Abstract
BackgroundClinical evaluation of a pressure ulcer is based on quantitative and qualitative evaluation. In clinical practice, acetate tracing is the standard technique used to measure wound surface area; however, it is difficult to use in daily practice (because of material availability, data storage issues, and time needed to calculate the surface area). Planimetry techniques developed with mobile health (mHealth) apps can be used to overcome these difficulties.ObjectiveThe goal of this study was to evaluate the metrological properties of a free-access mHealth app, called imitoMeasure, to assess pressure ulcers.MethodsThis was a noninterventional, validation study. We included patients with spinal cord injury presenting with a pressure ulcer, regardless of its stage or location. We performed wound measurements with a ruler, and we performed acetate tracing using a transparent dressing with a wound measurement grid. Wound evaluation via the mHealth app was conducted twice by the main investigator and also by a coinvestigator to determine validity, intrarater reproducibility, and interrater reproducibility. Bland-Altman plots and intraclass correlation coefficients were used to compute the minimal detectable change percentage.ResultsOverall, 61 different pressure ulcers were included. The validity, intrarater reproducibility, and interrater reproducibility of the mHealth app vs acetate tracing (considered the method of reference) were good, with intraclass correlation coefficients of 0.97 (95% CI 0.93-0.99), 0.99 (95% CI 0.98-0.99), and 0.98 (95% CI 0.96-0.99), respectively, and minimal detectable change percentages between 17% and 35%.ConclusionsThe imitoMeasure app had good validity and reproducibility. It could be an alternative to standard wound assessment methods. Further studies on larger and more diverse wounds are needed.Trial RegistrationClinicalTrials.gov NCT04402398; http://clinicaltrials.gov/ct2/show/NCT04402398
Highlights
Pressure ulcers are localized damage to the skin and underlying tissue resulting from long-term pressure or pressure in combination with shear or friction [1]
The validity, intrarater reproducibility, and interrater reproducibility of the mobile health (mHealth) app vs acetate tracing were good, with intraclass correlation coefficients of 0.97, 0.99, and 0.98, respectively, and minimal detectable change percentages between 17% and 35%
It could be an alternative to standard wound assessment methods
Summary
Pressure ulcers are localized damage to the skin and underlying tissue resulting from long-term pressure or pressure in combination with shear or friction [1]. Despite major prevention efforts in hospitals or rehabilitation centers these past decades, pressure ulcers remain a major public health issue. The National Pressure Ulcer Advisory Panel (NPUAP) reports a prevalence of pressure ulcers of 2.3% to 28% in long-term facilities, 10% to 18% in intensive care units, and up to 6% in rehabilitation https://mhealth.jmir.org/2021/2/e26443 XSLFO RenderX. Pressure ulcers are of concern in older adults, persons with neurological impairments (such as spinal cord injury), persons in intensive care units, and persons in palliative care. The objective of this work was to evaluate the metrological properties of a contactless digital planimetry app (imitoMeasure, Imito Ltd) for pressure ulcer measurement (width, length, surface area) in persons with spinal cord injury. Planimetry techniques developed with mobile health (mHealth) apps can be used to overcome these difficulties
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