Ms Aniawanis Makhtar
Location:Room 702a, EastGate House, 35-43 Newport Road, Cardiff CF24 0AB
'Burden of illness in painful diabetic foot ulcer: The older patients’ perspective'
Diabetic foot ulcer is one of the most common micro- vascular complications of diabetes. It is characterized by foot ulcers resulting from the vascular or neurological changes (or a combination of the two) that are, typically found in patients with diabetes mellitus (Salomè, et.al, 2010). A review has shown that the worldwide annual population-based incidence of diabetic foot ulcer ranges from 1 %to 4.1%, and the prevalence ranges from 4% to 10% (Singh et al., 2005). The approximate lifetime risk of a diabetic person developing a foot ulcer has been estimated at 15 to 25% According to a systematic review by Boultan, et.al (2005) 1.4% of type 2 diabetic patients in UK had active foot ulcers and 5% had ever had ulcer. In Malaysia, the prevalence of foot ulceration in patients who were attending a diabetic outpatient clinic was 6.0% (Ministry of Health Malaysia (MOH), 2004). Surprisingly, recent study conducted by Mazlina, et.al (2011) to access health- related of life of 140 diabetic patients with foot problems attending outpatient diabetic foot clinic in a tertiary hospital, showed that 47.1% had foot ulcers. These statistics highlight the necessity for increased awareness of diabetic foot problems in Malaysia.
Although extensive literature exists on the nature of and treatments for chronic wound pain as a primary condition little is known about the impact of chronic pain in diabetic foot ulcer. It can be argued that, traditionally, there has been a misconception that diabetic foot ulcers are not painful. Diabetic foot ulcer pain historically has been under investigated and is currently often overlooked because of an assumption that the patient will experience pain less due to peripheral sensory neuropathy (Bradbury & Price, 2008). Sibbald et al, (2003) note that pain in diabetic foot ulcer may be caused by the onset of limb-threatening complications such as deep infection, charcot changes, or critical ischemia. However, recently, a growing body of evidence has refuted that this view by demonstrating that a significant number of patients with diabetic foot ulcer reports moderate to severe pain. Quality of life studies consistently highlighted that pain is an overwhelming issue for patients living with a diabetic foot ulcer which profoundly affects their lives (Bradbury & Price 2008, Ribu et al 2006). Furthermore, Woo, et.al (2008) also suggests that the experience of living with a chronic wound has a huge impact on a patients’ quality of life, and pain is one of the symptoms that patients find particularly distressing. Thus, it is clear that pain affects a considerable proportion of the diabetic foot ulcer patient. Beyond this consistent finding however, the extent literature is extremely limited in sample size, scope and methodology. More research is required to fully understand and adequately manage this phenomenon in clinical practice.
The aim of the current research is to describe the impact of diabetic foot ulcer pain on health related quality of life in older patient with diabetic foot ulcer. A series of questionnaire will be used in this study. The finding will be able to help nurses to develop diabetic foot ulcer pain management guidelines which will assist nursing staff to develop and deliver an individualized care catering the patients’ need to reduce the discomfort and increased patient’s quality of life.