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Mairghani M, Sorensen J, Elmusharaf K, Patton D, Moore Z. The health-related quality of life in patients with diabetic foot ulcers in the Kingdom of Bahrain. J Tissue Viability 2023; 32:465-471. [PMID: 37385873 DOI: 10.1016/j.jtv.2023.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 06/13/2023] [Accepted: 06/16/2023] [Indexed: 07/01/2023]
Abstract
AIMS The aims of this study were to assess the health-related quality of life (HRQoL) of adult Bahraini patients with diabetic foot ulcers (DFU) and to explore factors associated with poor HRQoL. METHODS Cross-sectional HRQoL data were obtained from a sample of patients in active treatment for DFU at a large public hospital in Bahrain. Patient-reported HRQOL was measured using the following instruments: DFS-SF, CWIS and EQ-5D. RESULTS The patient sample included 94 patients, with a mean age of 61.8 (SD: 9.9) years, 54 (57.5%) were males, and 68 (72.3%) were native Bahrainis. Poorer HRQoL was found among patients who were unemployed, divorced/widowed, and those with a shorter duration of formal education. Additionally, patients with severe DFUs, persisting ulcers, and a longer duration of diabetes reported statistically significantly poorer HRQoL. CONCLUSIONS Findings from this study demonstrate a low level of HRQoL among Bahraini patients with DFUs. A longer duration of diabetes, in addition to ulcer severity and status statistically significantly influence HRQoL.
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Affiliation(s)
| | - Jan Sorensen
- Healthcare Outcomes Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Khalifa Elmusharaf
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
| | - Declan Patton
- Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Zena Moore
- Royal College of Surgeons in Ireland, Dublin, Ireland.
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Langendoen-Gort M, Groeneveld L, Prinsen CAC, Beulens JW, Elders PJM, Halperin I, Mukerji G, Terwee CB, Rutters F. Patient-reported outcome measures for assessing health-related quality of life in people with type 2 diabetes: A systematic review. Rev Endocr Metab Disord 2022; 23:931-977. [PMID: 35779199 PMCID: PMC9515038 DOI: 10.1007/s11154-022-09734-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2022] [Indexed: 11/26/2022]
Abstract
Patient-Reported Outcome Measures (PROMs) are important tools to assess outcomes relevant to patients, with Health-Related Quality Of Life (HRQOL) as an important construct to be measured. Many different HRQOL PROMs are used in the type 2 diabetes field, however a complete overview of these PROMs is currently lacking. We therefore aimed to systematically describe and classify the content of all PROMs that have specifically been developed or validated to measure (aspects of) HRQOL in people with type 2 diabetes. A literature search was performed in PubMed and EMBASE until 31 December 2021. Studies on the development or validation of a PROM measuring HRQOL, or aspects of HRQOL, in people with type 2 diabetes were included. Title and abstract and full-text screening were conducted by two independent researchers and data extraction was performed independently by one of the researchers. Data were extracted on language in which the PROM was developed, target population, construct(s) being measured, names of (sub)scales and number of items per (sub)scale. In addition, all PROMs and subscales were classified according to specific aspects of HRQOL based on the Wilson & Cleary model (symptom status, functional status, general health perceptions) to aid researchers in PROM selection. In total 220 studies were identified that developed or validated PROMs that measure (aspects of) HRQOL in people with type 2 diabetes. Of the 116 unique HRQOL PROMs, 91 (of the subscales) measured symptom status, 60 measured functional status and 26 measured general health perceptions. In addition, 16 of the PROMs (subscales) measured global quality of life. 61 of the 116 PROMs (subscales) also include characteristics of the individual (e.g. aspects of personality, coping) or environment (e.g. social or financial support) and patient-reported experience measures (PREMs, e.g. measure of a patient's perception of their personal experience of the healthcare they have received, e.g. treatment satisfaction), which are not part of the HRQOL construct. Only 9 of the 116 PROMs measure all aspects of HRQOL based on the Wilson & Cleary model. Finally, 8 of the 116 PROMs stating to measure HRQOL, measured no HRQOL construct. In conclusion, a large number of PROMs are available for people with type 2 diabetes, which intend to measure (aspects of) HRQOL. These PROMs measure a large variety of (sub)constructs, which are not all HRQOL constructs, with a small amount of PROMs not measuring HRQOL at all. There is a need for consensus on which aspects of HRQOL should be measured in people with type 2 diabetes and which PROMs to use in research and daily practice. PROSPERO: CRD42017071012. COMET database: http://www.comet-initiative.org/studies/details/956 .
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Affiliation(s)
- Marlous Langendoen-Gort
- General Practice, Amsterdam UMC, Location Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
- Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
| | - Lenka Groeneveld
- Epidemiology and Data Science, Amsterdam UMC, Location Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
- Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
| | - Cecilia A C Prinsen
- Epidemiology and Data Science, Amsterdam UMC, Location Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
- Amsterdam Public Health, Methodology, Amsterdam, The Netherlands
| | - Joline W Beulens
- Epidemiology and Data Science, Amsterdam UMC, Location Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
- Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Diabetes & Metabolism, Amsterdam, The Netherlands
| | - Petra J M Elders
- General Practice, Amsterdam UMC, Location Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
- Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Diabetes & Metabolism, Amsterdam, The Netherlands
| | - Ilana Halperin
- Department of Medicine, Temerty Faculty of Medicine, Sunnybrook Health Sciences Center, King's College Circle, University of Toronto, Toronto, ON, Canada
| | - Geetha Mukerji
- Department of Medicine, Temerty Faculty of Medicine, Sunnybrook Health Sciences Center, King's College Circle, University of Toronto, Toronto, ON, Canada
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, Canada
| | - Caroline B Terwee
- Epidemiology and Data Science, Amsterdam UMC, Location Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
- Amsterdam Public Health, Methodology, Amsterdam, The Netherlands
| | - Femke Rutters
- Epidemiology and Data Science, Amsterdam UMC, Location Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands.
- Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands.
- Amsterdam Cardiovascular Sciences, Diabetes & Metabolism, Amsterdam, The Netherlands.
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Romero-Collado À, Hernández-Martínez-Esparza E, Zabaleta-Del-Olmo E, Urpí-Fernández AM, Santesmases-Masana R. Patient-Reported Outcome Measures of Quality of Life in People Affected by Diabetic Foot: A Psychometric Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1602-1618. [PMID: 35659485 DOI: 10.1016/j.jval.2022.04.1737] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/10/2022] [Accepted: 04/19/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This psychometric systematic review aimed to identify the most suitable patient-reported outcome measures (PROMs) of quality of life (QoL) in people affected by diabetic foot. METHODS We performed a literature search in MEDLINE (PubMed), CINAHL (EBSCOhost), and PsycINFO (EBSCOhost) databases from inception to February 1, 2022. We also searched gray literature databases. Eligible studies were full-text reports developing a QoL condition-specific PROM or assessing one or more of its measurement properties in people affected by diabetic foot. We assessed the methodological quality of included studies independently using the "Consensus-Based Standards for the Selection of Health Measurement Instruments Risk of Bias" checklist. The measurement properties were evaluated using specific criteria. We graded the quality of the evidence using a "Grading of Recommendations Assessment, Development and Evaluation" approach modified by Consensus-Based Standards for the Selection of Health Measurement Instruments. RESULTS Forty-three reports (46 studies) providing information on the measurement properties of 10 different PROMs were included. We did not identify any instruments that could be recommended for use. We identified 2 PROMs that were not recommended for use and 8 that were potentially recommended but would require further investigation. Of these 8 PROMs, 4 had better evidence for content validity. CONCLUSIONS Available PROMs to measure QoL in people affected by diabetic foot have limited evidence for their measurement properties. There is no fully suitable PROM. Pending further evidence, 4 PROMs could potentially be recommended for use.
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Affiliation(s)
| | | | - Edurne Zabaleta-Del-Olmo
- Nursing Department, Faculty of Nursing, Universitat de Girona, Girona, Spain; Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Gerència Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain.
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4
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Fattah SA, Elmadani M, Abo-Elmatty DM, Awadallah M, Mehanna ET. Genetic variants of ALR (-106C → T /-12C → G) and serum PKC-δ are associated with peripheral neuropathy in Egyptian diabetic patients with impaired handwriting. J Diabetes Metab Disord 2022; 21:557-565. [PMID: 35673475 PMCID: PMC9167348 DOI: 10.1007/s40200-022-01008-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 02/12/2022] [Indexed: 11/26/2022]
Abstract
Purpose Diabetic peripheral neuropathy can injure the hand median nerve and cause extensive nerve damage. PKC and ALR are associated with progression of diabetic complications. We hypothesized a genetic association between the ALR polymorphisms (-106C → T/-12C → G) and elevated serum PKC-δ levels in diabetic neuropathy and its adverse effects on handwriting in Egyptian population. Methods One hundred DPN were compared with 100 DP and 100 healthy volunteers. ALR -106C → T/-12C → G variants were studied using the PCR-RFLP method. A routine set of standard laboratory markers was determined. Serum PKC-δ concentration was determined by ELISA. Logistic regression analysis and areas under the receiver characteristic curves (AUCs) were evaluated to investigate the predictors of diabetic neuropathy. Arabic handwriting was analyzed based on the recognition of functional features, word shape, and ascending/descending parts of letters. Results Individuals carrying ALR-106C → C and -12G → G had a significantly higher risk of developing diabetic neuropathy than individuals with -106C → T and -12C → G genotypes (P = 0.01, P = 0.02). Carriers of the (-106C → T) CC and (-12C → G) GG genotypes had significantly increased serum levels of PKC-δ, FBG, TC, and LDL-c. PKC- δ serum levels were significantly correlated with glycemic and lipid indicators (P < 0.001). PKC-δ is a significant predictor of diabetes with or without neuropathy at a cutoff value of 16.6, sensitivity was 89%, and specificity 100%. All DPN showed complete deterioration of handwriting after the onset of diabetic neuropathy. Conclusion The genetic variants ALR-106C → C / -12G → G and PKC-δ in serum may help in the detection and treatment of diabetic neuropathy in Egyptian population before writing performance is affected.
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Affiliation(s)
- Shaimaa A. Fattah
- Department of Biochemistry, Faculty of Pharmacy, Suez Canal University, Ismailia, 41522 Egypt
| | - Moshira Elmadani
- Forgery and Counterfeiting Researches Department, Forensic Medicine Authority, Minister of Justice, Ismailia, Egypt
| | - Dina M. Abo-Elmatty
- Department of Biochemistry, Faculty of Pharmacy, Suez Canal University, Ismailia, 41522 Egypt
| | - Mohamed Awadallah
- Forgery and Counterfeiting Researches Department, Forensic Medicine Authority, Minister of Justice, Ismailia, Egypt
| | - Eman T. Mehanna
- Department of Biochemistry, Faculty of Pharmacy, Suez Canal University, Ismailia, 41522 Egypt
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Abstract
Diabetic foot ulcer (DFU) is a severe complication of diabetes mellitus (DM). Patients with DFU have increased mortality and morbidity as well as decreased quality of life (QoL). The present scoping review aims to study the social issues of diabetic foot. Following PRISMA guidelines, the review was conducted in two databases (Scopus and Pubmed) with the use of the following keywords: “social aspects and diabetic foot”, “social characteristics and diabetic foot”, “social issues and diabetic foot”, “demographic profiles and diabetic foot”, “social determinants and diabetic foot”, “social capital and diabetic foot”, “social characteristics and gender and diabetic foot”, “social profiles and diabetic foot”, “social relationships and diabetic foot” and “social risk and diabetic foot”, from July to August 2021. Predetermined exclusion and inclusion criteria were selected. Forty-five studies (quantitative and qualitative) were eligible for inclusion in this review. Gender problems, socioeconomic status, social capital, and medical problems were the most important negative variables for diabetic foot. All the included variables reveal that the social impact of diabetic foot is the most important factor for management and prevention, in terms of aggravation and more, of the diabetic foot.
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Psychometric Validation of the Cardiff Wound Impact Schedule Questionnaire in a Spanish Population with Diabetic Foot Ulcer. J Clin Med 2021; 10:jcm10174023. [PMID: 34501471 PMCID: PMC8432453 DOI: 10.3390/jcm10174023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 12/30/2022] Open
Abstract
Diabetic foot ulcers (DFU) negatively affect the quality of life (QoL) of people with diabetes. The Cardiff Wound Impact Schedule (CWIS) questionnaire has been designed to measure the QoL of people with chronic foot wounds. However, no studies have been specifically designed to validate this instrument in a Spanish population. In this prospective study, a total of 141 subjects with DFU were recruited. DFU was determined by performing physical examinations. Medical records were exhaustively reviewed to collect clinical variables. The CWIS was transculturally adapted by a group of experts and a group of patients with DFU. The SF-36 and EQ-5D generic instruments were used as reference tools. The questionnaires were administered at 7 days and 4, 12, and 26 weeks after the baseline assessment by personal interview with each of the study subjects. The psychometric properties of the instrument were assessed using statistical methods. The content validity had an average of 3.63 (90.7% of the maximum score of 4). The internal consistency of the CWIS subscales had a standardized Cronbach’s alpha range from 0.715 to 0.797. The reproducibility was moderate with an intraclass correlation coefficient (ICC) range from 0.606 to 0.868. Significant correlations between CWIS domains and SF-36 and EQ-5D subscales were observed, demonstrating a good criterion validity of the CWIS questionnaire (p < 0.001). However, the construct validity of the CWIS was not validated with a comparative fit index (CFI) of 0.69, a root mean square error of approximation (RMSEA) of 0.09, and a standardized root mean square residual (SRMR) of 0.10. The sensitivity to changes over time was optimal in the three domains (i.e., social life, well-being, and physical symptoms) (p < 0.001). In conclusion, the Spanish version of the CWIS shows acceptable psychometric properties to assess the QoL of subjects with DFU, except for its construct validity.
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Okoro T, Sikirica V, Casillas L, Brion T, Devine J, Ong V, Howard K. Elicitation of disease concepts in patients with diabetic foot ulcers: a qualitative study. J Wound Care 2020; 29:S38-S45. [PMID: 32412892 DOI: 10.12968/jowc.2020.29.sup5a.s38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To identify in-depth information directly from patients with diabetic foot ulcers (DFU) on DFU symptoms, impacts on functioning and effects on health-related quality of life (HRQoL). METHOD Semi-structured, qualitative concept elicitation interviews were conducted with patients with DFUs (Wagner grade 1 or 2) until saturation was reached. Qualitative analysis (using MAXQDA, VERBI GmbH, Germany) of interview transcripts was conducted to identify concepts relevant to patients with DFUs, based on the frequency of mentions, and elucidate themes regarding impacts on HRQoL. RESULTS Of the 18 participants, most were male (n=14; 78%) and 10 (56%) presented with a Wagner grade of 1. Frequently reported symptoms were pain/discomfort (n=15; 83%), weeping/discharge (n=10; 56%), bleeding (n=10; 56%) and swelling (n=8; 44%). Overall, patients reported more impacts than symptoms-wound care/treatment burden (n=14; 78%), limitations on exercise/physical activity (n=13; 72%), mobility limitations (n=12; 67%), and offloading (n=12; 67%) were the most frequently mentioned. Based on findings from the patient interviews, a draft conceptual model was developed outlining interrelationships between DFU symptoms, impacts, and HRQoL from the patient perspective. CONCLUSION Qualitative interviews captured the breadth of disease-related concepts of direct importance to patients. The draft conceptual model developed from the analysis can help identify measures or instruments for use in assessing patient-reported symptoms or HRQoL in clinical practice and may have wider research applicability, including evaluation of treatment benefits in patients with DFUs.
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Affiliation(s)
| | | | | | - Triza Brion
- ICON Clinical Research, South San Francisco, CA, US
| | - Jacob Devine
- ICON Clinical Research, South San Francisco, CA, US
| | - Vivien Ong
- ICON Clinical Research, South San Francisco, CA, US
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van Doorn LP, Sijberden JP, Brouwers JJWM, Goossens LD, Hamming JF. Validation of the Dutch translation of the Cardiff wound impact schedule for evaluation of the health‐related quality of life of patients with chronic wounds. Int Wound J 2020; 17:1225-1230. [PMID: 32350991 PMCID: PMC7540679 DOI: 10.1111/iwj.13388] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/02/2020] [Indexed: 11/30/2022] Open
Abstract
The aim of this study was to validate a Dutch translation of the Cardiff wound impact schedule (CWIS), a disease‐specific instrument to measure the health‐related quality of life (HRQoL) in patients with chronic leg ulcers. To achieve this, the original instrument was translated. A total of 83 patients with chronic lower leg ulcers were included and completed the translated instrument and SF36 at baseline after assessment of their wound severity. Follow‐up was performed 1 week after inclusion. The psychometric properties of the instrument were assessed. Construct validity was positively evaluated by an expert panel. Face validity was positively evaluated in a cognitive debriefing of a pilot group. Discriminant validity was assessed by correlating 1‐year amputation risk according to the Wound, Ischaemia, foot Infection classification system with the instrument scores. Significant correlation could not be proven. Criterion validity was assessed by correlating domain scores of the instrument with domain scores of the gold standard: SF36. Moderate to high correlation was calculated for most domains of the instrument. Test‐retest reliability and internal consistency were evaluated as acceptable. In conclusion, the Dutch translation of the CWIS is a valid and reliable disease‐specific instrument to assess the HRQoL in patients with chronic lower leg ulcers.
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Affiliation(s)
- Louk P. van Doorn
- Deparment of Surgery, Leiden University Medical Center Leiden The Netherlands
| | - Jasper P. Sijberden
- Deparment of Surgery, Leiden University Medical Center Leiden The Netherlands
| | | | | | - Jaap F. Hamming
- Deparment of Surgery, Leiden University Medical Center Leiden The Netherlands
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A Longitudinal Study on the Association Between Diabetic Foot Disease and Health-Related Quality of Life in Adults With Type 2 Diabetes. Can J Diabetes 2020; 44:280-286.e1. [DOI: 10.1016/j.jcjd.2019.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/25/2019] [Accepted: 08/19/2019] [Indexed: 01/13/2023]
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Lozano-Platonoff A, Contreras-Ruiz J, Dominguez-Cherit J, Cardenas-Sanchez A, Alvarez-Rivero V, Martínez-Regalado JA. Translation, cross-cultural adaptation and validation of the "Cardiff wound impact schedule," a wound-specific quality of life instrument, to the native Spanish of Mexican patients. Int Wound J 2019; 17:167-173. [PMID: 31713315 DOI: 10.1111/iwj.13253] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/26/2019] [Accepted: 10/04/2019] [Indexed: 11/30/2022] Open
Abstract
The aim of this study was to translate into Mexican Spanish, cross-culturally adapt and validate the wound-specific quality of life (QoL) instrument Cardiff wound impact schedule (CWIS) for Mexican patients. This instrument went through the full linguistic translation process based on the guidelines of Beaton et al (Beaton DE, Bombardier C, Guillemin F, Ferraz MB, Guidelines for the process of cross-cultural adaptation of self-report measures, Spine Phila Pa, 1976, 2000, 318-391). We included a total of 500 patients with chronic leg ulcers. The expert committee evaluated the Face validity and they agreed unanimously that the instrument was adequate to assess the QoL of these patients, covering all relevant areas presented by them. The content validity index obtained was of 0.95. The construct validity demonstrated moderately significant correlations between related sub-scales of CWIS and SF-36 (P = .010 to P < .001). The instrument was able to discriminate between healed and unhealed ulcers. The instrument obtained an overall Cronbach's alpha of .952, corresponding to an excellent internal consistency (.903-.771 alpha range for domains). The CWIS can be appropriately used to assess the health-related QoL of Mexican patients with chronic leg ulcers.
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Affiliation(s)
- Adriana Lozano-Platonoff
- Section of Wound and Ostomy Care Center. Division of Dermatology, "Dr. Manuel Gea González" General Hospital, Mexico City, Mexico
| | - Jose Contreras-Ruiz
- Section of Wound and Ostomy Care Center. Division of Dermatology, "Dr. Manuel Gea González" General Hospital, Mexico City, Mexico
| | - Judith Dominguez-Cherit
- Section of Wound and Ostomy Care Center. Division of Dermatology, "Dr. Manuel Gea González" General Hospital, Mexico City, Mexico.,Department of Dermatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Andrea Cardenas-Sanchez
- Section of Wound and Ostomy Care Center. Division of Dermatology, "Dr. Manuel Gea González" General Hospital, Mexico City, Mexico
| | - Valeria Alvarez-Rivero
- Section of Wound and Ostomy Care Center. Division of Dermatology, "Dr. Manuel Gea González" General Hospital, Mexico City, Mexico
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Khunkaew S, Fernandez R, Sim J. Health-Related Quality of Life and Self-Care Management Among People With Diabetic Foot Ulcers in Northern Thailand. SAGE Open Nurs 2019; 5:2377960819825751. [PMID: 33415216 PMCID: PMC7774360 DOI: 10.1177/2377960819825751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/13/2018] [Accepted: 12/28/2018] [Indexed: 11/17/2022] Open
Abstract
Diabetic foot ulcers (DFUs) are a common complication of diabetes that impacts on the health-related quality of life (HRQOL). Foot care is an important factor in the self-care management of patients with DFUs. The objective of this study was to investigate the HRQOL and foot care management of people with DFUs. A cross-sectional study involving 41 people with DFUs was conducted at a large tertiary hospital in Northern Thailand. The Diabetic Foot Ulcer Scale-Short Form and the VA-Diabetes Foot Care Survey were used to assess the HRQOL and foot care management among people with DFUs. The majority of the participants were female (n = 24, 58.5%), and the mean age was 62.13 years. The scores for HRQOL in the six domains were as follows: leisure (66.95 ± 28.03), physical health (68.93 ± 28.51), dependence or daily life (80.08 ± 25.23), negative emotions (71.23 ± 29.48), worried about ulcers (62.20 ± 31.97), and bothered by ulcer care (69.36 ± 25.20). High scores indicate a high (good) HRQOL. Less than a third of the participants reported that they had received education about foot care management. Almost all participants reported that they washed their feet daily; however, a large proportion did not test the water temperature or use lubricants on their feet. Most of the participants did not have a mirror for checking under their feet (48.8%), and there was a lack of knowledge about how to use a mirror for foot inspections (51.2%). This study provides guidance for clinicians on the content and delivery of diabetes education programs for people with diabetes (and DFUs) in Northern Thailand. The findings provide guidance on existing knowledge and the need for programs to address barriers to foot self-care management both in terms of skills and attitudes.
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Affiliation(s)
- Saneh Khunkaew
- School of Nursing, University of Wollongong, New South Wales, Australia
| | - Ritin Fernandez
- School of Nursing, University of Wollongong, New South Wales, Australia
| | - Jenny Sim
- School of Nursing, University of Wollongong, New South Wales, Australia
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Ortega-Avila AB, Cervera-Garvi P, Ramos-Petersen L, Chicharro-Luna E, Gijon-Nogueron G. Patient-Reported Outcome Measures for Patients with Diabetes Mellitus Associated with Foot and Ankle Pathologies: A Systematic Review. J Clin Med 2019; 8:jcm8020146. [PMID: 30691204 PMCID: PMC6407033 DOI: 10.3390/jcm8020146] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 01/21/2019] [Accepted: 01/24/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Diabetes mellitus (DM) is a chronic and complex disease, which is a major cause of morbidity and mortality and affects all age groups. It commonly produces secondary effects on the foot, often making daily activities impossible. Patient-reported outcome measures (PROMs) provide a standardised method of obtaining patients’ outlooks on their functional status and wellbeing. Although many instruments have been proposed for obtaining data on persons with DM whose feet are affected by the disease, in many cases the psychometric properties of the instrument have yet to be established. The principal objective of our review was to identify PROMs specific for patients with DM affecting the foot and ankle and to evaluate the psychometric properties and methodological quality of these instruments. Methods: In this systematic review, we investigate studies (published in English or Spanish) based on the use of one or more PROMs specific to foot and ankle pathologies for patients with DM (type I or II). To do so, the databases PubMed, Scopus, CINAHL, PEDro and Google Scholar were searched for studies that analysed psychometric or clinimetric properties in this respect. These were assessed according to Terwee or COSMIN criteria. Results: Of the 1016 studies identified in the initial search, only 11 were finally included in the qualitative review. Analysis according to Terwee and COSMIN criteria showed that the Foot Health Status Questionnaire (FHSQ) presented the greatest number of positive values. Conclusions: The FHSQ is the highest-quality PROM currently available for the foot and ankle, for patients with DM.
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Affiliation(s)
- Ana Belen Ortega-Avila
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Penalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain.
| | - Pablo Cervera-Garvi
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Penalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain.
| | - Laura Ramos-Petersen
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Penalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain.
| | - Esther Chicharro-Luna
- Department of Behavioral Sciences and Health, Miguel Hernández University, San Juan de Alicante, 03550 Alicante, Spain.
| | - Gabriel Gijon-Nogueron
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Penalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain.
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain.
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Gamus A, Kaufman H, Keren E, Brandin G, Peles D, Chodick G. Validation of "Wound QoL" Hebrew version disease-specific questionnaire for patients with lower extremity ulcerations. Int Wound J 2018; 15:600-604. [PMID: 29797545 PMCID: PMC7949931 DOI: 10.1111/iwj.12903] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/17/2018] [Accepted: 01/17/2018] [Indexed: 11/26/2022] Open
Abstract
The slow healing process and high recurrence rate of lower extremity ulcerations (LEU) impose a considerable medical and economic burden and affect quality of life (QoL). Analyses of LEU-related QoL in Israel are limited due to lack of a validated Hebrew disease-specific evaluation instrument. The aim of this study was to validate the disease-specific Hebrew "Wound QoL" questionnaire. The validation of the "Wound QoL" disease-specific instrument, translated from English to Hebrew, was based on a comparison with the valid Hebrew version of the SF12v.2 health-related questionnaire. The convenience sample for the "Wound QoL" validation (n = 32) was obtained from patient populations in the Maccabi Health Services' outpatient clinics at the northern and southern parts of Israel. The study was conducted between June and September 2017. Face/construct validity was accepted by specialists' consensus. Internal consistency assessed by Cronbach's α was .893. Concurrent validity reflected by Pearson's correlations between the tools was in the range of 0.830 to 0.950. The Wound QoL Hebrew version is a valid and reliable instrument suitable for implementation in an Israeli cultural environment.
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Affiliation(s)
- Alexander Gamus
- Maccabi Health Services, Sackler Faculty of MedicineTel‐Aviv UniversityTel‐AvivIsrael
- Epidemiology and Database Research Unit, Sackler Faculty of MedicineTel Aviv UniversityTel‐AvivIsrael
| | - Hanna Kaufman
- Maccabi Health Services, Sackler Faculty of MedicineTel‐Aviv UniversityTel‐AvivIsrael
| | - Elad Keren
- Maccabi Health Services, Sackler Faculty of MedicineTel‐Aviv UniversityTel‐AvivIsrael
- Orthopedic DepartmentSoroka Medical CenterBeer‐ShebaIsrael
| | - Gila Brandin
- Maccabi Health Services, Sackler Faculty of MedicineTel‐Aviv UniversityTel‐AvivIsrael
| | - Daniel Peles
- Maccabi Health Services, Sackler Faculty of MedicineTel‐Aviv UniversityTel‐AvivIsrael
| | - Gabriel Chodick
- Maccabi Health Services, Sackler Faculty of MedicineTel‐Aviv UniversityTel‐AvivIsrael
- Epidemiology and Database Research Unit, Sackler Faculty of MedicineTel Aviv UniversityTel‐AvivIsrael
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14
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Henshaw FR, Brennan L, MacMillan F. Perceptions of hyperbaric oxygen therapy among podiatrists practicing in high-risk foot clinics. Int Wound J 2018; 15:375-382. [PMID: 29314628 PMCID: PMC7950176 DOI: 10.1111/iwj.12874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/07/2017] [Accepted: 11/16/2017] [Indexed: 11/29/2022] Open
Abstract
Foot ulceration is a devastating and costly consequence of diabetes. Hyperbaric oxygen therapy is recognised as an adjunctive therapy to treat diabetes-related foot ulceration, yet uptake is low. Semi-structured interviews were conducted with 16 podiatrists who manage patients with foot ulcers related to diabetes to explore their perceptions of, and the barriers/facilitators to, referral for hyperbaric oxygen. Podiatrists cited logistical issues such as location of facilities as well as poor communication pathways, lack of delegation and lack of follow up when patients presented for hyperbaric treatment. In general, podiatrists had an understanding of the premise of hyperbaric oxygen therapy and evidence to support its use but could only provide very limited citations of key papers and guidelines to support their position. Podiatrists stated that they felt a patient was lost from their care when referred for hyperbaric oxygen and that aftercare might not be adequate. Improved referral and delegation pathways for patients presenting for hyperbaric oxygen, as well as the provision of easily accessible evidence to support this therapy, could help to increase podiatrists' confidence in deciding whether or not to recommend their patients for hyperbaric oxygen therapy.
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Affiliation(s)
- Frances R Henshaw
- School of Science and HealthWestern Sydney UniversityPenrithNew South WalesAustralia
| | - Lauren Brennan
- School of Science and HealthWestern Sydney UniversityPenrithNew South WalesAustralia
| | - Freya MacMillan
- School of Science and HealthWestern Sydney UniversityPenrithNew South WalesAustralia
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15
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Translation and cross-cultural adaptation of the Cardiff Wound Impact Schedule to Brazilian Portuguese. J Tissue Viability 2017; 26:113-118. [DOI: 10.1016/j.jtv.2016.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 11/07/2016] [Accepted: 12/09/2016] [Indexed: 11/24/2022]
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16
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A systematic review of measurement properties of patient-reported outcome measures for use in patients with foot or ankle diseases. Qual Life Res 2017; 26:1969-2010. [DOI: 10.1007/s11136-017-1542-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2017] [Indexed: 12/20/2022]
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17
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Deufert D, Graml R. Disease-specific, health-related quality of life (HRQoL) of people with chronic wounds—A descriptive cross-sectional study using the Wound-QoL. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.wndm.2017.01.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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18
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Pickwell K, Siersma V, Kars M, Apelqvist J, Bakker K, Edmonds M, Holstein P, Jirkovská A, Jude EB, Mauricio D, Piaggesi A, Reike H, Spraul M, Uccioli L, Urbancic V, van Acker K, van Baal J, Schaper N. Minor amputation does not negatively affect health-related quality of life as compared with conservative treatment in patients with a diabetic foot ulcer: An observational study. Diabetes Metab Res Rev 2017; 33. [PMID: 27792855 DOI: 10.1002/dmrr.2867] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 10/12/2016] [Accepted: 10/16/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Health-related quality of life (HRQoL) is poor in patients with persistent diabetic foot ulcers and poor HRQoL predicts worse outcomes in these patients. Amputation is often considered a treatment failure, which is why conservative treatment is generally preferred over amputation. However, it is unclear whether minor amputation negatively affects HRQoL compared with conservative treatment in patients with diabetic foot ulcers. METHODS In the cohort of the multicenter, prospective, observational Eurodiale study, we determined difference in change of HRQoL measured by EQ-5D between patients with a diabetic foot ulcers that healed after conservative treatment (n = 676) and after minor amputation (n = 145). Propensity score was used to adjust for known confounders, attempting to overcome lack of randomization. RESULTS Baseline HRQoL was not significantly different between patients treated conservatively and undergoing minor amputation. In addition, there was no difference in the change of HRQoL between these groups. In patients who healed 6 to 12 months after the first visit, HRQoL on the anxiety/depression subscale even appeared to improve more in those who underwent minor amputation. CONCLUSIONS Minor amputation was not associated with a negative impact on HRQoL in patients with a diabetic foot ulcers. It may therefore not be considered treatment failure in terms of HRQoL but rather a viable treatment option. A randomized controlled trial is warranted to further examine the influence of minor amputations on health-related quality of life.
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Affiliation(s)
- K Pickwell
- Division of Endocrinology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - V Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - M Kars
- Division of Endocrinology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J Apelqvist
- Department of Endocrinology, University of Malmö, Malmö, Sweden
| | - K Bakker
- IDF Consultative Section and International Working Group on the Diabetic Foot, Heemstede, the Netherlands
| | - M Edmonds
- Diabetic Department, Kings College Hospital, London, United Kingdom
| | - P Holstein
- Copenhagen Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - A Jirkovská
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - E B Jude
- Diabetes Centre, Tameside General Hospital, Ashton-under-Lyne, UK
| | - D Mauricio
- Department of Endocrinology and Nutrition, Hospital de Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - A Piaggesi
- Sezione Dipartimentale Piede Diabetico, Dipartimento di Area Medica, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - H Reike
- Innere Abteilung, Mariannen Hospital, Werl, Germany
| | - M Spraul
- Mathias-Spital, Diabetic Department, Rheine, Germany
| | - L Uccioli
- Policlinico Tor Vergata, Department of Internal medicine, Rome, Italy
| | - V Urbancic
- Department of Endocrinology, University Medical Centre, Ljubljana, Slovenia
| | - K van Acker
- H Familie Ziekenhuis and Centre de Santé des Fagnes, Department of Endocrinology, Rumst and Chimay, Belgium
| | - J van Baal
- Department of Surgery, Twenteborg Ziekenhuis, Almelo, The Netherlands
| | - N Schaper
- Division of Endocrinology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
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19
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Nemcová J, Hlinková E, Farský I, Žiaková K, Jarošová D, Zeleníková R, Bužgová R, Janíková E, Zdzieblo K, Wiraszka G, Stepien R, Nowak-Starz G, Csernus M, Balogh Z. Quality of life in patients with diabetic foot ulcer in Visegrad countries. J Clin Nurs 2017; 26:1245-1256. [DOI: 10.1111/jocn.13508] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Jana Nemcová
- Jessenius Faculty of Medicine in Martin; Comenius University in Bratislava; Martin Slovak Republic
| | - Edita Hlinková
- Jessenius Faculty of Medicine in Martin; Comenius University in Bratislava; Martin Slovak Republic
| | - Ivan Farský
- Jessenius Faculty of Medicine in Martin; Comenius University in Bratislava; Martin Slovak Republic
| | - Katarína Žiaková
- Jessenius Faculty of Medicine in Martin; Comenius University in Bratislava; Martin Slovak Republic
| | - Darja Jarošová
- Faculty of Medicine; University of Ostrava; Ostrava Czech Republic
| | | | - Radka Bužgová
- Faculty of Medicine; University of Ostrava; Ostrava Czech Republic
| | - Eva Janíková
- Faculty of Medicine; University of Ostrava; Ostrava Czech Republic
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20
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Revisión sistemática sobre el impacto de las complicaciones podológicas de la diabetes mellitus sobre la calidad de vida. REVISTA ESPAÑOLA DE PODOLOGÍA 2017. [DOI: 10.1016/j.repod.2017.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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21
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Sriyani KA, Gunawardena N, Wasalathanthri S, Hettiarachchi P. Validation of Sinhala Version of Cardiff Wound Impact Schedule in Patients with Diabetic Leg and Foot Ulcers. Asian Nurs Res (Korean Soc Nurs Sci) 2016; 10:240-245. [PMID: 27692255 DOI: 10.1016/j.anr.2016.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 06/16/2016] [Accepted: 06/21/2016] [Indexed: 01/16/2023] Open
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22
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23
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Corbett LQ, Ennis WJ. What Do Patients Want? Patient Preference in Wound Care. Adv Wound Care (New Rochelle) 2014; 3:537-543. [PMID: 25126474 DOI: 10.1089/wound.2013.0458] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 08/06/2013] [Indexed: 11/12/2022] Open
Abstract
Patient preferences are statements made or actions taken by consumers that reflect their desirability of a range of health options. The concept occupies an increasingly prominent place at the center of healthcare reform, and is connected to all aspects of healthcare, including discovery, research, delivery, outcome, and payment. Patient preference research has focused on shared decisions, decisional aids, and clinical practice guideline development, with limited study in acute and chronic wound care populations. The wound care community has focused primarily on patient focused symptoms and quality of life measurement. With increasing recognition of wound care as a medical specialty and as a public health concern that consumes extensive resources, attention to the preferences of end-users with wounds is necessary. This article will provide an overview of related patient-centered concepts and begin to establish a framework for consideration of patient preference in wound care.
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Affiliation(s)
- Lisa Q Corbett
- Wound Healing/Surgery, Hartford Hospital/Hartford Healthcare, Inc. , Hartford, Connecticut
| | - William J Ennis
- Clinical Surgery, Section Wound Healing and Tissue Repair, University of Illinois Hospital and Health Sciences System , Chicago, Illinois
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24
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Huang Y, Wu M, Xing P, Xie T, Cao Y, Qian P, Ruan H. Translation and Validation of the Chinese Cardiff Wound Impact Schedule. INT J LOW EXTR WOUND 2014; 13:5-11. [PMID: 24659621 DOI: 10.1177/1534734614521233] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The objectives of the study were to translate the Cardiff Wound Impact Schedule (CWIS), a disease-specific quality-of-life measure, into Chinese, and to evaluate its psychometric properties. The CWIS went through the full linguistic translation process and was evaluated in patients with current diabetic foot ulcers (DFU). Patients were categorized using the Wagner grade. Mean CWIS scores were compared between categories to evaluate the scale’s ability to differentiate ulcer severity (Wagner grade). There were a total of 131 consecutive patients included in the study. Except item A22 (I am confident that the wound I have will heal), the results of item–domain correlation ( r ranged from .391 to .827) and small-group analysis (critical ratio, P < .05) were satisfactory. Furthermore, the Chinese CWIS also demonstrated good criterion validity when correlated with the Short Form-36 ( r = .79, P < .01). After deleting item 22, exploratory factor analysis of the items confirmed the existence of 3 hypothesized domains, physical symptoms and daily living (12 items), social life (7 items), and well-being (6 items), and totally explained 57.194% of the variance. The internal consistency of all scales of the Chinese CWIS was consistently high (Cronbach’s α ranged from .789 to .929). Split-half reliability was 0.748. Sensitivity was demonstrated between patients with different etiologies of diabetic foot ulcer and those with different ulcer severity (Wagner grade). From the authors’ view, the lately validated Chinese CWIS has good psychometric performance and may be appropriately used to assess the health-related quality of life of Chinese patients with DFUs.
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Affiliation(s)
- Yao Huang
- Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - MinJie Wu
- Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Ting Xie
- Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - YeMin Cao
- Shanghai TCM-Integrated Hospital, Shanghai, China
| | - Peifen Qian
- Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Ruan
- Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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25
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Fejfarová V, Jirkovská A, Dragomirecká E, Game F, Bém R, Dubský M, Wosková V, Křížová M, Skibová J, Wu S. Does the diabetic foot have a significant impact on selected psychological or social characteristics of patients with diabetes mellitus? J Diabetes Res 2014; 2014:371938. [PMID: 24791012 PMCID: PMC3984852 DOI: 10.1155/2014/371938] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 01/27/2014] [Accepted: 02/19/2014] [Indexed: 12/15/2022] Open
Abstract
UNLABELLED The aim of our case-control study was to compare selected psychological and social characteristics between diabetic patients with and without the DF (controls). METHODS 104 patients with and 48 without DF were included into our study. Both study groups were compared in terms of selected psychosocial characteristics. RESULTS Compared to controls, patients with DF had a significantly worse quality of life in the area of health and standard of living as shown by lower physical health domain (12.7 ± 2.8 versus 14.7 ± 2.5; P < 0.001) and environment domain (14.1 ± 2.2 versus 15 ± 1.8; P < 0.01) that negatively correlated with diabetes duration (r = -0.061; P = 0.003). Patients with DF subjectively felt more depressed in contrast to controls (24.5 versus 7.3%; P < 0.05); however, the depressive tuning was objectively proven in higher percentage in both study groups (83.2 versus 89.6; NS). We observed a significantly lower level of achieved education (P < 0.01), more patients with disability pensions (P < 0.01), and low self-support (P < 0.001) in patients with the DF compared to controls. In the subgroup of patients with a previous major amputation and DF (n = 6), there were significantly worse outcomes as in the environment domain (P < 0.01), employment status, and stress readaptation (P < 0.01) in contrast to the main study groups. CONCLUSIONS Patients with DF had a predominantly worse standard of living. In contrast to our expectations, patients with DF appeared to have good stress tolerability and mental health (with the exception of patients with previous major amputation) and did not reveal severe forms of depression or any associated consequences.
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MESH Headings
- Activities of Daily Living/psychology
- Adaptation, Psychological
- Aged
- Amputation, Surgical/adverse effects
- Amputation, Surgical/economics
- Amputation, Surgical/psychology
- Amputation, Surgical/rehabilitation
- Case-Control Studies
- Cost of Illness
- Czech Republic/epidemiology
- Depression/complications
- Depression/economics
- Depression/epidemiology
- Depressive Disorder, Major/complications
- Depressive Disorder, Major/economics
- Depressive Disorder, Major/epidemiology
- Diabetes Mellitus/economics
- Diabetes Mellitus/physiopathology
- Diabetes Mellitus/psychology
- Diabetic Foot/complications
- Diabetic Foot/physiopathology
- Diabetic Foot/psychology
- Diabetic Foot/surgery
- Female
- Humans
- Incidence
- Male
- Middle Aged
- Neuritis/complications
- Neuritis/epidemiology
- Psychiatric Status Rating Scales
- Quality of Life/psychology
- Severity of Illness Index
- Socioeconomic Factors
- Stress, Psychological/complications
- Stress, Psychological/economics
- Stress, Psychological/epidemiology
- Stress, Psychological/rehabilitation
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Affiliation(s)
- Vladimíra Fejfarová
- Diabetes Center, Institute for Clinical and Experimental Medicine, Vídeňská 1958, 140 21 Prague, Czech Republic
- *Vladimíra Fejfarová:
| | - Alexandra Jirkovská
- Diabetes Center, Institute for Clinical and Experimental Medicine, Vídeňská 1958, 140 21 Prague, Czech Republic
| | - Eva Dragomirecká
- Department of Social Work, Faculty of Arts, Charles University, 116 42 Prague, Czech Republic
| | - Frances Game
- Diabetes Unit, Derby Hospitals NHS Foundation Trust, Derby DU22 3NE, UK
| | - Robert Bém
- Diabetes Center, Institute for Clinical and Experimental Medicine, Vídeňská 1958, 140 21 Prague, Czech Republic
| | - Michal Dubský
- Diabetes Center, Institute for Clinical and Experimental Medicine, Vídeňská 1958, 140 21 Prague, Czech Republic
| | - Veronika Wosková
- Diabetes Center, Institute for Clinical and Experimental Medicine, Vídeňská 1958, 140 21 Prague, Czech Republic
| | - Marta Křížová
- Diabetes Center, Institute for Clinical and Experimental Medicine, Vídeňská 1958, 140 21 Prague, Czech Republic
| | - Jelena Skibová
- Diabetes Center, Institute for Clinical and Experimental Medicine, Vídeňská 1958, 140 21 Prague, Czech Republic
| | - Stephanie Wu
- Center for Lower Extremity Ambulatory Research, Dr. William M. Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, Chicago, IL 60064, USA
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26
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Whitmont K, McKelvey KJ, Fulcher G, Reid I, March L, Xue M, Cooper A, Jackson CJ. Treatment of chronic diabetic lower leg ulcers with activated protein C: a randomised placebo-controlled, double-blind pilot clinical trial. Int Wound J 2013; 12:422-7. [PMID: 23848141 DOI: 10.1111/iwj.12125] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 05/26/2013] [Accepted: 06/01/2013] [Indexed: 11/28/2022] Open
Abstract
Lower leg ulcers are a serious and long-term complication in patients with diabetes and pose a major health concern because of the increasing number of patients diagnosed with diabetes each year. This study sought to evaluate the clinical benefit of topical activated protein C (APC) on chronic lower leg ulcers in patients with diabetes. Twelve patients were randomly assigned to receive either APC (N = 6) or physiological saline (placebo; N = 6) in a randomised, placebo-controlled, double-blind pilot clinical trial. Treatment was administered topically, twice weekly for 6 weeks with final follow-up at 20 weeks. Wound area was significantly reduced to 34·8 ± 16·4% of week 0 levels at 20 weeks in APC-treated wounds (p = 0·01). At 20 weeks, three APC-treated wounds had completely healed, compared to one saline-treated wound. Full-thickness wound edge skin biopsies showed reduced inflammatory cell infiltration and increased vascular proliferation following APC treatment. Patient stress scores were also significantly reduced following APC treatment (p < 0·05), demonstrating improved patient quality of life as assessed by the Cardiff Wound Impact Questionnaire. This pilot trial suggests that APC is a safe topical agent for healing chronic lower leg ulcers in patients with diabetes and provides supporting evidence for a larger clinical trial.
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Affiliation(s)
- Kaley Whitmont
- Department of Rheumatology, Sutton Arthritis Research Laboratory, Institute of Bone and Joint, Kolling Institute of Medical Research, University of Sydney at Royal North Shore Hospital, St Leonards, NSW, Australia.,Department of Dermatology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Kelly J McKelvey
- Department of Rheumatology, Sutton Arthritis Research Laboratory, Institute of Bone and Joint, Kolling Institute of Medical Research, University of Sydney at Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Gregory Fulcher
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Ian Reid
- Department of Rheumatology, Sutton Arthritis Research Laboratory, Institute of Bone and Joint, Kolling Institute of Medical Research, University of Sydney at Royal North Shore Hospital, St Leonards, NSW, Australia.,High Risk Foot Service, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Lyn March
- Department of Rheumatology, Institute of Bone and Joint Research, University of Sydney, St Leonards, NSW, Australia
| | - Meilang Xue
- Department of Rheumatology, Sutton Arthritis Research Laboratory, Institute of Bone and Joint, Kolling Institute of Medical Research, University of Sydney at Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Alan Cooper
- Department of Dermatology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Christopher J Jackson
- Department of Rheumatology, Sutton Arthritis Research Laboratory, Institute of Bone and Joint, Kolling Institute of Medical Research, University of Sydney at Royal North Shore Hospital, St Leonards, NSW, Australia
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27
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Ogrin R, Houghton PE, Thompson GW. Effective management of patients with diabetes foot ulcers: outcomes of an Interprofessional Diabetes Foot Ulcer Team. Int Wound J 2013; 12:377-86. [PMID: 23834390 DOI: 10.1111/iwj.12119] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 05/07/2013] [Accepted: 06/01/2013] [Indexed: 12/01/2022] Open
Abstract
A longitudinal observational study on a convenience sample was conducted between 4 January and 31 December of 2010 to evaluate clinical outcomes that occur when a new Interprofessional Diabetes Foot Ulcer Team (IPDFUT) helps in the management of diabetes-related foot ulcers (DFUs) in patients living in a small urban community in Ontario, Canada. Eighty-three patients presented to the IPDFUT with 114 DFUs of average duration of 19·5 ± 2·7 weeks. Patients were 58·4 ± 1·4 years of age and 90% had type 2 diabetes, HbA1c of 8·3 ± 2·0%, with an average diabetes duration of 22·3 ± 3·4 years; in 69% of patients, 78 DFUs healed in an average duration of 7·4 ± 0·7 weeks, requiring an average of 3·8 clinic visits. Amputation of a toe led to healing in three patients (4%) and one patient required a below-knee amputation. Six patients died and three withdrew. Adding a skilled IPDFUT that is trained to work together resulted in improved healing outcomes. The rate of healing, proportion of wounds closed and complication rate were similar if not better than the results published previously in Canada and around the world. The IPDFUT appears to be a successful model of care and could be used as a template to provide effective community care to the patients with DFU in Ontario, Canada.
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Affiliation(s)
- Rajna Ogrin
- School of Physical Therapy, University of Western Ontario, London, ON, Canada.,Centre of Wound Management, Royal District Nursing Service Institute, St Kilda, VIC, Australia
| | - Pamela E Houghton
- Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
| | - G William Thompson
- Department of Internal Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
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28
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Fagerdahl AM, Boström L, Ulfvarson J, Bergström G, Ottosson C. Translation and validation of the wound-specific quality of life instrument Cardiff Wound Impact Schedule in a Swedish population. Scand J Caring Sci 2013; 28:398-404. [DOI: 10.1111/scs.12050] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 04/11/2013] [Indexed: 01/13/2023]
Affiliation(s)
- Ann-Mari Fagerdahl
- Department of Surgery; Department of Clinical Science and Education, Södersjukhuset; Karolinska Institutet; Stockholm Sweden
| | - Lennart Boström
- Department of Surgery; Department of Clinical Science and Education, Södersjukhuset; Karolinska Institutet; Stockholm Sweden
| | - Johanna Ulfvarson
- Division of Nursing; Department of Neurobiology and Society; Karolinska Institutet; Stockholm Sweden
| | - Gunnar Bergström
- Division of Intervention and Implementation Research; IMM Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
| | - Carin Ottosson
- Department of Orthopaedic Surgery; Department of Clinical Science and Education, Södersjukhuset; Karolinska Institutet; Stockholm Sweden
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29
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Lewko J, Polityńska B, Kochanowicz J, Zarzycki W, Mariak Z, Górska M, Krajewska-Kułak E. Median nerve conduction impairment in patients with diabetes and its impact on patients' perception of health condition: a quantitative study. Diabetol Metab Syndr 2013; 5:16. [PMID: 23522691 PMCID: PMC3623792 DOI: 10.1186/1758-5996-5-16] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 03/21/2013] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Impaired mobility and compromised manual dexterity leading to difficulties with the activities of daily living (ADL) are an inherent part of the clinical picture in diabetes. Hand function in diabetes is influenced by a variety of pathologies: the median nerve, the most important nerve of the hand, can suffer from metabolic disturbances, ischemia and/or entrapment neuropathies. The resulting deterioration in functional capacity is likely to have significant consequences for the ability to perform ADL, influencing adjustment to diabetes and affecting quality of life. The aim of the present study was to examine the influence of hand function as measured by median motor nerve conduction on quality of life, taking into account various aspects of functioning in patients with diabetes, including activities of daily living, psychological status and acceptance of illness. PATIENTS AND METHODS Seventy one hospital patients with diabetes participated in the study. Electrophysiological recordings of conductance in the median nerve were obtained for both hands and the relationship between hand function and functional status (BI), depression and anxiety (HADS), adjustment to illness (AIS) and their effect on quality of life (SF-36v2 and QLI) was studied. RESULTS Damage to the median nerve of the left hand was associated with significant differences in functioning in the physical, but not the mental component of the SF-36v2, p = 0.03 and in functional status (p = 0.006). QOL was associated with depression, patient age, acceptance of illness, functional ability and to a small, but significant extent with median nerve damage to the right hand on the measure of conduction velocities (R2 =0.726). CONCLUSIONS Nerve conductance studies demonstrated a small, but significant effect of hand function on quality of life. Impairment of the median nerve in the left hand was associated with functional difficulties in the activities of daily living and a diminished quality of life in the area of physical functioning. No dependencies of this kind were found for the right hand, which may reflect the greater compensatory capacity of the right hand resulting from improved efficiency due to practice.
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Affiliation(s)
- Jolanta Lewko
- Department of Integrated Medical Care, Medical University of Bialystok, M. Skłodowskiej-Curie str. 7A, Bialystok, 15-096, Poland
| | - Barbara Polityńska
- Department of Philosophy and Human Psychology, Medical University of Bialystok, Szpitalna str. 37, Białystok, 15-295, Poland
| | - Jan Kochanowicz
- Department of Invasive Neurology, Medical University of Bialystok, Marii Skłodowskiej-Curie str. 24A, Białystok, 15-276, Poland
- Department of Neurosurgery, Medical University of Bialystok, Marii Skłodowskiej-Curie str. 24A, Białystok, 15-276, Poland
| | - Wiesław Zarzycki
- Department of Endocrinology, Diabetes and Internal Medicine, Medical, University of Bialystok, Marii Skłodowskiej-Curie str. 24A, Białystok, 15-276, Poland
| | - Zenon Mariak
- Department of Neurosurgery, Medical University of Bialystok, Marii Skłodowskiej-Curie str. 24A, Białystok, 15-276, Poland
| | - Maria Górska
- Department of Endocrinology, Diabetes and Internal Medicine, Medical, University of Bialystok, Marii Skłodowskiej-Curie str. 24A, Białystok, 15-276, Poland
| | - Elżbieta Krajewska-Kułak
- Department of Integrated Medical Care, Medical University of Bialystok, M. Skłodowskiej-Curie str. 7A, Bialystok, 15-096, Poland
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Ultraviolet-C irradiation in the management of pressure ulcers in people with spinal cord injury: a randomized, placebo-controlled trial. Arch Phys Med Rehabil 2012; 94:650-9. [PMID: 23246896 DOI: 10.1016/j.apmr.2012.12.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 12/03/2012] [Accepted: 12/04/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To compare the effects of ultraviolet-C (UVC) with placebo-UVC on pressure ulcer healing in individuals with spinal cord injury (SCI). DESIGN Double-blind randomized trial with stratification for ulcer location to buttock or lower extremity. Subjects were followed up for 1 year postintervention. SETTING Rehabilitation institution. PARTICIPANTS Adult inpatients and outpatients (N=43) with SCI and stage 2 to 4 pressure ulcers (n=58). INTERVENTIONS Ulcers and periwound skin were irradiated 3 times per week using UVC or placebo-UVC. The endpoint was wound closure or hospital discharge without closure. MAIN OUTCOME MEASURES Primary outcome was weekly percent area relative to baseline. Secondary outcomes were mean percent area change between consecutive weeks, surface appearance, weeks to closure, and impact on quality of life and wound status postintervention. RESULTS Groups were similar at baseline for all demographic characteristics except ulcer duration (P=.02). Groups were similar when healing was compared overall. Subgroup analysis showed that the percent area relative to baseline for stage 2 buttock ulcers was significantly smaller in the group receiving UVC compared with placebo at weeks 3, 5, and 7. During weeks 1 through 8, these ulcers were 26% to 76% of baseline area using UVC versus 111% to 180% for placebo (achieved significant level [ASL], .03-.08; effect size, 0.5-0.8). Groups were similar in the percent area relative to baseline for stage 2 lower extremity ulcers. Group mean percent area change between consecutive weeks for all stage 2 ulcers was 36.6% with the use of UVC and 5.8% for placebo (ASL=.09). There were no group differences in the percent area relative to baseline and the mean percent area change between consecutive weeks for stage 3 to 4 ulcers. Groups were similar for all other secondary outcomes. CONCLUSIONS UVC is beneficial for stage 2 buttock ulcers. Further studies are warranted using a larger sample size, carefully considered exclusion criteria, and strategies to ensure homogeneity of the groups that are being compared.
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Bennetts CJ, Owings TM, Erdemir A, Botek G, Cavanagh PR. Clustering and classification of regional peak plantar pressures of diabetic feet. J Biomech 2012; 46:19-25. [PMID: 23089457 DOI: 10.1016/j.jbiomech.2012.09.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 08/09/2012] [Accepted: 09/07/2012] [Indexed: 12/01/2022]
Abstract
High plantar pressures have been associated with foot ulceration in people with diabetes, who can experience loss of protective sensation due to peripheral neuropathy. Therefore, characterization of elevated plantar pressure distributions can provide a means of identifying diabetic patients at potential risk of foot ulceration. Plantar pressure distribution classification can also be used to determine suitable preventive interventions, such as the provision of an appropriately designed insole. In the past, emphasis has primarily been placed on the identification of individual focal areas of elevated pressure. The goal of this study was to utilize k-means clustering analysis to identify typical regional peak plantar pressure distributions in a group of 819 diabetic feet. The number of clusters was varied from 2 to 10 to examine the effect on the differentiation and classification of regional peak plantar pressure distributions. As the number of groups increased, so too did the specificity of their pressure distributions: starting with overall low or overall high peak pressure groups and extending to clusters exhibiting several focal peak pressures in different regions of the foot. However, as the number of clusters increased, the ability to accurately classify a given regional peak plantar pressure distribution decreased. The balance between these opposing constraints can be adjusted when assessing patients with feet that are potentially "at risk" or while prescribing footwear to reduce high regional pressures. This analysis provides an understanding of the variability of the regional peak plantar pressure distributions seen within the diabetic population and serves as a guide for the preemptive assessment and prevention of diabetic foot ulcers.
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Affiliation(s)
- Craig J Bennetts
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195, USA
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Yao H, Ting X, Minjie W, Yemin C, Xiqiao W, Yuzhi J, Ming T, Weida W, Peifen Q, Shuliang L. The Investigation of Demographic Characteristics and the Health-Related Quality of Life in Patients With Diabetic Foot Ulcers at First Presentation. INT J LOW EXTR WOUND 2012; 11:187-93. [PMID: 23008342 DOI: 10.1177/1534734612457034] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To investigate the characteristics of diabetic patients with foot ulcers, their health-related quality of life (HRQoL), and the link between them. The study population included 131 consecutive patients presenting in a diabetic foot clinic with a new foot ulcer between December 1, 2011, and May 1, 2012. The authors collected sociodemographic data, foot and ulcer characteristics using the Wagner Grade, and HRQoL (using the SF-36 Scale) information; 54.2% of the patients were in Wagner 2 or Wagner 3 categories. In all the 8 SF-36 subscales and in the SF-36 summary scales, the patients with diabetic foot ulcer had significantly poorer HRQoL than the general population in China ( P < .01). Their Wagner Grade had negative correlation with all the SF-36 subscales and the summary scales ( P < .05). In conclusion, new diabetic foot ulcers were already in poor condition when patients first visited the diabetic foot clinic. Concomitantly, patients had worse HRQoL compared with the general population. More effective interventions are needed to improve their self-care level and HRQoL.
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Affiliation(s)
- Huang Yao
- Shanghai Jiao Tong University School of Nursing, Shanghai, China
| | - Xie Ting
- Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wu Minjie
- Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Cao Yemin
- Shanghai TCM-Integrated Hospital, Shanghai, China
| | - Wang Xiqiao
- Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiang Yuzhi
- Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tian Ming
- Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wu Weida
- Shanghai TCM-Integrated Hospital, Shanghai, China
| | - Qian Peifen
- Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lu Shuliang
- Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Hogg FRA, Peach G, Price P, Thompson MM, Hinchliffe RJ. Measures of health-related quality of life in diabetes-related foot disease: a systematic review. Diabetologia 2012; 55:552-65. [PMID: 22246373 DOI: 10.1007/s00125-011-2372-5] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Accepted: 09/20/2011] [Indexed: 10/14/2022]
Abstract
AIMS/HYPOTHESIS Patient-reported outcome measures (PROMs) are increasingly used as key performance indicators in chronic illness. We sought to review the value of these tools in assessing health-related quality of life (HRQOL) in patients with diabetes-related foot disease and identify the impact of each foot problem on life quality. METHODS A systematic review of literature on HRQOL PROMs in diabetes-related foot disease was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The quality of eligible studies was evaluated within pre-existing criteria. RESULTS 53 studies written between 1995 and 2010 met the inclusion criteria. A variety of HRQOL PROMs were used. Disease-specific tools were better than generic at quantifying temporal changes in life quality and showed greater sensitivity to ulcer/neuropathic severity. No studies have simultaneously evaluated disease-specific tools. Generic and utility HRQOL PROMs are frequently used as secondary outcome measures in randomised trials and cost-utility analysis. HRQOL is depressed in diabetes, further impaired by the presence of foot disease. Ulcer healing is associated with improvements in HRQOL. Patients with active ulceration report poorer HRQOL than those whom have undergone successful minor lower extremity amputation (LEA) but there is a paucity of quality data on HRQOL outcomes for diabetes-related LEA. CONCLUSIONS/INTERPRETATION No one PROM was identified as a 'gold standard' for assessing HRQOL in diabetes-related foot disease. Specific areas for further development include the most valid HRQOL PROM with disease-specific content; HRQOL outcomes in minor and major amputations and the role of HRQOL tools in routine clinical care.
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Affiliation(s)
- F R A Hogg
- St George's Vascular Institute, St James Wing, St George's Healthcare NHS Trust, 4th Floor, Blackshaw Road, London SW17 0QT, UK
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