Content Validation of Algorithms to Guide Negative Pressure Wound Therapy in Adults with Acute or Chronic Wounds: A Cross-sectional Study

Despite extensive use of negative pressure wound therapy (NPWT) and reported patient safety concerns, evidence-based algorithms to guide its safe and appropriate use in various wounds have only recently been developed. Preliminary content validity was established using literature review and expert-based face validity with a small sample of experts (N = 12). To examine the content validity of this set of three NPWT algorithms and to enhance understanding about previously identified wound terminology issues, a cross-sectional, mixed-methods, quantitative study was conducted among wound experts. The paper/pencil survey instrument consisted of the algorithms, a demographic questionnaire, and request to provide definitions of five commonly used terms: acute wound, chronic wound, and primary, secondary, and tertiary intention healing. A Likert scale (range 1 to 4) was included to rate the relevance of each of the 34 unique steps/statements/decision points contained in the algorithms, and space was provided to comment on each component. Convenience-sampling methods were used in three different settings: an international professional wound care meeting; a regional wound, ostomy, continence (WOC) nurses meeting; and an urban university with a suburban satellite campus. Of the 190 wound care experts invited to participate, 114 accepted. Participants' average age was 48 (range 23 to 68) years, and most were registered nurses (72%) practicing in the United States (94%). The content validity of the NPWT components was strong, with an overall mean rating of 3.76 (SD = 0.56, range 3.49 to 3.92; very relevant/appropriate, relevant/appropriate). The overall content validity index for the 5,696 responses received was 0.96 (range 0.88 to 1.0). Qualitative themes included comments about wound terminology and definitions, the presentation of the central algorithm, reading level, helpfulness/ease of use, the use of color, and information placement in the algorithm document. Some consensus on wound definitions was observed, but results also confirmed that important disparities in mutual understanding of what constitutes acute versus chronic wounding remain. Commonly used surgical closure definitions of primary, secondary, tertiary intention also were not clearly or correctly understood by a substantial number of participants. These NPWT algorithms are the first evidence-based, content-validated algorithms developed for a variety of acute and chronic wounds in adult patients. Future research is needed to test whether they facilitate safe patient care in clinical practice