Disability, pain, and wound-specific concerns self-reported by adults at risk of limb loss: A cross-sectional study using the World Health Organization Disability Assessment Schedule 2.0

Derek J Roberts; Sudhir K Nagpal; Alan J Forster; Timothy Brandys; Christine Murphy; Alison Jennings; Shira A Strauss; Evgeniya Vishnyakova; Julie Lawson; Daniel I McIsaac

doi:10.1371/journal.pone.0253288

Disability, pain, and wound-specific concerns self-reported by adults at risk of limb loss: A cross-sectional study using the World Health Organization Disability Assessment Schedule 2.0

PLoS One. 2021 Jun 15;16(6):e0253288. doi: 10.1371/journal.pone.0253288. eCollection 2021.

Authors

Derek J Roberts^{1

2}, Sudhir K Nagpal¹, Alan J Forster^{2

3

4

5}, Timothy Brandys¹, Christine Murphy¹, Alison Jennings², Shira A Strauss¹, Evgeniya Vishnyakova¹, Julie Lawson², Daniel I McIsaac^{2

3

5

6}

Affiliations

¹ Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada.
² Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
³ ICES, Toronto, Ontario, Canada.
⁴ Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada.
⁵ School of Epidemiology & Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
⁶ Departments of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada.

Abstract

Introduction: There has been limited study of patient-reported outcomes (PROs) in patients at risk of limb loss. Our primary objective was to estimate the prevalence of disability in this patient population using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0).

Materials and methods: We recruited patients referred to a limb-preservation clinic. Patients self-reported their disability status using the 12-domain WHODAS 2.0. Severity of disability in each domain was scored from 1 = none to 5 = extreme and the total normalized to a 100-point scale (total score ≥25 = clinically significant disability). We also asked patients about wound-specific concerns and wound-related discomfort or distress.

Results: We included 162 patients. Reasons for clinic referral included arterial-insufficient (37.4%), postoperative (25.9%), and mixed etiology (10.8%) wounds. The mean WHODAS 2.0 disability score was 35.0 (standard deviation = 16.0). One-hundred-and-nineteen (73.5%) patients had clinically significant disability. Patients reported they had the greatest difficulty walking a long distance (mean score = 4.2), standing for long periods of time (mean score = 3.6), taking care of household responsibilities (mean score = 2.7), and dealing with the emotional impact of their health problems (mean score = 2.5). In the two-weeks prior to presentation, 87 (52.7%) patients expressed concern over their wound(s) and 90 (55.6%) suffered a moderate amount or great deal of wound-related discomfort or distress. In adjusted ordinary least squares regression models, although WHODAS 2.0 disability scores varied with changes in wound volume (p = 0.03) and total revised photographic wound assessment tool scores (p<0.001), the largest decrease in disability severity was seen in patients with less wound-specific concerns and wound-related discomfort and distress.

Discussion: The majority of people at risk of limb loss report suffering a substantial burden of disability, pain, and wound-specific concerns. Research is needed to further evaluate the WHODAS 2.0 in a multicenter fashion among these patients and determine whether care and interventions may improve their PROs.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Amputation, Surgical / psychology*
Cross-Sectional Studies
Disability Evaluation*
Disabled Persons / psychology*
Female
Humans
Leg Injuries / psychology*
Leg Injuries / surgery
Male
Middle Aged
Pain / etiology*
Pain / psychology
Patient Reported Outcome Measures
Risk Factors
Self Report
World Health Organization

Grants and funding

DJR received funding from the Department of Surgery, University of Ottawa to support this work. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.