Assessing the Need for Developing a Comprehensive Content-Validated Pressure Ulcer Guideline
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An Item Content Validity Index (CVI) will be calculated as the percent of respondents rating the clinical relevance or validity of that item as 3 or 4 using the 4-point Likert scale below:
1 = Not relevant
2 = Unable to assess relevance without further information
3 = Relevant but needs minor attention
4 = Very relevant and succinct.
Solicitation of Input
Professional, patient, or patient advocate readers are invited to participate as peer reviewers in this PUCI content validation to determine clinical relevance for each step. The content validation form may be accessed at www.aawconline.org. With permission, each participant will be credited as participating in this historic initiative. As an added token of AAWCGS appreciation, returning a completed PUCI content validation survey will qualify respondents for a drawing for one free new or renewed membership to the AAWC.
Corresponding CVI values + standard deviation from the content validation study will be published along with the evidence level for each PUCI item and a list of items that did not meet at least one of the two content or evidence-based construct validity criteria will be deleted. Content validity24 data from all respondents, received by December 15, 2008, will be entered into an EXCEL® database and analyzed using the program’s automatic functions for descriptive statistics. Mean content validity score and the proportion of respondents rating each item a 3 or 4 (on the CVI) will be calculated for each aspect of care.
Supporting evidence for PU care: construct validity. In addition to content validation, each AAWCGS member will search the MEDLINE, CINAHL, and EMBASE databases to identify and summarize three or more studies providing the best available evidence supporting each aspect of PU patient and wound management. Standardized strength of evidence ratings (see Table 3) adapted from prior AHRQ guidelines for PU care20,21will be utilized along with diagnostic and prediction criteria adapted from the American Society of Plastic Surgeons (ASPS) Scales for Rating Levels of Evidence and Grading Practice Recommendations. 22
When complete, all PUCI recommendations that meet the standardized content validity and/or strength of evidence criteria will be made available for free public use on the AAWC website, www.aawconline.org and, if accepted, on the NGC website, www.guideline.gov. Other content-validated algorithms have been published for venous ulcers41 and general wound care. 29 In addition, the need for professional education to prevent PUs has been validated. 42 The sole wound care guideline identified in this literature search with outcomes of its use validated as a standard in two prospective controlled clinical trials addressed venous ulcers. 43
Although still far from becoming a standard, the PUCI can grow and improve in content validity with input and review of the Ostomy Wound Management readership — people who qualify as having the interest and knowledge to rate the clinical relevance of these steps of PU care. Ostomy Wound Management readers, therefore, are encouraged to assist in PUCI development and content validation by rating clinical relevance of guideline items. This task should take less than 1 hour and may be done in intervals at the reader’s convenience by downloading the virus-free file.