Quality of life in patients with cronical lower limb ischaemia: Before and after revascularisation

Sammanfattning: The aim of this thesis was to assess quality of life in patients with varying degrees of lower limb ischaemia before and after revascularisation, to assess quality of life in relation to the degree of ischaemia and the respondents’ sense of coherence (SOC) and in comparison with a healthy control group, and to compare two different quality of life instruments regarding their usefulness as outcome measures. Patients were assessed using the Nottingham Health Profile (NHP) and the SOC scale before and six months after successful revascularisation and compared with 102 healthy controls. The Kruskal-Wallis analysis of variance and the Mann-Whitney U test were used for comparison of the NHP part I and the chi-squared test was used for part II of the NHP. The effects of haemodynamically successful revascularisation at six months were analysed by Wilcoxon signed ranks test. Quality of life after haemodynamically successful or unsuccessful revascularisation was investigated at baseline, six and twelve months using Friedman’s two-way analysis of variance (part I) and the Cochran test (part II). Eighty patients were assessed before and one month after revascularisation, using comparable domains of the NHP and the Short-Form 36 (SF-36) questionnaire. The ability of the two instruments to discriminate among levels of lower limb ischaemia was analysed using the Mann-Whitney U test and the responsiveness in detecting within-subject changes over time was analysed by the Wilcoxon signed rank test. Internal consistency was measured using Cronbach’s alpha. Quality of life was markedly impaired at baseline among patients with lower limb ischaemia in all investigated respects, and compared with controls, mostly as regards pain, low energy and restricted mobility as revealed by a logistic regression analysis. Quality of life represented an interplay between the degree of ischaemia and the patients’ SOC. Haemodynamically successful revascularisation led to significantly improved quality of life at six months, in particular with regard to pain, sleep, physical mobility, hobbies and holidays and to a level similar to healthy controls in sleep, social isolation, work and family relationships. Critical ischaemia patients did not reach the same level of quality of life as the claudicants or the controls. The intervention resulted in an immediate and relatively lasting improvement in quality of life at the one-year follow-up. Despite haemodynamic failure, patients had significant improvements regarding pain, emotional reactions and sleep. A haemodynamically successful revascularisation for claudicants demonstrated the most marked quality of life benefits, including all health dimensions that were not normal at baseline, while critical ischaemia patients had improved quality of life with regard to pain, sleep and physical mobility. NHP and SF-36 were both found to be reliable measures. The SF-36 scores were less skewed than the NHP scores, while NHP discriminated better among levels of ischaemia and was more responsive in detecting changes over time than SF-36. Thus, the findings showed that success of the intervention is multidimensional in its nature requiring information through traditionally used measures of medical effectiveness, the walking ability of the patients and valuing quality of life and aspects like that measured by the SOC scale. These findings may form a basis for future treatment planning, decision-making and evaluation of treatment for lower limb ischaemia patients.