title: Identification of symptom clusters in patients with chronic venous leg ulcers.
abstract: BACKGROUND
  Patients with venous leg ulcers experience multiple symptoms, including pain, depression, and discomfort from lower leg inflammation and wound exudate. Some of these symptoms impair wound healing and decrease quality of life (QOL). The presence of co-occurring symptoms may have a negative effect on these outcomes. The identification of symptom clusters could potentially lead to improvements in symptom management and QOL.
  
  
  OBJECTIVE
  To identify the prevalence and severity of common symptoms and the occurrence of symptom clusters in patients with venous leg ulcers.
  
  
  METHODS
  For this secondary analysis, data on sociodemographic characteristics, medical history, venous history, ulcer and lower limb clinical characteristics, symptoms, treatments, healing, and QOL were analyzed from a sample of 318 patients with venous leg ulcers who were recruited from hospital outpatient and community nursing clinics for leg ulcers. Exploratory factor analysis was used to identify symptom clusters.
  
  
  RESULTS
  Almost two-thirds (64%) of the patients experienced four or more concurrent symptoms. The most frequent symptoms were sleep disturbance (80%), pain (74%), and lower limb swelling (67%). Sixty percent of patients reported three or more symptoms at a moderate-to-severe level of intensity (e.g., 78% reported disturbed sleep frequently or always; the mean pain severity score was 49 of 100, SD 26.5). Exploratory factor analysis identified two symptom clusters: pain, depression, sleep disturbance, and fatigue; and swelling, inflammation, exudate, and fatigue.
  
  
  CONCLUSIONS
  Two symptom clusters were identified in this sample of patients with venous leg ulcers. Further research is needed to verify these symptom clusters and to evaluate their effect on patient outcomes.
authors.affiliation: School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
authors.forename: Helen
authors.initials: H
authors.lastname: Edwards
authors.affiliation: School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia. Electronic address: k.finlayson@qut.edu.au.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Finlayson
authors.affiliation: School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
authors.forename: Helen
authors.initials: H
authors.lastname: Skerman
authors.affiliation: School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Alexander
authors.affiliation: Department of Physiological Nursing, University of California at San Francisco, San Francisco, California, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Miaskowski
authors.affiliation: Department of Physiological Nursing, University of California at San Francisco, San Francisco, California, USA.
authors.forename: Bradley
authors.initials: B
authors.lastname: Aouizerat
authors.affiliation: School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
authors.forename: Michelle
authors.initials: M
authors.lastname: Gibb
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D064887:Observational Studies as Topic; D015995:Prevalence; D012720:Severity of Illness Index; D014647:Varicose Ulcer / Q000453:epidemiology / Q000503:physiopathology*
keywords: Venous leg ulcers; fatigue; pain; sleep disturbance; symptom clusters; venous insufficiency