Development, Validity, Reliability, and Responsiveness of a New Leg Ulcer Measurement Tool
Advances in Skin & Wound Care
E pidemiologic studies performed in the United States and other countries suggest that chronic leg ulcers occur in 1% to 2% of the population. 1,2 Venous insufficiency is the most common underlying cause, occurring in 40% to 50% of patients with lower extremity ulcers. 1,2 Over the course of a year, 7% of people with diabetes will develop foot ulcers. 3 These ulcers often result in lower leg amputation, with serious functional and lifestyle repercussions. 4 Not only are leg ulcers associated
... lcers associated with significant human consequences, but they also represent a tremendous financial burden to health care. For example, the cost per healed wound in the United Kingdom was estimated to range from £342 to £6741, depending on the treatment. These estimates were based on 12 published multinational leg ulcer studies involving 842 ulcers. 5 In Canada, the annual cost of home care expenditures for leg ulcers in 1 urban region was estimated to be $1.3 million. 6 In the United States, the cost for treatment of leg ulcers for working-age individuals with diabetes averaged $2687 per patient per year, or $4595 per ulcer per episode. 7 Numerous therapies have been developed over the last 30 to 40 years to accelerate closure of chronic wounds. Assessing the effectiveness of these therapies requires a measurement tool that ABSTRACT OBJECTIVE: To develop and validate an assessment tool-the Leg Ulcer Measurement Tool (LUMT)-that would be able to detect changes in the appearance of lower extremity ulcers. SUBJECTS: Twenty-two subjects with chronic leg ulcers of various etiologies (arterial, venous, diabetes) participated in the validation study. DESIGN: An interdisciplinary panel consisting of 9 local wound care specialists confirmed content validity. Concurrent criterion validity was determined by correlation of the size domain (1 of 14 clinician-rated domains in the LUMT) with acetate tracing measurement of wound surface area. Reliability was determined using repeated assessments by 4 wound care specialist and 2 inexperienced evaluators; responsiveness was determined using monthly reassessments by a single rater for 4 months. RESULTS: Concurrent criterion validity was r = 0.82. Excellent values of intrarater and interrater reliability (ICC > 0.75) were obtained for total LUMT scores and for many of the 14 individual domains; however, several domains were found to be less reproducible. The LUMT detected change in wound status over time (responsiveness coefficient = 0.84). CONCLUSION: The LUMT can be used by 1 or more assessors, with relatively little previous training, to make reproducible evaluations of lower extremity ulcer appearance and to document change in appearance over time. The LUMT represents a novel assessment tool specifically designed and validated for clinical or research use on chronic leg ulcers.