Patients' experiences of living with peripheral arterial disease awaiting intervention: a qualitative study.

The aim of this study was to investigate patients' experiences of living with peripheral arterial disease (PAD) and the influence on activities of daily living. Twenty-four patients with various degrees of PAD were interviewed. The transcribed texts were analysed using manifest and latent content analysis. Living with PAD meant carrying a hard-to-bear physical, social and emotional burden, and struggling for relief. The experience of burden was interpreted in the following themes representing consequences and strategies for gaining control in daily life: (I) "being limited by the burden" (II) "striving to relieve the burden" (III) "accepting and adapting to the feeling of burden". The use of different coping strategies was crucial to achieve some relief. Pain and sleep disturbance emerged as a major feature of living with PAD, and by combining both analgesics and non-pharmacological methods some pain relief was received. To provide optimal alleviation of pain for these patients, education about pain and pain management is of great importance followed by regular evaluations of the pain and pain management. Furthermore, the study underlines the importance of preventing the progression of the vascular disease and from the individual power and knowledge support and preserve as independent life as possible.

Nottingham Health Profile and Short-Form 36 Health Survey questionnaires in patients with chronic lower limb ischemia: before and after revascularization.

OBJECTIVE: The purpose of this study was to compare the usefulness of the Nottingham Health Profile (NHP) and the Short-Form 36 Health Survey (SF-36) as general outcome measures after vascular intervention for lower limb ischemia with respect to patients' quality of life, on the basis of validity, reliability, and responsiveness analyses. PATIENTS AD METHODS: Eighty patients, 40 with claudication and 40 with critical ischemia, were assessed before and one month after revascularization by using comparable domains of the NHP and the SF-36 questionnaires. RESULTS: The SF-36 scores were less skewed and were distributed more homogeneously than the NHP scores. Discriminate validity results showed that NHP was better than SF-36 in discriminating among levels of ischemia with respect to pain and physical mobility. For both questionnaires, the reliability standards were satisfactory in most respects. The NHP was more responsive than the SF-36 in detecting within-patient changes. All of the NHP domains not zero at baseline were improved significantly one month after hemodynamically successful revascularization for patients with claudication, whereas patients with critical ischemia showed significant abatement of pain and improvements in physical mobility and social isolation. The SF-36 scores indicated a significant decrease in bodily pain and improvements in physical functioning and vitality for patients with claudication, and decrease in bodily pain and improvement in physical functioning for patients with critical ischemia. CONCLUSIONS: The findings indicated that both NHP and SF-36 were reliable. The SF-36 scores were less skewed than the NHP scores, whereas NHP discriminated better among levels of ischemia and was more responsive in detecting quality-of-life changes over time than SF-36 in these particular patients.

A 1-year follow-up quality of life study after hemodynamically successful or unsuccessful surgical revascularization of lower limb ischemia.

PURPOSE: The impact of hemodynamically successful or unsuccessful bypass grafting or angioplasty on patients' quality of life was assessed throughout the first year postsurgery. METHODS: A total of 146 patients, 97 patients who underwent successful revascularization and 49 patients who underwent unsuccessful revascularization, were assessed for quality of life with the Nottingham Health Profile. RESULTS: Hemodynamically successful revascularization resulted in an immediate and lasting impact on the patients' quality of life. Despite hemodynamic failure, patients had improvements in pain, emotional reactions, sleep, and family relationships at the 1-year follow-up assessment. A successful revascularization in patients with claudication demonstrated the most marked quality of life benefits, including all health dimensions that were not normal at baseline. Patients with critical ischemia had improved quality of life for pain, sleep, and physical mobility. High ankle pressure, in the claudicant group, and a high sense of coherence were significantly associated with high quality of life. CONCLUSION: The treatment of lower limb ischemia resulted in an immediate and relatively lasting improvement in patients' quality of life. Patients who underwent hemodynamically successful bypass grafting procedures or angioplasty demonstrated higher quality of life benefits than patients who underwent a failed bypass grafting procedure. Quality of life was further determined by means of the patients' sense of coherence.

The effects of successful intervention on quality of life in patients with varying degrees of lower-limb ischaemia.

OBJECTIVES: to assess the quality of life after successful intervention among patients with varying degrees of lower-limb ischaemia in comparison with healthy controls and the respondents>> degree of sense of coherence. MATERIALS AND METHODS: one hundred and twelve patients and 102 healthy controls were assessed for quality of life (Nottingham Health Profile) and sense of coherence. MAIN RESULTS: successful angioplasty or surgical intervention led to an improved quality of life at 6 months, in particular with regard to pain, sleep, physical mobility, hobbies and holiday and to a level similar to healthy controls in sleep, social isolation, paid employment and family relationships. It remained at a significantly lower level than that of healthy controls with regard to pain, emotional reactions, physical mobility, energy, housework, hobbies, holidays, sex and social life. Critical ischaemia patients did not reach the same level of quality of life as the claudicants or the healthy controls. CONCLUSION: successful treatment for chronic limb ischaemia improved the quality of life significantly, more so in claudicants than in patients with critical ischaemia. The degree to which the quality of life improved was associated with the patients>> sense of coherence and their ankle pressure.

Quality of life associated with varying degrees of chronic lower limb ischaemia: comparison with a healthy sample.

OBJECTIVES: To assess quality of life in patients with varying degrees of ischaemia in comparison with controls, and to determine whether the degree of lower limb ischaemia and sense of coherence were associated with quality of life. MATERIALS AND METHODS: 168 patients, including 93 claudicants and 75 patients with critical ischaemia and 102 controls were studied. Quality of life was assessed using the Nottingham Health Profile in addition to the Sense of Coherence scale. MAIN RESULTS: Patients with lower limb ischaemia scored significantly reduced quality of life in all aspects compared to controls. Pain, physical mobility and emotional reactions were the significant independent factors when using logistic regression analysis. The grade of disease and low sense of coherence were significantly associated with low quality of life. Increasing lower limb ischaemia significantly conferred worse pain, sleeping disturbances and immobility. CONCLUSION: This study showed that the quality of life was impaired among patients with lower limb ischaemia, in all investigated respects. The degree to which quality of life was affected seems to represent an interplay between the grade of ischaemia and the patient's sense of coherence. This suggests the need for a multidimensional assessment prior to intervention.