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A clinimetric analysis of the Pressure Ulcer Risk Primary or Secondary Evaluation Tool: PURPOSE-T

14 November 2019
Volume 28 · Issue 20


The assessment of patients' risk for developing pressure ulcers is a routine and fundamental nursing process undertaken to prevent avoidable harm to patients in all care settings. Many risk assessment tools are currently used in clinical practice, however no individual tool is recommended by advisory bodies such as the National Institute for Health and Care Excellence or the European Pressure Ulcer Advisory Panel. The evidence base on the value of structured risk assessment tools in reducing the incidence or severity of pressure ulcers is poor. This purpose of this article is to provide a clinimetric analysis of the recently developed Pressure Ulcer Risk Primary or Secondary Evaluation Tool (PURPOSE-T) and identify areas for future research to improve the utility of structured risk assessment in identifying patients at risk of developing pressure ulcers.

Pressure ulceration has detrimental impacts on patients both physically and psychologically and is associated with significant economic implications for health services. It is therefore paramount that at-risk patients are identified before significant pressure-related tissue damage occurs in order to effectively implement primary preventive interventions (Mervis and Phillips, 2019). The use of pressure ulcer risk assessment tools (PURAT) in adult patients is highly recommended by the European Pressure Ulcer Advisory Panel (EPUAP et al, 2014), advocated as a ‘consideration’ by the National Institute for Health and Care Excellence (2014), but considered to have no impact on the incidence or severity of pressure ulcers by the Cochrane Collaboration (Moore and Patton, 2019).

The lack of consensus surrounding the value of PURAT indicates a potential lack of evidence for the clinimetric properties of the tools evaluated, specifically features of the tools identified in seminal work by Feinstein (1987): reliability, validity and sensitivity. Notably, the most commonly utilised risk assessment tools—the Waterlow and Braden tools—have been demonstrated to have low sensitivity and specificity in differentiating the levels of risk in patients, potentially limiting their clinical value (Qaseem et, al 2015). This article evaluates the clinimetrics of a PURAT developed by Nixon et al (2015): PURPOSE-T.

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