Health related quality of life in patients with venous ulceration: Use of the Nottingham health profile

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Abstract
Introduction: The Nottingham health profile (NHP) has been used in several studies of patients being treated for chronic venous leg ulceration, though there is a paucity of information on the validity of the NHP in this patient group. This study was carried out to determine this validity and to compare and contrast the results with a previous study that had used the MOS short form 36 (SF-36) in this patient group. Methods: Patients in four health trusts suffering from venous ulceration were interviewed at entry and after 12 weeks of treatment using high compression bandaging. Information was collected on ulcer history, general medical history, and the NHP was completed at both time points. After 12 weeks, a record was made of whether all areas of ulceration had cleared from the patients' legs (healed) or whether some ulceration remained (unhealed). Results: Of the 383 patients who made up the study population, 37% experienced complete healing of their ulceration after 12 weeks of treatment. While internal consistencies of the NHP scores were reasonable (Cronbach's α > 0.63), there were a high proportion of patients who scored 0 (best possible health) at entry into the study, most notably for social isolation (67.5%), emotional status (48.9%) and energy (47.4%). Despite these limitations, there was strong evidence that treatment led to significant improvements in all dimensions of the NHP for the total group (all p < 0.01). These improvements were greatest in patients whose ulcers healed compared with patients whose ulcers failed to heal for bodily pain (mean difference d = 9.4, p = 0.004). Patients whose overall health status improved had significantly greater improvements for all dimensions of the NHP (p < 0.05). Conclusion: The NHP, has limitations in terms of a large floor effect (best possible health), but has similar internal consistency to the SF-36 in patients with leg ulceration. However, unlike the SF-36, the NHP is sensitive to change in the patients' ulcer status, and should therefore be considered in studies of venous leg ulcer healing.