Modification and validation of the Bluebelle Wound Healing Questionnaire (WHQ) for assessing surgical site infection in wounds healing by secondary intention

Rhiannon Macefield; Laura Mandefield; Jane M Blazeby; Caroline Fairhurst; Kalpita Baird; Catherine Arundel; Ian Chetter; Belen Corbacho Martin; Catherine Hewitt; Athanasios Gkekas; Andrew Mott; Dr Pedro Saramago Goncalves; Samantha Swan; David Torgerson; Jacqueline Wilkinson; Sabeen Zahra; Stephen Dixon; Josie Hatfield; Angela Oswald; Jo Dumville; Mr Matthew Lee; Thomas Pinkney; Nikki Stubbs; Lyn Wilson; A Clothier; D Bosanquet; M Blow; C Price; J Todd; T Munro; W Pillay; A Pradhan; A Garnham; M Wall; K Powezka; A Syed; D Gerrard; A Croucher; N Hadjievangelou; A Firth; T Roe; G Smith; C Bicknell; C Carr; E Negbenose; L Tarusan; A Vesey; D Wilson; D Bell; J Fletcher; C Greenwood; T Wallace; S Vallabhaneni; S Holder; J Williams; S Sim; A L Tambyraja; F Kerray; A Ng; M Sylvester; L Slater; S T Rashid; A Palacios; K Feld; S Nandhra; G Stansby; N Parr; L Jones; J Milne; C Stubbs; R Hinchliffe; C Twine; G A Antoniou; C Corbett; S Munt; S Warran; R Fletcher; W Al-Jundi; M Burrows; P Stather; R Barnes; T Woodrow; B Adams; O Agu; Y Gleeson; R D'Souza; L Erete; S Jones; C Checketts; D Bajic; R Matravers; I Loftus; J Budge; B Azhar; M Juszczak; A Syed; R Hancox; C Pearce; N Suggett; A Whitehouse; G Kuhan; S Premnath; N Dattani; V Hollings; F Khasawneh; J AlShakarchi; E Packer

doi:10.1016/j.jtv.2025.100889

Modification and validation of the Bluebelle Wound Healing Questionnaire (WHQ) for assessing surgical site infection in wounds healing by secondary intention

Rhiannon Macefield, Laura Mandefield, Jane M Blazeby, Caroline Fairhurst, Kalpita Baird, Catherine Arundel^*, Ian Chetter, Belen Corbacho Martin, Catherine Hewitt, Athanasios Gkekas, Andrew Mott, Dr Pedro Saramago Goncalves, Samantha Swan, David Torgerson, Jacqueline Wilkinson, Sabeen Zahra, Stephen Dixon, Josie Hatfield, Angela Oswald, Jo DumvilleMr Matthew Lee, Thomas Pinkney, Nikki Stubbs, Lyn Wilson, A Clothier, D Bosanquet, M Blow, C Price, J Todd, T Munro, W Pillay, A Pradhan, A Garnham, M Wall, K Powezka, A Syed, D Gerrard, A Croucher, N Hadjievangelou, A Firth, T Roe, G Smith, C Bicknell, C Carr, E Negbenose, L Tarusan, A Vesey, D Wilson, D Bell, J Fletcher, C Greenwood, T Wallace, S Vallabhaneni, S Holder, J Williams, S Sim, A L Tambyraja, F Kerray, A Ng, M Sylvester, L Slater, S T Rashid, A Palacios, K Feld, S Nandhra, G Stansby, N Parr, L Jones, J Milne, C Stubbs, R Hinchliffe, C Twine, G A Antoniou, C Corbett, S Munt, S Warran, R Fletcher, W Al-Jundi, M Burrows, P Stather, R Barnes, T Woodrow, B Adams, O Agu, Y Gleeson, R D'Souza, L Erete, S Jones, C Checketts, D Bajic, R Matravers, I Loftus, J Budge, B Azhar, M Juszczak, A Syed, R Hancox, C Pearce, N Suggett, A Whitehouse, G Kuhan, S Premnath, N Dattani, V Hollings, F Khasawneh, J AlShakarchi, E Packer

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

1 Citation (Scopus)

Abstract

Background
Surgical wounds healing by secondary intention are common. Healing is often complicated by surgical site infection (SSI). SSI assessment is important to guide treatment but existing methods generally require in-person assessment, making them resource intensive. A validated patient-reported SSI outcome measure may be useful to overcome this limitation.

Aim
To modify and validate the Bluebelle Wound Healing Questionnaire (WHQ) for wounds healing by secondary intention.

Methods
The 18-item Bluebelle WHQ developed for wounds healing by primary intention was modified to make it applicable to secondary healing wounds. Testing was performed as part of the SWHSI-2 randomised trial assessing negative pressure wound dressings versus standard care. Participants completed the WHQ at five timepoints; in-person (baseline, post-healing) and by post (3, 6, 12
months). A reference SSI assessment was performed by a research nurse at the time of wound healing. Acceptability and criterion validity (ability of the Bluebelle WHQ to discriminate between SSI/no SSI) were explored by examining questionnaire return rates, levels of missing data and total score sensitivity/specificity values (receiver operating characteristic curve (ROC)).

Results
Baseline in-person questionnaire return rates were highest (672/686; 98%), with postal return rates of 428/615 (68.5%), 274/416 (65.9%) and 186/296 (62.8%) at follow up points. Overall, low levels of item-missing data were observed with few problems completing the questionnaire reported. Ability to discriminate between SSI/no SSI was good (Area under ROC=0.796)

Conclusion
The modified Bluebelle WHQ is a valuable tool for post-discharge assessment of wounds healing by secondary intention. It is recommended for use in research and clinical practice.

Original language	English
Article number	100889
Number of pages	8
Journal	Journal of Tissue Viability
Volume	34
Issue number	3
Early online date	18 Mar 2025
DOIs	https://doi.org/10.1016/j.jtv.2025.100889
Publication status	Published - 12 May 2025

Bibliographical note

Publisher Copyright:
© 2025 The Authors

Keywords

Surgical site infection
wound assessment
secondary intention healing
surgical wounds
patient reported outcome (PRO)

Access to Document

10.1016/j.jtv.2025.100889Licence: CC BY

Handle.net

Persistent link

Cite this

Macefield, R., Mandefield, L., Blazeby, J. M., Fairhurst, C., Baird, K., Arundel, C., Chetter, I., Martin, B. C., Hewitt, C., Gkekas, A., Mott, A., Saramago Goncalves, D. P., Swan, S., Torgerson, D., Wilkinson, J., Zahra, S., Dixon, S., Hatfield, J., Oswald, A., ... Packer, E. (2025). Modification and validation of the Bluebelle Wound Healing Questionnaire (WHQ) for assessing surgical site infection in wounds healing by secondary intention. Journal of Tissue Viability, 34(3), Article 100889. https://doi.org/10.1016/j.jtv.2025.100889

@article{d420272ab9f348b0bad8c58d34603c6c,

title = "Modification and validation of the Bluebelle Wound Healing Questionnaire (WHQ) for assessing surgical site infection in wounds healing by secondary intention",

abstract = "Background Surgical wounds healing by secondary intention are common. Healing is often complicated by surgical site infection (SSI). SSI assessment is important to guide treatment but existing methods generally require in-person assessment, making them resource intensive. A validated patient-reported SSI outcome measure may be useful to overcome this limitation. Aim To modify and validate the Bluebelle Wound Healing Questionnaire (WHQ) for wounds healing by secondary intention. Methods The 18-item Bluebelle WHQ developed for wounds healing by primary intention was modified to make it applicable to secondary healing wounds. Testing was performed as part of the SWHSI-2 randomised trial assessing negative pressure wound dressings versus standard care. Participants completed the WHQ at five timepoints; in-person (baseline, post-healing) and by post (3, 6, 12 months). A reference SSI assessment was performed by a research nurse at the time of wound healing. Acceptability and criterion validity (ability of the Bluebelle WHQ to discriminate between SSI/no SSI) were explored by examining questionnaire return rates, levels of missing data and total score sensitivity/specificity values (receiver operating characteristic curve (ROC)). Results Baseline in-person questionnaire return rates were highest (672/686; 98\%), with postal return rates of 428/615 (68.5\%), 274/416 (65.9\%) and 186/296 (62.8\%) at follow up points. Overall, low levels of item-missing data were observed with few problems completing the questionnaire reported. Ability to discriminate between SSI/no SSI was good (Area under ROC=0.796) Conclusion The modified Bluebelle WHQ is a valuable tool for post-discharge assessment of wounds healing by secondary intention. It is recommended for use in research and clinical practice.",

keywords = "Surgical site infection, wound assessment, secondary intention healing, surgical wounds, patient reported outcome (PRO)",

author = "Rhiannon Macefield and Laura Mandefield and Blazeby, \{Jane M\} and Caroline Fairhurst and Kalpita Baird and Catherine Arundel and Ian Chetter and Martin, \{Belen Corbacho\} and Catherine Hewitt and Athanasios Gkekas and Andrew Mott and \{Saramago Goncalves\}, \{Dr Pedro\} and Samantha Swan and David Torgerson and Jacqueline Wilkinson and Sabeen Zahra and Stephen Dixon and Josie Hatfield and Angela Oswald and Jo Dumville and Lee, \{Mr Matthew\} and Thomas Pinkney and Nikki Stubbs and Lyn Wilson and A Clothier and D Bosanquet and M Blow and C Price and J Todd and T Munro and W Pillay and A Pradhan and A Garnham and M Wall and K Powezka and A Syed and D Gerrard and A Croucher and N Hadjievangelou and A Firth and T Roe and G Smith and C Bicknell and C Carr and E Negbenose and L Tarusan and A Vesey and D Wilson and D Bell and J Fletcher and C Greenwood and T Wallace and S Vallabhaneni and S Holder and J Williams and S Sim and Tambyraja, \{A L\} and F Kerray and A Ng and M Sylvester and L Slater and Rashid, \{S T\} and A Palacios and K Feld and S Nandhra and G Stansby and N Parr and L Jones and J Milne and C Stubbs and R Hinchliffe and C Twine and Antoniou, \{G A\} and C Corbett and S Munt and S Warran and R Fletcher and W Al-Jundi and M Burrows and P Stather and R Barnes and T Woodrow and B Adams and O Agu and Y Gleeson and R D'Souza and L Erete and S Jones and C Checketts and D Bajic and R Matravers and I Loftus and J Budge and B Azhar and M Juszczak and A Syed and R Hancox and C Pearce and N Suggett and A Whitehouse and G Kuhan and S Premnath and N Dattani and V Hollings and F Khasawneh and J AlShakarchi and E Packer",

note = "Publisher Copyright: {\textcopyright} 2025 The Authors",

year = "2025",

month = may,

day = "12",

doi = "10.1016/j.jtv.2025.100889",

language = "English",

volume = "34",

journal = "Journal of Tissue Viability",

issn = "0965-206X",

publisher = "Tissue Viability Society",

number = "3",

}

Macefield, R, Mandefield, L, Blazeby, JM, Fairhurst, C, Baird, K, Arundel, C, Chetter, I, Martin, BC, Hewitt, C, Gkekas, A, Mott, A, Saramago Goncalves, DP, Swan, S, Torgerson, D, Wilkinson, J, Zahra, S, Dixon, S, Hatfield, J, Oswald, A, Dumville, J, Lee, MM, Pinkney, T, Stubbs, N, Wilson, L, Clothier, A, Bosanquet, D, Blow, M, Price, C, Todd, J, Munro, T, Pillay, W, Pradhan, A, Garnham, A, Wall, M, Powezka, K, Syed, A, Gerrard, D, Croucher, A, Hadjievangelou, N, Firth, A, Roe, T, Smith, G, Bicknell, C, Carr, C, Negbenose, E, Tarusan, L, Vesey, A, Wilson, D, Bell, D, Fletcher, J, Greenwood, C, Wallace, T, Vallabhaneni, S, Holder, S, Williams, J, Sim, S, Tambyraja, AL, Kerray, F, Ng, A, Sylvester, M, Slater, L, Rashid, ST, Palacios, A, Feld, K, Nandhra, S, Stansby, G, Parr, N, Jones, L, Milne, J, Stubbs, C, Hinchliffe, R , Twine, C, Antoniou, GA, Corbett, C, Munt, S, Warran, S, Fletcher, R, Al-Jundi, W, Burrows, M, Stather, P, Barnes, R, Woodrow, T, Adams, B, Agu, O, Gleeson, Y, D'Souza, R, Erete, L, Jones, S, Checketts, C, Bajic, D, Matravers, R, Loftus, I, Budge, J, Azhar, B, Juszczak, M, Syed, A, Hancox, R, Pearce, C, Suggett, N, Whitehouse, A, Kuhan, G, Premnath, S, Dattani, N, Hollings, V, Khasawneh, F, AlShakarchi, J & Packer, E 2025, 'Modification and validation of the Bluebelle Wound Healing Questionnaire (WHQ) for assessing surgical site infection in wounds healing by secondary intention', Journal of Tissue Viability, vol. 34, no. 3, 100889. https://doi.org/10.1016/j.jtv.2025.100889

Modification and validation of the Bluebelle Wound Healing Questionnaire (WHQ) for assessing surgical site infection in wounds healing by secondary intention. / Macefield, Rhiannon; Mandefield, Laura; Blazeby, Jane M et al.
In: Journal of Tissue Viability, Vol. 34, No. 3, 100889, 12.05.2025.

Research output: Contribution to journal › Article (Academic Journal) › peer-review

TY - JOUR

T1 - Modification and validation of the Bluebelle Wound Healing Questionnaire (WHQ) for assessing surgical site infection in wounds healing by secondary intention

AU - Macefield, Rhiannon

AU - Mandefield, Laura

AU - Blazeby, Jane M

AU - Fairhurst, Caroline

AU - Baird, Kalpita

AU - Arundel, Catherine

AU - Chetter, Ian

AU - Martin, Belen Corbacho

AU - Hewitt, Catherine

AU - Gkekas, Athanasios

AU - Mott, Andrew

AU - Saramago Goncalves, Dr Pedro

AU - Swan, Samantha

AU - Torgerson, David

AU - Wilkinson, Jacqueline

AU - Zahra, Sabeen

AU - Dixon, Stephen

AU - Hatfield, Josie

AU - Oswald, Angela

AU - Dumville, Jo

AU - Lee, Mr Matthew

AU - Pinkney, Thomas

AU - Stubbs, Nikki

AU - Wilson, Lyn

AU - Clothier, A

AU - Bosanquet, D

AU - Blow, M

AU - Price, C

AU - Todd, J

AU - Munro, T

AU - Pillay, W

AU - Pradhan, A

AU - Garnham, A

AU - Wall, M

AU - Powezka, K

AU - Syed, A

AU - Gerrard, D

AU - Croucher, A

AU - Hadjievangelou, N

AU - Firth, A

AU - Roe, T

AU - Smith, G

AU - Bicknell, C

AU - Carr, C

AU - Negbenose, E

AU - Tarusan, L

AU - Vesey, A

AU - Wilson, D

AU - Bell, D

AU - Fletcher, J

AU - Greenwood, C

AU - Wallace, T

AU - Vallabhaneni, S

AU - Holder, S

AU - Williams, J

AU - Sim, S

AU - Tambyraja, A L

AU - Kerray, F

AU - Ng, A

AU - Sylvester, M

AU - Slater, L

AU - Rashid, S T

AU - Palacios, A

AU - Feld, K

AU - Nandhra, S

AU - Stansby, G

AU - Parr, N

AU - Jones, L

AU - Milne, J

AU - Stubbs, C

AU - Hinchliffe, R

AU - Twine, C

AU - Antoniou, G A

AU - Corbett, C

AU - Munt, S

AU - Warran, S

AU - Fletcher, R

AU - Al-Jundi, W

AU - Burrows, M

AU - Stather, P

AU - Barnes, R

AU - Woodrow, T

AU - Adams, B

AU - Agu, O

AU - Gleeson, Y

AU - D'Souza, R

AU - Erete, L

AU - Jones, S

AU - Checketts, C

AU - Bajic, D

AU - Matravers, R

AU - Loftus, I

AU - Budge, J

AU - Azhar, B

AU - Juszczak, M

AU - Syed, A

AU - Hancox, R

AU - Pearce, C

AU - Suggett, N

AU - Whitehouse, A

AU - Kuhan, G

AU - Premnath, S

AU - Dattani, N

AU - Hollings, V

AU - Khasawneh, F

AU - AlShakarchi, J

AU - Packer, E

PY - 2025/5/12

Y1 - 2025/5/12

N2 - Background Surgical wounds healing by secondary intention are common. Healing is often complicated by surgical site infection (SSI). SSI assessment is important to guide treatment but existing methods generally require in-person assessment, making them resource intensive. A validated patient-reported SSI outcome measure may be useful to overcome this limitation. Aim To modify and validate the Bluebelle Wound Healing Questionnaire (WHQ) for wounds healing by secondary intention. Methods The 18-item Bluebelle WHQ developed for wounds healing by primary intention was modified to make it applicable to secondary healing wounds. Testing was performed as part of the SWHSI-2 randomised trial assessing negative pressure wound dressings versus standard care. Participants completed the WHQ at five timepoints; in-person (baseline, post-healing) and by post (3, 6, 12 months). A reference SSI assessment was performed by a research nurse at the time of wound healing. Acceptability and criterion validity (ability of the Bluebelle WHQ to discriminate between SSI/no SSI) were explored by examining questionnaire return rates, levels of missing data and total score sensitivity/specificity values (receiver operating characteristic curve (ROC)). Results Baseline in-person questionnaire return rates were highest (672/686; 98%), with postal return rates of 428/615 (68.5%), 274/416 (65.9%) and 186/296 (62.8%) at follow up points. Overall, low levels of item-missing data were observed with few problems completing the questionnaire reported. Ability to discriminate between SSI/no SSI was good (Area under ROC=0.796) Conclusion The modified Bluebelle WHQ is a valuable tool for post-discharge assessment of wounds healing by secondary intention. It is recommended for use in research and clinical practice.

AB - Background Surgical wounds healing by secondary intention are common. Healing is often complicated by surgical site infection (SSI). SSI assessment is important to guide treatment but existing methods generally require in-person assessment, making them resource intensive. A validated patient-reported SSI outcome measure may be useful to overcome this limitation. Aim To modify and validate the Bluebelle Wound Healing Questionnaire (WHQ) for wounds healing by secondary intention. Methods The 18-item Bluebelle WHQ developed for wounds healing by primary intention was modified to make it applicable to secondary healing wounds. Testing was performed as part of the SWHSI-2 randomised trial assessing negative pressure wound dressings versus standard care. Participants completed the WHQ at five timepoints; in-person (baseline, post-healing) and by post (3, 6, 12 months). A reference SSI assessment was performed by a research nurse at the time of wound healing. Acceptability and criterion validity (ability of the Bluebelle WHQ to discriminate between SSI/no SSI) were explored by examining questionnaire return rates, levels of missing data and total score sensitivity/specificity values (receiver operating characteristic curve (ROC)). Results Baseline in-person questionnaire return rates were highest (672/686; 98%), with postal return rates of 428/615 (68.5%), 274/416 (65.9%) and 186/296 (62.8%) at follow up points. Overall, low levels of item-missing data were observed with few problems completing the questionnaire reported. Ability to discriminate between SSI/no SSI was good (Area under ROC=0.796) Conclusion The modified Bluebelle WHQ is a valuable tool for post-discharge assessment of wounds healing by secondary intention. It is recommended for use in research and clinical practice.

KW - Surgical site infection

KW - wound assessment

KW - secondary intention healing

KW - surgical wounds

KW - patient reported outcome (PRO)

U2 - 10.1016/j.jtv.2025.100889

DO - 10.1016/j.jtv.2025.100889

M3 - Article (Academic Journal)

C2 - 40359686

SN - 0965-206X

VL - 34

JO - Journal of Tissue Viability

JF - Journal of Tissue Viability

IS - 3

M1 - 100889

ER -

Modification and validation of the Bluebelle Wound Healing Questionnaire (WHQ) for assessing surgical site infection in wounds healing by secondary intention

Abstract

Bibliographical note

Keywords

Access to Document

Handle.net

Fingerprint

Cite this