Sinicization And Application Of Diabetic Foot Ulcer Healing Scale DMIST

ObjectivesTo translate the English version of diabetic foot ulcer healing scale DMIST;to test the reliability and validity of the Chinese version of DMIST in diabetic foot ulcers,and to preliminarily explore the feasibility of the Chinese version of the DMIST in China.Methods1.The English version of diabetic foot ulcer healing scale DMIST was translated,back-translated,proofread,cross-cultural debugged and content validity tested based on the Brislin two-way translation method to form the Chinese version of DMIST.2.From January 2021 to June 2021,all wounds meeting the criteria were enrolled in the department of Metabolism and Endocrinology in a tertiary hospital in Changsha,79 diabetic foot ulcers were enrolled in this study.The researchers used the self-designed general information questionnaire and wound general information questionnaire to collect basic information,and evaluated the wound with the Chinese version of diabetic foot ulcer healing scale DMIST,Pressure Ulcer Scale for Healing and Bates-Jensen Wound Assessment Tool.We tested the the reliability of Chinese version of diabetic foot ulcer healing scale DMIST by internal consistency reliability,inter-rater reliability and test-retest reliability.The validity of the Chinese version of diabetic foot ulcer healing scale DMIST was tested by calibration correlation validity.3.From July 2021 to January 2022,all wounds meeting the criteria were enrolled in the department of Metabolism and Endocrinology in three tertiary hospitals in Changsha and Xiangtan,148 diabetic foot ulcers were enrolled in this study.We evaluated the wound with the Chinese version of diabetic foot ulcer healing scale DMIST,Pressure Ulcer Scale for Healing and Bates-Jensen Wound Assessment Tool on the 1st day,7th day and 28th day.The standard of effective dressing change was the reduction of wound area>50%after 28 days.The wounds were divided into effective dressing change group（n=62）and ineffective dressing change group（n=79）.Paired t test was used to compare the scale scores of the effective dressing change group before and after treatment.The effective size（ES）and standardized response mean（SRM）were calculated to test the responsibility of the scale.The Receiver Operating Characteristic Curve（ROC）was used to calculate the cut-off value of diabetic foot ulcer healing scale DMIST for diabetic foot ulcers that ineffective wound dressing change.Then the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of the scale were further derived.Multiple linear regression was used to analyze the factors influencing the score of the scale.Results1.The Chinese version of the diabetic foot ulcer healing scale DMIST with 7 items including depth,maceration,inflammation/infection,size,tissue type of wound bed,type of wound edge,tunneling or undermining was developed in this study.2.The content validity index at item level and scale level of the Chinese version of diabetic foot ulcer healing scale DMIST were both 1.00,indicating good content validity.The total score of the DMIST was strongly correlated with the Pressure Ulcer Scale for Healing and Bates-Jensen Wound Assessment Tool（r=0.773and 0.883,P<0.05）.The Cronbach’sαcoefficient of the total scale was 0.804,the inter-evaluation reliability was0.928,and the test-retest reliability was 0.748.3.The DMIST score of effective dressing change group between the1^st day and 28^th day was significantly different,the effective size was 1.047and standardized response mean was 1.313（P<0.05）.The ROC curve analysis for predicting the ineffectiveness of dressing change in diabetic foot ulcers,showed that the area under the curve was 0.869,and 9 points were taken as the cut-off value,with a sensitivity of 91.14%,specificity of 80.64,accuracy of 86.52%,positive predictive value of 85.71%and negative predictive value of 87.72%.The factors influencing DMIST score included hemoglobin A1c,Wagner classification,plantar ulcer and multiple sites ulcer.ConclusionThe Chinese version of the diabetic foot ulcer healing scale DMIST has good reliability,validity and responsibility,and is a systematic,comprehensive,and scientific healing evaluation tool for diabetic foot ulcer patients in China.It can evaluate the wound healing of diabetic foot ulcer,and would contribute to the accumulation of evidence for diabetic foot management.Hemoglobin A1c,Wagner classification,plantar ulcer and multiple sites ulcer were independent risk factors for the wound severity of diabetic foot ulcer.