Analyzing factors affecting quality of life in patients hospitalized with chronic wound

A domain specific health-related quality of life of omani patients living with chronic wounds

AIM

Chronic wounds, defined as wounds that do not heal in a logical set of stages, impact patients' quality of life by disrupting their self-esteem, sleep, social interaction, work capacity, and psychological well-being. Chronic wounds are a prevalent problem in Oman due to the high number of patients with diabetes, sickle cell disease, road traffic accidents, and decubitus ulcer. Therefore, it is paramount to analyse the health-related quality of life (HRQOL) of these patients with chronic wounds.

MATERIAL AND METHODS

An observational, cross-sectional, descriptive study with a quantitative approach was conducted among 275 adult patients with chronic wounds in three tertiary hospitals of Muscat from June to December 2021 using a self-reported Cardiff life wound impact questionnaire and the Bates-Jensen wound assessment tool. Data were analysed with IBM SPSS version 23 using inferential statistics and chi-square test.

RESULTS

We found that the majority of participants were men (178; 64.7 %), aged between 41 and 60 years (107; 38.9 %), predominantly with diabetic wounds (80; 29.1 %). Respondents reported poor HRQOL across all domains: well-being (63.24 ± 18.092), physical (53.24 ± 18.387), and social (59.54 ± 19.025). Statistically significant poorer HRQOL was observed among the elderly above 60 years, illiterates, those with traumatic wounds, and those receiving medication and dressing as treatment.

CONCLUSIONS

Our findings indicate that Omani patients with chronic wounds experience low HRQOL. It is imperative for healthcare providers to offer comprehensive care to these patients. To enhance their quality of life and alleviate suffering, evaluating both the wounds and HRQOL is essential. Such assessments will enable the optimisation of treatment and coping strategies for patients.

Gdansk Wound-QoL Questionnaire: Pilot Study on Health-Related Quality of Life of Patients with Chronic Ulcers with Emphasis on Professional Physician-Patient Relations

INTRODUCTION

Chronic wounds lower health-related quality of life (QoL), as they affect various aspects of life due to pain, odor, tedious treatment, and stigma from society. Implementing proper treatment, where patient is well informed and active is a key for best outcomes.

OBJECTIVES

The aim of the study was to evaluate health-related QoL among the patients with chronic ulcers, with the use of new scale Gdansk Wound QoL.

METHODS

We enrolled 108 patients who met the inclusion criteria. Before the education on day 0 patients were asked to fill in Gdansk Wound-QoL questionnaire, that was developed in cooperation between dermatologists, general and plastic surgeons, as well as wound nurses, as well as fill the follow-up Gdansk Would-QoL questionnaire on day 30, which was also the end of the study.

RESULTS

Study participants (N = 108) were on average 76.1 ± 10.8 years and all of whom had a venous ulcer on their lower limbs of average wound area of 10.8 cm2. QoL, according to the Gdansk Wound-QoL questionnaire, increased on average by 36.7% after 30 days trial. Moreover, on the follow-up visit 94.4% of the patients stated that their knowledge on the disease has increased and everyone was satisfied with the course of treatment proposed by the current doctor. Furthermore, 44.4% of the study group increased their activity at the end of the study.

CONCLUSIONS

This pilot descriptive observational study shows that Gdansk Wound-QoL questionnaire can provide professionals in wound care good feedback on health-related QoL of patients with chronic wounds. This information has the potential to enhance patients well-being and overall comfort.

Multifunctional antibacterial hydrogels for chronic wound management

Chronic wounds have gradually evolved into a global health challenge, comprising long-term non-healing wounds, local tissue necrosis, and even amputation in severe cases. Accordingly, chronic wounds place a considerable psychological and economic burden on patients and society. Chronic wounds have multifaceted pathogenesis involving excessive inflammation, insufficient angiogenesis, and elevated reactive oxygen species levels, with bacterial infection playing a crucial role. Hydrogels, renowned for their excellent biocompatibility, moisture retention, swelling properties, and oxygen permeability, have emerged as promising wound repair dressings. However, hydrogels with singular functions fall short of addressing the complex requirements associated with chronic wound healing. Hence, current research emphasises the development of multifunctional antibacterial hydrogels. This article reviews chronic wound characteristics and the properties and classification of antibacterial hydrogels, as well as their potential application in chronic wound management.

Development and validation of a Chinese version chronic wound health-related quality of life instrument: A methodological study

AIMS AND OBJECTIVES

To develop a Chinese version of a chronic wound health-related quality of life (QoL) instrument and to examine the psychometric properties of this instrument.

BACKGROUND

Existing QoL instruments are not tailored to the linguistic and cultural characteristics of Chinese-speaking patients; a version addressing this gap will increase clinical understanding of their healthcare experience and may help guide chronic wound care.

DESIGN

A methodological study.

METHODS

The method advanced by DeVellis (2017) was used to develop the instrument. An initial pool of 38 items was created. To optimize scale length and test reliability and validity, exploratory and confirmatory factor analyses were conducted. A total of 23 items formed the final pool. After two rounds of expert discussions, the average content validity index of the final 23 items was .89.

RESULTS

A total of 226 patients completed the instrument and were divided into two groups for further analysis. Exploratory factor analysis revealed that 15 items remained in four factors (social activity restrictions, physical and psychological disturbance, wound burden and daily life limitation), which accounted for 64.87% of the variance. Confirmatory factor analysis revealed an acceptable fit of the hypothesized factor structure and the convergent and discriminant validities were achieved. Cronbach's α coefficients for each factor were .807, .773, .799 and .713, respectively.

CONCLUSION

The Chinese version of a chronic wound health-related QoL instrument consists of 15 items in four subscales and demonstrates good reliability and validity.

RELEVANCE TO CLINICAL PRACTICE

This instrument can be used intermittently or continuously to evaluate the treatment effect of chronic wounds by assessing health-related QoL. Scholars in Chinese-speaking regions may find this culturally compatible instrument useful when conducting studies related to chronic wounds.

PATIENT OR PUBLIC CONTRIBUTION

Two hundred twenty-six participants provided their perspectives on health-related QoL.

Improving immersive experiences in virtual natural setting for public health and environmental design: A systematic review and meta-analysis of randomized controlled trials

In recent years, virtual reality (VR) technology has emerged as a powerful tool in the field of therapeutic landscapes. For hospitalized patients or individuals with limited mobility, VR provides highly personalized therapy by simulating authentic natural environments within a safe, convenient, and engaging setting. This study investigated the effectiveness of immersing patients in virtual natural environments for health recovery and compared the varying impacts of different types of landscapes on patients' recovery levels. The aim was to complement traditional medical approaches and enhance environmental design in the field of public health. Researchers systematically reviewed databases (January 2018 to August 2, 2023) to identify randomized controlled trials comparing the efficacy of virtual nature immersion with other treatments. The inclusion/exclusion criteria were established based on the population, intervention, comparison, outcomes, study design, and other aspects (expanded PICO) framework. The Cochrane tool was employed to assess the risk of bias. Meta-analysis was conducted by pooling the mean differences with a 95% confidence interval. Among 30 trials, a total of 2123 patients met the inclusion criteria, with 15 studies included in the meta-analysis. 30 trials met the criteria. Results show significant improvements in pain, anxiety, fear, and some physiological indicators with virtual nature-based treatments. On the other hand, natural scenes incorporating blue and green elements have been applied more extensively and have shown more significant effects. In comparison to conventional methods, this study strongly advocates that virtual reality environments are a crucial tool in bridging the gap between patients and nature, demonstrating their potential to reshape medical interventions and improve environmental design in the field of public health.

Systematic review and quality assessment of clinical and economic evidence for superabsorbent wound dressings in a population with chronic ulcers

Effective exudate management is key for optimal ulcer healing. Superabsorbent dressings are designed to have high fluid handling capacity, reduced risk of exudate leakage, fluid retention under compression, and to sequester harmful exudate components. This study aimed to systematically identify existing evidence for the clinical efficacy and cost-effectiveness of superabsorbent dressings for the treatment of moderate-to-highly exudating chronic ulcers of various etiologies. The aim is focused on examining the 'class' effect of all superabsorbers, not any particular dressing. Clinical and cost effectiveness systematic reviews were conducted, searching Embase, MEDLINE, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature. The Cost Effectiveness Analysis Registry and Econ papers were also searched for the economic review. Outcomes of interest included ulcer closure, dressing properties, hospital- and infection-related outcomes, safety, and economic outcomes. Fourteen studies were included in the clinical systematic review. Eleven were case series, with one randomised controlled trial, one retrospective matched observational study, and one retrospective cohort study. The studies investigated eight superabsorbent dressings and were heterogeneous in their patient population and outcomes. Superabsorbent dressings may result in favourable outcomes, including reductions in frequency of dressing change and pain scores. As most studies were case series, drawing firm conclusions was difficult due to absence of a comparator arm. The economic systematic review identified seven studies, five of which were cost-utility analyses. These suggested superabsorbent dressings are a more cost-effective option for the treatment of chronic ulcers compared with standard dressings. However, the small number and low quality of studies identified in both reviews highlights the need for future research.

Specialized Nurse-led Care of Chronic Wounds During Hospitalization and After Discharge: A Randomized Controlled Trial

OBJECTIVE

To evaluate the effectiveness of specialized nurse-led care of patients with chronic wounds, provided both during hospitalization and postdischarge, on wound healing and readmission rates.

METHODS

An unblinded randomized controlled trial was conducted. Participants were patients with chronic wounds, randomly assigned to either the experimental group (cared for by wound care nurses both during hospitalization and postdischarge) or to the control group (cared for according to standard practice). Wound healing was identified as the primary outcome.

RESULTS

Overall, 1,570 patients were randomized, 1,298 of whom were included in the per-protocol analysis (707 in the experimental group and 591 in the control group). Nurse-led wound care quadrupled the probability of healing and reduced the number of treatment weeks and hospital readmissions.

CONCLUSIONS

Chronic wound care that was entrusted to specialized nurses improved outcomes in terms of wound healing, repair and regeneration, length of treatment, and rate of readmission, compared with standard practice. Future studies should evaluate the impact of care provided by specialized wound care nurses on patients' quality of life and healthcare costs. Nurse managers should promote the implementation of chronic wound clinical-care pathways entrusted to specialized nurses to improve patients' clinical outcomes and reduce hospital readmissions.

Translation and validation of 17-item Wound-QoL questionnaire in a Chinese population

We aimed to translate the 17-item questionnaire to measure the quality of life of patients with chronic wounds (Wound-QoL-17) and verify its reliability and validity in the Chinese population. The standard Chinese version of the Wound-QoL-17 was determined through translation, back translation, and cultural adaptation. A total of 121 patients with chronic wounds from the wound center of a tertiary hospital in Beijing were recruited. Through a questionnaire and physical examination, we tested the criterion-related validity, known group validity, structural validity, internal consistency coefficient (Cronbach's alpha), and test-retest correlation. A new structure of four factors was extracted by exploratory factor analysis, and the cumulative contribution rate was 72.23%. The total score and that of the four factors, which were significantly correlated with the EuroQol Five Dimensions Questionnaire (EQ-5D) and the Short Form-36 Health Survey (SF-36) (P < 0.05), also showed statistically significant differences between patients with different pain grades, with or without wound odour, and between different groups of patients reporting wound changes in the past 2 weeks. Cronbach's alpha was between 0.779 and 0.906, while the test-retest reliability was between 0.532 and 0.802. We concluded that the Chinese Wound-QoL-17 has good reliability and validity and is suitable for evaluating the quality of life of patients with chronic wounds.

Social Aspects of Diabetic Foot: A Scoping Review

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.

HEALTH-RELATED QUALITY OF LIFE IN PEOPLE WITH CHRONIC WOUNDS AND ASSOCIATED FACTORS

ABSTRACT Objective to assess health-related quality of life in people with chronic wounds and its association with sociodemographic and health characteristics. Method a cross-sectional and analytical study conducted with 85 individuals with chronic wounds in a university hospital from Paraíba, Brazil. The data were collected from June to September 2019 through interviews guided by the Medical Outcome Study 36-item Short-Form Health Survey generic Quality of Life assessment instruments and the Cardiff Wound Impact Schedule specific tool for people with chronic wounds. The Student's t, ANOVA, Mann-Whitney's U, Kruskal-Wallis and Kolmogorov-Smirnov tests were applied to analyze the data, with 5% significance. Results there was predominance of aged and married women with venous wounds not healing for over 24 weeks. The mean score of the generic instrument, which was 35.08, indicated a negative association between the physical capacity domain and female gender; as well as between vitality and age over 60 years old; between emotional aspects and marital status; of functional capacity, limitation of physical activity and emotional aspects with lack of religious practices; and of functional capacity with worse financial situation, all with p≤0.042. The specific instrument had a mean score of 45.57 and presented negative associations in the physical domain with female gender; as well as between social life without religious practices and social life with worse financial situation, all with p≤0.047. Conclusion the scores of the specific and generic instruments indicated low Quality of Life influenced by factors such as female gender, advanced age, being divorced/separated, lack of religious practices and having financial problems.

QUALIDADE DE VIDA RELACIONADA À SAÚDE DE PESSOAS COM FERIDAS CRÔNICAS E FATORES ASSOCIADOS

RESUMO Objetivo avaliar a qualidade de vida relacionada à saúde de pessoas com feridas crônicas e sua associação com características sociodemográficas e de saúde. Método estudo transversal e analítico, realizado com 85 pessoas com feridas crônicas de um hospital universitário da Paraíba - Brasil. Os dados foram coletados de junho a setembro de 2019, por meio de entrevistas, norteadas pelos instrumentos de avaliação da qualidade de vida genérico - Medical Outcome Study 36-item Short-Form Health Survey e específico para pessoas com feridas crônicas - Cardiff Wound Impact Schedule. Para analisar os dados, aplicaram-se os testes t de Student, ANOVA, Teste U de Mann-Whitney, Kruskal-Wallis e Kolmogorov-Smirnov, com significância de 5%. Resultados predominaram mulheres idosas, casadas, com feridas venosas que não cicatrizavam há mais de 24 semanas. O escore médio do instrumento genérico, que foi de 35,08, apontou associação negativa entre o domínio capacidade física e o sexo feminino; vitalidade e idade acima de 60 anos; aspectos emocionais e estado civil; capacidade funcional, limitação de atividade física e aspectos emocionais com falta de práticas religiosas; capacidade funcional com pior situação financeira, todos com p≤0,042. O instrumento específico teve escore médio de 45,57 e apresentou associações negativas no domínio físico com o sexo feminino; vida social sem práticas religiosas e vida social com pior situação financeira, todos com p≤0,047. Conclusão as pontuações dos instrumentos específico e genérico indicaram baixa qualidade de vida influenciadas por fatores como sexo feminino, idade avançada, estar divorciado/separado, falta de práticas religiosas e ter problemas financeiros.

Health-related quality of life and chronic wound characteristics among patients with chronic wounds treated in primary care: A cross-sectional study in Singapore

Chronic wounds commonly decrease patients' quality of life. Understanding how chronic wounds impact a patient's health‐related quality of life (HRQoL) is important for healthcare service delivery and treatment management. This study explored HRQoL among patients suffering from chronic wounds and investigated associations with patients' socio‐demographics and wound characteristics. Two hundred and thirty‐three patients across six primary care clinics were assessed and responded to a survey that collected information on socio‐demographic, wound characteristics, and HRQoL using the EQ‐5D‐5L instrument. Data were analysed by descriptive statistics and generalised linear models. The mean age of patients was 61.2 (SD: 14.6) years; 68.2% were males; and 61.8% were of Chinese origin. Arterial ulcers had the greatest negative impact on HRQoL related to mobility, self‐care, pain/discomfort and anxiety/depression, and the lowest VAS mean score 62.31 (SD: 28.3; range: 0‐100) indicating the worst health. HRQoL related to mobility was significantly associated with age (β = 0.008, P < .001), non‐Chinese ethnicity (β = 0.25, P = .001), mixed ulcers (β = −0.41, P = .022), atypical hard‐to‐heal wounds (β = −0.38, P = .021), wounds with low (β = 0.24, P = .044) to moderate (β = 0.29, P = .018) exudate level, and a wound duration ≥6 months (β = 0.19, P = .033). The findings can be used to improve healthcare delivery for patients with chronic wound to optimise their HRQoL.

Does Social Support Moderate Wound Pain and Health-Related Quality of Life in Patients With Chronic Wounds? A Multicenter Descriptive Cross-sectional Study

PURPOSE

We sought to explore the relationships among social support, health-related quality of life (HRQOL), and wound pain, and to examine whether social support would moderate the relationship between wound pain and HRQOL.

DESIGN

A multicenter descriptive cross-sectional study.

SUBJECTS AND SETTINGS

Individuals with chronic wounds attending wound clinics affiliated with 3 public hospitals in Beijing, China.

METHODS

Sociodemographic and wound characteristics of 162 participants were retrieved from medical records. Participants completed questionnaires for wound-related pain intensity (Numerical Rating Scale), social support (Social Support Rating Scale), and HRQOL (Medical Outcome Study Short Form-36). The moderating effect analysis was examined using the PROCESS analytic tool developed by Hayes, based on the bias-corrected bootstrapping method.

RESULTS

Results revealed that higher pain intensity was significantly related to lower HRQOL (P < .01), and higher social support was associated with better HRQOL (P < .01). However, there was no significant correlation between social support and wound pain (P = .55). Importantly, the moderating effect of social support on the relationship between wound pain and HRQOL was statistically significant (P = .008).

CONCLUSIONS

We found that social support moderated the impact of wound pain on HRQOL in patients with chronic wounds. This finding suggests that support obtained from social networks may be a beneficial intervention to improve the HRQOL of patients with chronic wounds, especially those suffering from high-intensity wound pain.

The measurement properties of assessment tools for chronic wounds: A systematic review

BACKGROUND

Chronic wounds are an increasing problem in the aging population, patients experience a lower health-related quality of life and the care for these patients is associated with high costs. Thorough wound assessments facilitate objective monitoring of wound status and progress. A wound assessment tool can guide clinicians in these wound assessments and in recording wound progress or deterioration.

OBJECTIVE

Systematically identify assessment tools for chronic wounds, investigate their measurement properties, and summarize the data per assessment tool.

DESIGN

Systematic review METHODS: The databases Medline (PubMed interface), Embase, CINAHL, and CENTRAL were systematically searched until May 2020 (updated in February 2021). Studies reporting the development and/or the evaluation of measurement properties of assessment tools for chronic wounds were included. The "Consensus-based Standards for the selection of health Measurement Instruments" risk of Bias checklist was applied to evaluate the methodological quality of the included studies. Each reported measurement property was rated against criteria for good measurement properties. The evidence was summarized and the quality of the evidence was graded using a modified Grades of Recommendation, Assessment, Development, and Evaluation approach. Study selection, data extraction and quality appraisal were conducted independently by two reviewers and double-checked by a third reviewer.

RESULTS

Twenty-seven studies describing the measurement properties of fourteen assessment tools for chronic wounds were included. None of the studies reported a content validity evaluation by a relevance study or a comprehensiveness study in professionals. Six articles reported the development or revision of an existing assessment tool. The reported measurement properties included: structural validity (5 studies), reliability (18 studies), hypotheses testing for construct validity (18 studies) and responsiveness (7 studies). Internal consistency, cross-cultural validity / measurement invariance and measurement error were not reported. If criterion validity was assessed, the results were allocated to hypotheses testing for construct validity as no 'gold standard' is available.

CONCLUSIONS

Fourteen assessment tools for chronic wounds were identified. Construct validity (by hypotheses testing) and responsiveness of the Pressure Ulcer Scale for Healing version 3.0 were supported by sufficient ratings based on moderate to high level quality of evidence. Reliability of the (Revised) Photographic Wound Assessment Tool had a sufficient rating based on moderate quality of evidence. The ratings of the measurement properties of the other wound assessment tools were either insufficient or indeterminate, or a sufficient result was supported by low to very low quality of evidence. Registration number in PROSPERO: CRD42020183920 Tweetable abstract: A systematic review giving a clear overview of the measurement properties of available assessment tools for chronic wounds.