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Author/dateObjectiveFacility/settingPopulationMethodsOutcomesComments
Primary studies
Baharestani 1994To describe and understand the lived experience of carers of people with pressure ulcersHome care
USA
Six elderly women carers of husbands with grade III or IV pressure ulcersQualitative researchFive major themes were revealed:
1. Difficult care-giving, which was delineated into the physical, emotional, safety and financial realms
2. Frailty of the care-giver
3. Limited socialisation
4. Limited social support systems
5. Limited care-giving knowledge
Carers reported a limited knowledge of treatment of pressure ulcers and devices. “I had also tried one of those foam things – an egg” (referring to an egg-crate); “I think it was a neighbour who suggested it”
Franks & Moffatt 1999To review the literature on quality of life issues in chronic wound management (including pressure ulcers)AllVariousLiterature search (non-systematic)There is a lack of information on health- related quality of life in people who suffer from pressure ulcers. Only one study was identifiedChronic wounds have an important impact on bodily pain, mobility and psychiatric morbidity
Franks, Winterberg & Moffatt 2002To determine health-related quality of life of patients with and without pressure ulcersCommunity setting
UK
75 people with pressure ulcers compared to 100 controlsCase-control study using the SF-36Cases had poorer health but this failed to achieve statistical significance Modified Barthel index indicated that there may be deficits in self-care and mobility not detected by the SF-36The sensitivity of the SF-36 tool may be poor in this group. There is a need to develop a specific quality of life tool for people with pressure ulcers
Krause 1998To identify the relationship between the number of skin sores, and days adversely impacted by skin sores, with multiple indicators of life adjustment after spinal cord injuryOutpatients
USA
1017 adults who had a traumatic spinal cord injury at least two years previouslyPostal survey using the Life Situation Questionnaire (a measure of multiple long-term outcomes after spinal cord injury)Skin sores were associated with:
• lower levels of subjective well-being
• negative emotions
• health problems
• reduced career opportunities, finances, living circumstances and interpersonal relationships
The more sores the greater the size of the problem
The research relates to ‘skin sores’ and not necessarily pressure ulcers
Langemo et al. 2000To describe, understand and give meaning to the experience of living with a pressure ulcerCommunity
USA
Eight participants with pressure ulcersQualitative researchPressure ulcers had a profound negative effect on subject's lives, including physical, social, financial status, body image, independence. Those with a stage 4 pressure ulcer and flap repair or those with a spinal cord injury experienced a grieving process. All patients had knowledge deficits in self- care and prevention of future ulcersThe researchers felt that the data adequately reflected the lived experience of having a pressure ulcer
Rintala 1995To review the literature on quality of life issues related to pressure ulcersAllVariousLiterature search (non-systematic): electronic databases searched included MEDLINE, psychological abstracts, ad hoc reference collectionsThere have been very few studies that address the relationship between particular quality of life factors and pressure ulcers Most of the literature relates to spinal cord injury patients and elderly nursing home residents
Lack of research makes it difficult to say which quality of life domain is affected by having pressure ulcers
The hypothesis of this review is unclear. Author appears to be looking for a relationship between quality of life issues causing pressure ulcers, rather than impact of pressure ulcers on quality of life Methodological weaknesses were common in the studies reviewed, including small sample size, and are difficult to generalise
U˝nalan et al. 2001To compare the quality of life scores of primary care- givers of people with spinal cord injury Healthy population- matched controlsCommunity Istanbul50 primary care-givers compared with 40 healthy age-matched controlsCase-control using SF-36Differences in health state between care-givers to people with pressure ulcers and spinal cord injury were compared with care-givers to people with spinal cord injury only
No differences were found in the SF-36 results It may be that caring for someone with a lower grade pressure ulcer for shorter periods of time may not have as great an effect on carer quality of life as caring for someone with a higher grade pressure ulcer
Analysis of impact of having a pressure ulcer was not the primary objective of the study
Excluded studies
Ishizaki et al. 1997Results not able to be made general as experiment conducted of impact of bed-rest on psychological factors conducted on 10 young, healthy subjects. Some evidence that best rest causes psychological distress
Styf et al. 2001Study investigated whether head-down tilt better than horizontal bed-rest for experiments on pain and psychosomatic reactions experienced by microgravity caused by bed-rest.

From: Appendix 8, Quality of life evidence table

Cover of The Use of Pressure-Relieving Devices (Beds, Mattresses and Overlays) for the Prevention of Pressure Ulcers in Primary and Secondary Care
The Use of Pressure-Relieving Devices (Beds, Mattresses and Overlays) for the Prevention of Pressure Ulcers in Primary and Secondary Care.
NICE Clinical Guidelines, No. 7.
National Collaborating Centre for Nursing and Supportive Care (UK).
Copyright © 2004, Royal College of Nursing.

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