Influence of ulceration etiology on the global quality of life and its specific dimensions, including the control of pain, in patients with lower limb vascular insufficiency

Health-related quality of life of patients with hard-to-heal ulcers measured with the 15D instrument: a prospective study

OBJECTIVE

The aim of the study was to investigate the health-related quality of life (HRQoL) of patients with hard-to-heal ulcers in a prospective study setting, and further to investigate the factors associated with HRQoL.

METHOD

Patients with hard-to-heal ulcers referred to the Wound Centre of Tampere University Hospital, Finland, completed the 15D HRQoL questionnaire. The 15D scores were compared to an age- and sex-matched general population cohort and to patients with chronic pain and cancer. The baseline background and clinical data of patients with hard-to-heal ulcers were obtained from patient records and the Registry of Chronic Wounds at the Wound Centre, and follow-up information via questionnaires sent to the study participants six months after the first visit. Factors associated with baseline HRQoL and HRQoL changes during the follow-up were analysed.

RESULTS

A total of 142 patients with hard-to-heal ulcers were included in the study. The mean 15D score of the patients with hard- to-heal ulcers was lower than that of the general population cohort and patients with breast and prostate cancer, but higher than that of patients with chronic pain. Patients with an arterial or mixed ulcer had the lowest 15D scores, and negative correlations were detected between 15D scores and age, number of comorbidities and use of pain medication. During follow-up, the 15D score improved significantly in 43% of the patients, but ulcer healing was not associated with increasing 15D scores.

CONCLUSION

In this study, the HRQoL of patients with hard-to-heal ulcers was substantially impaired. In addition to ulcer aetiology, age and comorbidities were associated with HRQoL-highlighting the importance of multidisciplinary care-and this most likely explains the lack of correlation between ulcer healing and 15D score change during follow-up.

Healing Process, Pain, and Health-Related Quality of Life in Patients with Venous Leg Ulcers Treated with Fish Collagen Gel: A 12-Week Randomized Single-Center Study

The aim of the study was to assess the effectiveness of fish skin collagen and its impact on healing, pain intensity, and quality of life in patients with venous leg ulcers (VLUs). This study included 100 adults with VLUs. Eligible patients were randomized to either tropocollagen gel treatment (group A, n = 47) or placebo alone (group B, n = 45). We applied the gel to the periwound skin for 12 weeks. All groups received standard wound care, including class 2 compression therapy and wound hygiene procedures. We assessed the healing rate (cm2/week) and quality of life (QoL) using the Skindex-29 and CIVIQ scales. In group A, more ulcers healed, and the healing rate was faster. In both study groups, patients showed a significant improvement in quality of life after the intervention, but there was a greater improvement in the tropocollagen group. In group A, the greatest improvement was related to physical symptoms and the pain dimension. This study showed that the application of fish collagen gel to the periwound skin improves the healing process and QoL in patients with VLUs. The 12-week treatment with collagen reduced the severity of physical complaints, pain, and local skin symptoms, which determined the quality of life in patients with VLUs to the greatest extent.

Acceptance of illness, quality of life and nutritional status of patients after lower limb amputation due to diabetes mellitus

INTRODUCTION

Diabetes mellitus is one of the most common chronic diseases with a high number of sufferers worldwide. Diabetic neuropathy and diabetic angiopathy lead to serious infectious complications which are very difficult to combat and may finally lead to the amputation of a lower limb. The aim of the study was to evaluate the quality of life, the level of acceptance of the illness and the nutritional status of patients after lower limb amputation due to diabetes.

METHODS

Ninety-nine patients (23 men and 76 women) were enrolled into the study. They had all undergone lower limb amputation due to diabetic foot and were treated in the Department of General and Oncological Surgery. The following questionnaires were used: the WHO Quality of Life-BREF (WHOQOL-BREF), the Mini Nutritional Assessment (MNA), the Acceptance of Illness Scale (AIS) and the anonymous specific socio-demographic characteristics questionnaire.

RESULTS

The diabetes-related amputees were revealed to have a higher QoL within the social domain (mean score 64.48), an intermediate QoL - within the environmental domain (mean score 63.04) and the mental domain (mean score 59.61), and a lower QoL - within physical (somatic) domain (mean score 54.69). There was no statistical correlation between genders or between all the domains of QoL (P > 0.05). The mean MNA score was 22.66, which means that patients were at risk of malnutrition. There were statistical differences between women and men as regards nutritional status (P = 0.034). The mean AIS score was 27.65 (27.09 women and 29.48 men), which means that the respondents accept their disease. There was no statistical correlation between gender and the acceptance of the disease (P = 0.288). There was not statistical correlation between age and QoL (P > 0.05). There were statistical differences between age and nutritional status (P < 0.05), and between age and acceptance of the illness (P = 0.044).

CONCLUSIONS

The better the quality of life was in all the domains, the better the level of acceptance of illness was. The less malnourished the patient was, the better their quality of life was in all the domains.

Occurrence and Severity of Pain in Patients with Venous Leg Ulcers: A 12-Week Longitudinal Study

Background: The aim of the study was to analyze the dynamics of pain severity and its predictors in a group of patients with chronic venous leg ulcers. Methods: A 12-week longitudinal study included 754 patients with chronic venous leg ulcers. Subjective severity of pain was measured at weekly intervals with an 11-point visual analogue scale (VAS). Results: A significant decrease in VAS scores has been observed throughout the entire analyzed period. Higher severity of pain during follow-up was independently predicted by the presence of pus and/or unpleasant smell from the ulceration during the first visit, as well as by the occurrence of posterior and/or circumferential ulcers. The presence of ulcer redness during the first visit was associated with lesser pain severity; also, a significant interaction effect between the ulceration redness and warmth was observed. Conclusions: Implementation of complex holistic care may contribute to a substantial decrease in the occurrence and severity of pain in a patient with venous leg ulcers. Pain control seems to depend primarily on clinical parameters and topography of venous ulcers. The predictors of pain severity identified in this study might be considered during the planning of tailored care for patients with venous leg ulcers.