Reliability and Validity of the Chinese Version of DESIGN-R, an Assessment Instrument for Pressure Ulcers

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Xiaohong Zhong, MSN, RN; Takashi Nagase, PhD, MD; Lijuan Huang, PhD, RN; Toshiko Kaitani, PhD, RN, WOCN; Shinji Iizaka, PhD, RN; Yuko Yamamoto, MHS, RN; Toshiki Kanazawa, BSN, RN; and Hiromi Sanada, PhD, RN, WOCN

Index: Ostomy Wound Manage. 2013;59(2):36–43.


  Lack of a valid and reliable assessment instrument may have contributed to a lack of wound healing research in China. The DESIGN-R tool scores the severity of pressure ulcers (PUs) and monitors healing using the observable state assessment; it was developed by the Scientific Education Committee of the Japanese Society of Pressure Ulcers (JSPU) and tested for reliability and validity. A Chinese version of DESIGN-R was developed based on Brislin’s model of translation and tested for validity and reliability. Using a purposive sampling method, 44 practicing registered nurses (RNs) and 11 physicians (MDs) were recruited from 52 departments of Nanfang Hospital, Guangdong, China. Based on their experience, they were classified as general medical staff (gMS) or experienced medical staff (eMS). All used the Chinese version of DESIGN-R to assess eight photographs of PUs and descriptors. In addition, eight eMS also used the Bates-Jensen Wound Assessment Tool (BWAT) to assess the same wounds. Inter-rater reliability was high (total ICC score = 0.960). ICC inflammation/infection scores were 0.530 and 0.759 for gMS and eMS, respectively; granulation ICC scores were 0.532 and 0.794 in gMS and eMS, respectively. The correlation coefficients between the BWAT and DESIGN-R tool were >0.80 for all eight raters. The results suggest the Chinese version of DESIGN-R is valid and reliable and may be a useful scoring tool for RNs and MDs to monitor PU status in daily clinical practice. Additional research is warranted, and clinical instruments for inflammation/infection and granulation assessment must be developed for gMS.

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