Katrin Baade

The “Wound‐QoL”: A short questionnaire measuring quality of life in patients with chronic wounds based on three established disease‐specific instruments

The aim of this study was to develop a short questionnaire measuring health‐related quality of life (HRQoL) in chronic wounds. Three validated instruments assessing HRQoL in chronic wounds—the Freiburg Life Quality Assessment for wounds, the Cardiff Wound Impact Schedule, and the Würzburg Wound Score—were completed by 154 German leg ulcer patients in a longitudinal study. For implementation in the new, shorter questionnaire Wound‐QoL, all of those 92 items that covered the core content of the three questionnaires and showed good psychometric properties were selected. Internal consistency, convergent validity, and responsiveness were analyzed using the study data on the selected items (a new approach called virtual validation). Subscales were determined with factor analysis. Item, instruction, and response scale wording were harmonized. Seventeen items were included in the Wound‐QoL, which could be attributed to three subscales on everyday life, body, and psyche. Both global score and subscale scores were internally consistent with Cronbachs alpha between 0.71 and 0.91. The global score showed significant convergent validity (r = 0.48 to 0.69) and responsiveness (r = 0.18 to 0.52); the same was true for the subscale scores. The Wound‐QoL for measurement of HRQoL in chronic wounds proved to be internally consistent, valid, and responsive in German leg ulcer patients. The findings of this virtual validation study need to be confirmed in a longitudinal validation study on the final Wound‐QoL, which is currently being conducted.

Validity and feasibility of the wound-QoL questionnaire on health-related quality of life in chronic wounds

Chronic wounds have a major socioeconomic impact due to their frequency, chronicity, and societal costs. Patients experience substantial quality of life (QoL) impairments. The use of questionnaires for a continuous assessment of QoL and resulting interventions to improve the situation of the individual are an important cornerstone of a guideline‐based wound care. The aim of this study was to investigate the validity of the Wound‐QoL questionnaire. Patients with chronic wounds from two different centers were included in the prospective study. All patients completed the Wound‐QoL and two other QoL questionnaires (European Quality of Life‐5 Dimensions, EQ‐5D, and Freiburg Life Quality Assessment for wounds, FLQA‐wk) at baseline and at two more time points (4 and 8 weeks, respectively). Wound status was defined with an anchor question. Two hundred and twenty‐seven patients (48.5% women) participated in the study. Mean age was 66.9 years (range 17–96, median 69.5). Indications were venous leg ulcers (40.1%), pyoderma gangraenosum (14.1%), diabetic or ischemic foot ulcers (5.3%), pressure ulcers (2.6%), and other etiologies (30.0%). The Wound‐QoL showed good internal consistency, with high Cronbachs alpha in all the subscales and in the global scale in all time points (>0.8). Convergent validity was satisfactory since there were significantly (p ≤ 0.001) good correlations with the EQ‐5D (range = 0.5–0.7) and FLQA‐wk global score (r > 0.8) at every time point. Responsiveness was high, too. The Wound‐QoL is a simple, valid tool for the longitudinal assessment of QoL in patients with chronic wounds. This questionnaire is suitable for use in clinical trials, quality of care studies and clinical routine.

Quality-of-life evaluation in chronic wounds: comparative analysis of three disease-specific questionnaires

The study directly compared the feasibility and performance of three instruments measuring health‐related quality of life (HRQoL) in chronic ulcers: the Freiburg Life Quality Assessment for wounds (FLQA‐w), the Cardiff Wound Impact Schedule (CWIS) and the Würzburg Wound Score (WWS). The questionnaires were evaluated in a randomly assigned order in a longitudinal observational study of leg ulcer patients. Psychometric properties (internal consistency, responsiveness and construct validity) were analysed. Patient acceptance was recorded. Analysis of n = 154 patients revealed good internal consistency (Cronbachs alpha ≥ 0·85) for all instruments. There were minor floor effects in all questionnaires (<1%) and some ceiling effects in the CWIS. Construct validity was satisfactory, for example, correlation with EuroQoL‐5D was r = 0·70 in the FLQA‐w, r = 0·47/0·67/0·68 in the CWIS dimensions and r = 0·60 in the WWS. The proportion of missing values was higher in the CWIS, and overall patient acceptance was highest in the FLQA‐w for wounds (54% best preferences) and lowest in the WWS (14%). In conclusion, the FLQA‐w, the CWIS and the WWS are reliable, sensitive and valid instruments for the assessment of HRQoL in leg ulcers. However, they show differences in clinical feasibility and patient acceptance.