Chronic wounds compromise health-related quality of life

Chronic wounds, particularly arterial ulcers, severely impair patients’ health-related quality of life (HRQoL) by restricting their mobility and self-care, and by causing pain, discomfort, anxiety, and depression, according to a recent Singapore study.

“Understanding how chronic wounds impact HRQoL is important for healthcare service delivery and treatment management,” the researchers said.

The current cross-sectional analysis included 233 patients (mean age 61.2 years, 68.2 percent men, 61.8 percent Chinese ethnicity) seeking care across six primary care clinics in Singapore. Participants were asked to accomplish a survey designed to collect basic sociodemographic and wound information, as well as assess HRQoL using the EQ-5D-5L instrument.

More than a third (34.3 percent) of participants had atypical hard-to-heal wounds (AHHW) and a similar proportion (33.5 percent) suffered from diabetic foot ulcers. Most (70.4 percent) harboured only one wound. Majority of wounds were at the foot (40.3 percent) or lower legs (33.0 percent). While around half (46.7 percent) of the wounds were small (<2 cm²), around a third had medium (32.2 percent) or high (2.6 percent) exudate levels. [Int Wound J 2021;doi:10.1111/iwj.13708]

Notably, almost half (48.1 percent) of wounds were infected.

Of all HRQoL domains, mobility suffered the greatest, with a mean score of 1.81. HRQoL scores varied widely according to wound aetiology, with arterial ulcers causing the largest negative impact. Patients with such wounds had a mean mobility score of 2.23, self-care of 1.92, pain/discomfort of 2.00, and anxiety/depression of 1.69. Similarly, the visual analogue scale (VAS) rating for pain for arterial ulcers was 62.31.

Wound duration also appeared to be an important factor for HRQoL, such that longer durations tended to associate with poorer mobility and pain/discomfort, suggesting worse perceived HRQoL among patients who had had their wounds for 6 months to 1 year.

Regression analysis confirmed that wound duration over 6 months had a strong negative and significant impact on mobility-related HRQoL (p=0.033), while durations of 6 weeks to 3 months impaired VAS pain (p=0.031). Wound exudate of low (p=0.044) and medium (p=0.018) levels likewise compromised mobility-related HRQoL.

Sociodemographic factors likewise affected HRQoL, with increasing age negatively impacting the domain of usual activities (p=0.001) and non-Chinese ethnicity hurting the domains of mobility (p=0.001), self-care (p=0.046), and anxiety/depression (p=0.025). In contrast, increasing age had a significant positive impact on mobility (p=0.001).

“This study assessed HRQoL and characteristics of chronic wounds in primary care patients in Singapore,” the researchers said. “The findings can be used to improve healthcare delivery for patients with chronic wound to optimize their HRQoL.

“This could, for example, be done by targeting areas in which patients experience the lowest HRQoL and provide treatments to alleviate problems related to that specific domain of health,” they added.