Is the Braden Mobility Subscale Alone as Predictive as the Braden Scale?

Purpose:

Pressure injury is known to cause not only debilitating physical effects, but also leads to substantial psychological and financial burdens.  Given the importance of this issue, it remains imperative that nurses identify patients that are at risk of developing pressure injury, so that preventive interventions can be initiated early.  Risk assessment tools are used to assist nurses in identifying such patients.  However, research has suggested that using risk assessment tools may be no more effective in preventing actual pressure injury than clinical judgement.  Research has also suggested impaired mobility is a significant risk factor for developing pressure injury, and that mobility assessment alone may be an adequate alternative for assessing pressure injury risk for the purpose of instituting preventive interventions.  Thus, the purpose of the study is to ascertain whether the Braden mobility subscale is comparable to the Braden scale in predicting the development of pressure injury.

Methods:

This is a retrospective case-control study on review of medical records of adult patients admitted to an acute care hospital. One hundred cases of patients with pressure injury were matched with controls of patients who had no pressure injury at a 1:1 ratio for age, gender, length of stay, having had surgery and have been admitted to the intensive care unit or high dependency unit. Bivariate analysis, logistic regression analysis and backward logistic regression were undertaken using SPSS version 19.0.

Results:

We found that patients who were assessed using the Braden mobility subscale as having "very limited mobility" or worse (cut-off score ≤ 2) is 5.23 [95% confidence interval (95%CI): 2.66 – 10.20] times more likely to develop pressure injury compared to those with "slightly limited" or "no limitation" to mobility. In contrast those assessed using the Braden scale as having "low risk" or higher risks (cut-off score ≤ 16) is 3.35 [95%CI: 1.77 – 6.33] times more likely to develop pressure injury compared to those assessed as having “no risk”. Using full model logistic regression analysis and including other Braden subscales, the mobility subscale was the only subscale that was a significant predictor of pressure injury. When using backward logistic regression to determine the most parsimonious model, the Braden mobility subscale remained a significant factor in predicting pressure injury.

Conclusion:

The study found that the Braden mobility subscale alone was as good as the Braden scale as a tool for predicting pressure injury.  In addition, other Braden subscales (i.e., moisture, activity, sensory, nutrition, and friction and shear) did not improve the prediction of pressure injury.