Longer-term changes in quality of life in chronic leg ulceration.

Studies that have examined patients' health-related quality of life have consistently shown improvements following intensive and effective treatments over relatively short follow-ups. However, little is known of the longer-term effects of treatment on patients. As part of a study in southwest London, United Kingdom, all patients having a current leg ulcer were examined (n = 113) and those who were able completed the Nottingham Health Profile (n = 95) and were then followed up at 24 and 48 weeks. The patients had a mean age of 76 +/- 13 (SD) years, with 60 (63.2%) being women. Before the study, the ulcer had been present for a median of 8 months (range 0.5-144), and a median area of ulceration of 4.0 cm2 (range 0.5-171.5 cm2). After 24 weeks, there was a significant improvement in pain (mean difference [d] = 9.6, p = 0.002), which was true for both the 41 patients with ulcers present (d=10.07, p = 0.013) and the 43 patients whose ulcers had healed (d = 11.46, p = 0.047). However, after 48 weeks, these improvements had been reduced in both groups (healed ulceration d = 5.76, unhealed patients d = 6.41). Energy, which had improved after 24 weeks in the patients whose ulcers, had healed (d = 11.46), deteriorated in both patient groups after 48 weeks (healed = -5.67, unhealed = -13.43). Mobility status was maintained with healed ulceration (d = 1.05) but deteriorated with unhealed ulceration (d = -13.19). The positive effects of treatment on health-related quality of life may not be sustained over time. This may be a consequence of the general deterioration in the health status of these elderly patients as they age.