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EWMA2008 Presented at the 18 th Conference of the European Wound Management Association, 14-16 May 2008, Lisbon, Portugal Abstract Aim: Leg ulcers represent an important health problem because their prevalence in western countries varies from 0.6 to 3.6 per 1000 1 . A survey among leg ulcer patients carried out in the Czech Republic in 2006 revealed that more than 3% respondents suffer or had suffered from leg ulcers, either currently or in the past 2 . In last years, many studies evaluated quality of life of leg ulcer patients which is decreased as it was showen by many of these studies 3-5 . The aim of this preliminary study was to collect data about quality of life of the patients with chronic leg ulcers in the Czech Republic . Methods: A special questionnaire focused on quality of life of patients with chronic leg ulcers was developed in our department of dermatology. A questionnaire is divided in 6 parts, the questions are aimed at pain, physical, social and psychological impact, at daily activities and at aspects of treatment. 30 patients (8 men and 22 women) have been included in the study so far, with mean age 68.0 years (range 47-87 years). Mean ulcer duration was 29.3 months (range 4-120 months). Most patients (63%) had leg ulcers of venous origin, 37% had mixed leg ulcers. Psychometric data of our questionnaire are part of a study to establish the reliability/validity of the tool and they will be published later. Results: Pain is the most dominant negative experience of leg ulcer patients 6-10 . In our study, 97% reported ulcer pain. 47% experienced pain during the night, 29% reported pain during the day and 23% reported pain both during the day Science, Practice and Education Quality of Life in the Patients with Chronic Leg Ulcers – A Preliminary Report References 1. Nemeth KA, Harrison MB, Graham ID, Burke S. Understanding venous leg ulcer pain: results of a longitudinal study. Ostomy/ Wound Manage 2004;50(1):34-46. 2. Kucera Z. Leg ulcer prevalence in the Czech Republic: Omnibus survey results 2006. EWMA Journal 2006;6(2):28-29. 3. Flanagan M, Vogensen H, Haase L. Case series investigating the experience of pain in patients with chronic venous leg ulcers treated with a foam dressing releasing ibuprofen. World Wide Wounds 2006;available from URL: htp://worldwidewounds.com/2006/april/Flanagan/ Ibuprofen.html 4. Lindholm C, Bjellerup M, Christensen OB, Zederfeldt B. Quality of life in chronic leg ulcer patients. An assessment according to the Nottingham Health Profile. Acta Derm Venereol (Stockh) 1993;73:440-443. and night. 26.2% patients described the pain located in the wound bed, 13.6% reported pain in the area surrounding the wound. Most patients, 60.2%, reported pain both in the wound bed and in the surrounding area. 66% reported persistent pain, 19.5% reported pain with activity, 36% described pain at dressing change. Mean pain intensity score was 5.43 (using numerical rating scale as an assessment of pain intensity). Pain may lead to sleep disturbance 11 . In our study, 43.7% patients reported disturbed sleep every night or very often. According to literature 12,13 , chronic leg ulcers may negatively influence daily activities. 74.9% patients experienced moderate restrictions in leisure activities and 59.3% reported moderate restrictions in household duties. Many patients have problems with their clothing style, they usually wear long skirts or trousers 12 . 44.6% patients reported partial or complete change of their clothing style (especially women). The patients usually have to wear larger size of shoes especially because of compression bandages. In our study, 38.9% patients had to change their shoes completely and 41.6% changed their shoes partially. Social impact of leg ulcers is also considerable 12 . 80.6% reported certain social isolation caused by problems connected with their leg ulcer. Psychological aspects are very important 11 , our patients often complained about bad mood ,they described depression and feelings of hopelessness. Conclusions: Leg ulcers can influence nearly every aspect of the patient’s life. Therefore the care must be more intensively focused on quality of life of these patients. m 5. Franks PJ, Moffatt CJ, Doherty DC, Smithdale R, Martin R. Longer-term changes in quality of life in chronic leg ulceration. Wound Rep Reg 2006;14:536-541. 6. Briggs M, Bennett MI, Closs SJ, Cocks K. Painful leg ulceration: a prospective, longitudinal cohort study. Wound Rep Reg 2007;15:186-191. 7. Moffatt CJ., Franks PJ, Hollinworth H. Understanding wound pain and trauma: an international perspective. EWMA Position Document: Pain at wound dressing changes 2002;2-7. 8. Cooper SM, Hofman D.,Burge SM. Leg ulcers and pain, a review. Lower Extremity Wounds 2003;2:189-197 9. Jorgensen B, Friis GJ, Gottrup F. Pain and quality of life for patients with venous leg ulcers: proof of concept of the efficacy of Biatain-Ibu, a new pain reducing wound dressing. Wound Rep Reg 2006;14:233-239 10. Krasner D. Painful venous ulcers: themes and stories about their impact on quality of life. Ostomy/Wound Management 1998;44(9):38-49. Veronika Slonkova, MD, Ass.Prof. Vladimir Vasku, MD Department of Dermatovenereology, St.Anna University Hospital Brno, Czech Republic Corresponding author + reprint requests: Veronika Slonkova, MD, Department of Dermatovenereology, St.Anna University Hospital, Pekarska 53, 656 91 Brno, Czech Republic veronika.slonkova@fnusa.cz 11. Douglas V. Living with a chronic leg ulcer: an insight into patient’s experience and feelings. J Wound Care 2001;10:355-360. 12. Persoon A, Heinen MM, Vleuten CJM, Rooij MJ, Kerkhof PCM, Achterberg T. Leg ulcers: a review of their impact on daily life. J Clin Nurs 2004;13:341-354. 13. Heinen MM, van Achterberg T, Scholte op Reimer W, van de Kerkhof PCM, de Laat E. Venous leg ulcer patients: a review of the literature on lifestyle and painrelated interventions. J Clin Nurs 2004;13:355-366. EWMA Journal 2008 vol 8 no 3 23
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