Evaluation of the internal and external responsiveness of the Pressure Ulcer Scale for Healing (PUSH) tool for assessing acute and chronic wounds

Abstract

Aim: To examine the internal and external responsiveness of the Pressure Ulcer Scale for Healing (PUSH) tool for assessing the healing progress in acute and chronic wounds.

Background: It is important to establish the responsiveness of instruments used in conducting wound care assessments to ensure that they are able to capture changes in wound healing accurately over time.

Design: Prospective longitudinal observational study.

Method: The key study instrument was the PUSH tool. Internal responsiveness was assessed using paired t‐testing and effect size statistics. External responsiveness was assessed using multiple linear regression. All new patients with at least one eligible acute or chronic wound, enrolled in the Nurse and Allied Health Clinic‐Wound Care programme between 1 December 2012 – 31 March 2013 were included for analysis (N = 541).

Results: Overall, the PUSH tool was able to detect statistically significant changes in wound healing between baseline and discharge. The effect size statistics were large. The internal responsiveness of the PUSH tool was confirmed in patients with a variety of different wound types including venous ulcers, pressure ulcers, neuropathic ulcers, burns and scalds, skin tears, surgical wounds and traumatic wounds. After controlling for age, gender and wound type, subjects in the ‘wound improved but not healed’ group had a smaller change in PUSH scores than those in the ‘wound healed’ group. Subjects in the ‘wound static or worsened’ group had the smallest change in PUSH scores. The external responsiveness was confirmed.

Conclusion: The internal and external responsiveness of the PUSH tool confirmed that it can be used to track the healing progress of both acute and chronic wounds.