Confiabilidade interobservadores e responsividade da escala Resvech 2. 0 "Resultados esperados de la valoración y evaluación de la cicatrización de las heridas crónicas"

Abstract

Introduction: Scales proposed for the evaluation of chronic ulcers in general have been used to treat people with venous ulcers, without, however, studying their specific psychometric properties for this type of lesion. Objectives: To analyze the reliability (equivalence) and responsiveness of the RESVECH 2.0 scale for venous ulcers evaluation and healing evolution. Method: This is a methodological research, of multicenter character, inserted in the matrix project “Translation, cross-cultural adaptation, reliability and responsiveness of scales of evaluation of functional capacity, healing and quality of life of people with venous ulcers”, approved by the Committee. of Ethics in Research of the Hospital das Clinicas of the Federal University of Goias, main research center, with opinion number 1,500,799, having as its participant center the Fluminense Federal University (UFF). The research had two places of study, the Wound Repair Outpatient Clinic of the Antonio Pedro University Hospital, in Niteroi, RJ and the other, consisted of dressing rooms of the public health network, in the city of Goiânia, GO. The study population consisted of SUS users with venous ulcers who attended the research sites and nurses who worked in the treatment of these individuals at the wound repair outpatient clinic in Niteroi. In order to collect interobserver reliability data, the clinical nurses who participated in the study were previously trained to use the RESVECH 2.0 scale, and subsequently the scale was applied by three nurses (two clinical nurses and one research nurse, considered the gold standard). independently and simultaneously during dressing. To collect responsiveness data, the scale was applied at the baseline of the study, and then, once every 4 weeks, up to 12 weeks, thus making three assessments. Results: For interobserver reliability we analyzed 23 venous ulcers by trio of observers in different combinations and made 33 observations in total. The Kappa coefficient reached in the RESVECH 2.0 total reliability score of 0.796 and 0.823 between the gold standard nurse and the clinical nurses, indicating good and very good agreement. Still in relation to the total score, Pearson's coefficient (r) was used, reaching 0.955 and 0.965, indicating a very strong correlation between the measurements; also Lin's correlation (rho_c), with coefficients of 0.952 and 0.937 among the observers, indicating moderate agreement and finally the intraclass correlation coefficient (ICC) of 0.976 and 0.979, obtaining excellent reliability. For responsiveness we used the method based on data distribution through effect size (TE), considered as small, medium and large. In the anchor-based method, the anchors used were: Pressure Ulcer Scale for Healing (PUSH), healing rate, and the Global Assessment Scale for Change in Patient and Professional Perception to assess the minimally significant difference in which it was rated. like none, small, medium and big change. To verify this difference, the Student's t-test for paired samples was used. Thirty-eight patients with 60 venous ulcers participated in the study. There was a loss in follow-up, totaling 59 ulcers evaluated at D60. The effect size between the first and second evaluation was small for sub-items and total score, between the second and third had no effect, while between the first and third evaluation showed average effect for sub-items and total score. Minimally significant change was observed for the total score and subscores of the scale in the three assessments according to the Global Change Rating Scale and healing rate. Conclusion: RESVECH 2.0 has good interobserver reliability, has shown validity regarding the size of the effect, since it is commonly used the anchor-based method and is responsive to changes in venous ulcer healing evolution. Product: RESVECH 2.0 Scale Application Instruction Tutorial