perspective. The purpose of the present study was to perform in-depth qualitative interviews with patients diagnosed with varying types of hard-to-heal wounds to identify outcomes important to them. METHOD Participants were recruited from wound care clinics in Canada, Denmark, the Netherlands and the US, and were included if they had a hard-to-heal wound (i.e., lasting ≥3 months), were aged ≥18 years, and fluent in English, Dutch or Danish. Qualitative interviews took place between January 2016 and March 2017. An interpretive description qualitative approach guided the data analysis. Interviews were audio-recorded, transcribed and coded line-by-line. Codes were categorised into top-level domains and themes that formed the final conceptual framework. RESULTS We performed 60 in-depth interviews with patients with a range of wound types in different anatomic locations that had lasted from three months to 25 years. Participants described outcomes that related to three top-level domains and 13 major themes: wound (characteristics, healing); HRQoL (physical, psychological, social); and treatment (cleaning, compression stocking, debridement, dressing, hyperbaric oxygen, medication, suction device, surgery). CONCLUSION The conceptual framework developed as part of this study represents the outcome domains that mattered the most to the patients with hard-to-heal wounds. Interview quotes were used to generate items that formed the WOUND-Q scales, a patient-reported outcome measure for patients with hard-to-heal wounds.
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Affiliation(s)
- Elena Tsangaris
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, US
| | - Emiel Lwg van Haren
- Department of Plastic and Reconstructive Surgery, Catharina Ziekenhuis, Eindhoven, the Netherlands
| | - Lotte Poulsen
- Research Unit for Plastic Surgery, Odense University Hospital, University of Southern Denmark, Denmark
- Odense Explorative Patient Network, Odense, Denmark
| | - Lee Squitieri
- RAND Corporation, Santa Monica, CA, US
- Plastic and Reconstructive Surgery, Adventist Health White Memorial, Los Angeles, CA, US
| | - Maarten M Hoogbergen
- Department of Plastic and Reconstructive Surgery, Catharina Ziekenhuis, Eindhoven, the Netherlands
| | - Karen Cross
- St. Michael's Hospital, Keenan Research Centre, Toronto, Ontario, Canada
| | - Jens Ahm Sørensen
- Research Unit for Plastic Surgery, Odense University Hospital, University of Southern Denmark, Denmark
- Odense Explorative Patient Network, Odense, Denmark
| | - Tert C van Alphen
- Department of Plastic and Reconstructive Surgery, Catharina Ziekenhuis, Eindhoven, the Netherlands
| | - Andrea Pusic
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, US
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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Simonsen NV, Klassen AF, Rae C, Dalaei F, Cano S, Poulsen L, Pusic AL, Sørensen JA. Further psychometric validation and test-retest reproducibility of the WOUND-Q. Int Wound J 2024; 21:e14354. [PMID: 37581232 PMCID: PMC10777769 DOI: 10.1111/iwj.14354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/03/2023] [Indexed: 08/16/2023] Open
Abstract
WOUND-Q is a condition-specific patient-reported outcome measure developed for all types of chronic wounds, located anywhere on the body. To establish reliability and validity of a patient-reported outcome measure, multiple pieces of evidence are required. The purpose of this study was to examine the measurement properties of 9 of the 13 WOUND-Q scales and perform a test-retest reproducibility study in an international sample. In August 2022, we invited members of an international online community (Prolific.com) with any type of chronic wound to complete a survey containing the WOUND-Q scales, the Wound-QoL and EQ-5D. A test-retest survey was performed 7 days after the first survey. It was possible to examine the reliability and validity of eight of the nine WOUND-Q scales by Rasch Measurement Theory (RMT). To examine test-retest reproducibility intraclass correlation coefficients (ICCs), the standard error of the measurement and the smallest detectable change were calculated. In total, 421 patients from 22 different countries with 11 different types of chronic wounds took part in this study. Our analyses provided further evidence of the reliability and validity of the scales measuring wound characteristics (assessment, drainage, smell), health-related quality of life (life impact, psychological, sleep, social) and wound treatment (dressing).
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Affiliation(s)
- Nina Vestergaard Simonsen
- Department of Plastic Surgery, Odense University Hospital, Odense, DenmarkUniversity of Southern DenmarkOdenseDenmark
| | | | - Charlene Rae
- Department of PediatricsMcMaster UniversityHamiltonCanada
| | - Farima Dalaei
- Department of Plastic Surgery, Odense University Hospital, Odense, DenmarkUniversity of Southern DenmarkOdenseDenmark
| | | | - Lotte Poulsen
- Research Unit for Plastic SurgeryOdense University Hospital, Løntoft, Nyhøj and Poulsen Plastic SurgeryOdenseDenmark
| | - Andrea L. Pusic
- Patient‐Reported Outcomes, Value & Experience (PROVE) Center, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Jens Ahm Sørensen
- Department of Plastic Surgery, Odense University Hospital, Odense, DenmarkUniversity of Southern DenmarkOdenseDenmark
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Lommi M, Raffaele B, Tolentino Diaz MY, Montini G, Puleio C, Porcelli B. Nursing outcomes in wound care management: A mixed method study. Nurs Open 2023; 10:2249-2263. [PMID: 36478413 PMCID: PMC10006662 DOI: 10.1002/nop2.1477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/19/2022] [Accepted: 11/04/2022] [Indexed: 12/12/2022] Open
Abstract
AIM The aim of the study was to analyse the management of chronic wound outcomes and the experience of patients with chronic ulcers. DESIGN Explanatory mixed method. METHODS This study consisted in a sequential explanatory mixed method with a quantitative and a qualitative phase. In the first phase, quantitative data were collected during a longitudinal study, in a convenience sample of 44 patients presenting at a nursing outpatients' clinic. Linear regression was conducted to evaluate the associations between variables. In phase two, 14 patients from the initial sample were interviewed, and the data were analysed using Giorgi's descriptive phenomenological method. RESULTS The participants, mostly males, in conditions of comorbidity and polypharmacotherapy, were mainly affected by venous leg ulcers. An association between the quality of life of patients (both physical and mental) and some socio-demographic and clinical factors has been confirmed. I Variance analysis showed a significant wound improvement across all the measurement times. The themes identified through the qualitative analysis were: "Cared by self," "Cared by Healthcare Providers" and "Quality of life".
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Affiliation(s)
- Marzia Lommi
- UOC Care to the Person, Local Health Authority Roma 2, Italy, Rome, Italy
| | - Barbara Raffaele
- UOC Care to the Person, Local Health Authority Roma 2, Italy, Rome, Italy
| | | | - Graziella Montini
- UOC Care to the Person, Local Health Authority Roma 2, Italy, Rome, Italy
| | - Cinzia Puleio
- UOC Care to the Person, Local Health Authority Roma 2, Italy, Rome, Italy
| | - Barbara Porcelli
- UOC Care to the Person, Local Health Authority Roma 2, Italy, Rome, Italy
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SCI-QOL and WOUND-Q Have the Best Patient-reported Outcome Measure Design: A Systematic Literature Review of PROMs Used in Chronic Wounds. Plast Reconstr Surg Glob Open 2023; 11:e4723. [PMID: 36699211 PMCID: PMC9831160 DOI: 10.1097/gox.0000000000004723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 10/26/2022] [Indexed: 01/27/2023]
Abstract
Chronic wounds are a significant burden on healthcare systems due to high costs of care (2%-4% total healthcare cost) and a considerable burden on patient's quality of life. Patient-reported outcome measures (PROMs) are questionnaires developed to enable patient self-assessments of their outcomes. A gap in knowledge exists because previous reviews on wound-specific PROMs did not evaluate the quality of the development. The main question is which PROM has the best quality development properties and should be used in clinical care and research. Methods PubMed, Embase, and CINAHL were searched from their inception through December 2021. Studies that included patients aged 18 years or older, with chronic wounds, and who reported using a condition-specific PROM for wounds were extracted. We excluded generic PROMs, comments, guidelines, and editorial letters. The COSMIN-guidelines were used to evaluate the quality of the PROMs. Results Of the 16,356 articles, a total of 251 articles describing 33 condition-specific PROMs for wounds were used. In total, 17 of 33 (52%) PROMs were developed for specific wound types, and nine of 33 (27%) PROMs were developed for any type of wound. Two of 33 (6%) PROMs were not rated because no development article was available. Only the SCI-QOL (Spinal Cord Injury-QOL) and the WOUND-Q rated "very good" in PROM design. Conclusions Thirty-three condition-specific PROMs were found. Only the SCI-QOL and the WOUND-Q rated very good in PROM design. The WOUND-Q is the only condition-specific PROM, which can be used in all types of chronic wounds in any anatomic location.
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Raepsaet C, Alves P, Cullen B, Gefen A, Lázaro-Martínez JL, Lev-Tov H, Najafi B, Santamaria N, Sharpe A, Swanson T, Woo K, Beeckman D. Clinical research on the use of bordered foam dressings in the treatment of complex wounds: A systematic review of reported outcomes and applied measurement instruments. J Tissue Viability 2022; 31:514-522. [DOI: 10.1016/j.jtv.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/16/2022] [Indexed: 10/18/2022]
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10
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van de Vyver M, Boodhoo K, Frazier T, Hamel K, Kopcewicz M, Levi B, Maartens M, Machcinska S, Nunez J, Pagani C, Rogers E, Walendzik K, Wisniewska J, Gawronska-Kozak B, Gimble JM. Histology Scoring System for Murine Cutaneous Wounds. Stem Cells Dev 2021; 30:1141-1152. [PMID: 34130483 DOI: 10.1089/scd.2021.0124] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Monitoring wound progression over time is a critical aspect for studies focused on in-depth molecular analysis or on evaluating the efficacy of potential novel therapies. Histopathological analysis of wound biopsies can provide significant insight into healing dynamics, yet there is no standardized and reproducible scoring system currently available. The purpose of this study was to develop and statistically validate a scoring system based on parameters in each phase of healing that can be easily and accurately assessed using either Hematoxylin & Eosin (H&E) or Masson's Trichrome (MT) staining. These parameters included re-epithelization, epithelial thickness index, keratinization, granulation tissue thickness, remodeling, and the scar elevation index. The initial phase of the study was to (1) optimize and clarify healing parameters to limit investigator bias and variability; (2) compare the consistency of parameters assessed using H&E versus MT staining. During the validation phase of this study, the accuracy and reproducibility of this scoring system was independently iterated upon and validated in four different types of murine skin wound models (Excisional; punch biopsy; pressure ulcers; burn wounds). A total of n = 54 histology sections were randomized, blinded, and assigned to two groups of independent investigators (n = 5 per group) for analysis. The sensitivity of each parameter (ranging between 80% and 95%) is reported with illustrations on the appropriate assessment method using ImageJ software. In the validated scoring system, the lowest score (score:0) is associated with an open/unhealed wound as is evident immediately and within the first day postinjury, whereas the highest score (score:12) is associated with a completely closed and healed wound without excessive scarring. This study defines and describes the minimum recommended criteria for assessing wound healing dynamics using the SPOT skin wound score. The acronym SPOT refers to the academic and scientific institutions that were involved in the development of the scoring system, namely, Stellenbosch University, Polish Academy of Sciences, Obatala Sciences, and the University of Texas Southwestern.
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Affiliation(s)
- Mari van de Vyver
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Kiara Boodhoo
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Katie Hamel
- Obatala Sciences, Inc., New Orleans, Louisiana, USA
| | - Marta Kopcewicz
- Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Olsztyn, Poland
| | - Benjamin Levi
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Michelle Maartens
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sylwia Machcinska
- Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Olsztyn, Poland
| | - Johanna Nunez
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Chase Pagani
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Emma Rogers
- Obatala Sciences, Inc., New Orleans, Louisiana, USA
| | - Katarzyna Walendzik
- Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Olsztyn, Poland
| | - Joanna Wisniewska
- Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Olsztyn, Poland
| | - Barbara Gawronska-Kozak
- Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Olsztyn, Poland
| | - Jeffrey M Gimble
- Obatala Sciences, Inc., New Orleans, Louisiana, USA.,Department of Medicine, Structural and Cellular Biology, and Surgery, Center for Stem Cell Research and Regenerative Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
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11
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Klassen AF, van Haren ELWG, van Alphen TC, Cano S, Cross KM, van Dishoeck AM, Fan KL, Michael Hoogbergen M, Orgill D, Poulsen L, Ahm Sørensen J, Squitieri L, Tsangaris E, Vasilic D, Pusic AL. International study to develop the WOUND-Q patient-reported outcome measure for all types of chronic wounds. Int Wound J 2021; 18:487-509. [PMID: 33694326 PMCID: PMC8273613 DOI: 10.1111/iwj.13549] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/11/2020] [Accepted: 12/18/2020] [Indexed: 12/13/2022] Open
Abstract
Patient‐reported outcome measures (PROMs) for chronic wounds mainly focus on specific types of wounds. Our team developed the WOUND‐Q for use with all types of wounds in any anatomic location. We conducted 60 concept elicitation interviews with patients in Canada, Denmark, the Netherlands, and the United States. Analysis identified concepts of interest to patients and scales were formed and refined through cognitive interviews with 20 patients and input from 26 wound care experts. Scales were translated into Danish and Dutch. An international field‐test study collected data from 881 patients (1020 assessments) with chronic wounds. Rasch measurement theory (RMT) analysis was used to refine the scales and examine psychometric properties. RMT analysis supported the reliability and validity of 13 WOUND‐Q scales that measure wound characteristics (assessment, discharge, and smell), health‐related quality of life (life impact, psychological, sleep impact, and social), experience of care (information, home care nurses, medical team, and office staff), and wound treatment (dressing and suction device). The WOUND‐Q can be used to measure outcomes in research and clinical practice from the perspective of patients with any type of wound.
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Affiliation(s)
- Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Emiel L W G van Haren
- Department of Plastic and Reconstructive Surgery, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | - Tert C van Alphen
- Department of Plastic and Reconstructive Surgery, Catharina Ziekenhuis and Da Vinci Kliniek, Geldrop, Eindhoven, The Netherlands
| | | | - Karen M Cross
- Department of Surgery, Division of Plastic Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Anne-Margreet van Dishoeck
- Department of Plastic and Reconstructive and Hand Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Kenneth L Fan
- Department of Plastic Surgery, Georgetown University School of Medicine, Plastic and Reconstructive Surgery, MedStar Health Research Institute, Washington, District of Columbia, USA
| | - Maarten Michael Hoogbergen
- Department of Plastic and Reconstructive Surgery, Catharina Ziekenhuis, Eindhoven, and Da Vinci Kliniek, Geldrop, Eindhoven, The Netherlands
| | - Dennis Orgill
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lotte Poulsen
- Research Unit for Plastic Surgery, Odense University Hospital, University of Southern Denmark, and Odense Explorative Patient Network, Odense, Denmark
| | - Jens Ahm Sørensen
- Research Unit for Plastic Surgery, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Lee Squitieri
- RAND Corporation, Santa Monica, California, USA.,Plastic and Reconstructive Surgery, Adventist Health White Memorial, Los Angeles, California, USA
| | - Elena Tsangaris
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Dalibor Vasilic
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Andrea L Pusic
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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