eISSN: 2299-0046
ISSN: 1642-395X
Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii
Current issue Archive Manuscripts accepted About the journal Editorial board Reviewers Abstracting and indexing Subscription Contact Instructions for authors Ethical standards and procedures
Editorial System
Submit your Manuscript
SCImago Journal & Country Rank
vol. 40
Original paper

The effectiveness of two different sub-bandage pressure values on healing and quality of life outcomes for patients with venous leg ulcers

Vesna Karanikolic
1, 2
Aleksandra Ignjatovic
Mirjana Marinkovic
Lidija Djordjevic

Faculty of Medicine, University of Niš, Niš, Serbia
Clinic for Dermatology, Nis, Serbia
Adv Dermatol Allergol 2023; XL (1): 47-53
Online publish date: 2023/02/27
Article file
- The effectiveness.pdf  [0.16 MB]
Get citation


Venous leg ulcers (VLUs) often heal slowly and result in long-term suffering and intensive use of health care resources [1, 2]. VLUs represent a growing health problem, and they are a condition that is very expensive to treat for both the health system and the patients.

VLUs endanger the patient’s normal life. Treatment of VLUs requires dedication and cooperation between the patient and the doctor. The health-related impact of VLUs is increasingly recognized as a valuable outcome measure for assessing interventions, especially when complete cure is improbable [3].

Patients with VLUs often have different symptoms: pain, sleep disturbance, depression, swelling of the lower extremities, fatigue and symptoms associated with inflammation of the lower leg (redness, localized heat, discomfort due to high exudate levels and itching) [4]. The patients experience a high-level burden of symptoms. Patients with VLUs have four or more concomitant symptoms [5]. It should be noted that approximately 20% to 30% of patients have ulcers that heal very slowly or do not heal at all, despite receiving adequate medical care [6].

How there are differences between different compression systems in relation to cost, application expertise, comfort and ease of use, all relevant information must be provided to both doctors and patients [79].


The aim of the study is to compare the effectiveness of two different sub-bandage pressure values on healing and quality of life outcomes.

Material and methods

One hundred and sixteen patients with VLUs over 18 years of age who were treated on an outpatient basis at the Nis Clinical Centre were monitored. Patients were followed for 24 weeks. A duplex scan of the lower extremity veins and arteries was performed. In all patients, an ankle-brachial pressure index (ABPI) was determined. The direction of the flow was estimated in the 20–30° reverse Trendelenburg position during the Valsalva manoeuvre.

In a standing position, a cuff inflation-deflation method was performed with rapid cuff inflation to induce reflux. A significant flow in the feet indicated reflux. A reflux time of < 0.5 s was used to determine and diagnose the presence of reflux.

Patients with ABPI < 0.8, with pre-existing heart failure (ejection fraction < 35), patients on immunosuppressive drugs, patients with malignant diseases, pregnant women, and patients with cortical therapy were excluded from the study. Patients with VLUs associated with pyoderma gangrenous, other neutrophilic dermatoses, cutaneous vasculitis and bilateral ulcerations were excluded from this study, too.

This research used patient data such as age, sex, previous venous surgery, previous episodes of ulceration, body mass index (BMI), history of deep vein thrombosis, calf circumference, ulceration location, size of the ulcer, number of ulcers, ulcer duration and healing rate. The presence of venous ulceration infection, lipodermatosclerosis and dermatitis was determined in all patients.

In order to determine the dimensions of venous ulceration, measurements of the maximum diameter of the width and length of the ulceration were performed. Dimensions were determined by mapping a two-dimensional digital image to a polygonal mesh. The circumference of the ankle and calf was measured in a supine position, with minimum (ankle) and maximum (calf).

The definition of VLU healing was the point at which complete epithelialization of the limb occurred. Data on the quality of life measures were collected through a patient questionnaire at the beginning of treatment and 24 weeks later.

Randomization was computer generated. This research was approved by the Review Board of the Nis Clinical Centre (No. 2015-05-07) and patients in this research had given the informed consent.

The randomization of the patients was performed in relation to the degree of compression. The first group of patients received class III compression therapy with a compression pressure of 35–40 mm Hg (moderate pressure). The second group had an elastic bandage added to Class III compressive agents and the compressive pressure was > 45 mm Hg (high pressure).

Local treatment of VLUs involved the use of antibiotics and local antiseptics. The standard treatment regimen included wound debridement. Absorbent bandages were applied to the wet wounds. The dressings were changed between one and 7 days, based on the amount of wound exudate. After debridement and rewinding of the VLUs, bandage systems were applied. The first and second layers included gauze without any pressure. In the first group, for the third layer, tubulcus (tubular compression system) was used. Different tubulcus sizes (S, M, L, XL, and XXL) were used depending on the circumferences of the leg measured of the ankle, and the largest part of the calf. An additional elastic bandage was placed over the tubulcus for the patients of the second group. Elastic bandages were placed spirally with 50% overlap with the patient in a supine position and the foot in dorsiflexion. The bandages were characterized as long stretch (200% stretch). The applied elastic bandage was renewed after two and 4 months, and cleaned in between. The compression system was placed on the patient’s leg every morning, and the bandages were removed during the night. Before applying the compression bandage, patients were educated by a competent practitioner.

In a group of patients with healed venous ulcerations, we advised to continue using tubulcus in order to prevent recurrence.

Quality of life measures included:

  • Quality of Life Index (QL) consists of five items that measure the domains of activity, psychological perspective, health support, and daily life. The QL index was developed for the chronically ill patients. A large number of studies conducted in the United States have shown good validity and reliability of this index [10, 11]. The study by Spitzer et al. [10] showed correlations of 0.74–0.84 for reliability and coefficient a = 0.77 for internal consistency among evaluators.

  • Numeric Pain Rating Scale (NPRS) is one of the most commonly used scales for measuring pain intensity. The advantage of this scale is reflected in its simplicity. NPRS values range from 0 to 10, with 0 “absence of pain” and 10 “strongest pain imaginable”. The benefits of this scale are reflected in simplicity, sensitivity to small changes in pain, easy comprehensibility and repeatability [12].

  • Geriatric Depression Scale (GDS): advantage of this scale is that it can be easily filled in by the elderly [13]. The abbreviated version of this 15-item scale is very easy to use. A large number of studies have shown good reliability and high sensitivity (84%) and specificity (95%) among cognitively intact elderly people [14].

Statistical analysis

The data are presented in the form of arithmetic mean, standard deviation, and as absolute and relative numbers. If the distribution of data is normal, the comparison of continuous variables between groups was performed by t test. If the distribution of data did not satisfy the normality of the data, the comparison of continuous variables between groups was performed by Mann-Whitey test. The χ2 test was used to compare categorical features. Cox regression analysis was used to assess risk factors for healing. The Kaplan-Meier curve and log rank test were used to estimate healing by type of compression. The hypothesis was tested with a significance threshold of p < 0.05. Data were analysed using R software (Version 2.15.2, Tubulcus; Laboratoires Innothera, Arcueil, France).


Overall, 139 patients were assessed for eligibility. One hundred and twenty-three patients were randomized. We analysed 116 patients. The first group consisted of 56 patients with a moderate pressure compressive therapy, while the second group was composed of 60 patients with a high pressure compressive therapy. For the patient CONSORT [15] flow diagram see Figure 1.

Figure 1

Flow diagram of the progress through the phases of a parallel randomized trial: (A) group with a moderate pressure and (B) group with a high pressure


The study included 116 patients, 52 (44.8%) male patients and 64 (55.2%) female patients. The average age of the examined population was 62.87 ±10.86 (min. 42 years, max. 85 years). Age and sex did not differ statistically significantly in relation to the type of compression (p = 0.441 and p = 0.822, respectively). The calf circumference was statistically significantly smaller (p = 0.033), and the size of the ulcer was statistically significantly larger in the high pressure compression group (p = 0.038). Lipodermatosclerosis was statistically significantly more common in the high pressure compression group (55.0% vs. 33.9%, p = 0.036). Healing at 24 weeks was statistically significantly more common in patients in the high pressure compression group (55.0% vs. 32.1%, p = 0.022) (Table 1).

Table 1

Demographic and clinical characteristics in relation to the level of compression

ParameterTotalSub-bandage pressureP-value
High pressureModerate pressure
Age [years]62.87 ±10.8662.12 ±11.7263.68 ±9.890.441
Gender, n (%):
BMI (mean ± SD)30.28 ±1.6230.20 ±1.780.780
Calf circumference (mean ± SD)36.57 ±6.4339.04 ±5.870.033
Duration of the ulcer (years ± SD)8.46 ±5.768.84 ±5.530.469
Size of the ulcer [cm2] (mean ± SD)16.80 ±9.8714.68 ±9.580.038
Previous episodes of ulceration, n (%)8674.14371.74376.80.677
History of deep vein thrombosis, n (%)4740.52440.02341.11.000
Previous operation, n (%)3631.01830.01832.10.961
Location, n (%):
 Right leg6152.63151.73053.60.985
 Left leg5547.42948.32646.4
Superficial reflux only, n (%)32.623.311.81.000x
Perforating vein incompetence, n (%)7060.33660.03460.71.000
Deep venous reflux, n (%)5043.12745.02341.10.811
Dermatitis, n (%)6051.73050.03053.60.842
Lipodermatosclerosis, n (%)5244.83355.01933.90.036
Infection, n (%)7665.53761.73969.60.479
> 50% of wound covered with fibrin, n (%)5749.13151.72646.40.705
Healed ulcerations, n (%)5144.03355.01832.10.022

Quality of life, GDS scores and NPRS scores at the beginning of the follow-up period were equalized between groups (p = 0.080, p = 0.071; p = 0.078). In patients with high compression, there was a statistically significant increase in QL scores (p = 0.005), decrease in GDS scores (p = 0.040) and NPRS scores (p = 0.002) during 24 weeks. In patients with moderate compression, during 24 weeks, there was a statistically significant increase in QL scores (p = 0.013) (Table 2).

Table 2

QL, GDS and NPRS in the follow-up period in relation to the type of compression

ScoreSub-bandage pressureP-value1
High pressureModerate pressure
QL1 at baseline5.50 ±1.675.02 ±1.410.080
QL1 at 24 weeks5.78 ±1.925.38 ±1.840.323
GDS2 at baseline7.72 ±2.906.82 ±1.840.071
GDS2 at 24 weeks7.02 ±3.066.29 ±1.510.005
NRS3 at baseline4.72 ±1.094.36 ±0.920.078
NRS3 at 24 weeks4.33 ±1.054.11 ±0.930.155

1 QL, quality of life: range 0–10, where 0 = poor QL and 10 = excellent QL.

2 Geriatric Depression Scale (GDS): range 0–15, where 0 = no depression and 15 = high risk of depression.

3 Numerical pain rating scale (NPRS): range 0–10, where higher scores indicate higher levels of pain.

Kaplan-Meier curve shows a statistically significant difference in healing with respect to the type of compression (p = 0.011) (Figure 2).

Figure 2

Kaplan-Meier healing curve with respect to the compression type


Multivariate Cox regression analysis showed that statistically significant healing predictors were duration of the ulcer (OR = 0.921), size of the ulcer (OR = 0.786, p < 0.001), high sub-bandage pressure (OR = 5.603, p < 0.001), and the presence of infection (OR = 0.211, p = 0.006) (Table 3).

Table 3

Association of demographic and clinical parameters with healing (Cox regression analysis – multivariable model)

ParameterBSEHR95% CIP-value
Duration of the ulcer–0.0830.0320.9210.8650.9790.009
Size of the ulcer–0.2410.0530.7860.7080.873< 0.001
High sub-bandage pressure1.7230.3985.6032.56912.221< 0.001
Previous episodes of ulceration–0.1940.3860.8240.3861.7550.615
Deep venous reflux-0.4080.5410.6650.2311.9190.451
Infection–1.5560.3750.2110.1010.440< 0.001

[i] B – regression coefficient, HR – hazard ratio, 95% CI – 95% confidence interval.

It was determined that the quality of life after 24 weeks is affected by the size of the ulcer (p = 0.007), duration of the ulcer (p = 0.049) and the presence of infections (p < 0.001) (Table 4).

Table 4

Risk factors that affect the quality of life after 24 weeks

ParameterUnstandardized coefficientsStandardized coefficients βP-value
Constant8.8270.888< 0.001
Duration of the ulcer–0.0460.024–0.1380.060
Size of the ulcer [cm2]–0.0460.017–0.2380.007
Moderate pressure–0.3770.254–0.1000.141
Duration of the ulcer–0.6750.339–0.1780.049
Infection–1.6740.325–0.423< 0.001

[i] Adjusted R2 = 0.501, B – regression coefficient, SE – standard error.


A large number of different research studies deal with the issues of treatment and care of patients with chronic diseases. One of the very important questions that arise is how health professionals can influence the improvement of the well-being and life of patients with chronic diseases [16].

Compression therapy, which is used as the gold standard in the treatment of VLUs, in a certain number of patients can lead to limitations in daily activity and social activity. Numerous studies [17] dealing with this problem have shown that a large number of patients with VLUs believe that health professionals are not always qualified enough to provide them with adequate treatment. These studies have shown that these professionals do not always empathize with their patients’ situation.

Compression bandage, which is used in the treatment of patients with VLUs, has a positive effect on wound healing, improves the quality of life, increases patient mobility and reduces pain. It should be noted that in addition to the correct choice of compression systems, it is very important to determine the compressive categories. There are a number of guides [18] that recommend the distribution of the bandage pressure, the site of bandage application on the extremity and the position of the extremity. If inadequately compressed bandage is applied, it can cause serious complications and worsen the course and disease outcome.

If compression therapy is adequately applied, venous ulcers will heal in 40% to 95% of cases [1921]. However, despite the application of adequate therapy, venous ulcers will not heal in a relatively large number of patients. This is a very big health, social and economic problem because there is a relatively large group of patients that doctors fail to adequately treat.

The size and duration of venous ulcers have been identified in a large number of studies as the most significant risk factors for delayed healing of VLUs [2224]. Studies have indicated that deep vein involvement [25], age [25] and history of DVT [26] are risk factors for slow VLU healing. Patients’ sex [25], general mobility [26], ankle movement [25], venous surgery [27], ABPI, 50% of wound covered with fibrin [25] and hip/knee replacement surgery [28] are also factors that slow down the healing process. Despite the clear correlation of these factors with delayed VLU healing, studies have shown the importance of other parameters as well as their interconnectedness [23, 24].

A randomized, open, prospective, single-centre study [22] examined how different compression strength affects the degree and rate of VLU healing. The results of the study showed the need to determine the compression system in relation to individual leg characteristics. In this study, a higher pressure led to a faster healing rate of venous ulcers.

A study by Finlayson et al. [7] compared the healing rate and quality of life for patients with VLUs relative to the compression system applied. A four-layer compression bandage system compared to Class 3 compression hosiery leads to significantly faster healing of VLUs after 24 weeks of treatment. The results of the study did not show statistically significant differences between the two groups in the proportions of healed patients in relation to the applied compression therapy. Quality of life and intensity of pain did not show a statistically significant difference between the examined groups.

A number of studies have shown the advantage of using multicomponent compression systems over single-component systems because their application achieves a higher degree of compression. Research has also shown a better effect of high-compression stocking systems compared to short-stretch bandages [29].

Our study showed that the healing rate was statistically significantly higher in the group with a higher pressure applied compared to the moderate pressure (p = 0.034). Patients with VLUs in which a high pressure was applied healed considerably faster in relation to VLUs in which a moderate pressure was applied (p = 0.008).

In patients with VLUs, pain is very often present in everyday life. The intensity of pain varied among patients from mild to so severe that patients also considered suicide [3032]. Studies have shown that pain was present in about 74% of patients with VLUs, while patients described pain as “moderate to severe” in 56% of cases [32].

Pain that occurs in patients with VLUs leads to a decrease in physical activity or walking [33]. Pain was very common in patients with leg and ankle oedema [34]. Productive activities were disrupted due to the presence of pain in these patients [35]. These patients were less likely to come out due to the presence of pain and feelings of discomfort although they remained in contact with their environment [36]. In patients with VLUs, pain mostly occurred at night [37], leading to sleep problems [38]. Feelings of discomfort and pain did not allow some patients to fall asleep, while others woke up after a short sleep after the cessation of analgesics. Patients have characterized the intensity of this pain as “unbearable pain” or “tear-inducing pain” [39, 40].

Patients with VLUs also have problems with social life in terms of limited leisure activities, as well as reduced social contacts with friends and family members [41].

Various psychological problems also occur in these patients. In these patients, negative emotional reactions occur with the appearance of the feeling that the disease controls them. Most patients had a pessimistic vision of the future and a negative experience in their body image [41].

Bad mood and depression are present in patients with VLUs [31, 32]. Studies have shown a direct link between depression and the treatment of these patients [42]. Mood improves in patients in proportion to the cure [30]. Anxiety and depression are present in a large number of patients with VLUs, which is directly correlated with the number of experienced venous ulcers [4345].

Previous studies have shown in patients with VLUs, the following factors and physical complaints that lead to QL worsening: unpleasantly smelling wound [46, 47], wound pain [48], pain and itchiness of the skin [47], exudate [48] and joint deformation [49, 50].

Our study showed that QL, GDS scores and NPRS scores at the beginning of the follow-up period were equalized among groups. During the 24-week treatment period in the high compression group, there was a statistically significant increase in QL scores, decrease in GDS scores and NPRS scores. In patients with moderate compressions during 24 weeks’ treatment, there is a statistically significant increase in QL scores, while there was no statistically significant decrease in GDS scores and NPRS scores. The reason for this result lies in the fact that a larger number of ulcers healed in the group of patients with high compression and they had an improvement in QL, reducing the severity of pain and an improvement in the psychological domain.

Our study singled out as the most significant risk factors that affect the quality of life after 24 weeks – the size of the ulcer, duration of the ulcer and the presence of infections. This can be explained by the fact that the mentioned parameters represent statistically significant predictors in the healing rate. In patients who experienced healing of venous ulcers, QL improved, pain levels and depressive disorders decreased.


This study showed that patients with VLUs who received a high pressure, healed considerably faster compared to the group of patients to whom a moderate pressure was applied. The application of compression therapy leads to VLU healing, but when a high pressure was applied, there was a statistically significant increase in QL scores, decrease in GDS scores and NPRS scores compared to the group of patients to whom a moderate pressure was applied.

Conflict of interest

The authors declare no conflict of interest.



Anand S, Dean C, Nettleton R, et al. Health related quality of life tools for venous-ulcerated patients. Br J Nurs 2003; 12: 48-59.


Abbade LPF, Lastoria S. Venous ulcer: epidemiology, physiopathology, diagnosis and treatment. Int J Dermatol 2005; 44: 449-56.


Howard A, Davies AH. Health-related quality of life in patients with venous ulceration. Phlebology 2001; 16: 12-6.


Jones J, Barr W, Robinson I, et al. Depression in patients with chronic venous ulceration. Br J Nurs 2006; 15: s17-23.


Edwards H, Finlayson K, Skerman H, et al. Identification of symptom clusters in patients with chronic venous leg ulcers. J Pain Symptom Manage 2014; 47: 867-75.


Walker N, Rodgers A, Birchall N, et al. Leg ulcers in New Zealand: age at onset, recurrence and provision of care in an urban population. N Z Med J 2002; 115: 286-9.


Finlayson KJ, Courtney MD, Gibb MA, et al. The effectiveness of a four-layer compression bandage system in comparison to Class 3 compression hosiery on healing and quality of life for patients with venous leg ulcers: a randomised controlled trial. Int Wound J 2014; 11: 21-7.


Karanikolic V, Karanikolic A, Petrovic D, et al. Prognostic factors related to delayed healing of venous ulcer treated with compression therapy. Dermatol Sin 2015; 33: 206-9.


Milic DJ, Zivic SS, Bogdanovic DC, et al. A randomized trial of class 2 and class 3 elastic compression in the prevention of recurrence of venous ulceration. J Vasc Surg Venous Lymphat Disord 2018; 6: 717-23.


Spitzer WO, Dobson AJ, Hall J, et al. Measuring the quality of life of cancer patients: a concise QL-index for use by physicians. J Chronic Dis 1981; 34: 585-97.


Bowling A. Measuring Health: a Review of the Quality of Life Measurement Scales. 2nd edn. Open University Press, Buckingham 1997.


Haefeli M, Elfering A. Pain assessment. Eur Spine J 2006; 15: S17-24.


Brink T, Yesavage J, Lum O, et al. Screening tests for geriatric depression: Geriatric Depression Scale (GDS). Clin Gerontol 1982; 1: 37-44.


McDowell I, Newell C. Measuring Health: a Guide to Rating Scales and Questionnaires. 2nd edn. Oxford University Press, New York 1996.


The CONSORT Statement, www.consort-statement.org (accessed 1 December 2017).


Herber OR, Schnepp W, Rieger MA. A systematic review on the impact of leg ulceration on patients’ quality of life. Health Qual Life Outcomes 2007; 25: 44.


Anderson I. Quality of life and leg ulcers: will NHS reform address patient need? Br J Nurs 2000; 9: 830-2.


Miertová M, Dlugošová K, Ovšonková A, et al. Chosen aspects of quality of life in patients with venous leg ulcers. Cent Eur J Nurs Midw 2016; 7: 527-33.


Partsch H, Damstra RJ, Tazelaar DJ, et al. Multicentre, randomised controlled trial of four-layer bandaging versus short-stretch bandaging in the treatment of venous leg ulcers. Vasa 2001; 30: 108-13.


Milic DJ, Zivic SS, Bogdanovic DC, et al. A randomized trial of the tubulcus multilayer bandaging system in the treatment of extensive venous ulcers. J Vasc Surg 2007; 46: 750-5.


Karanikolic V, Binic I, Jovanovic D, et al. The effect of age and compression strength on venous leg ulcer healing. Phlebology 2018; 33: 618-26.


Karanikolic V, Golubovic M, Stevanovic G, et al. The influence of compression strength and patient and wound variables on venous leg ulcers healing. Dermatol Sin 2019; 37: 194-8.


Parker CN, Finlayson KJ, Shuter P, et al. Risk factors for delayed healing in venous leg ulcers: a review of the literature. Int J Clin Pract 2015; 69: 967-77.


Raffetto JD, Ligi D, Maniscalco R, et al. Why venous leg ulcers have difficulty healing: overview on pathophysiology, clinical consequences, and treatment. J Clin Med 2020; 10: 29-33.


Franks PJ, Moffatt CJ, Connolly M, et al. Factors associated with healing leg ulceration with high compression. Age Ageing 1995; 24: 407-10.


Marston WA, Carlin RE, Passman MA, et al. Healing rates and cost efficacy of outpatient compression treatment for leg ulcers associated with venous insufficiency. J Vasc Surg 1999; 30: 491-8.


Skene AI, Smith JM, Doré CJ, et al. Venous leg ulcers: a prognostic index to predict time to healing. BMJ 1992; 305: 1119-21.


Margolis DJ, Allen-Taylor L, Hoffstad O, et al. The accuracy of venous leg ulcer prognostic models in a wound care system. Wound Repair Regen 2004; 12: 163-8.


O’Meara S, Cullum N, Nelson EA, et al. Compression for venous leg ulcers. Cochrane Database Syst Rev 2012; 11: CD000265.


Palfreyman S. Assessing the impact of venous ulceration on quality of life. Nurs Times 2008; 104: 34-7.


Green J, Jester R, McKinley R, et al. Patient perspectives of their leg ulcer journey. J Wound Care 2013; 22: 58, 60-2, 64-6.


Edwards H, Finlayson K, Skerman H, et al. Identification of symptom clusters in patients with chronic venous leg ulcers. J Pain Symptom Manage 2014; 47: 867-75.


Hyland ME, Lay A, Thomson B. Quality of life of leg ulcer patients: questionnaire and preliminary findings. J Wound Care 1994; 3: 294-8.


Chase S, Melloni M, Savage A. A forever healing: the lived experience of venous ulcer disease. J Vasc Nursing 1997; 10: 73-8.


Chase SK, Whittemore R, Crosby N, et al. Living with chronic venous ulcers: a descriptive study of knowledge and functional health status. J Commun Health Nursing 2000; 17: 1-13.


Cullum NRB. Leg ulcers: Nursing Management – A Researchbased Guide. Scutari Press 1995; 125-34.


Hyde CWB, Horsfall J, Winder G. Older women’s experience of living with chronic leg ulceration. Int J Nursing Practice 1999; 5: 189-98.


Walshe C. Living with a venous leg ulcer: a descriptive study of patients’ experiences. J Adv Nursing 1995; 22: 1092-100.


Hareendran A, Bradbury A, Budd J, et al. Measuring the impact of venous leg ulcers on quality of life. J Wound Care 2005; 14: 53-7.


Green J, Jester R, McKinley R, et al. The impact of chronic venous leg ulcers: a systematic review. J Wound Care 2014; 23: 601-12.


Herber O, Schnepp W, Rieger M. A systematic review on the impact of leg ulceration on patients’ quality of life. Health and Quality of Life Outcomes 2007; 5: 44.


Finlayson K, Edwards H, Courtney M. The impact of psychosocial factors on adherence to compression therapy to prevent the recurrence of venous leg ulcers J Clin Nurs 2010; 19: 1289-97.


Jones J, Barr W, Robinson J, et al. Depression in patients with chronic venous ulceration. Br J Nurs 2006; 15: S17-23.


Świnoga M, Kłos M, Miniszewska J, et al. Health-related quality of life in dermatological and allergodermatological patients. Adv Derm Allergol 2012; 29: 69-73.


Kowalewska B, Jankowiak B, Krajewska-Kułak E, et al. Quality of life in skin diseases as perceived by patients and nurses. Adv Dermatol Allergol 2020; 37: 956-61.


Hareendran A, Doll H, Wild DJ, et al. The venous leg ulcer quality of life (VLU-QoL) questionnaire: development and psychometric validation. Wound Rep Reg 2007; 15: 465-73.


Byrne O, Kelly M. Living with a chronic leg ulcer. J Commun Nurs 2010; 24: 4-9.


Phillips T, Stanton B, Provan A, et al. A study of the impact of leg ulcers on quality of life: financial, social, and psychologic implications. J Am Acad Dermatol 1994; 31: 49-53.


Skavberg Roaldsen K, Biguet G, Elfving B. Physical activity in patients with venous leg ulcer – between engagement and avoidance. A patient perspective. Clin Rehabil 2011; 25: 275-86.


Szewczyk MT, Kêdziora-Kornatowska K, Cierzniakowska K, et al. Functional and biopsychosocial restrictions among patients with a venous ulcer. Arch Med Sci 2006; 2: 36-41.

Copyright: © 2023 Termedia Sp. z o. o. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (http://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
Quick links
© 2023 Termedia Sp. z o.o.
Developed by Bentus.