Measuring healing in leg ulcers: practice considerations

Clinical nursing practice requires reliable and valid methods of measuring healing in patients with leg ulcers. By comparing the reliability and validity of four methods of measuring leg ulcer healing, digital planimetry (computerized area measurement), the Kundin Wound Gauge (volume and area measurement), the Healing Scale (measuring perceptions of healing), and the Johnson Scale (measuring wound characteristics), with the standard technique of stereophotogrammetry, implications for nursing practice and research were identified. Stereophotogrammetry, defined as topographical mapping measuring volume and area, was found to be reliable and suitable for clinical trial evaluations and for monitoring healing in hospitals or clinics. In a sample of hospital and community patients with leg ulcers (n = 82), weekly clinical comparisons using digital planimetry and the Kundin Wound Gauge, both reliable methods, supported the suitability of these measures, for monitoring healing in any setting (r = .99; r = .98, respectively). The Healing and Johnson Scales did not show concurrent validity when compared with stereophotogrammetric methods and had limited reliability. This study provided three reliable and valid methods of measuring healing suitable for practice. Time intervals and endpoints for clinical trials and evaluating practice need to be considered in terms of instrument error rates and delayed healing in older people.