title: Health related quality of life, cognitive function, and depression in diabetic patients with foot ulcer or amputation. A preliminary study.
abstract: BACKGROUND
  Diabetic foot ulcers, foot infection, Charcot foot arthropathy, and lower extremity amputation have a severe negative effect on the health-related quality of life in individuals with diabetes. The purpose of this study was to determine if there is a relationship between these negative effects and cognitive impairment or clinical depression.
  
  
  METHODS
  Sixty adults with diabetes completed the Short Form 36 (SF-36) Health Survey questionnaire, two screening examinations for cognitive function (Mini Mental Exam and Clock-Drawing Test), and a screening examination for depression (Zung Self-Rating Depression Scale). The two focus groups were composed of 20 subjects each who were undergoing treatment for (1) diabetic foot ulcers or active Charcot foot arthropathy or (2) lower extremity amputation. Twenty diabetic individuals without foot-related morbidity but with evidence of peripheral neuropathy as measured by insensitivity to the Semmes-Weinstein 5.07 (10 gm) monofilament comprised the control group.
  
  
  RESULTS
  The SF-36 Health Survey score was significantly impaired in both the diabetic foot ulcer and Charcot arthropathy group (p <0.001) and amputee (p <0.000) group. There was no evidence of cognitive impairment or depression in either group. The negative impact on health-related quality of life was similar in both focus groups (p <0.314).
  
  
  CONCLUSIONS
  The results of this preliminary study suggest that the negative impact on health-related quality of life in diabetic patients with foot ulcers or Charcot foot arthropathy may be as severe as in similar patients with lower extremity amputation. The negative effect did not seem to cause cognitive impairment or clinical depression in either focus group.
authors.affiliation: Loyola University Medical Center, Orthopaedic Surgery and Rehabilitation, Maywood, IL 60153, USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Willrich
authors.forename: Michael
authors.initials: M
authors.lastname: Pinzur
authors.forename: Misty
authors.initials: M
authors.lastname: McNeil
authors.forename: Danaius
authors.initials: D
authors.lastname: Juknelis
authors.forename: Lawrence
authors.initials: L
authors.lastname: Lavery
mesh_terms: D000328:Adult; D000671:Amputation, Surgical / Q000523:psychology*; D003072:Cognition Disorders / Q000209:etiology*; D003863:Depression / Q000209:etiology*; D017719:Diabetic Foot / Q000150:complications / Q000523:psychology* / Q000601:surgery; D017144:Focus Groups; D006304:Health Status; D006801:Humans; D010865:Pilot Projects; D011581:Psychological Tests; D011788:Quality of Life; D011795:Surveys and Questionnaires