Minor amputation does not negatively affect health‐related quality of life as compared with conservative treatment in patients with a diabetic foot ulcer: An observational study

Pickwell, Kristy M.; Siersma, Volkert; Kars, Marleen; Apelqvist, Jan; Баккер, К.; Edmonds, Michael; Holstein, P.; Jirkovská, Alexandra; Jude, E. B.; Mauricio, Dı́dac; Piaggesi, Alberto; Reike, Heinrich; Spraul, Maximilian; Uccioli, Luigi; Urbančič, V.; Acker, Kristien Van; Baal, Jeff Van; Schaper, Nicolaas C.

doi:10.1002/dmrr.2867

Cited by 33 publications

(31 citation statements)

References 31 publications

(36 reference statements)

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“…Another study of DFUs demonstrated that improvement in the anxiety/depression score on the EQ-5D-5L instrument was significantly higher in patients who healed by minor amputation compared with patients who healed with conservative methods. The authors stated that oftentimes amputation is perceived as a "failure"; however, the results of their study demonstrated that minor amputation is a viable treatment option (22). Overall, the above findings suggest that amputations not be viewed as a failure and that, in select patients (generally patients with better underlying cardiovascular status), amputation can improve self-reported HRQOL when it results in an improvement of physical function.…”

Section: The Impact Of Dfd On Hrqolmentioning

confidence: 96%

“…Excellent correlation has been found between PCS and MCS scores calculated from the SF-36 and SF-12 in patients with DFD (21). The SF-36 has shown good correlation with wound-specific outcome instruments, such as the Diabetic Foot Ulcer Scale and the Cardiff Wound Impact Schedule (CWIS) (22).…”

Section: Hrqol In Patients With Dfd: How We Can Measure It?mentioning

confidence: 99%

“…It consists of two components, a descriptive system and a visual analogue scale. The EQ-5D-5L has been shown to be equivalent to the SF-36 in assessing HRQOL in patients with diabetes (24) and has been used in several pivotal studies in patients with DFD (22,25).…”

Section: Five-level Euroqol Versionmentioning

confidence: 99%

See 2 more Smart Citations

Assessing Health-Related Quality of Life in Patients With Diabetic Foot Disease: Why Is It Important and How Can We Improve? The 2017 Roger E. Pecoraro Award Lecture

Wukich

Raspovic

2018

Diabetes Care

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Patient-reported outcomes (PROs) have become an important subject in the area of diabetes-related foot complications. Self-reported health-related quality of life (HRQOL) surveys can provide a generic measure of overall health (global) and can be disease specific (i.e., diabetes) or even region specific (i.e., lower-extremity function). Analysis of PRO measures utilizing validated instruments allows health care providers to determine whether medical and surgical treatments are providing patients with the highest level of outcome possible and are actually improving HRQOL. The 36-item Short Form (SF-36), EuroQol five-dimension questionnaire (EQ-5D-5L), and Foot and Ankle Ability Measure (FAAM) are examples of commonly used HRQOL surveys. Low HRQOL has been associated with higher rates of hospital admission and mortality in patients with diabetes. Previous studies have demonstrated that patients with diabetes-related foot disease have low self-reported physical quality of life but do not typically report low mental quality of life. The impact of mental quality of life may be underestimated in these patients using the SF-36. In this article, we will discuss several widely used outcome instruments used to measure patient HRQOL and the impact of diabetic foot disease on HRQOL. As health care providers, we must continue to adjust and modify our treatments to achieve the best patient outcomes and associated high quality of life. Assessing PROs will become increasingly important as health care systems transition from a volume-based reimbursement model to a value-based model.

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Section: The Impact Of Dfd On Hrqolmentioning

confidence: 96%

Section: Hrqol In Patients With Dfd: How We Can Measure It?mentioning

confidence: 99%

See 1 more Smart Citation

Assessing Health-Related Quality of Life in Patients With Diabetic Foot Disease: Why Is It Important and How Can We Improve? The 2017 Roger E. Pecoraro Award Lecture

Wukich

Raspovic

2018

Diabetes Care

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“…One group has reported that first ulcers are associated with depression and that this is independently associated with mortality at 5 years (52). Others, however, have reported that both quality of life and depressive symptoms are reversed by healingdeither with or without amputation (53)(54)(55). Wukich et al (56) have recently reported that people with diabetic foot disease fear major amputation more than they fear death.…”

Section: Improving Well-being: the Patient Agendamentioning

confidence: 99%

Current Challenges and Opportunities in the Prevention and Management of Diabetic Foot Ulcers

et al. 2018

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Diabetic foot ulcers remain a major health care problem. They are common, result in considerable suffering, frequently recur, and are associated with high mortality, as well as considerable health care costs. While national and international guidance exists, the evidence base for much of routine clinical care is thin. It follows that many aspects of the structure and delivery of care are susceptible to the beliefs and opinion of individuals. It is probable that this contributes to the geographic variation in outcome that has been documented in a number of countries. This article considers these issues in depth and emphasizes the urgent need to improve the design and conduct of clinical trials in this field, as well as to undertake systematic comparison of the results of routine care in different health economies. There is strong suggestive evidence to indicate that appropriate changes in the relevant care pathways can result in a prompt improvement in clinical outcomes.Despite considerable advances made over the last 25 years, diabetic foot ulcers (DFUs) continue to present a very considerable health care burdendone that is widely unappreciated. DFUs are common, the median time to healing without surgery is of the order of 12 weeks, and they are associated with a high risk of limb loss through amputation (1-4). The 5-year survival following presentation with a new DFU is of the order of only 50-60% and hence worse than that of many common cancers (4,5). While there is evidence that mortality is improving with more widespread use of cardiovascular risk reduction (6), the most recent datadderived from a Veterans Health Adminstration populationdreported that 1-, 2-, and 5-year survival was only 81, 69, and 29%, respectively, and the association between mortality and DFU was stronger than that of any macrovascular disease (7). Iversen et al. (8) have also shown that the occurrence of a DFU was an independent predictor of mortality even at 10 years.The cost to health care services is also enormous. The estimated global cost of diabetes in 2015 was $1.3 trillion (9), and it has been reported that up to one-third of diabetes expenditure is on lower-limb-related problems in the U.S. (10). The latest data from the U.K. estimate that the total annual cost of management of DFUs exceeds £1 billion ($1.32 billion) and represents almost 1% of the total National Health Service budget (11). The equivalent figure from the U.S. has been estimated to be $9-13 billion (12). GEOGRAPHIC DIFFERENCES IN CLINICAL OUTCOMEThere is also wide variation in clinical outcome within the same country (13-15), suggesting that some people are being managed considerably less well than others.

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“…Outpatient clinics that specifically look after patients with dysvascular foot disease are effective in reducing these patients' complications and hospitalisations [1], [2]. Dysvascular foot disease is associated with disability and reduced quality of life on a number of validated tools for measuring quality of life such as SF-36 and NeuroQol [4], [5]. Hospital admissions with diabetic foot disease have been estimated to cost over a billion dollars in Australia alone [3].…”

Section: Introductionmentioning

confidence: 99%

The association between SARC‐F status and quality of life in High Risk Foot Clinic patients

Churilov

Чурилов

Proctor

et al. 2019

JCSM Clinical Reports

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Background High Risk Foot Clinic (HRFC) patients have foot ulceration commonly associated with poorer quality of life (QoL). A positive SARC-F test is predictive of sarcopenia. The objective of this study is to investigate whether SARC-F positive status is associated with lower QoL among attendees of HRFC, which is currently unknown. Methods and resultsIn this cross-sectional study ambulatory HRFC patients were recruited at metropolitan tertiary referral hospital over one year. Demographics, comorbidities, SARC-F and EQ-5D-3L (EuroQol Group) outcomes were collected. Association between SARC-F status and EQ-5D visual analogue scale measurement, as well as individual EQ-5D-3L dimensions were investigated using, respectively, linear robust and ordinal logistic regression modelling. The clinic was attended by 122 new patients, 85 of whom (69%) completed the questionnaires with no selection bias identified. 43/85 (51%) patients were SARC-F positive as indicated by a score of 4 or greater. No significant differences between SARC-F positive and negative patients were identified in age or diabetes status. SARC-F positive patients had consistently lower EQ-5D-3L visual analogue scale measurement [mean 5.3 (SD 2.0); median 5 (IQR: 4, 6.5)] compared to SARC-F negative patients [6.6 (SD 1.9); 7 (5.5, 7.5)], adjusted mean difference -1.2 (95%CI: -2.1, -0.4; p=0.007). SARC-F positive patients demonstrated consistent and statistically significantly worse EQ-5D-3L scores on mobility, personal care and usual activities, but not on anxiety/depression and pain/discomfort components. Conclusions Approximately half of HRFC patients are SARC-F positive and exhibit significantly lower QoL as measured by EQ-5D-3L compared to SARC-F negative patients.

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Minor amputation does not negatively affect health‐related quality of life as compared with conservative treatment in patients with a diabetic foot ulcer: An observational study

Cited by 33 publications

References 31 publications

Assessing Health-Related Quality of Life in Patients With Diabetic Foot Disease: Why Is It Important and How Can We Improve? The 2017 Roger E. Pecoraro Award Lecture

Assessing Health-Related Quality of Life in Patients With Diabetic Foot Disease: Why Is It Important and How Can We Improve? The 2017 Roger E. Pecoraro Award Lecture

Current Challenges and Opportunities in the Prevention and Management of Diabetic Foot Ulcers

The association between SARC‐F status and quality of life in High Risk Foot Clinic patients

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