title: Importance of factors determining the low health-related quality of life in people presenting with a diabetic foot ulcer: the Eurodiale study.
abstract: OBJECTIVE
  To identify the factors responsible for the low health-related quality of life associated with foot ulcers and the relative importance of these factors.
  
  
  METHODS
  A total of 1232 patients with a new foot ulcer, who presented at one of the 14 centres in 10 European countries participating in the Eurodiale study, were included in this cross-sectional study. Patient and ulcer characteristics were obtained as well as results from the Euro-Qol-5D questionnaire, a health-related quality of life instrument with five domains (mobility, self-care, usual activities, pain/discomfort and anxiety/depression). To analyse the relative importance of comorbidities and ulcer- and patient-related factors for health-related quality of life, linear regression models were used to calculate the relative contributions of each factor to the fit (R(2) ) of the model.
  
  
  RESULTS
  Patients reported poor overall health-related quality of life, with problems primarily in the mobility and pain/discomfort domains. Among the comorbidities, the inability to stand or walk without help was the most important determinant of decreased health-related quality of life in all five domains. Among ulcer-related factors, ulcer size, limb-threatening ischaemia and elevated C-reactive protein concentration also had high importance in all domains. The clinical diagnosis of infection, peripheral arterial disease and polyneuropathy were only important in the pain/discomfort domain.
  
  
  CONCLUSIONS
  The factors that determine health-related quality of life are diverse and to an extent not disease-specific. To improve health-related quality of life, treatment should not only be focused on ulcer healing but a multifactorial approach by a specialized multidisciplinary team is also important.
authors.affiliation: Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors.forename: V
authors.initials: V
authors.lastname: Siersma
authors.forename: H
authors.initials: H
authors.lastname: Thorsen
authors.forename: P E
authors.initials: PE
authors.lastname: Holstein
authors.forename: M
authors.initials: M
authors.lastname: Kars
authors.forename: J
authors.initials: J
authors.lastname: Apelqvist
authors.forename: E B
authors.initials: EB
authors.lastname: Jude
authors.forename: A
authors.initials: A
authors.lastname: Piaggesi
authors.forename: K
authors.initials: K
authors.lastname: Bakker
authors.forename: M
authors.initials: M
authors.lastname: Edmonds
authors.forename: A
authors.initials: A
authors.lastname: Jirkovska
authors.forename: D
authors.initials: D
authors.lastname: Mauricio
authors.forename: G
authors.initials: G
authors.lastname: Ragnarson Tennvall
authors.forename: H
authors.initials: H
authors.lastname: Reike
authors.forename: M
authors.initials: M
authors.lastname: Spraul
authors.forename: L
authors.initials: L
authors.lastname: Uccioli
authors.forename: V
authors.initials: V
authors.lastname: Urbancic
authors.forename: K
authors.initials: K
authors.lastname: van Acker
authors.forename: J
authors.initials: J
authors.lastname: van Baal
authors.forename: N C
authors.initials: NC
authors.lastname: Schaper
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D017719:Diabetic Foot / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D011788:Quality of Life; D012648:Self Care / Q000706:statistics & numerical data