Pressure ulcers are wounds that result when people are immobile or have reduced mobility. They tend to occur over bony prominences. Pressure ulcers can range from superficial skin damage to deep, extensive wounds that extend through to the bone. The prevention and treatment of pressure ulcers have been identified as major costs for health-care providers.
In order to compare interventions to prevent or treat pressure ulcers it is necessary to be able to examine their impact on quality of life. This can be done through the use of preference-based patient reported outcome measures (PROMs), which are questionnaires that ask about the participant's state of health. PROMs are grouped into those that are designed for only those with a specific condition and generic ones that can be completed by a wide range of people with many different health problems. It is currently unclear which of these are best for people with pressure ulcers.
The purpose of the study was to explore the feasibility of using generic PROMs in patients with pressure ulcers or at risk of developing pressure ulcers.
Approach
The study took place in the UK but there are likely to be similar issues in Canada and other countries. Participants were identified in the hospital and community through a database of patients who were using pressure relieving mattresses and equipment. In the hospital area a handheld tablet computer was used to administer the survey and if requested, assistance was provided. In the community setting this was not feasible, so a postal survey was carried out. During the survey a total of 525 patients were screened for inclusion but over half (52 per cent) of the patients were unable to be approached because clinical staff thought that they were too unwell or would have problems understanding due to dementia or mental capacity. A total of 273 participants were included within the acute hospital setting. In the community, 130 questionnaires were sent and 41 replies received (32 per cent response rate). The effectiveness of the survey questionnaires are assessed based on standards that have been used in many previous studies including: completion rates, agreement and ability to distinguish between different groups.
Highlights of the findings
The results of the study suggested that generic PROMs can effectively capture the impact of pressure ulcers on quality of life. The generic PROM questionnaires showed good measurement properties based on commonly accepted criteria used to evaluate the performance of questionnaires. They displayed high completion rates and agreement in measuring the impact on quality of life.
The presence of an ulcer had a negative impact on quality of life and also led to a perceived lower level of dignity. The PROM questionnaires were able to measure the difference between those who had an ulcer and those who did not have an ulcer.
The study highlighted that collecting data from this group of patients can best be achieved when it is guided by interviewers compared to self-completion. It also underscored that a large proportion of patients with pressure ulcers may be too ill or have problems with understanding to participate in research studies.
Implications for practice
Pressure ulcers are a consequence of reduced mobility which can be due to a wide range of illness and treatments. This may mean that it can be difficult to separate the impact of the illness or treatment from the impact of the pressure ulcer so generic PROMs should be used rather than one developed for pressure ulcers. The high number of people who were unable to participate and the low response rate for the postal self-completion group suggest that interviewers to guide participants should be used with this group of patients. This has potential resource issues implications due to the greater time and costs of interviewers. The study also emphasized that any participants in research studies may not necessarily be equivalent to the wider group of people who have pressure ulcers. It also highlighted that having a pressure ulcer has a negative effect on dignity and so clinicians should try and take this into consideration when caring for this group of patients.
(Reprinted with permission from AlbertaRN magazine, Vol 71 No 4)