Reliability and agreement of instrumental skin barrier measurements in clinical pressure ulcer prevention research

Abstract

In skin and wound research the instrumental measurement of skin function is established. Despite the widespread use, empirical evidence about measurement errors is widely lacking. The aim of this study was to measure reliability and agreement of skin temperature, transepidermal water loss, epidermal hydration, and erythema at the heel and sacral skin. Four experienced researchers performed skin measurements in 15 subjects. Lowest reliability was observed for transepidermal water loss at the sacral skin (ICC (1) 0.46 (95% CI 0.00-0.78)) and highest for skin temperature at the heel skin (ICC (1) 0.99 (95% CI 0.99-1.00)). Lowest Standard Errors of Measurement were calculated for skin temperature measurements at the heels (0.11°C) and highest for erythema measurements at the sacral skin (26.7 arbitrary units). There was a clear association between variability of estimates and reliability coefficients. Single measurements of skin temperature, stratum corneum, and epidermal hydration at the sacral and heel skin areas can be used in clinical research and practice. Means of at least two measurements should be used for estimating transepidermal water loss and erythema. Evidence is needed to inform researchers about relative and absolute measurement errors of commonly applied instruments and measurements in skin and wound research.

Keywords: Epidermis; erythema; hydration; reliability; stratum corneum.

FIGURE 1

Bland‐Altman plot of skin temperature water loss measurements at the sacral skin area at baseline (n = 15)

FIGURE 2

Bland‐Altman plot of skin temperature measurements at the heel skin area at baseline (n = 15)

FIGURE 3

Bland‐Altman plot of transepidermal water loss measurements at the sacral skin area at baseline (n = 15)

FIGURE 4

Bland‐Altman plot of transepidermal water loss measurements at the heel skin area at baseline (n = 15)

FIGURE 5

Bland‐Altman plot of stratum corneum hydration measurements at the sacral skin area at baseline (n = 15)

FIGURE 6

Bland‐Altman plot of stratum corneum hydration measurements at the heel skin area at baseline (n = 15)

FIGURE 7

Bland‐Altman plot of epidermal hydration measurements at the sacral skin area at baseline (n = 15)

FIGURE 8

Bland‐Altman plot of epidermal hydration measurements at the heel skin area at baseline (n = 15)

FIGURE 9

Bland‐Altman plot of erythema measurements at the sacral skin area at baseline (n = 15)

FIGURE 10

Bland‐Altman plot of erythema measurements at the heel skin area at baseline (n = 15)