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Janke TM, Kozon V, Valiukeviciene S, Rackauskaite L, Reich A, Stępień K, Chernyshov P, Jankechová M, van Montfrans C, Amesz S, Barysch M, Montero EC, Augustin M, Blome C. Validation of the Wound-QoL-17 and the Wound-QoL-14 in a European sample of 305 patients with chronic wounds. Int Wound J 2024; 21:e14505. [PMID: 38049311 PMCID: PMC10898406 DOI: 10.1111/iwj.14505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/08/2023] [Indexed: 12/06/2023] Open
Abstract
The Wound-QoL assesses the impact of chronic wounds on patients' health-related quality of life (HRQoL). A 17-item and a shortened 14-item version are available. The Wound-QoL-17 has been validated for multiple languages. For the Wound-QoL-14, psychometric properties beyond internal consistency were lacking. We aimed to validate both Wound-QoL versions for international samples representing a broad range of European countries, including countries for which validation data had yet been pending. Patients with chronic wounds of any aetiology or location were recruited in Austria, Lithuania, the Netherlands, Poland, Slovakia, Spain, Switzerland and Ukraine. Psychometric properties were determined for both Wound-QoL versions for the overall sample and, if feasible, country-wise. We included 305 patients (age 68.5 years; 52.8% males). Internal consistency was high in both Wound-QoL-17 (Cronbach's α: 0.820-0.933) and Wound-QoL-14 (0.779-0.925). Test-retest reliability was moderate to good (intraclass correlation coefficient: 0.618-0.808). For Wound-QoL-17 and Wound-QoL-14, convergent validity analyses showed highest correlations with global HRQoL rating (r = 0.765; r = 0.751) and DLQI total score (r = 0.684; r = 0.681). Regarding clinical data, correlations were largest with odour (r = -0.371; r = -0.388) and wound size (r = 0.381; r = 0.383). Country-wise results were similar. Both Wound-QoL versions are valid to assess HRQoL of patients with chronic wounds. Due to its psychometric properties and brevity, the Wound-QoL-14 might be preferrable in clinical practice where time is rare. The availability of various language versions allows for the use of this questionnaire in international studies and in clinical practice when foreign language patients are being treated.
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Affiliation(s)
- Toni Maria Janke
- Institute for Health Services Research in Dermatology and Nursing (IVDP)University Medical Center Hamburg‐Eppendorf (UKE)HamburgGermany
| | - Vlastimil Kozon
- Society Wound Diagnosis and Wound Management AustriaVienna Medical AcademyViennaAustria
| | - Skaidra Valiukeviciene
- Department of Dermatology and VenereologyHospital of Lithuanian University of Health Sciences Kauno KlinikosKaunasLithuania
| | - Laura Rackauskaite
- Department of Dermatology and VenereologyHospital of Lithuanian University of Health Sciences Kauno KlinikosKaunasLithuania
| | - Adam Reich
- Department of Dermatology, Institute of Medical SciencesMedical College of Rzeszów UniversityRzeszówPoland
| | - Katarzyna Stępień
- Department of Dermatology, Institute of Medical SciencesMedical College of Rzeszów UniversityRzeszówPoland
| | - Pavel Chernyshov
- Department of Dermatology and VenereologyBogomolets National Medical UniversityKievUkraine
| | - Monika Jankechová
- Faculty of Health and Social Work St. Ladislaw in Nove ZamkySt. Elizabeth University of Health and Social WorkBratislavaSlovakia
| | - Catherine van Montfrans
- Department of DermatologyErasmus University Medical Center RotterdamRotterdamThe Netherlands
| | - Stella Amesz
- Department of Health Sciences, Section of Nursing ScienceUniversity Medical Center GroningenGroningenThe Netherlands
| | - Marjam Barysch
- Department of DermatologyUniversity Hospital ZurichZurichSwitzerland
| | | | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP)University Medical Center Hamburg‐Eppendorf (UKE)HamburgGermany
| | - Christine Blome
- Institute for Health Services Research in Dermatology and Nursing (IVDP)University Medical Center Hamburg‐Eppendorf (UKE)HamburgGermany
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Senft JD, Fleischhauer T, Poß-Doering R, Frasch J, Feißt M, Awounvo S, Müller-Bühl U, Altiner A, Szecsenyi J, Laux G. Primary Care Disease Management for Venous Leg Ulceration in German Healthcare: Results of the Ulcus Cruris Care Pilot Study. Healthcare (Basel) 2023; 11:2521. [PMID: 37761717 PMCID: PMC10531034 DOI: 10.3390/healthcare11182521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/29/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Despite proven effectiveness, compression therapy is applied in only 20-40% of patients with venous leg ulceration, leading to avoidable chronification and morbidity. The Ulcus Cruris Care project was established to develop a new disease-management concept comparable to existing programs for chronic diseases to support evidence-based treatment of venous leg ulceration. This prospective controlled study assessed its first implementation. Interventional elements comprised online training for general practitioner practices, software support for case management, and educational materials for patients. A total of 20 practices and 40 patients were enrolled in a 1:1 ratio to the intervention and control group. Guideline-conform compression therapy was applied more frequently in the intervention group (19/20 [95%] vs. 11/19 [58%]; p = 0.006). For patients with ulcers existing ≤ 6 months, the healing rate at 12 weeks was 8/11 [73%] (intervention) compared to 4/11 [36%] (control; p = 0.087). Patients after intervention had higher scores for self-help and education in the PACIC-5A questionnaire (42.9 ± 41.6 vs. 11.4 ± 28.8; p = 0.044). Treatment costs were EUR 1.380 ± 1.347 (intervention) and EUR 2.049 ± 2.748 (control; p = 0.342). The results of this study indicate that the Ulcus Cruris Care intervention may lead to a significant improvement in care. Consequently, a broader rollout in German healthcare seems warranted.
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Affiliation(s)
- Jonas D. Senft
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Thomas Fleischhauer
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Regina Poß-Doering
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Jona Frasch
- aQua Institute for Applied Quality Promotion and Research in Health Care GmbH, Maschmühlenweg 8-10, 37073 Göttingen, Germany
| | - Manuel Feißt
- Institute of Medical Biometry, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Sinclair Awounvo
- Institute of Medical Biometry, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Uwe Müller-Bühl
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Attila Altiner
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Gunter Laux
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
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Raepsaet C, Alves P, Cullen B, Gefen A, Lázaro-Martínez JL, Lev-Tov H, Najafi B, Santamaria N, Sharpe A, Swanson T, Woo K, Beeckman D. Clinical research on the use of bordered foam dressings in the treatment of complex wounds: A systematic review of reported outcomes and applied measurement instruments. J Tissue Viability 2022; 31:514-522. [DOI: 10.1016/j.jtv.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/16/2022] [Indexed: 10/18/2022]
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Topp J, Blome C, Augustin M, Mohr N, Debus ES, Diener H, Sommer R. Determining the Minimal Important Difference for the Wound-QoL Questionnaire. Patient Prefer Adherence 2021; 15:1571-1578. [PMID: 34285475 PMCID: PMC8286720 DOI: 10.2147/ppa.s315822] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/02/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The questionnaire for the quality of life with chronic wounds (Wound-QoL) is a valid and reliable instrument to determine the disease-specific health-related QoL of patients with chronic wounds. For the interpretation of HRQoL scores, it is additionally important to know which differences in scores are considered meaningful. The minimal important difference (MID) is defined as a change in HRQoL that a patient would consider meaningful, such that the patient would judge a treatment to be beneficial and worthy of repeating. OBJECTIVE To interpret changes in the Wound-QoL scores and draw conclusions regarding the relevance of detected changes; the purpose of this study was to estimate the MID of the Wound-QoL global score and its subscales for patients with chronic wounds. PATIENTS AND METHODS Patients completed the Wound-QoL before and four to six weeks after treatment and additionally gave a global rating of wound status change after treatment. The global rating of change served as an anchor question. MIDs were calculated based on an anchor-based and a distribution-based method. RESULTS In total, 227 patients participated in the study. The mean age of the study population was 66.9 (± 12.7) median was 69.5, and 51.5% of the patients were female. MIDs for the Wound-QoL global score ranged from 0.47 to 0.52, proposing an overall estimation of 0.50. CONCLUSION The results can be used to measure and interpret changes in wound-specific QoL over time.
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Affiliation(s)
- Janine Topp
- Institute for Health Services Research in Dermatology and Nursing (IVDP), German Center for Health Services Research in Dermatology (CVderm), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christine Blome
- Institute for Health Services Research in Dermatology and Nursing (IVDP), German Center for Health Services Research in Dermatology (CVderm), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), German Center for Health Services Research in Dermatology (CVderm), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Nicole Mohr
- Institute for Health Services Research in Dermatology and Nursing (IVDP), German Center for Health Services Research in Dermatology (CVderm), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Eike Sebastian Debus
- Department of Vascular Medicine, University Medical Center Hamburg‐Eppendorf (UKE), Hamburg, Germany
| | - Holger Diener
- Department of Vascular Medicine, University Medical Center Hamburg‐Eppendorf (UKE), Hamburg, Germany
| | - Rachel Sommer
- Institute for Health Services Research in Dermatology and Nursing (IVDP), German Center for Health Services Research in Dermatology (CVderm), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Correspondence: Rachel Sommer Institute for Health Services Research in Dermatology and Nursing (IVDP), German Center for Health Services Research in Dermatology (CVderm), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, GermanyTel +49 (0) 40 7410 24724Fax +49 (0) 40 7410 40160 Email
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Warren RB, Gooderham M, Burge R, Zhu B, Amato D, Liu KH, Shrom D, Guo J, Brnabic A, Blauvelt A. Comparison of cumulative clinical benefits of biologics for the treatment of psoriasis over 16 weeks: Results from a network meta-analysis. J Am Acad Dermatol 2019; 82:1138-1149. [PMID: 31884091 DOI: 10.1016/j.jaad.2019.12.038] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/06/2019] [Accepted: 12/19/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Cumulative clinical improvement and speed of improvement are important to psoriasis patients. OBJECTIVE Compare cumulative benefits of biologics over 12 to 16 weeks in the treatment of moderate to severe psoriasis. METHODS A systematic literature review identified phase III trial data on Psoriasis Area and Severity Index (PASI) responses for biologics during 12 and 16 weeks of treatment. Cumulative clinical benefit, measured by the area under the curve for PASI ≥75% improvement (PASI 75), ≥90% improvement (PASI 90), and 100% improvement (PASI 100), was compared using the network meta-analysis and Bayesian methodology on the relative probability of achieving percentage of maximum area under the curve. RESULTS Among biologics approved for psoriasis treatment, anti-interleukin-17 biologics demonstrated consistently greater cumulative clinical benefits on PASI 75, PASI 90, and PASI 100 over the 12- or 16-week period than anti-interleukin-23 and other biologics. For biologics with 12-week data, ixekizumab and brodalumab showed greater cumulative benefits for PASI 75, PASI 90, and PASI 100 than secukinumab, followed by guselkumab, infliximab, adalimumab, ustekinumab, and etanercept. Ixekizumab showed greater cumulative benefits than all other biologics reporting 16-week data. LIMITATIONS Recently approved biologics were not included. CONCLUSION Ixekizumab (at 12 weeks and 16 weeks) and brodalumab (at 12 weeks) had greater cumulative clinical benefit than all of other biologics studied.
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Affiliation(s)
- Richard B Warren
- Salford Royal NHS Foundation Trust, The University of Manchester, National Institute for Health Research Manchester Biomedical Research Centre, Manchester, United Kingdom
| | | | - Russel Burge
- Lilly Corporate Center, Indianapolis, Indiana; University of Cincinnati.
| | - Baojin Zhu
- Lilly Corporate Center, Indianapolis, Indiana
| | - David Amato
- Lilly Corporate Center, Indianapolis, Indiana
| | | | - David Shrom
- Lilly Corporate Center, Indianapolis, Indiana
| | - Jiaying Guo
- Lilly Corporate Center, Indianapolis, Indiana
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Quality of life assessment and use of patient-reported outcomes in practice. PHLEBOLOGIE 2017. [DOI: 10.12687/phleb2382-6-2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
SummaryBackground: Patient-reported outcomes (PROs) are essential components of wound and vascular diagnostics and management. Aim: To provide an overview of PROs as diagnostic tools in the management of chronic wounds.Methods: Review of different concepts on inclusion of PROs in wound practice from literature.Results: PROs are indispensable sources of information for the understanding of the biopsycho- social context of wound diseases. Essential dimensions to be recorded are pain, health-related quality of life and patient benefit. Psychological parameters, adherence, treatment goals and treatment benefits are often needed. Further fields of interest include cumulative life course impairment, coping with disease, stigmatisation specifically applied according to clinical questions.Conclusion: Patient-reported outcomes are mandatory for the diagnostic work-up of chronic wounds. They also provide essential information in the course of a disease, can be diagnostic clues for non-adherence and treatment failures. Measurement of many PRO parameters in wound disease, such as health-related quality of life and pain, is facilitated by validated instruments, which are recommended for practice.
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Abstract
BACKGROUND One of the most significant, and growing, challenges in modern medicine, i.e. the treatment of chronic wounds, is marked by nonuniform data. This concerns both prevalence and incidence of chronic dermatosis, in particular venous ulcers (ulcus cruris), as well as the impact on the health-related quality of life, and practical and economic parameters of the success of different therapies. PURPOSE The aim of this work is to examine the epidemiology of chronic wounds, in particular age-associated venous ulcers, their impact on health-related quality of life, the treatment regimen, and practical and economic parameters of the success of different therapies. MATERIALS AND METHODS Performed were analysis of data on the care of venous ulcers in Germany, based on secondary data of Barmer GEK from 2009 and 2012, comparison with data of a NHS Kent Community Health Trust study, and analysis of studies concerning structures, processes and critical success factors for the treatment of chronic wounds, including economic effects. CONCLUSION Early causal therapy with treatment based on the stage of the wound, consequent goal-oriented interdisciplinary care, and relapse prophylaxis is critical for successful healing of venous ulcers. The costs of treatment significantly correlate with the duration of treatment which can be reduced by up to 60% using guideline-based concepts for the treatment of chronic wounds. Treatment success, in particular with regard to cost-benefit considerations, can be optimized by telemedicine networks of key players who treat chronic wounds.
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Heyer K, Herberger K, Protz K, Glaeske G, Augustin M. Epidemiology of chronic wounds in Germany: Analysis of statutory health insurance data. Wound Repair Regen 2016; 24:434-42. [DOI: 10.1111/wrr.12387] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 11/22/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Kristina Heyer
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - Katharina Herberger
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - Kerstin Protz
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - Gerd Glaeske
- Center for Social Policy Research; University of Bremen; Bremen Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
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Power through standards: The Federal Conference for Outcome Measurement and Benefit Assessment of Chronic Wounds. PHLEBOLOGIE 2016. [DOI: 10.12687/phleb2304-2-2016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Summary
Background When concerning documentation and follow up measurement for chronic wounds, uniform standards are a vital precondition for further development of care in Germany. The Federal Consensus Conference “Outcome Measurement and Benefit Assessment for Chronic Wounds” has taken action and has approved systematic recommendations including small data records since 2013.
Aim In the following review rationales, objectives, methods and action outcomes of the Federal Consensus Conference are summarized.
Results Experts from more than 25 different scientific expert associations, professional associations, organizations specialized in care, representatives of statutory health insurance companies as well as the Federal Ministry of Health participated in the consensus formation. From 2013–2015 a total of eight consensus meetings as well as six online consensus enquiries were agreed upon. These entailed a) the relevant subject areas for consensus formation, b) the necessary standards for wound documentation, c) recommendations concerning the enquiries on quality of life for people with chronic wounds, d) recommendations for minimal clinically relevant differences, e) standards on utilization of secondary data and f) recommendations for health-economic analytics of ulcus cruris. The first four publications concerning this topic were finalized.
Conclusions The combination of personal attendance meetings and online enquiries with a broad panel of experts has proved to be an efficient tool for consensus formation regarding the documentation criteria and outcome criteria for chronic wounds using the example of ulcus cruris. The present results are subject of an active implementation in 2016/2017 and at the same time provide a chance for an improved process- and result quality concerning nationwide care.
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The German national consensus on wound documentation and outcomes: Rationale, working programme and current status. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.wndm.2015.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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