Identification of Symptom Clusters in Patients With Chronic Venous Leg Ulcers

• Published in: Journal of pain and symptom management 2014-05, Vol.47 (5), p.867-875
• Main Authors: Edwards, Helen, RN, PhD, OAM, Finlayson, Kathleen, RN, PhD, Skerman, Helen, BSc, MSocSci, PhD, Alexander, Kimberly, RN, PhD, Miaskowski, Christine, RN, PhD, FAAN, Aouizerat, Bradley, PhD, MAS, Gibb, Michelle, RN, MNsgSc, M Wound Care
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anesthesia & Perioperative Care; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Chronic Disease; Chronic pain; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Disorders of higher nervous function. Focal brain diseases. Central vestibular syndrome and deafness. Brain stem syndromes; Exploratory factor analysis; fatigue; Female; Humans; Leg ulcers; Male; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Observational Studies as Topic; pain; Pain Medicine; Pharmacology. Drug treatments; Prevalence; Quality of life; Severity of Illness Index; sleep disturbance; Sleep problems; symptom clusters; Symptoms; Varicose Ulcer - epidemiology; Varicose Ulcer - physiopathology; venous insufficiency; Venous leg ulcers
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2013.06.003

Abstract Context 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. Objectives 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. Conclusion 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.