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The purpose of this study was to examine the patient- and proxy-report agreement on the Wound-quality of life (QoL) questionnaire to assess health-related QoL in patients with chronic wounds. Patients and their proxies (in this case, relatives) were recruited via different nursing services in Germany and asked to complete the Wound-QoL. Intraclass correlation coefficients were calculated for each Wound-QoL scale and the total score, and weighted Cohen's Kappa coefficients for individual items. Proxies tended to report lower health-related QoL in the Wound-QoL than their relatives with chronic wounds. Agreement between the two perspectives was moderate on single-item level and excellent on scale level. Proxy-reports can be helpful, if patients are unable to provide information, although caution remains when interpreting the results. However, the patient's own perspective remains preferable.

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The Wound-QoL questionnaire has been tested in a previous study, indicating that the instrument is a reliable and valid measurement for the assessment of HRQoL in chronic wounds. The aim of this study was to examine the test-retest reliability of the Wound-QoL. Patients were asked to complete the Wound-QoL twice within 3-7 days. Next to descriptive statistics, internal consistency was determined. Test-retest reliability was calculated with the intraclass correlation coefficient. The data showed ICCs between 0.79 and 0.86, which can be considered evidence of excellent reliability. Another indicator of very good reliability, high internal consistency of both global score, and subscale scores were found. The availability of the Wound-QoL provides a step forward in allowing measurement of the HRQoL in chronic wounds. The instrument is fit for use to measure outcomes in clinical trials and as well to assess treatment outcomes in routine practice.

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BACKGROUND AND OBJECTIVES: Compression therapy is a mainstay in the causal treatment of patients with venous leg ulcers. It facilitates healing, reduces pain and recurrences, and increases quality of life. Up until now, there is a scarcity of scientific data with respect to the level of care and the specific knowledge of patients with venous leg ulcers. PATIENTS AND METHODS: At first presentation, patients with venous leg ulcers anonymously answered a standardized questionnaire. Participating facilities nationwide included 55 outpatient care services, 32 medical practices, four wound centers, and one specialized care center. RESULTS: Overall, 177 patients (mean age of 69.4; 75.1 % women) participated in the study. The average duration of florid venous leg ulcers was 17 months. With regard to compression therapy, 31.1 % of patients received none; 40.1 % used bandages; 28.8 % used stockings. Of the latter, 13.7 % were treated with compression class III; 67.4 %, with compression class II; and 19.6 %; with compression class I. While 70.6 % put on their stockings after getting out of bed in the morning, 21.1 % wore them day and night. In 39.2 % of individuals, the stockings caused them discomfort. Merely 11.7 % owned a donning device. On average, bandages were worn for 40.7 weeks, and 69 % were used without underpadding. In 2.8 % of patients, ankle and calf circumference was measured to monitor therapeutic success. 45.9 % reported doing leg exercises. CONCLUSIONS: Although it is considered a basic therapeutic measure in venous leg ulcers, one-third of all patients received no compression treatment. Moreover, given the long duration of ulcers, adequate product selection and correct use have to be questioned, too. Our findings indicate that improvements in the level of knowledge among users and prescribers as well as patient training are required.

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HINTERGRUND UND ZIELE: Eine Säule der kausalen Therapie bei Patienten mit Ulcus cruris venosum ist die Kompressionstherapie. Sie unterstützt die Abheilung, reduziert Schmerzen und Rezidive und steigert die Lebensqualität. Bislang existieren kaum wissenschaftliche Daten zu dem Versorgungsstand und fachspezifischem Wissen von Patienten mit Ulcus cruris venosum. PATIENTEN UND METHODIK: Standardisierte Fragebögen wurden bundesweit in 55 Pflegediensten, 32 Arztpraxen, vier Wundzentren und -sprechstunden sowie einem Pflegetherapiestützpunkt von Patienten mit Ulcus cruris venosum bei Erstvorstellung anonym ausgefüllt. ERGEBNISSE: Insgesamt nahmen 177 Patienten (Durchschnittsalter 69,4 Jahre; 75,1 % Frauen) teil. Ein florides Ulcus cruris venosum bestand im Mittel 17 Monate. 31,1 % hatten keine Kompressionstherapie, 40,1 % Binden und 28,8 % Strümpfe. Bei der Bestrumpfung hatten 13,7 % Kompressionsklasse III, 64,7 % Kompressionsklasse II und 19,6 % Kompressionsklasse I. 70,6 % legten die Strümpfe nach dem Aufstehen an, 21,1 % trugen sie Tag und Nacht. 39,2 % bereiteten die Strümpfe Beschwerden. Lediglich 11,7 % hatten eine An- und Ausziehhilfe. Die Binden wurden im Mittel 40,7 Wochen getragen und bei 69 % nicht unterpolstert. Bei 2,8 % wurde der Knöchel- und Waden-Umfang zur Erfolgskontrolle gemessen. Venensport machten 45,9 %. SCHLUSSFOLGERUNGEN: Ein Drittel hatte keine Kompressionsversorgung, obwohl diese eine Basismaßnahme der Therapie des Ulcus cruris venosum ist. Zudem ist deren korrekte Auswahl und Anwendung angesichts der langen Bestandsdauer der Ulzerationen zu hinterfragen. Weiterführende Fachkenntnisse bei Anwendern und Verordnern sowie Patientenschulungen sind erforderlich.

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BACKGROUND: Compression bandaging is the most prevalent form of treatment for venous leg ulcers. Successful treatment requires knowledge of the appropriate materials and the ability to employ them following current guidelines. This study investigates German health-care providers for their knowledge of bandage materials and their practical ability in applying short-stretch compression bandages. PARTICIPANTS AND METHODS: Within the framework of nationwide practical education on compression therapy, the participants' knowledge was quantified by asking standardized questions. Furthermore, their practical ability was evaluated by having them apply compression bandages within a pressure range of 50-60 mmHg. Another criterion was the pressure drop after a four-time dorsiflexion. RESULTS: Overall, 891 providers (3.3 % physicians, 5.5 % medical assistants, 90.7 % nursing staff) participated. Within the practical test only few (just under 10%) applied the bandages with the intended pressure; 77.0 % applied them below and 13.7 % above the target pressure. After a four-time dorsiflexion there was an average pressure drop of 6.7 mmHg. Surveying the participant's skills revealed that only 11.9 % knew about padding beneath compression bandages, 15.0 % knew of multi-component systems, and 14.8 % were familiar with ulcer stocking systems. CONCLUSIONS: Clearly, compression material and its application are unfamiliar to most practice employees. Without question there are deficits in the provision of compression therapy.

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