Quality of Life Research

, Volume 14, Issue 7, pp 1705–1718 | Cite as

Quality of life of people with venous leg ulcers: A comparison of the discriminative and responsive characteristics of two generic and a disease specific instruments

  • Cynthia P. lglesias
  • Yvonne Birks
  • Elizabeth A. Nelson
  • Elizabeth Scanlon
  • Nicky A. Cullum
Article

Abstract

Background: Venous leg ulcers are an important source of morbidity in society. Measuring the impact of leg ulcers on quality of life is important within clinical and economic evaluations. In this study we report a validation study of the leg ulcer disease specific Hyland questionnaire and compare its discriminative and responsive characteristics to general health quality of life measures: the SF-12 and EQ-5D. Methods: HRQoL of venous leg ulcer patients from 9 UK regions was measured using SF-12, EQ-5D and Hyland, at baseline and every three months for 1 year. Psychometric analysis was used to confirm the validity of the Hyland questionnaire. Quarterly scores for all instruments were calculated. Effect size and standardised mean difference were used to investigate the responsiveness to ulcer healing and discriminative abilities of the instruments. Results: Three hundred and eighty seven individuals were recruited into the VenUS I study. Baseline health related quality of life data from the study participants suggested a two factor solution for the Hyland. This questionnaire was associated with small and moderate ability to discriminate individuals according to age, mobility, initial ulcer size and ulcer duration. SF-12 and EQ-5D had good evaluative properties; both instruments were responsive to changes in HRQoL after ulcer healing. High levels of bodily pain were reported in the SF-12 questionnaire, whilst only minor ulcer related discomfort was reported in the Hyland. Discussion: SF-12 and EQ-5D are suitable for exploring dimensions of health related quality of life in people with chronic venous leg ulceration. The responsiveness to healing of the Hyland questionnaire is unclear. We would recommend the use of generic instruments for the measurement of HRQoL in patients with venous leg ulcers.

Keywords

EQ-5D Health related quality of life Hyland SF-12 Venous leg ulcers 

Abbreviations

HRQoL

health related quality of life

SF-12

Short Form 12

EQ-5D

Euroqol 5 dimensions

ES

effect size

MSD

mean standard difference

PCS

Physical Component Score

MCS

Mental Component Score

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References

  1. 1.
    Chase, SK, Melloni, M, Savage, A. 1997A forever healing: The lived experience of venous ulcer diseaseJ Vasc Nurs.157378PubMedGoogle Scholar
  2. 2.
    Walshe, C. 1995Living with a venous leg ulcer: A descriptive study of patients’ experiencesJ Adv Nurs.2210921100PubMedGoogle Scholar
  3. 3.
    Ebbeskog, B, Ekman, SL. 2001Elderly persons’ experiences of living with venous leg ulcer: Living in a dialectal relationship between freedom and imprisonmentScand J Caring Sci.152352343PubMedGoogle Scholar
  4. 4.
    Hyde, C, Ward, B, Horsfall, J, Winder, G. 1999Older women’s experience of living with chronic leg ulcerationInt J Nurs Pract.5189198PubMedGoogle Scholar
  5. 5.
    Flett, R, Harcourt, B, Alpass, F. 1994Psychosocial aspects of chronic lower leg ulceration in the elderlyWest J Nurs Res.16183192PubMedGoogle Scholar
  6. 6.
    Roe, B, Cullum, N, Hamer, C. 1998Patients’ perceptions of chronic leg ulceration. Leg Ulcers; Nursing Management. A Research Based GuideBalliere TindallLondon.125134Google Scholar
  7. 7.
    Wissing, U, Ek, AC, Unosson, M. 2001A follow-up study of ulcer healing, nutrition, and life-situation in elderly patients with leg ulcersJ Nutr Health Aging.53742PubMedGoogle Scholar
  8. 8.
    Walters, SJ, Morrell, CJ, Dixon, S. 1999Measuring health-related quality of life in patients with venous leg ulcersQual Life Res.8327336PubMedGoogle Scholar
  9. 9.
    Franks, PJ, Moffatt, CJ. 2001Health related quality of life in patients with venous ulceration: Use of the Nottingham health profileQual Life Res.10693700PubMedGoogle Scholar
  10. 10.
    Hyland, M. 1994Quality of life of leg ulcer patients: questionnaire and preliminary findingsJ Wound Care.3294298Google Scholar
  11. 11.
    Launois, R, Reboul-Marty, J, Henry, B. 1996Construction and validation of a quality of life questionnaire in chronic lower limb venous insufficiency (CIVIQ)Qual Life Res.5539554PubMedGoogle Scholar
  12. 12.
    Augustin, M, Dieterle, W, Zschocke, I,  et al. 1997Development and validation of a disease-specific questionnaire on the quality of life of patients with chronic venous insufficiencyVasa.26291301PubMedGoogle Scholar
  13. 13.
    Ware, J,Jr, Kosinski, M, Keller, SD. 1996A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validityMed Care.3422033PubMedGoogle Scholar
  14. 14.
    Kind, P. 1996Quality of Life and Pharmacoeconomics in Clinical TrialsLippincott–RavenPhiladelphia.Google Scholar
  15. 15.
    Hyland, M. 2003A brief gruide to the selection of quality of life instrumentHealth Qual Life Outcomes.12428PubMedGoogle Scholar
  16. 16.
    Norusis M. (1986). SPSS for windows (Version 10.0)Google Scholar
  17. 17.
    Cattell, R. 1966The scree test for the number of factorsMultivar Behavi Res.1245276Google Scholar
  18. 18.
    Kline, P. 1988Psychology Exposed: Or, The Emperor’s New Clothes.RoutledgeLondonGoogle Scholar
  19. 19.
    Friendly M. Planning a factor analytic study, 2003. http://www.psych.yorku.ca/lab/psy6140/fa/facplan.htmGoogle Scholar
  20. 20.
    Cronbach, LJ. 1951Coefficient alpha and the internal structure of testsPsycometrika.16297334Google Scholar
  21. 21.
    Kind P, Hardman G, Macran S. (1999). UK Population Norms for EQ-5D. 172. Centre for Health Economics Discussion Paper, University of York.Google Scholar
  22. 22.
    Iglesias, CP, Birks, YF, Torgerson, DJ. 2001Improving the measurement of quality of life in older people: The York SF-12QJM.94695698PubMedGoogle Scholar
  23. 23.
    Crosby, RD, Kolotkin, RL, Williams, GR. 2003Defining clinically meaningful change in health-related quality of lifeJ Clin Epidemiol.56395407PubMedGoogle Scholar
  24. 24.
    Fairclough DL. (2002). Design and Analysis of Quality of Life Studies in Clinical Trials. Chapman & Hall/CRCGoogle Scholar
  25. 25.
    Goldstein, H, Browne, W, Rasbash, J. 2002Multilevel modelling of medical dataStat Med.213291315PubMedGoogle Scholar
  26. 26.
    Goldstein, H, Healy, NJR, Rasbash, J. 1994Multilevel time series models with applications to repeated measures dataStat Med.1316431655PubMedGoogle Scholar
  27. 27.
    Spiegelhalter DJ, Thomas A, Best NG. (2003). WinBUGS Version 14. MRC Biostatistics Research Unit CambridgeGoogle Scholar
  28. 28.
    Gelman A. (2004). Prior distributions for variance parameters in hierachical models. In: Econometrics from Economics Working Paper Archive at WUSTLGoogle Scholar
  29. 29.
    Abrams KR, Brazier J, O’Hagan T, Kharoubi S, Tsuchiya A. (2003). Modelling partially & completely missing preference based outcome measures (PBOMs). http://www shef ac uk/chebs/FFortnights/FF6/Abrams pptGoogle Scholar
  30. 30.
    Iglesias CP, Nelson EA, Cullum N, Torgerson DJ. (2004). VenUS I: A randomized controlled trial of two types of bandage for treating venous leg ulcers. Health Technol Assess NHS R&D HTA Program. 8Google Scholar
  31. 31.
    Ware JE, Kosinski M. (2001). SF-36 Physical and mental health summary scales: A manual for users of Version 1.2.Google Scholar
  32. 32.
    Iglesias, C, Torgerson, DJ. 2000Does length of questionnaire matter? A randomised controlled trial of response rates to a mailed questionnaireJ Health Serv Res Policy.5219221PubMedGoogle Scholar

Copyright information

© Springer 2005

Authors and Affiliations

  • Cynthia P. lglesias
    • 1
  • Yvonne Birks
    • 1
  • Elizabeth A. Nelson
    • 1
  • Elizabeth Scanlon
    • 1
  • Nicky A. Cullum
    • 1
  1. 1.Department of Health SciencesUniversity of YorkNorth YorkshireUK

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