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Inter-rater reliability assessment of new diabetic foot ulcers (The Diabetic Foot Ulcer Assessment Scale) based on photograph
Hasniati Haeruddina, Saldy Yusufb,
Corresponding author
saldy_yusuf@yahoo.com

Corresponding author.
, Ilhamjaya Patellongic, Kaharuddin Abdul Rasidd, Harbaeni Harkama, Edy Supardie
a Gema Insan Akademik College of Health Sciences Makassar, Indonesia
b Faculty of Nursing, Hasanuddin University, Makassar, Indonesia
c Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
d Faculty of Cultural Science, Hasanuddin University, Makassar, Indonesia
e Nani Hasanuddin College of Health Sciences Makassar, Indonesia
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">As a major complication of Diabetes Mellitus &#40;DM&#41;&#44; the prevalence of diabetic foot ulcers &#40;DFU&#41; was reported 25&#37; among DM patient&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> In Indonesia&#44; DFU is a significant chronic wound in-home care setting&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> and 12&#37; in a hospital setting&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Thus&#44; in the clinical setting&#44; it is very important to assess the wound healing process&#44; including DFU&#46; Assessment of DFU status becomes the first corner in the management of DFU&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">There are several assessment tools that have been used for DFU&#44; including the Bates-Jensen Wound Assessment Tool &#40;BWAT&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5&#44;6</span></a> and Pressure Ulcers Scale for Healing &#40;PUSH&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> By evaluating DFU correctly&#44; the outcome of the wound care process can be evaluated and communicated between nurses&#46; Therefore&#44; a valid and reliable DFU assessment scale is pivotal needed to ensure the quality of data&#46; Recently&#44; a new assessment scale has been developed&#44; namely The New Diabetic Foot Ulcer Assessment Scale &#40;DFUAS&#41;&#46; DFUAS has been reported excellent to measure sensitivity&#44; specificity&#44; positive predictive value&#44; and negative predictive&#44; respectively&#44; 89&#37;&#44; 71&#37;&#44; 86&#37;&#44; and 77&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Despite&#44; it has good validity&#44; the reliability particularly has not been known between nurses&#46; Thus&#44; this study aimed to evaluate the reliability of DFUAS among different nurses&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Method</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Design and participants</span><p id="par0015" class="elsevierStylePara elsevierViewall">This research design was a comparison measurement between wound care nurses&#46; This research involved wound care nurses from seven cities in Indonesia and conducted from July to August 2017&#46; The inclusion criteria were certified wound care nurses who hold wound certification&#44; nursing education with at least hold a diploma degree&#44; and work experience with DFU at least 2 years&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Translation process</span><p id="par0020" class="elsevierStylePara elsevierViewall">The forward translation of DFUAS was translated into Bahasa by English expert and evaluated by two wound care nurses differently for clearance of the text meaning&#44; then being revised particularly for the technical term&#46; After that&#44; the backward translation was performed to compare with the original version to compare content and construct appropriateness&#46; Lastly&#44; the Indonesian version was evaluated for structure and language content by Indonesian language expert from Hasanuddin University&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Interreliability evaluation</span><p id="par0025" class="elsevierStylePara elsevierViewall">Eighteen photographs which reflect various clinical DFU status sent to participants via online &#40;WhatsApp&#44; Email&#44; or Line application&#41;&#46; The participants were asked to evaluate DFU status based on photograph for six days using the Indonesian version of DFUAS&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Data analysis</span><p id="par0030" class="elsevierStylePara elsevierViewall">Cohen&#39;s kappa was used to evaluate inter reliability between nurses &#40;SPSS 22&#44; for Windows&#41;&#46; This study was approved by the Ethics Committee&#44; Faculty Medicine&#44; Hasanuddin University &#40;No&#46; 275&#47;H4&#46;8&#46;4&#46;5&#46;31&#47;PP36-KOMETIK&#47;2017&#41;&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Results</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Characteristics of participants</span><p id="par0035" class="elsevierStylePara elsevierViewall">Thirty-three wound care nurses participated in the current study and evaluated 18 photographs of DFU using Indonesian version of DFUAS &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">The mean age of participants was &#40;32&#46;21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD 5&#46;68&#41; years old&#44; majority from undergraduate &#40;<span class="elsevierStyleItalic">n</span>&#58; 28&#44; 84&#46;8&#37;&#41;&#44; with working experience dominantly &#8804;5 years &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>28&#44; 84&#46;8&#37;&#41;&#44; and with various wound care certification &#40;data not shown&#41;&#46; The Cohen&#39;s kappa revealed that the inter-rater reliability for depth &#40;0&#46;76&#8211;0&#46;80&#41;&#44; size &#40;0&#46;80&#8211;0&#46;86&#41;&#44; size score &#40;0&#46;87&#8211;0&#46;89&#41;&#44; inflammation&#47;infection &#40;0&#46;69&#8211;0&#46;77&#41;&#44; proportion of granulation tissue &#40;0&#46;73&#8211;0&#46;79&#41;&#44; type of necrotic tissue &#40;0&#46;65&#8211;0&#46;73&#41;&#44; proportion of necrotic tissue &#40;0&#46;87&#8211;0&#46;89&#41;&#44; proportion of slough &#40;0&#46;58&#8211;0&#46;65&#41;&#44; maceration &#40;0&#46;79&#8211;0&#46;85&#41;&#44; type of wound edge &#40;0&#46;91&#8211;0&#46;93&#41;&#44; and tunneling &#40;0&#46;90&#8211;0&#46;91&#41;&#44; with overall reliability was 0&#46;93&#44; and similar based on experience &#40;0&#46;92&#44; &#8804;5 years&#41; and &#40;&#62;0&#46;92&#44; 5 years&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">The current study was set out with the aim to evaluate inter-reliability of the Indonesian version of DFUAS among wound care nurses&#46; It is interesting to note that in all eleven sub-scale were moderate&#44; strong&#44; and almost perfect&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Regarding the proportion of slough&#44; the reliability from weak to moderate&#44; it seems possible that these result due to evaluation based on a photograph&#46; However&#44; using photographs to evaluate reliability of the assessment scale of wound healing has been used previously&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> In this study&#44; we also found the interrater reliability was stable between different experience&#44; therefore&#44; it can be assumed that the Indonesian version of DFUAS can be useful as assessment scale between wound care nurses&#46; However&#44; our major limitation is that we performed evaluation based on photographs instead of direct evaluation&#44; which result in some sub variable unable to evaluate&#46; Therefore&#44; the recommendation for further study should be performed in a clinical setting&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conclusion</span><p id="par0050" class="elsevierStylePara elsevierViewall">This study confirmed DFUAS has an adequate reliability&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflict of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The aim of this study is to evaluate the reliability of the Diabetic Foot Ulcer Assessment Scale &#40;DFUAS&#41; among different nurses&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This research design was a comparison measurement between wound care nurses&#46; The forward translation of DFUAS was translated into Indonesian and used to evaluated DFU status based on a photograph DFUAS that has been translated into Bahasa was used to evaluate the DFU status based on photographs&#46; Cohen&#39;s kappa was used to evaluate inter reliability between nurses&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The Cohen&#39;s kappa revealed that the inter-rater reliability for depth &#40;0&#46;76&#8211;0&#46;80&#41;&#44; size &#40;0&#46;80&#8211;0&#46;86&#41;&#44; size score &#40;0&#46;87&#8211;0&#46;89&#41;&#44; inflammation&#47;infection &#40;0&#46;69&#8211;0&#46;75&#41;&#44; proportion of granulation tissue &#40;0&#46;73&#8211;0&#46;79&#41;&#44; type of necrotic tissue &#40;0&#46;65&#8211;0&#46;73&#41;&#44; proportion of necrotic tissue &#40;0&#46;87&#8211;0&#46;89&#41;&#44; proportion of slough &#40;0&#46;58&#8211;0&#46;65&#41;&#44; maceration &#40;0&#46;79&#8211;0&#46;85&#41;&#44; type of wound edge &#40;0&#46;91&#8211;0&#46;93&#41;&#44; and tunneling &#40;0&#46;90&#8211;0&#46;91&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">This study confirmed DFUAS has an adequate reliability between different wound nurses &#40;inter-rater reliability&#41;&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Method"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
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        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Peer-review under responsibility of the scientific committee of the International Conference on Women and Societal Perspective on Quality of Life &#40;WOSQUAL-2019&#41;&#46; Full-text and the content of it is under responsibility of authors of the article&#46;</p>"
      ]
    ]
    "multimedia" => array:2 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:3 [
          0 => array:1 [
            "imagen" => "gr1a.jpeg"
          ]
          1 => array:1 [
            "imagen" => "gr1b.jpeg"
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          2 => array:1 [
            "imagen" => "gr1c.jpeg"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Indonesian version of the new diabetic foot ulcer assessment scale&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
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        "tabla" => array:1 [
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              "tabla" => array:1 [
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                  \t\t\t\t">Photo 7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Photo 8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Photo 11&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Photo 12&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Photo 13&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Photo 14&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Photo 15&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Photo 16&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Photo 17&nbsp;\t\t\t\t\t\t\n
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ISSN: 11308621
Original language: English
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

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