The Diabetic Foot Ulcer Scale (DFS): a quality of life instrument for use in clinical trials

Abstract

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 ...

Education for secondary prevention of foot ulcers in people with diabetes: a randomised controlled trial

“…Differences observed consisted of the intervention group having higher scores in certain foot care items, such as checking shoes before putting them on, daily washing and the use of moisturising cream. No differences were reported for items concerned with choice of footwear or with prevention of accidental damage, although it is known that accidents and factors relating to footwear are most often implicated in the cause of new ulcers [29,30]. This failure to change aspects of behaviour most likely to be associated with increased risk is important and suggests that even though these items were specifically targeted in the educational interview, they might need even greater emphasis in any future work.…”

“…Participants were also asked to complete HADS as a measure of mood, which comprises seven items on anxiety and seven on depression and is suitable for people with physical illness. The Diabetic Foot Scale (DFS) [29] was included as a disease-specific measure of quality of life (although only items contained in the short form DFS [DFS-SF] [30] were analysed). This assesses the effect of foot problems on aspects of daily life, such as leisure, physical health, daily activities, emotions, family, friends and satisfaction.…”

Validity and reliability of the Greek version of the Diabetic Foot Ulcer Scale - Short Form (DFS-SF)

“…19 The DFS-SF, which was employed in this study, is its shorter version and has 29 items on a 5-point likert-type scale which are scored on six scales: leisure (five items), dependence/daily life (five items), negative emotions (six items), physical health (five items), worried about ulcers/feet (four items), and bothered by ulcer care (four items). Domain scores are based on the sum of all items associated with that domain (raw item scores are reverse coded when necessary) and the scores per dimension are transformed to a 0-100 scale, with higher scores corresponding to better HRQoL.…”

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

“…When compared with the SF-12, the Neuro-QoL has been found to be superior in assessing the severity of neuropathic symptoms and in its impact on HRQOL (28). Similarly, the Diabetic Foot Ulcer Scale, based on 58 questions, is valid and reliable in assessing HRQOL in patients with foot ulcers (29).…”