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Study Design 

A cross-sectional study was conducted among patients with diabetic
foot ulcers (n=144) who attended the National Center for Diabetes,
Endocrinology and Genetics (NCDEG) in Jordan during the period Nov 2015 to Jan 2016.
Patients were included in the study if their age was > 18 years.
Patients who attended the clinic twice or more during the study period were
interviewed during their first attendance. Pregnant or lactating women,
patients with history of stroke, cancer, or mental retardation were excluded.
Patients who met the inclusion criteria had been invited to participate in the
study after explaining the study and its goal. All participants who agreed to
participate in this study has signed the informed consent.  

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Data Collection 

A self -administered questionnaires was used to collect data on
socio-demographic and clinical characteristics. 
Findings from the physical assessment were recorded in the questionnaire
including presence of neuropathy symptoms, presence of peripheral vascular disease
(PVD), site of the ulcer, number of ulcers, recurrence of the ulcer, duration
of the ulcer, presence of previous amputation and ulcer classification grade 1,
2, 3, 4 or 5 according to Wagner classification.(17) Other relevant
data were abstracted from the medical records including diabetes complications
and co-morbidity, anthropometric and biomedical data.

 

 

Physical assessment

Vascular assessment was determined by palpating dorsalis pedis and
posterior tibial pulses, presence of intermittent claudication and assessment
of clinical signs and symptoms of ischemia (loss of hair, shine skin, pale skin
and skin temperature). Neurological assessment was performed for detecting the
presence of neuropathic symptoms as numbness, tingling pain and burning sensation.
Musculoskeletal assessment was performed for detecting the presence of the
previous amputation. Ulcer assessment included ulcer site, recurrence of the
ulcer, ulcer duration, number of ulcers and ulcer classification grade 1, 2, 3,
4 or 5 according to Wagner classification.

Diabetic Foot
Scale (DFS-SF):

The DFS is a descriptive system, which provides a comprehensive
measurement of the impact of diabetic foot ulcers on patients’ quality of life
through self-administration. The DFS consists of 58 items grouped into 11
domains that developed and validated into 29 items comprising six subscales to
reduce patient burden and the number of outcome measures, and to improve
sensitivity to change in clinical condition. The six domains are leisure
(enjoying life), physical health, daily activities dependence, negative
emotions, concern about wound and wound care. After we took the permissions for
use DFS-SF from Mapi Research Trust (MRT), the questionnaire was translated
using forward-backward method.

The final version was pilot-tested among 24 patients and the
necessary changes had been made. . The internal consistency of subscales
(Cronbach’s alpha) ranged from 0.74 to 0.83. The instrument demonstrated good
constructional validity when correlated with the SF-8

SF-8 Health Survey:

The SF-8 Health Survey represents a major advance in the
application of SF technology for purposes of achieving both brevity and
comprehensiveness in population health surveys. The SF-8 was developed to
replicate the SF-36 version 2 with one question for each health domain. The
eight domains are vitality, physical functioning, bodily pain, general health
perceptions, and physical role functioning, emotional role functioning, social
role functioning and mental health. Each SF-8 single-item scale and the SF-8
summary measures can be scored on the same norm-based metrics as the SF-36
scales and summary measures. The SF-8 is an 8-item version of the SF-36 that
yields a comparable 8-dimension health profile and comparable estimates of
summary scores for the physical and mental components of health.(18)

The Arabic
version of the SF-36, which has been translated and culturally adapted in
Lebanon (Sabbah et al., 2003) was used. (19)

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