Quality of Life in Different Stages of Chronic Venous Insufficiency and Leg Ulcer

Abstract

Background: Chronic venous insufficiency (CVI) is a frequent disease, reaching from mild ankle edema to severe venous leg ulcer. Previous studies have focused on the quality of life (QoL) in patients with leg ulcer, but not in patients with early forms of CVI nor stagerelated differences. Objective: To assess the quality of life in patients with CVI stages I, II, IIIa and IIIb (venous leg ulcer). Patients and Methods: Survey in a representative sample. 324 consecutive patients with different stages of CVI of a unit for phlebology and chronic wounds in the University hospital Freiburg were asked to answer validated questionnaires. In a period of 12 months, complete data were obtained from 276 patients. QoL was assessed by the Nottingham Health Profile (NHP), a generic QoL instrument, and the Freiburg Quality of Life Assessment (FLQA), a disease-specific questionnaire. The emotional status was assessed using the Symptom Checklist (SCL-90 R). Results: Qol was increasingly impaired from CVI stage I to CVI stage IIIb in the following areas: Pain and other physical complaints, physical mobility, energy level, social life, everyday life and stress due to treatment. In patients with CVI I QoL was only reduced in terms of sleep disturbances; patients with CVI II were also impaired in everyday life, pain and physical mobility. As a trend, QoL in CVI stage IIIa (healed leg ulcer) corresponded to stage II, whereas stage IIIb and mixed ulcer showed similar results. In most areas, female patients were more affected by QoL reductions. Neither age differences nor other sociodemographic parameters accounted for the stage differences of CVI. The general emotional status did not differ from normal population. Conclusions: QoL in patients with CVI can be severely impaired. The degree of impairment can at least partially be predicted by the stage of the disease. Reduction of QoL may have negative social as well as economic effects. The data suggest that psychosocial problems, including the question of QoL, should be considered in the treatment of CVI.