The Development and Preliminary Validity Testing of the Healing Progression Rate Tool

Accurate assessment and clear documentation are important aspects of wound care; they provide a basis for appropriate patient care decisions and reimbursement. A descriptive, qualitative study was conducted to develop and provide preliminary evidence of the validity of a new tool to measure wound healing (the Healing Progression Rate [HPR]), a modified version of the Pressure Ulcer Scale for Healing (PUSH). Three (3) groups of current and future practitioners participated in the instrument development and evaluation process: 1) 3 wound care experts/authors (2 physical therapists, 1 nurse) with a minimum of 15 years of experience, 2) 6 additional wound care experts (4 nurses and 2 physical therapists) with a minimum of 10 years experience, and 3) 120 participants (77 [64.2%] RNs, 2 [1.7%] nursing students, 12 [10%] physical therapists [PTs], and 29 [24.2%] PT students). After the instrument was developed, the first group of 3 wound care experts used 2 photos of the same pressure injury at different points in time for 30 different wound cases to determine wound status (improved, worse, or the same) using the HPR and PUSH tools. The 6 experts from group 2 completed a similar exercise and, after completing a demographic questionnaire, the nonexpert participants scored 20 randomly selected cases (10 with the PUSH and 10 with the HPR) followed by a 4-question survey about the instruments. All data were collected on spreadsheets. Descriptive statistics were generated and mean HPR and PUSH scores for each image were compared to expert scores using a paired t-test. If the mean of participants' image scores was significantly higher or lower than that of the experts, it was placed in the "higher" or "lower" group. If the difference was not statistically significant, the image was placed in the "same" group. Chi-squared tests (χ2) were used to compare the frequency distribution within each of these 3 groups for the HPR and PUSH tools. Due to violations of normality, the nonparametric Friedman's analysis of variance and Wilcoxon signed rank test were used to compare the experts' votes on which tool they thought captured the difference between the pre- and post-wound pictures and to perform post hoc testing, respectively. Qualitative data from the exit survey were reviewed and grouped into common themes. In 8 cases, a statistically significant difference was found among the number of votes (from the 6 experts) for which tool best reflected the change in wound status (χ2 (2) = 11.20; P = .004). Post hoc comparison revealed experts believed the change in HPR score better reflected the change in wound status compared to the PUSH tool (P = .026). Almost 75% of nonexpert participants preferred the HPR, rating it as more objective (73%). The results of this preliminary validation study suggest that further validation and reliability testing is warranted.