The diabetic foot ulcer scale (DFS) questionnaire is a specific instrument designed to assess the impact of foot ulcers and their treatment on quality of life in people with diabetes. Based on the results of semi-structured interviews and focus-group discussions with foot ulcer patients and caregivers, the DFS consists of 58 items grouped into 11 domains: leisure, physical health, daily activities, emotions, noncompliance, family, friends, positive attitude, treatment, satisfaction, and financial.Two studies have been conducted to develop and validate the DFS. The first of these included 173 patients with diabetes and current foot ulcers (n = 48), healed foot ulcers (n = 54), or no history of foot ulcers (n = 71). A generic measure of health status, the SF-36, was used to test construct validity.The DFS had good internal consistency. Significant differences between patients with current ulcers and those with healed ulcers were observed in the mean scores for the leisure, emotions, and financial domains (p < 0.05). Marked differences were also observed in physical health, daily activities, and friends domains, indicating that the DFS is able to discriminate patients with healed ulcers from those with current ulcers.The DFS was further evaluated in a relevant clinical setting (n = 288); confirmatory factor analysis confirmed the hypothesised factor structure of the DFS, but with slight suggestions for improved scaling. The DFS scales also demonstrated adequate test-retest reliability and sensitivity to change in wound status over time KEYWORDSdiabetes; foot ulcer; quality of life; treatment; diabetic foot ulcer scale study conducted in the United Kingdom that involved face-to-face semi-structured interviews with ten patients (six men, four women; mean age, 61 years; range, 46 to 74 years) and three caregivers. All of these patients currently had diabetic foot ulcers, and were referred by either a neuropathy specialist/consultant or a diabetic foot ulcer nurse. Subsequent focus-group discussions with patients and caregivers were conducted to define further the domains of quality of life affected by diabetic foot ulcers. A total of 14 patients and 11 caregivers from the United Kingdom consented to participate in these discussions, consisting of two patient groups and two caregiver groups. The groups were not attended by anyone involved in treating the patients and were all facilitated by the same moderator. Following each focusgroup discussion, the research team reviewed the group responses to identify major issues. Themes arising in one group were presented to subsequent groups for further elucidation of the concepts and domains. These themes included the impact of ulcers on mobility and the resulting implications for daily activities and social activities, the impact of ulcers on leisure activities, and psychological issues, such as knowing that one is at high risk for ulceration, discovering the presence of an ulcer, having to obtain treatment for foot ulcers, or having a toe, foot, or leg amputated.The ...

The digital imaging method was faster and easier to use and the patients preferred it, as it was a noncontact method. In addition it also provides a photographic record for comparison.

There is little doubt that provision of special care for people with diabetic foot ulcers reduces morbidity and amputation. Global efforts have been made to improve care for those who have or are prone to develop diabetic foot ulcers. However, equal to successful treatment and prevention is the need to understand how people feel about having a foot ulcer and its impact on their lifestyle. This information is important in choosing the optimum treatment approachÐone that is effective as well as acceptable to the patients themselves and their carers. Recent major advances in wound care research have resulted in new treatments for people with diabetic foot ulcers. It is important to understand how these treatments differ from traditional ones in the way they affect patient well-being. Because of the fears, emotions and worries frequently underlying a consultation concerning diabetic foot problems it can be useful for clinicians to have access to a method of assessing these psychological issues in a systematic and comprehensive manner. The assessment of health-related quality of life (HRQoL) is one such method that may contribute to the evaluation of future foot ulcer treatments and care practices.

No abstract

Ao Jockey Club de S~o Paulo, pelo financiamento da pesquisa, demonstrando interesse pela ciência. Ao Dr. Luiz Alberto Marinho, pelo apoio e confiança indispensâveis em nosso trabalho. Aos fiéis amigos Marco Antonio, Fab10la, Carlos Eduardo, Valéria e Soraia pela compreens~o nos momentos mais dificeis.