Quality of life in people with venous leg ulcers: an integrative review.

OBJECTIVE: To explore the impact of venous leg ulcers on health-related quality of life and analyse the quality of life instruments that have been used for this topic.
BACKGROUND: Venous leg ulcers represent more than 80% of all chronic leg ulcers. Several studies have demonstrated that health-related quality of life is affected in patients with such lesions.
METHOD: An integrative review was conducted, together with an additional methodological review of quality of life instruments. Eight electronic databases were searched, and all studies published between 2003 and 2008 were considered in with both qualitative and quantitative approaches and in Spanish, English, French, German and Portuguese. Thus, no restrictions were applied as regards study design.
RESULTS: Twenty-two studies were included; one used mixed methods, three employed qualitative methods and the remaining articles used a quantitative approach. Pain was the factor most frequently identified as affecting health-related quality of life. The generic instruments most commonly used were Short Form-36 and adaptations, the Nottingham Health Profile and EuroQol-5, whilst the disease-specific tools were Hyland, Cardiff Wound Impact Schedule and Charing Cross Venous Leg Ulcer Questionnaire. Two new instruments were also identified, venous leg ulcer quality of life and Sheffield Preference-based Venous Leg Ulcer 5D.
CONCLUSIONS: The negative impact of venous leg ulcers on health-related quality of life is confirmed in this review. This impact has been measured using a variety of specific health-related quality of life instruments. However, the review findings suggest that the Charing Cross Venous Leg Ulcer Questionnaire is the most appropriate instrument due to its disease-specific psychometric characteristics.