THE IMPACT OF CLINICAL FACTORS AND SOCIODEMOGRAPHIC VARIABLES ON HEALTH-RELATED QUALITY OF LIFE IN VENOUS LEG ULCERATION
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Leg ulceration negatively affects quality of life (QOL). The relationship between important clinical attributes such as ulcer severity, pain and health related quality of life (HRQL) is poorly understood. The Wilson and Cleary model of Health Related Quality of Life (WC model) is a guiding framework that links clinical measures to QOL. Thesis Objectives: I describe the relationship between ulcer severity, comorbidity, etiology and pain and HRQL. Methods: An integrative mixed-methods approach was used: a systematic review of studies that examined the relationship between clinical variables and HRQL or QOL as outlined in the WC model (n=22); a review of studies (n=11) that compared the HRQL of persons with leg ulcers to population normative scores; and, an analysis of the relationship between clinical factors and HRQL in a cohort of 564 persons with venous leg ulcers drawn from two randomized control trials. Results: There is empirical support for the causal linkages between disease severity, symptoms, function, health perception and QOL that comprise the causal pathway as outlined in the WC model. Venous ulcers are associated with a poor quality of life, and numerous aspects of functioning are impaired, in particular physical function. In 564 individuals with venous ulcers, pain was present in 78.8%. Those younger than 65 years were 1.5 times more likely to be in the higher pain group compared to those 65 and older. Physical HRQL was significantly impaired. Predictors of poor physical HRQL included venous-arterial ulcers, a more severe ulcer, arthritis and a higher level of pain. Poor mental HRQL was associated with the younger age group, a comorbid condition and a higher level of pain. Increasing ulcer duration negatively affected mental state, but the findings were of borderline significance. Conclusion: The WC model is a clinically useful framework to select variables to represent HRQL and to base hypotheses about causal associations between clinical variables and QOL. Future research should focus on specifying the measurement models to represent disease severity, symptom status and functional status. Clinically the WC model is a useful bedside heuristic to explore the impact on leg ulceration on daily life and wellbeing.