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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.
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