Validation and Clinimetric Properties of the Persian Version of the Leg Ulcer Measurement Tool

Abstract

The Leg Ulcer Measurement Tool is a clinician-rated instrument designed to assess wound characteristics and monitor healing in patients with leg ulcers. No validated Persian version exists for use in Iranian healthcare settings. This study aimed to culturally adapt the tool into Persian and evaluate its clinimetric properties. This methodological study was conducted between December 2024 and October 2025 in Iran. Cross-cultural adaptation included forward translation, synthesis, back-translation, expert review and pilot testing. Face and content validity were assessed qualitatively and quantitatively. Construct validity was examined via comparison with the Bates-Jensen Wound Assessment Tool and known-groups analysis based on ulcer severity. Predictive validity was evaluated using logistic regression for amputation and healing outcomes. Intra- and inter-rater reliability were assessed using kappa, Gwet's AC, percent agreement and intraclass correlation coefficients. Predictive accuracy for amputation was analysed with receiver operating characteristic curves. All items demonstrated acceptable face and content validity. Severe ulcers showed significantly higher scores than mild/moderate ulcers (p < 0.001). Convergent validity with the comparative tool was high (r = 0.96–1.00) and total scores were strongly correlated (r = 0.864, p < 0.001). Higher baseline scores predicted increased odds of amputation (odds ratio = 1.13) and lower odds of complete healing (odds ratio = 0.93). Reliability was excellent (intraclass correlation coefficient > 0.99) and predictive accuracy for amputation was good (area under the curve = 0.80). The Persian Leg Ulcer Measurement Tool is valid, reliable and clinically accurate for assessing wound characteristics and predicting outcomes in Iranian patients, supporting its use in clinical practice and research.