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Objective Measurement of Scarring by Multiple Assessors: Is the Tissue Tonometer a Reliable Option?

Corica, Gavin Frank BSc, GradDipSci*; Wigger, Nicholas Charles*; Edgar, Dale Wesley BPhtyHons*†§; Wood, Fiona Melanie FRACS, AM*†‡§; Carroll, Sara BAppSc, MSc*

doi: 10.1097/01.BCR.0000225963.41796.54
Original Articles

Depending on the patient population, the incidence of scarring is as great as 75% after burns. Skin pliability and functional recovery are affected negatively by hypertrophic scarring. Therapists use various treatment strategies to improve scar outcomes. However, a simple, objective, clinically useful method of measuring scar response to treatment eludes us. This study examines the inter-rater reliability and validity of scar pliability measures using the modified tissue tonometer (MTT). Twenty-four patients were tested by two blinded, randomly allocated raters. The MTT was used to assess scar pliability with a standardized, repeated-measures design. One normal and up to three scar points were assessed for each subject. One subject was excluded from the data analyses. Concerning inter-rater reliability, the intraclass correlation coefficient for averaged measures between measurers was 0.957, and the standard error of measurement was 0.025 mm. For validity, a significant difference (P = .0000) between scar (2.64 ± 0.5 mm) and normal tissue (3.23 ± 0.46 mm) measurements was demonstrated. Scar pliability scores between raters are extremely reliable and reproducible using the MTT. It can differentiate between injured and uninjured tissue. Hence, it provides clinicians with a reliable, transportable, and objective tool to document scar outcomes. The MTT provides a standardized method to longitudinally measure scar tissue pliability after burn injury.

From the *School of Physiotherapy, Curtin University of Technology; †Burn Service of Western Australia at Royal Perth Hospital, Telstra Burn Outcome Centre, Princess Margaret Hospital for Children; ‡University of Western Australia; and §McComb Foundation, Perth, Western Australia.

Address correspondence to D. Edgar, Burns Unit, Royal Perth Hospital, Wellington Street, GPO Box X2213 Perth WA 6847.

© 2006 The American Burn Association