Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Diabet Med. 2013 Nov;30(11):1382-7. doi: 10.1111/dme.12254. Epub 2013 Jul 15.
To identify the factors responsible for the low health-related quality of life associated with foot ulcers and the relative importance of these factors.
A total of 1232 patients with a new foot ulcer, who presented at one of the 14 centres in 10 European countries participating in the Eurodiale study, were included in this cross-sectional study. Patient and ulcer characteristics were obtained as well as results from the Euro-Qol-5D questionnaire, a health-related quality of life instrument with five domains (mobility, self-care, usual activities, pain/discomfort and anxiety/depression). To analyse the relative importance of comorbidities and ulcer- and patient-related factors for health-related quality of life, linear regression models were used to calculate the relative contributions of each factor to the fit (R(2) ) of the model.
Patients reported poor overall health-related quality of life, with problems primarily in the mobility and pain/discomfort domains. Among the comorbidities, the inability to stand or walk without help was the most important determinant of decreased health-related quality of life in all five domains. Among ulcer-related factors, ulcer size, limb-threatening ischaemia and elevated C-reactive protein concentration also had high importance in all domains. The clinical diagnosis of infection, peripheral arterial disease and polyneuropathy were only important in the pain/discomfort domain.
The factors that determine health-related quality of life are diverse and to an extent not disease-specific. To improve health-related quality of life, treatment should not only be focused on ulcer healing but a multifactorial approach by a specialized multidisciplinary team is also important.
确定导致足部溃疡相关健康相关生活质量低下的因素及其相对重要性。
本横断面研究纳入了来自参与 Eurodiale 研究的 10 个欧洲国家的 14 个中心的 1232 名新发足部溃疡患者。收集了患者和溃疡特征以及 Euro-Qol-5D 问卷的结果，该问卷是一种具有五个领域（移动性、自我护理、日常活动、疼痛/不适和焦虑/抑郁）的健康相关生活质量工具。为了分析合并症以及溃疡和患者相关因素对健康相关生活质量的相对重要性，使用线性回归模型计算每个因素对模型拟合（R²）的相对贡献。
患者报告整体健康相关生活质量较差，主要在移动性和疼痛/不适领域存在问题。在合并症中，无法站立或行走而无需帮助是所有五个领域健康相关生活质量下降的最重要决定因素。在溃疡相关因素中，溃疡大小、肢体威胁性缺血和 C 反应蛋白浓度升高在所有领域也具有重要意义。感染、外周动脉疾病和多发性神经病的临床诊断仅在疼痛/不适领域重要。
决定健康相关生活质量的因素多种多样，在一定程度上不是疾病特异性的。为了提高健康相关生活质量，治疗不仅应侧重于溃疡愈合，而且由专门的多学科团队进行多因素治疗也很重要。
