A longitudinal study of patients with diabetes and foot ulcers and their health-related quality of life: wound healing and quality-of-life changes

Abstract

Objective The objectives of this study were to assess ulcer healing in patients with diabetic foot ulcers during a 1-year follow-up, to compare health-related quality of life (HRQL) between those with healing ulcers and those with ulceration, and to assess whether changes in healing affect patients' HRQL. Methods Data were collected at baseline, after 6 months ( T 2), and after 12 months ( T 3). Adult patients ( n=127) with type 1 or type 2 diabetes and foot ulcers were recruited from outpatient clinics. Self-assessed HRQL was measured using the SF-36 Health Survey at all measurement points. Sociodemographic and clinical data were obtained at baseline, and data on healing, ulceration, and amputation were obtained at T 2 and T 3. Results Of 127 patients included at baseline, 35% had persistent ulcer, 37% had healed ulcer, 6% had undergone amputation, and 7% had died at T 3. In addition, 9% had undergone amputation at T 2. Significant differences were observed between patients with healed ulcers and patients with persistent ulcers on general health at baseline; on physical functioning, general health, and social functioning at T 2; and on five of eight subscales in the SF-36 (e.g., physical functioning, role limitation—physical, general health, social functioning, and mental health) and on the physical summary score at T 3. Furthermore, HRQL improved significantly in social functioning and mental health in parallel with healing of ulcers, and deteriorated in the social functioning subscale in parallel with nonhealing of ulcers. Conclusions Only 37% of ulcers healed during the 1-year follow-up. Poor HRQL during follow-up was associated with poor ulcer prognosis.