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Nancy Bergstrom - One of the best experts on this subject based on the ideXlab platform.
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Comparison Study of Braden Scale and Time-to-Erythema Measures in Long-term Care.
Journal of wound ostomy and continence nursing : official publication of The Wound Ostomy and Continence Nurses Society, 2015Co-Authors: Tracey L. Yap, Mary Pat Rapp, Susan M. Kennerly, Stanley G. Cron, Nancy BergstromAbstract:PURPOSE The Braden Scale for Predicting Pressure Sore Risk is used to assess risk, and the Centers for Medicare & Medicaid guidelines suggest the use of a tissue tolerance procedure that detects time-to-erythema (TTE) to further refine tissue tolerance, a component of the Braden Scale. The aim of this study was to compare the Braden Scale and TTE as risk classification methods and their utility in identifying care planning interventions. DESIGN Descriptive study using retrospective chart review. SUBJECTS AND SETTING Participants were a convenience sample of 89 adults 65 years or older residing in a long-term care facility in the Midwestern United States. The sample was drawn from a facility-generated list of 90 residents who had both Braden Scale and tissue tolerance testing performed within 24 hours of admission from any setting, readmission after a hospital stay, or performed as part of a routine annual reassessment. METHODS Results of staff performance on the Braden Scale and TTE were compared as risk classification methods and based on their utility for identifying care planning interventions. Data were collected during 1 session when TTE and the Braden Scale were completed. Agreement between the 5 risk categories from the Braden Scale and 5 TTE risk categories was analyzed via the kappa statistic and Kendall tau-c statistic. Spearman or Pearson correlation coefficients were calculated as appropriate for ordinal and continuous risk, intervention, and severity measures. RESULTS The mean Braden Scale score was 17.5 ± 3 (mean ± SD); the mean TTE-Bed was 2.35 ± 0.57 hours and the mean TTE-Chair was 2.18 ± 0.52. Using a Braden Scale score of 18 or less as a cut point for identifying clinically relevant risk for pressure ulcer development, 55 participants were deemed at risk, 62 had mobility subScale scores less than 4, 76 had activity subScale scores less than 4, and 73 were incontinent. The weighted kappa statistic demonstrated weak agreement between TTE-Bed and the Braden Scale Total Score (κ = 0.04; 95% CI: 0.002-0.07). Agreement was not significant for TTE-Chair and the Braden Scale Total Score (κ = 0.01; 95% CI: -0.01 to 0.04), TTE-Bed and Braden Scale-Mobility (κ = 0.09; 95% CI: -0.05 to 0.23) and between TTE-Chair and Braden Scale-Activity (κ = 0.07; 95% CI: -0.05 to 0.19). The TTE-Chair and TTE-Bed assessment demonstrated fair agreement (κ = 0.37; 95% CI: 0.19-0.55). The Braden Scale cumulative score where a lower score equates to higher risk was found to be correlated with the total number of interventions observed in the care plan (r = -0.62; P < .0001). Correlation between the Braden Scale-Mobility subScale score and in-bed mobility specific interventions was r = -0.64 (P < .0001), whereas correlation for TTE-Bed category and specific in-bed mobility interventions was r = 0.21 (P = .05). CONCLUSION Study findings provide little support for tissue tolerance testing versus assessment using the validated Braden Scale for assessment of pressure ulcer risk. Study findings support the use of the Braden Scale to develop an individualized care plan based on the areas of risk.
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Construct validity of the moisture subScale of the Braden Scale for Predicting Pressure Sore Risk.
Advances in skin & wound care, 2013Co-Authors: Tolulope Omolayo, Mary Pat Rapp, Kilty Brown, Ryan Barrett, Susan D. Horn, Nancy BergstromAbstract:In this study, the construct validity of the moisture subScale of the Braden Scale for Predicting Pressure Sore Risk is partially supported by the significant inverse relationships between moisture subScale scores, the number of wet observations and soiled observations, brief changes, and differences among the moisture subScale score groups.
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validation of the mobility subScale of the Braden Scale for predicting pressure sore risk
Nursing Research, 2004Co-Authors: Geralyn C Powers, Tana Zentner, Francine Nelson, Nancy BergstromAbstract:Background: The Braden Scale for Predicting Pressure Sore Risk has been tested extensively for reliability and validity, but the validity of each subScale has not been evaluated. Because subScale scores are intended to guide patient care decisions, validity is an important issue. Objective: To establish the convergent construct validity of the mobility subScale of the Braden Scale. Methods: The study evaluated 16 members at a veterans' home (4 members representing each score on the mobility subScale). Movement, as recorded by a Motionlogger Actigraph, a wristwatch-sized accelerometer and microprocessor that measures physical movement (activity), was measured continuously. Each person wore an Actigraph on the nondominant ankle for 72 hours. Results: The mean activity for each of the four subScale score groups was plotted, producing a histogram in which higher scores were associated with greater activity (F[3, 15] = 31.69; A Q p <.001, one-way analysis of variance), as expected. Pair wise multiple comparisons between groups showed that only the subgroup with a score of 4 was significantly different in mean activity (p <.001) from the other three score groups. Conclusions: Convergent construct validity for the Braden mobility subScale was supported. A Q A larger sample and establishment of a threshold to eliminate minor, ineffective movements from Motionlogger Actigraph measures may distinguish between significant and nonsignificant movement.
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Validation of the mobility subScale of the Braden Scale for Predicting Pressure sore risk
Nursing research, 2004Co-Authors: Geralyn C Powers, Tana Zentner, Francine Nelson, Nancy BergstromAbstract:Background: The Braden Scale for Predicting Pressure Sore Risk has been tested extensively for reliability and validity, but the validity of each subScale has not been evaluated. Because subScale scores are intended to guide patient care decisions, validity is an important issue. Objective: To establish the convergent construct validity of the mobility subScale of the Braden Scale. Methods: The study evaluated 16 members at a veterans' home (4 members representing each score on the mobility subScale). Movement, as recorded by a Motionlogger Actigraph, a wristwatch-sized accelerometer and microprocessor that measures physical movement (activity), was measured continuously. Each person wore an Actigraph on the nondominant ankle for 72 hours. Results: The mean activity for each of the four subScale score groups was plotted, producing a histogram in which higher scores were associated with greater activity (F[3, 15] = 31.69; A Q p
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Predictive validity of the Braden Scale among black and white subjects
Nursing research, 2002Co-Authors: Nancy Bergstrom, Barbara BradenAbstract:Background: The Braden Scale for Predicting Pressure Sore RiskE (Braden Scale) has been tested for predictive validity, but the cut-off scores for Blacks has not been compared to White populations. Objectives: The purpose of this brief report is to determine if the Braden Scale predicts pressure ulcer risk similarly for Blacks and Whites. Method: A multisite study of the predictive validity of the Braden Scale was conducted in nursing homes, tertiary care, and Veteran's Administration Medical Centers in three cities (Omaha, Chicago, and Raleigh) selected to maximize ethnic diversity. A total of 843 subjects, 666 (79%) White, 159 (12%) Black were studied. Two nurses independently rated each randomly selected subject on admission and every other day until discharge, using the Braden Scale or the Skin Assessment Tool. Results: Whites had a higher incidence of pressure ulcers (15%) than did Blacks (5%), but there was no statistically significant difference in the mean Braden Scale score between groups ( x 19.4, SD 2.8, White versus x 19.8, SD 2.75, Black). A score of 18 best predicts risk for both groups (sensitivity 70%, specificity 77%, with 75% correct predictions for Whites and sensitivity 75%, specificity 76%, with percent correct 76% for Blacks). There was no difference in the area under the receiver-operator characteristic (ROC) curves (0.75, SE 0.03, White and 0.82, SE 0.07, Black subjects, z =.005). Conclusions: A score of 18 can be used for identifying Black and White individuals at risk for pressure ulcers.
Theo Dassen - One of the best experts on this subject based on the ideXlab platform.
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an interrater reliability study of the assessment of pressure ulcer risk using the Braden Scale and the classification of pressure ulcers in a home care setting
International Journal of Nursing Studies, 2009Co-Authors: Jan Kottner, Ruud J G Halfens, Theo DassenAbstract:BACKGROUND: Measurement error can seriously affect the validity of pressure ulcer risk assessment and of pressure ulcer classification. OBJECTIVES: Determination of interrater reliability and agreement of pressure ulcer risk and pressure ulcers using the Braden Scale and the EPUAP system. DESIGN AND SETTING: Duplicate assessments by trained nurses during two nationwide pressure ulcer prevalence surveys in the years 2007 and 2008 in The Netherlands in the home care setting. PARTICIPANTS: Home care clients which participated in 2007 (n=352) and 2008 (n=339) in the pressure ulcer prevalence surveys. METHODS: The Braden Scale was used to assess pressure ulcer risk. Skin examination was conducted to detect pressure related tissue damages and to classify them according to the EPUAP. RESULTS: In 2007 and 2008, Intraclass Correlation Coefficients for Braden Scale sum scores were 0.90 (95% CI: 0.88-0.92) and 0.88 (95% CI: 0.85-0.91) respectively, and corresponding Standard Errors of Measurement were 1.00 and 0.98. 95% limits of agreement were -2.8 to 2.8 and -2.7 to 2.7 respectively. The items "moisture", "sensory perception" and "nutrition" contained largest amounts of measurement error. Proportions of agreement for the classification of pressure ulcers were 96% and interrater reliability was 0.81 and 0.79. Most disagreements were observed for the classification of grade 1 pressure ulcers. CONCLUSIONS: The standardized study procedure applied in the annual nationwide pressure ulcer prevalence surveys leads to reliable and reproducible results regarding pressure ulcer risk and pressure ulcer prevalence in the home care setting. Researchers and practitioners should be careful when drawing inferences from single pressure ulcer risk factors included in the Braden Scale. Descriptions of the items "moisture", "sensory perception" and "nutrition" should be made more clearly and unambiguous.
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an interrater reliability study of the assessment of pressure ulcer risk using the Braden Scale and the classification of pressure ulcers in a home care setting
International Journal of Nursing Studies, 2009Co-Authors: Jan Kottner, Ruud J G Halfens, Theo DassenAbstract:Abstract Background Measurement error can seriously affect the validity of pressure ulcer risk assessment and of pressure ulcer classification. Objectives Determination of interrater reliability and agreement of pressure ulcer risk and pressure ulcers using the Braden Scale and the EPUAP system. Design and setting Duplicate assessments by trained nurses during two nationwide pressure ulcer prevalence surveys in the years 2007 and 2008 in The Netherlands in the home care setting. Participants Home care clients which participated in 2007 ( n =352) and 2008 ( n =339) in the pressure ulcer prevalence surveys. Methods The Braden Scale was used to assess pressure ulcer risk. Skin examination was conducted to detect pressure related tissue damages and to classify them according to the EPUAP. Results In 2007 and 2008, Intraclass Correlation Coefficients for Braden Scale sum scores were 0.90 (95% CI: 0.88–0.92) and 0.88 (95% CI: 0.85–0.91) respectively, and corresponding Standard Errors of Measurement were 1.00 and 0.98. 95% limits of agreement were −2.8 to 2.8 and −2.7 to 2.7 respectively. The items "moisture", "sensory perception" and "nutrition" contained largest amounts of measurement error. Proportions of agreement for the classification of pressure ulcers were 96% and interrater reliability was 0.81 and 0.79. Most disagreements were observed for the classification of grade 1 pressure ulcers. Conclusions The standardized study procedure applied in the annual nationwide pressure ulcer prevalence surveys leads to reliable and reproducible results regarding pressure ulcer risk and pressure ulcer prevalence in the home care setting. Researchers and practitioners should be careful when drawing inferences from single pressure ulcer risk factors included in the Braden Scale. Descriptions of the items "moisture", "sensory perception" and "nutrition" should be made more clearly and unambiguous.
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an interrater reliability study of the Braden Scale in two nursing homes
International Journal of Nursing Studies, 2008Co-Authors: Jan Kottner, Theo DassenAbstract:Abstract Background Adequate risk assessment is essential in pressure ulcer prevention. Assessment Scales were designed to support practitioners in identifying persons at pressure ulcer risk. The Braden Scale is one of the most extensively studied risk assessment instruments, although the majority of studies focused on validity rather than reliability. Objectives The first aim was to measure the interrater reliability of the Braden Scale and its individual items. The second aim was to study different statistical approaches regarding interrater reliability estimation. Design and methods An interrater reliability study was conducted in two German nursing homes. Residents ( n =152) from 8 units were assessed twice. The raters were trained nurses with a work experience ranging from 0.5 to 30 years. Data were analysed using an overall percentage of agreement, weighted and unweighted kappa and the intraclass correlation coefficient. Results Differences between nurses rating the overall Braden score ranged from 0 up to 9 points. Interrater reliability expressed by the intraclass correlation coefficient ranged from 0.73 (95% CI 0.26–0.91) to 0.95 (95% CI 0.87–0.98). Calculated intraclass correlation coefficients for individual items ranged from 0.06 (95% CI −0.31 to 0.48) to 0.97 (95% CI 0.93–0.99) with the lowest values being measured for the items "sensory perception" and "nutrition". There was no association between work experience and the level of interrater reliability. With two exceptions, simple kappa-values were always lower than weighted kappa-values and intraclass correlation coefficients. Conclusions Although the calculated interrater reliability coefficients for the total Braden score were high in some cases, several clinically relevant differences occurred between the nurses. Due to interrater reliability being very low for the items "sensory perception" and "nutrition", it is doubtful if their assessment contributes to any valid results. The calculation of weighted kappa or intraclass correlation coefficients is the most appropriate interrater reliability estimates.
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Interpreting interrater reliability coefficients of the Braden Scale: a discussion paper.
International Journal of Nursing Studies, 2007Co-Authors: Jan Kottner, Theo DassenAbstract:There are many studies investigating psychometric properties of the Braden Scale, a Scale that predicts the risk for pressure ulcers. The main focus of these studies is validity as opposed to reliability. In order to estimate the degree of interrater reliability a literature review revealed that numerous statistical approaches and coefficients were used (Pearson's product-moment correlation, Cohen's kappa, overall percentage of agreement, intraclass correlation). These coefficients were calculated for the individual items and the overall Braden score and were used inconsistently. The advantages and limitations of every coefficient are discussed and it is concluded that most of them are inappropriate measures. Therefore, estimating the degree of the Braden Scale interrater reliability is limited to a certain extent. It is shown that the intraclass correlation coefficient is an appropriate statistical approach for calculating the interrater reliability of the Braden Scale. It is recommended to present intraclass correlation coefficients in combination with the overall percentage of agreement.
Anthony S. Burns - One of the best experts on this subject based on the ideXlab platform.
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Determining Pressure Injury Risk on Admission to Inpatient Spinal Cord Injury Rehabilitation: A Comparison of the FIM, Spinal Cord Injury Pressure Ulcer Scale, and Braden Scale
Archives of physical medicine and rehabilitation, 2019Co-Authors: Heather M. Flett, Jude J. Delparte, Carol Y. Scovil, Johanne Higgins, Marie-thérèse Laramée, Anthony S. BurnsAbstract:Abstract Objective Assess the utility of the admission Spinal Cord Injury Pressure Ulcer Scale (SCIPUS), Braden Scale, and the FIM for identifying individuals at risk for developing pressure injury during inpatient spinal cord injury (SCI) rehabilitation. Design Retrospective cohort. Setting Two tertiary rehabilitation centers. Participants Individuals (N=754) participating in inpatient SCI rehabilitation. Interventions Not applicable. Main Outcome Measures Logistic regression analysis was performed to determine the utility of the SCIPUS, Braden Scale, and FIM for identifying individuals at risk for developing pressure injury (PI) during inpatient SCI rehabilitation. Sensitivity, specificity, positive predictive value, negative predictive value, false negative rate, odds ratio, likelihood ratio, and area under the curve (AUC) are reported. Results The SCIPUS total score and its individual items did not demonstrate acceptable accuracy (AUC≥0.7) whereas the Braden Scale (0.73) and the FIM score (0.74) did. Once items were dichotomized into high and low risk categories, 1 Braden item (friction and shear), 5 FIM items (bathing, toileting, bed/chair transfer, tub/shower transfer, toilet transfer), the FIM transfers subScale, FIM Motor subScale, and the FIM instrument as a whole, maintained AUCs ≥0.7 and negative predictive values ≥0.95. The FIM bed/chair transfer score demonstrated the highest likelihood ratio (2.62) and overall was the most promising measure for determining PI risk. Conclusion Study findings suggest that a simple measure of mobility, admission FIM bed/chair transfer score of 1 (total assist), can identify at-risk individuals with greater accuracy than both an SCI specific instrument (SCIPUS) and a PI specific instrument (Braden). The FIM bed/chair transfer score can be readily determined at rehabilitation admission with minimal administrative and clinical burden.
Hong-lin Chen - One of the best experts on this subject based on the ideXlab platform.
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Standard laboratory tests are recommended as supplements to the Braden Scale for pressure ulcer risk
Journal of clinical nursing, 2018Co-Authors: Man-li Zha, Hong-lin ChenAbstract:We read the article with the great interest written by Skogestad IJ et al. on the supplements to the Braden Scale for pressure ulcer risk among medical inpatients(Skogestad et al. 2017). In this prospective, cross-sectional survey, which involved 328 medical inpatients and aimed to describe the prevalence of pressure ulcers and pressure ulcer risk in medical patients and to detect possible risk factors, including sociodemographic factors, comorbidities, symptom experience and laboratory blood values, the authors found that patient-reported symptoms and standard laboratory results served as supplemental indicators of pressure ulcer risk may improve identification of patients at risk of pressure ulcer. We agree with the authors’ viewpoint that standard laboratory indexes should be used as supplemental indicators of pressure ulcer risk. This article is protected by copyright. All rights reserved.
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construct validity of the Braden Scale for pressure ulcer assessment in acute care a structural equation modeling approach
Ostomy Wound Management, 2017Co-Authors: Hong-lin Chen, Yingjuan Cao, Wangqin Shen, Bin ZhuAbstract:The Braden Scale is the most widely used pressure ulcer risk assessment system in the world. To investigate its construct validity using structural equation modeling (SEM), a secondary analysis of retrospective data of patients admitted to an acute care facility was conducted using the records of 2588 patients who were at risk for pressure ulcers and admitted between January 2013 and December 2013. Data were extracted to an Excel sheet and analyzed, including demographic characteristics (ie, patients age, gender, weight, and disease spectrum), as well as total Braden scores and subScale scores. The SEM was set according to modification indices suggestion. The original Braden Scale model was supported by χ2(9) = 22.854, CFI = 0.902, GFI = 0.974, root mean square error of approximation (RMSEA) = 0.092, indicating inadequate model fit. After modification according to software indices, χ2(2) = 2.052, CFI = 0.999, GFI = 0.999, RMSEA = 0.020 indicated an acceptable fit of the model (final model). The factor loadings of 6 subScales were all significant (P <.001), with .147 for nutrition, .137 for activity, .167 for friction and shear, .825 for sensory perception, .626 for mobility, and .556 for moisture subScale. The nutrition, activity, and friction and shear subScales were corrected to examine their relationships with other Braden Scale subScales (nutrition with activity [φ -0.063], activity with friction/shear [φ 0.136], and nutrition (φ friction/shear [0.159]). The factor loadings ranged from -0.067 to 0.159. These findings suggest the original Braden Scale has inadequate construct validity for acute care patients and that new risk-predicting Scales should be designed based on data mining. Second, according to the factor loadings in the SEM, the most important risk factor in the Braden Scale for this patient population is sensory perception, followed by mobility and moisture. This suggests practitioners should pay particular attention to pressure ulcer prevention when patients have limited sensory perception, mobility limitations, and/or when moisture status is less than optimal.
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Construct Validity of the Braden Scale for Pressure Ulcer Assessment in Acute Care: A Structural Equation Modeling Approach.
Ostomy wound management, 2017Co-Authors: Hong-lin Chen, Yingjuan Cao, Wangqin Shen, Bin ZhuAbstract:The Braden Scale is the most widely used pressure ulcer risk assessment system in the world. To investigate its construct validity using structural equation modeling (SEM), a secondary analysis of retrospective data of patients admitted to an acute care facility was conducted using the records of 2588 patients who were at risk for pressure ulcers and admitted between January 2013 and December 2013. Data were extracted to an Excel sheet and analyzed, including demographic characteristics (ie, patients age, gender, weight, and disease spectrum), as well as total Braden scores and subScale scores. The SEM was set according to modification indices suggestion. The original Braden Scale model was supported by χ2(9) = 22.854, CFI = 0.902, GFI = 0.974, root mean square error of approximation (RMSEA) = 0.092, indicating inadequate model fit. After modification according to software indices, χ2(2) = 2.052, CFI = 0.999, GFI = 0.999, RMSEA = 0.020 indicated an acceptable fit of the model (final model). The factor loadings of 6 subScales were all significant (P
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Braden Scale (ALB) for assessing pressure ulcer risk in hospital patients: A validity and reliability study
Applied nursing research : ANR, 2016Co-Authors: Hong-lin Chen, Wei Zhang, Yingjuan Cao, Jing Wang, Bao-sha HuaiAbstract:•We modified the Braden(ALB) Scale by defining nutrition subScale based on serum albumin for in hospital patients.•The Braden(ALB) Scale has similar validity compared with the original Braden Scale for in hospital patients.•The Braden(ALB) Scale has better inter-rater reliability than the original Braden Scale for in hospital patients.
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Calibration power of the Braden Scale in predicting pressure ulcer development.
Journal of wound care, 2016Co-Authors: Hong-lin Chen, Yingjuan Cao, Jing Wang, Bao-sha HuaiAbstract:Objective: Calibration is the degree of correspondence between the estimated probability produced by a model and the actual observed probability. The aim of this study was to investigate the calibration power of the Braden Scale in predicting pressure ulcer development (PU). Method: A retrospective analysis was performed among consecutive patients in 2013. The patients were separated into training a group and a validation group. The predicted incidence was calculated using a logistic regression model in the training group and the Hosmer-Lemeshow test was used for assessing the goodness of fit. In the validation cohort, the observed and the predicted incidence were compared by the Chi-square (χ2) goodness of fit test for calibration power. Results: We included 2585 patients in the study, of these 78 patients (3.0%) developed a PU. Between the training and validation groups the patient characteristics were non-significant (p>0.05). In the training group, the logistic regression model for predicting pressure...
Jan Kottner - One of the best experts on this subject based on the ideXlab platform.
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an interrater reliability study of the assessment of pressure ulcer risk using the Braden Scale and the classification of pressure ulcers in a home care setting
International Journal of Nursing Studies, 2009Co-Authors: Jan Kottner, Ruud J G Halfens, Theo DassenAbstract:BACKGROUND: Measurement error can seriously affect the validity of pressure ulcer risk assessment and of pressure ulcer classification. OBJECTIVES: Determination of interrater reliability and agreement of pressure ulcer risk and pressure ulcers using the Braden Scale and the EPUAP system. DESIGN AND SETTING: Duplicate assessments by trained nurses during two nationwide pressure ulcer prevalence surveys in the years 2007 and 2008 in The Netherlands in the home care setting. PARTICIPANTS: Home care clients which participated in 2007 (n=352) and 2008 (n=339) in the pressure ulcer prevalence surveys. METHODS: The Braden Scale was used to assess pressure ulcer risk. Skin examination was conducted to detect pressure related tissue damages and to classify them according to the EPUAP. RESULTS: In 2007 and 2008, Intraclass Correlation Coefficients for Braden Scale sum scores were 0.90 (95% CI: 0.88-0.92) and 0.88 (95% CI: 0.85-0.91) respectively, and corresponding Standard Errors of Measurement were 1.00 and 0.98. 95% limits of agreement were -2.8 to 2.8 and -2.7 to 2.7 respectively. The items "moisture", "sensory perception" and "nutrition" contained largest amounts of measurement error. Proportions of agreement for the classification of pressure ulcers were 96% and interrater reliability was 0.81 and 0.79. Most disagreements were observed for the classification of grade 1 pressure ulcers. CONCLUSIONS: The standardized study procedure applied in the annual nationwide pressure ulcer prevalence surveys leads to reliable and reproducible results regarding pressure ulcer risk and pressure ulcer prevalence in the home care setting. Researchers and practitioners should be careful when drawing inferences from single pressure ulcer risk factors included in the Braden Scale. Descriptions of the items "moisture", "sensory perception" and "nutrition" should be made more clearly and unambiguous.
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an interrater reliability study of the assessment of pressure ulcer risk using the Braden Scale and the classification of pressure ulcers in a home care setting
International Journal of Nursing Studies, 2009Co-Authors: Jan Kottner, Ruud J G Halfens, Theo DassenAbstract:Abstract Background Measurement error can seriously affect the validity of pressure ulcer risk assessment and of pressure ulcer classification. Objectives Determination of interrater reliability and agreement of pressure ulcer risk and pressure ulcers using the Braden Scale and the EPUAP system. Design and setting Duplicate assessments by trained nurses during two nationwide pressure ulcer prevalence surveys in the years 2007 and 2008 in The Netherlands in the home care setting. Participants Home care clients which participated in 2007 ( n =352) and 2008 ( n =339) in the pressure ulcer prevalence surveys. Methods The Braden Scale was used to assess pressure ulcer risk. Skin examination was conducted to detect pressure related tissue damages and to classify them according to the EPUAP. Results In 2007 and 2008, Intraclass Correlation Coefficients for Braden Scale sum scores were 0.90 (95% CI: 0.88–0.92) and 0.88 (95% CI: 0.85–0.91) respectively, and corresponding Standard Errors of Measurement were 1.00 and 0.98. 95% limits of agreement were −2.8 to 2.8 and −2.7 to 2.7 respectively. The items "moisture", "sensory perception" and "nutrition" contained largest amounts of measurement error. Proportions of agreement for the classification of pressure ulcers were 96% and interrater reliability was 0.81 and 0.79. Most disagreements were observed for the classification of grade 1 pressure ulcers. Conclusions The standardized study procedure applied in the annual nationwide pressure ulcer prevalence surveys leads to reliable and reproducible results regarding pressure ulcer risk and pressure ulcer prevalence in the home care setting. Researchers and practitioners should be careful when drawing inferences from single pressure ulcer risk factors included in the Braden Scale. Descriptions of the items "moisture", "sensory perception" and "nutrition" should be made more clearly and unambiguous.
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an interrater reliability study of the Braden Scale in two nursing homes
International Journal of Nursing Studies, 2008Co-Authors: Jan Kottner, Theo DassenAbstract:Abstract Background Adequate risk assessment is essential in pressure ulcer prevention. Assessment Scales were designed to support practitioners in identifying persons at pressure ulcer risk. The Braden Scale is one of the most extensively studied risk assessment instruments, although the majority of studies focused on validity rather than reliability. Objectives The first aim was to measure the interrater reliability of the Braden Scale and its individual items. The second aim was to study different statistical approaches regarding interrater reliability estimation. Design and methods An interrater reliability study was conducted in two German nursing homes. Residents ( n =152) from 8 units were assessed twice. The raters were trained nurses with a work experience ranging from 0.5 to 30 years. Data were analysed using an overall percentage of agreement, weighted and unweighted kappa and the intraclass correlation coefficient. Results Differences between nurses rating the overall Braden score ranged from 0 up to 9 points. Interrater reliability expressed by the intraclass correlation coefficient ranged from 0.73 (95% CI 0.26–0.91) to 0.95 (95% CI 0.87–0.98). Calculated intraclass correlation coefficients for individual items ranged from 0.06 (95% CI −0.31 to 0.48) to 0.97 (95% CI 0.93–0.99) with the lowest values being measured for the items "sensory perception" and "nutrition". There was no association between work experience and the level of interrater reliability. With two exceptions, simple kappa-values were always lower than weighted kappa-values and intraclass correlation coefficients. Conclusions Although the calculated interrater reliability coefficients for the total Braden score were high in some cases, several clinically relevant differences occurred between the nurses. Due to interrater reliability being very low for the items "sensory perception" and "nutrition", it is doubtful if their assessment contributes to any valid results. The calculation of weighted kappa or intraclass correlation coefficients is the most appropriate interrater reliability estimates.
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Interpreting interrater reliability coefficients of the Braden Scale: a discussion paper.
International Journal of Nursing Studies, 2007Co-Authors: Jan Kottner, Theo DassenAbstract:There are many studies investigating psychometric properties of the Braden Scale, a Scale that predicts the risk for pressure ulcers. The main focus of these studies is validity as opposed to reliability. In order to estimate the degree of interrater reliability a literature review revealed that numerous statistical approaches and coefficients were used (Pearson's product-moment correlation, Cohen's kappa, overall percentage of agreement, intraclass correlation). These coefficients were calculated for the individual items and the overall Braden score and were used inconsistently. The advantages and limitations of every coefficient are discussed and it is concluded that most of them are inappropriate measures. Therefore, estimating the degree of the Braden Scale interrater reliability is limited to a certain extent. It is shown that the intraclass correlation coefficient is an appropriate statistical approach for calculating the interrater reliability of the Braden Scale. It is recommended to present intraclass correlation coefficients in combination with the overall percentage of agreement.