Elsevier

Wound Medicine

Volume 5, June 2014, Pages 4-8
Wound Medicine

Use of the WoundQoL instrument in routine practice: Feasibility, validity and development of an implementation tool

https://doi.org/10.1016/j.wndm.2014.04.001Get rights and content

Abstract

Background

WoundQoL is a newly developed instrument for the assessment of health-related quality of life (HRQoL) in chronic wounds. An implementation tool (“WoundAct”) which facilitates the start of measures in case of HRQoL impairments.

Objective

To evaluate the feasibility and validity of WoundQoL and to develop under routine care conditions.

Methods

Prospective non-interventional, cross-sectional evaluation study including patients of four ambulant wound clinics. HRQoL was measured in patients with chronic wounds of any kind by WoundQoL and EuroQol-5D (EQ-5D). Moreover, a feasibility questionnaire was used and clinical wound parameters were obtained. Additionally, the implementation tool “WoundAct” was used which identifies the need for action in areas of markedly reduced HRQoL.

Results

Date were obtained from n = 100 consecutive patients. Mean WoundQoL total values differed between 3.5 and 0.5 (scale from 4 = maximum to 0 = no QoL reduction). Single-item analysis revealed areas of reduced HRQoL in 88 (88%) of the patients. The total WoundQoL score and the three single scales showed good internal consistency (Crohnbach's alpha between 0.85 and 0.92). Construct validity measured by correlation with the EQ-5D scale was satisfactory (r = 0.65, p < 0.001). Feasibility was high with < 1% of missing items and a high patient acceptance (>95% approval). Mean filling time was 2.4 min. The implementation questionnaire WoundAct was perceived a helpful tool for health carers.

Conclusion

WoundQoL is a feasible and valid questionnaire for the assessment of HRQoL in chronic wounds. The implementation tool WoundAct is convenient for implementing active measures to improve patient condition.

Introduction

Patients with chronic wounds show marked reductions in health-related quality of life (HRQoL) [1], [2], [3], [4]. Thus, evaluation of HRQoL is a major component of wound care in studies and in clinical routine. Development and refinement of methods for the evaluation of HRQoL has been a research topic in the past decades [5], [6], [7] and stringent criteria for the development and validation of such instruments were raised [8], [9], [10].

The most frequently used and cited disease-specific questionnaires for the evaluation of HRQoL in wounds are the Freiburg Life Quality Assessment for chronic wounds (FLQA-w, [11]), the Cardiff Wound Impact Scale (CWIS, [12], [13]) and the Würzburg Wound Scales (WWS, [14]). A recent study revealed that these questionnaires show satisfying validity, however, they also have limitations and shortcomings [15]. For this, the WoundQoL questionnaire was developed which combines components of all three questionnaires but rearranges and abbreviates the scales to a 17-items-questionnaire loading onto 3 subscales [15]. In order to identify areas of need for action, a panel of wound specialists and patients developed an implementation tool called WoundAct.

The present study intended to test the WoundQoL questionnaire under routine conditions in different wound clinics. In particular, patient feasibility was assessed. Moreover, the feasibility of the WoundAct tool was to be evaluated.

Section snippets

Patients and centers

In this non-interventional health care study, patients from one university and three community wound clinics in Hamburg were consecutively included at presentation for a first or consecutive visit. Routine treatment was applied according to local standards.

Quality of life evaluation

HRQoL was evaluated using the WoundQoL questionnaire and the EQ-5D.

The WoundQoL is a wound-specific questionnaire developed for use in clinical routine and in wound research [15]. It consists of 17 items with Likert scales from 0 to 4 (no –

Results

The patient cohort of n = 100 (mean age 69.3 years, median age 73 years, 51% women) consisted of patients with vascular (n = 65), immunological (n = 18) and post-surgical (n = 17) hard-to-heal wounds.

Mean total score of WoundQoL was 1.3 ± 0.9 (Table 1); 45% showed a score > 2. Mean values for the subscales for as follows: “Body” 1.0 ± 0.8, “Psyche” 1.7 ± 1.1, “Everyday life” 1.3 ± 1.2. Distribution analysis shows a fair distribution of the global as well as of the subscores with no ceiling and only moderate

Discussion

The aim of the present study was to further evaluate the WoundQoL questionnaire which measures HRQoL in chronic wounds. By purpose, the current validation focused on real-world care for different types and stages of chronic wounds. It was not intended to gain information on the QoL outcomes from defined treatments but to observe the psychometric properties and the handling of the questionnaire in routine wound care.

The WoundQoL was generated from three existing validated instruments [15] for

Conclusion

The WoundQoL questionnaire measuring the health-related quality of life in patients with chronic wounds has been shown to be valid and feasible for use in practice. The implementation questionnaire WoundAct was perceived a helpful tool for health care professionals to transfer patient needs into active measures.

Conflict of interest

No potential conflicts of interest relevant to this article were reported.

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