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Impact of venous ulcers on patients' quality of life: an integrative review

Impacto de las úlceras venosas en la calidad de vida de los pacientes: revisión integrativa

ABSTRACT

Objective:

To analyze knowledge gathered about the impact of venous ulcers on patients' quality of life.

Method:

Systematic bibliographic review study with an integrative approach. Databases of MEDLINE, LILACS, IBECS, CINAHL Complete, Web of Science, Scopus, and CUIDEN Plus were used for selection with the PICOT guiding criteria, through the DeCS and MeSH: adult, aged, varicose ulcer, and quality of life, in Portuguese, Spanish, and English. The inclusion criteria were: full original articles available in the databases selected with adherence to the theme in Portuguese, Spanish, and English, published from 2007 to 2016.

Results:

The sample included 14 national and international articles with different methodological approaches and investigative contexts, published from 2012 to 2016.

Conclusion:

Chronic venous ulcers act on patients' bio-psycho-social-spiritual and socioeconomic spheres, having a negative impact on their quality of life.

Descriptors:
Varicose Ulcer; Quality of Life; Adult; Aged; Review

RESUMEN

Objetivo:

Analizar las producciones de conocimiento sobre el impacto de las úlceras venosas en la calidad de vida de los pacientes.

Método:

Estudio de revisión bibliográfica sistemática, tipo integrativa. Para la selección, se utilizaron las bases de datos MEDLINE; LILACS; IBECS; CINAHL Complete; Web of Science; Scopus y CUIDEN Plus, con criterios orientadores PICOT; mediante DECs y MeSH: adulto, anciano, úlcera varicosa y calidad de vida, en portugués, español e inglés. Fueron criterios de inclusión: artículos originales integralmente disponibles en las citadas bases, referentes a la temática, en idiomas Portugués, Español e Inglés, publicados entre los años 2007 y 2016.

Resultados:

La muestra incluyó 14 artículos nacionales e internacionales con diversos abordajes metodológicos y contextos de investigación, en publicaciones realizadas desde 2012 hasta 2016.

Conclusión:

Las úlceras venosas crónicas actúan sobre las esferas biopsicoespiritual y socioeconómica de los pacientes, con repercusiones negativas en la calidad de vida.

Descriptores:
Úlcera Varicosa; Calidad de Vida; Adulto; Anciano; Revisión

RESUMO

Objetivo:

analisar as produções de conhecimento sobre o impacto das úlceras venosas na qualidade de vida dos pacientes. Método: estudo de revisão bibliográfica sistemática, do tipo integrativa. Utilizaram-se, para seleção, as bases de dados MEDLINE; LILACS; IBECS; CINAHL Complete; Web of Science; Scopus e CUIDEN Plus, pelos critérios orientadores PICOT; através do DECs e MeSH: adulto, idoso, úlcera varicosa e qualidade de vida, nos idiomas português, espanhol e inglês. Os critérios de inclusão foram: artigos originais disponibilizados na íntegra, nas bases de dados selecionadas, com aderência à temática nos idiomas Português, Espanhol e Inglês, publicados entre os anos de 2007 e 2016.

Resultados:

a amostra incluiu 14 artigos nacionais e internacionais com diversas abordagens metodológicas e contextos investigativos, publicados entre os anos de 2012 e 2016.

Conclusão:

as úlceras venosas crônicas atuam sobre as esferas biopsicoespiritual e socioeconômica dos pacientes, repercutindo negativamente sobre a qualidade de vida.

Descritores:
Úlcera Varicosa; Qualidade de Vida; Adulto; Idoso; Revisão

INTRODUCTION

Increases in the life expectancy lead to a rise in the incidence of chronic diseases, which results in specific practices of healthcare professionals for the promotion of care, with the purpose of reducing the impact of these pathologies on the patients affected, as well as providing them with quality of life(11 Nunes HJM, Queirós PJP. Patient with stroke: hospital discharge planning, functionality and quality of life. Rev Bras Enferm[Internet]. 2017 [cited 2017 May 17]; 70(2):433-42. Available from: http://www.scielo.br/pdf/reben/v70n2/0034-7167-reben-70-02-0415.pdf
http://www.scielo.br/pdf/reben/v70n2/003...
).

In this context, non-communicable chronic diseases are included that, in terms of presenting high incidence and prevalence rates, may lead to patient disability and premature mortality. Because these issues are related to the illness process, they must be understood and interpreted by healthcare professionals, in order to achieve satisfactory results from the care provided. Chronic venous ulcers are found among the noncommunicable diseases that affect the population.

According to the Scottish Intercollegiate Guidelines Network(22 Scottish Intercollegiate Guidelines Network. Management of chronic venous leg ulcers: a national clinical guideline. Edinburgh: Scottish Intercollegiate Guidelines Network [Internet]. 2010 [cited 2017 May 17];1-46. Available from: http://www.sign.ac.uk/assets/sign120.pdf
http://www.sign.ac.uk/assets/sign120.pdf...
), venous ulcers are the most severe wounds found in chronic venous insufficiency syndrome of the lowers limbs, and are thus characterized as a public health issue(33 Belczack SQ, Gornati VC, Aun R, Sincos IR, Fragoso H. Treatment of varicose ulcer of the lower limbs by surgery and Unna boot: savings for the Brazilian healthcare system. Einstein[Internet]. 2011 [cited 2017 May 17]; 9(3):377-85. Available from: http://www.scielo.br/pdf/eins/v9n3/1679-4508-eins-9-3-0377.pdf
http://www.scielo.br/pdf/eins/v9n3/1679-...
). Epidemiological data indicate that these wounds represent approximately 80% to 90% of leg ulcer cases(44 Barbosa JAG, Campos LMN. Guidelines for the treatment of venous ulcer. Enferm Glob[Internet]. 2010 [cited 2017 May 18]; 20:1-13. Available from: http://scielo.isciii.es/pdf/eg/n20/pt_revision2.pdf
http://scielo.isciii.es/pdf/eg/n20/pt_re...
-55 Asociación Española de Enfermería Vascular y Heridas. Guía de práctica clínica: Consenso sobre úlceras vasculares y pie diabético. Sevilla: AEEVH [Internet]. 2014 [cited 2017 May 18]; 2:1-90. Available from: https://www.aeev.net/pdf/AEEV%2035%20.pdf
https://www.aeev.net/pdf/AEEV%2035%20.pd...
).

The clinical condition of venous ulcers in the population affected causes difficulties associated with activities of daily living, due to pain, depression, loss of self-esteem, social isolation, work incapacity, and hospitalizations or outpatient consultations(66 Evangelista DG, Magalhães ERM, Moretão DIC, Stival MM, Lima LR. Impact of chronic wounds in the quality of life for users of family health strategy. Rev Enferm Centro O Min[Internet]. 2012 [cited 2018 Jul 18]; 2(2):254-63. Available from: http://www.seer.ufsj.edu.br/index.php/recom/article/download/15/308
http://www.seer.ufsj.edu.br/index.php/re...
). Social reclusion and feelings of shame are also seen in the population affected, due to aesthetic changes and clinical/functional disorders caused by ulcerative wounds(77 Silva FAA, Moreira TMM. Sociodemografic and clinical characteristics of customers with venous leg ulcer. Rev Enferm UERJ[Internet]. 2011 [cited 2017 May 18]; 19(3):468-72. Available from: http://www.facenf.uerj.br/v19n3/v19n3a22.pdf
http://www.facenf.uerj.br/v19n3/v19n3a22...
). In addition to this, living with the disease tends to lead to discrimination and, in most cases, to lack of support from family members and friends, thus affecting these patients' quality of life.

Therefore, promoting the quality of life of this population is of utmost importance. The recommendations of the World Health Organization defines quality of life as “individuals' perception that their needs are being met or that opportunities to achieve their happiness and self-fulfillment are being denied, regardless of their physical health condition or social and economic situation”(88 OMS. Promoción de la Salud. Glossario. Genebra: OMS; 1998.).

The present study is related to the overall healthcare area, which is responsible for intervening in issues and situations related to the population's health in general or to that of a specified group. It is relevant for presenting the issue of quality of life associated with chronic venous ulcers, because this pathology causes fear; anxiety; the expectation of a loss of well-being; limitation; impediment to the practice of activities of daily living; and social and professional restrictions. Thus it leads to high social and economic costs(99 Joaquim FL, Camacho ACLF, Sabóia VM, Santos RC, Santos LSF, Nogueira GA. Impact of home visits on the functional capacity of patients with venous ulcers. Rev Bras Enferm[Internet]. 2016 [cited 2017 May 18]; 69(3):439-47. Available from: http://www.scielo.br/pdf/reben/v69n3/en_0034-7167-reben-69-03-0468.pdf
http://www.scielo.br/pdf/reben/v69n3/en_...
).

OBJECTIVE

To analyze knowledge gathered about the impact of chronic venous ulcers on patients' quality of life.

METHOD

Study design

The methodology adopted for the development of the present study was a systematic bibliographic review with an integrative approach. This methodology allows for scientific knowledge to be systemized so that researchers are able to come close to the theme to be studied, outline an overview on scientific productions on the theme with its evolution over time, and envision the possibilities of research(1010 Mendes KDS, Silveira RCCP, Galvão CM. Integrative literature review: a research method to incorporate evidence in health care and nursing. Texto Contexto Enferm[Internet]. 2008 [cited 2017 May 18]; 17(4):758-764. Available from: http://www.scielo.br/pdf/tce/v17n4/18.pdf
http://www.scielo.br/pdf/tce/v17n4/18.pd...
).

This type of review is developed by following the next six steps: identification of the theme and selection of the research question; establishment of inclusion and exclusion criteria for sample selection; identification of preselected and selected studies; categorization; analysis and interpretation of the results; and presentation of the review(1010 Mendes KDS, Silveira RCCP, Galvão CM. Integrative literature review: a research method to incorporate evidence in health care and nursing. Texto Contexto Enferm[Internet]. 2008 [cited 2017 May 18]; 17(4):758-764. Available from: http://www.scielo.br/pdf/tce/v17n4/18.pdf
http://www.scielo.br/pdf/tce/v17n4/18.pd...
).

The integrative systematic review was initially developed with the identification of the research theme, which was the quality of life in patients with chronic venous ulcers. Next, the research question was defined, which was the impact of chronic venous ulcers in patients' quality of life. From this definition, the study's guiding question was established, based on the PICOT strategy, which presents prognosis or prediction as a question for its formulation, in which “P” indicates who or which people, “I” shows how the pathology influences the prognosis, “C” compares the influence of the prognosis in the absence of the pathology, “O” shows the influence of the pathological prognosis on what will be studied, and “T” indicates the influence of the prognosis over time(1111 Stillwell SB, Fineout-Overhoult E, Melnyk BM, Williamson KM. Searching for the evidence: strategies to help you conduct a successful search. Am J Nurs[Internet]. 2010 [cited 2017 May 18]; 110(5):41-7. Available from: http://www.nursingcenter.com/nursingcenter_redesign/media/EBP/AJNseries/Searching.pdf
http://www.nursingcenter.com/nursingcent...
). Therefore, the guiding question of the present study based on the PICOT strategy was: “Which factors influence the quality of life of adult and aged patients with venous ulcers during their treatment?” This is shown in Figure 1:

Figure 1
Illustrative diagram of the guiding question's development process

Data source

The search was undertaken in the following databases: MEDLINE (Medical Literature Analysis and Retrieval System Online); LILACS (Latin American and Caribbean Literature on Health Sciences); IBECS (Spanish Bibliographical Index of Health Sciences); BDENF (Nursing Database); CINAHL Complete (Cumulative Index to Nursing and Allied Health Literature); Web of Science; Scopus; and CUIDEN Plus.

Data collection and organization

The search strategy adopted was the use of descriptors and the Boolean operators “OR” and “AND.” Descriptors relevant to the theme were selected based on the PICOT strategy and identified through DeCS and MeSH, namely: adult; aged; varicose ulcer; and quality of life. Therefore, these descriptors in Portuguese, Spanish, and English were used for the articles' search.

The inclusion criteria adopted for the search were: full original articles available in the selected databases that presented adherence to the theme in Portuguese, Spanish, and English, published from 2007 to 2016, with the aim of identifying evidence on the theme published within the last 10 years. The search was undertaken during May 2017.

The exclusion criteria adopted were scientific productions that only presented abstracts, and publications related to the validation of questionnaires.

The search with descriptors associated with Boolean operators enabled the identification of preselected studies (Figure 2).

Figure 2
Illustrative diagram of the methodological development for the identification of preselected studies and selection of the studies to be included in the review

After the identification of preselected studies (n=213), the reading of the publications' titles, abstracts, and descriptors was carried out by two independent reviewers to verify their adequacy to the theme and relevance to be selected and included in the review (Figure 2), in order to proceed with the articles' full reading for categorization, analysis, and interpretation of the results, and presentation of the review.

The reading of the preselected material led to the exclusion of 184 publications because they: were related to the validation of questionnaires (LILACS: n=01/Web of Science: n=02); only presented the abstract (CINAHL: n=03/Web of Science: n= 04/Scopus: n= 02); or did not present adherence to the theme (n=169). These articles were related to: therapy approaches in the healing process (LILACS: n=09/IBECS: n=01/BDENF: n=07/CINAHL: n=23/Web of Science: n=69/Scopus: n=37/CUIDEN Plus: n=19); assessment of depression symptoms (LILACS: n=04); preliminary note (LILACS: n=01); and integrative review (MEDLINE: n=01/BDENF: 01).

Twenty-nine articles published from 2012 to 2016 were selected. Of these, six were available 15 times in two or more databases. Therefore, these publications were excluded from the review. Consequently, at the end of the bibliographical survey, 14 articles were obtained for full reading to proceed with categorization, analysis, and interpretation of the results; and presentation of the review.

It is worth mentioning that the search was based on articles published from 2007 to 2016. However, the reading of the selected material showed that articles published from 2007 to 2011 that met the inclusion criteria, did not effectively approach the theme quality of life, but rather issues related to procedures and care that improved quality of life, according to the authors, without describing and discussing dimensions that led to improvement.

Data analysis

Data analysis was carried out by means of a summarization of the methodological characteristics of the articles selected, with the goal of achieving the objective of the study. The data collected were described and organized in tables with information regarding PRISMA(1212 Galvão TF, Pansani TSA, Harrad D. Main items to report Systematic reviews and meta-analyzes: the recommendation PRISMA. Epidemiol Serv Saúde [Internet]. 2015 [cited 2017 Jun 07]; 24(2):335-42. Available from: http://www.scielo.br/pdf/ress/v24n2/2237-9622-ress-24-02-00335.pdf
http://www.scielo.br/pdf/ress/v24n2/2237...
) guidelines and level of evidence(1111 Stillwell SB, Fineout-Overhoult E, Melnyk BM, Williamson KM. Searching for the evidence: strategies to help you conduct a successful search. Am J Nurs[Internet]. 2010 [cited 2017 May 18]; 110(5):41-7. Available from: http://www.nursingcenter.com/nursingcenter_redesign/media/EBP/AJNseries/Searching.pdf
http://www.nursingcenter.com/nursingcent...
) (Chart 1); as well as references, objectives, method, participants, instrument, factors that influence quality of life, and dimensions affected (Chart 2).

Chart 1
Screening of the studies included in the IR, according to PRISMA(1212 Galvão TF, Pansani TSA, Harrad D. Main items to report Systematic reviews and meta-analyzes: the recommendation PRISMA. Epidemiol Serv Saúde [Internet]. 2015 [cited 2017 Jun 07]; 24(2):335-42. Available from: http://www.scielo.br/pdf/ress/v24n2/2237-9622-ress-24-02-00335.pdf
http://www.scielo.br/pdf/ress/v24n2/2237...
) guidelines and level of evidence(1313 Salomé GM, Ferreira LM. Quality of life in patients with venous ulcers treated with Unna's boot compressive therapy. Rev Bras Cir Plást[Internet]. 2012 [cited 2017 Jun 05]; 27(3):466-71. Available from: http://www.scielo.br/pdf/rbcp/v27n3/en_24.pdf
http://www.scielo.br/pdf/rbcp/v27n3/en_2...
)
Chart 2
Description of the studies included in the integrative review according to reference, objectives, method, participants, instrument, factors that influence quality of life, and dimensions affected

RESULTS

The search in the databases initially resulted in 213 articles, of which 14 were included(1313 Salomé GM, Ferreira LM. Quality of life in patients with venous ulcers treated with Unna's boot compressive therapy. Rev Bras Cir Plást[Internet]. 2012 [cited 2017 Jun 05]; 27(3):466-71. Available from: http://www.scielo.br/pdf/rbcp/v27n3/en_24.pdf
http://www.scielo.br/pdf/rbcp/v27n3/en_2...

14 Dias TYAF, Costa IKF, Liberato SMD, Souza AJG, Mendes FRP, Torres GV. Quality of life for venous ulcer patients: a comparative study in Brazil/Portugal. O Braz J Nurs[Internet]. 2013 [cited 2017 Jun 05]; 12(2):491-500. Available from: http://www.objnursing.uff.br/index.php/nursing/article/view/4344/pdf
http://www.objnursing.uff.br/index.php/n...

15 Lopes CR, Figueiredo M, Ávila AM, Soares LMBM, Dionisio VC. Evaluation of limitations of venous ulcers in legs. J Vasc Bras[Internet]. 2013 [cited 2017 Jun 05]; 12(1):5-9. Available from: http://www.scielo.br/pdf/jvb/v12n1/en_03.pdf
http://www.scielo.br/pdf/jvb/v12n1/en_03...

16 Dias TYAF, Costa IKF, Salvetti MG, Mendes CKTT, Torres GV. Influences of health care services and clinical characteristics on the quality of life of patients with venous ulcer. Acta Paul Enferm[Internet]. 2013 [cited 2017 Jun 05]; 26(6):529-34. Available from: http://www.scielo.br/pdf/ape/v26n6/en_04.pdf
http://www.scielo.br/pdf/ape/v26n6/en_04...

17 Saraiva DMRF, Bandarra AJF, Agostinho ES, Pereira NMM, Lopes TS. Quality of life of service users with chronic venous ulcers. Referência[Internet]. 2013 [cited 2017 Jun 05]; 3(10):109-18. Available from: http://www.scielo.mec.pt/pdf/ref/vserIIIn10/serIIIn10a13.pdf
http://www.scielo.mec.pt/pdf/ref/vserIII...

18 Dias TYAF, Costa IKF, Melo MDM, Torres SMSGSO, Maia EMC, Torres GV. Quality of life assessment of patients with and without venous ulcer. Rev Latino-Am Enfermagem[Internet]. 2014 [cited 2017 Jun 05]; 22(4):576-81. Available from: http://www.scielo.br/pdf/rlae/v22n4/0104-1169-rlae-22-04-00576.pdf
http://www.scielo.br/pdf/rlae/v22n4/0104...

19 Lozano SFS, Marinel JR, Carrasco EC, González RJP, Escudero RJR, Sánchez IN, et al. Venous leg ulcer in the context of chronic venous disease. Phlebol[Internet]. 2014 [cited 2017 Jun 05]; 29(4):220-6. Available from: http://journals.sagepub.com/doi/pdf/10.1177/0268355513480489
http://journals.sagepub.com/doi/pdf/10.1...

20 Torres GV, Balduino LSC, Costa IKF, Mendes FRP, Vasconcelos QLDAQ. Comparison of quality of life domains in patientswith venous ulcer. Rev Enferm UERJ[Internet]. 2014 [cited 2017 Jun 05]; 22(1):57-64. Available from: http://www.facenf.uerj.br/v22n1/v22n1a09.pdf
http://www.facenf.uerj.br/v22n1/v22n1a09...

21 Wachholz PA, Masuda PY, Nascimento DC, Taira CMH, Cleto NG. Quality of life profile and correlated factors in chronic leg ulcer patients in the mid-west of São Paulo State, Brazil. An Bras Dermatol[Internet]. 2014 [cited 2017 Jun 05]; 89(1):73-81. Available from: http://www.scielo.br/pdf/abd/v89n1/0365-0596-abd-89-01-0073.pdf
http://www.scielo.br/pdf/abd/v89n1/0365-...

22 Finlayson KJ, Courtney MD, Gibb MA, O'Brien JA, Parker CN, Edwards HE. The effectiveness of a four-layer compression bandage system in comparison with class 3 compression hosiery on healing and quality of life in patients with venous leg ulcers: a randomized controlled trial. Int Wound J[Internet]. 2014 [cited 2017 Jun 05]; 11:21-7. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1742-481X. 2012.01033.x/epdf
http://onlinelibrary.wiley.com/doi/10.11...

23 Salomé GM, Blanes L, Ferreira LM. The impact of skin grafting on the quality of life and self-esteem of patients with venous leg ulcers. World J Surg[Internet]. 2014 [cited 2017 Jun 05]; 38:233-40. Available from: https://link.springer.com/article/10.1007/s00268-013-2228-x
https://link.springer.com/article/10.100...

24 Sell BT, Souza MV, Martins T, Amante LN. Quality of life of pacients with vasculogenic ulcers according to Ferrans and Powers: wounds. J Health Sci[Internet]. 2015 [cited 2017 Jun 06]; 17(3):160-4. Available from: http://www.pgsskroton.com.br/seer/index.php/JHealthSci/article/view/3062/2849
http://www.pgsskroton.com.br/seer/index....

25 Tracz E, Zamojska E, Modrzejewski A, Zaborski D, Grzesiak W. Quality of life in patients with venous stasis ulcers and others with advanced venous insufficiency. Holist Nurs Pract[Internet]. 2015 [cited 2017 Jun 06]; 29(2):96-102. Available from: https://insights.ovid.com/pubmed?pmid=25658932
https://insights.ovid.com/pubmed?pmid=25...
-2626 Araújo RO, Silva DC, Souto RQ, Marconato AMP, Costa IKF, Torres GV. Impact of varicose ulcers on the quality of life of persons receiving primary care. Aquichan[Internet]. 2016 [cited 2017 Jun 06]; 16(1):56-66. Available from: http://www.scielo.org.co/pdf/aqui/v16n1/v16n1a07.pdf
http://www.scielo.org.co/pdf/aqui/v16n1/...
) in the review. With the aim of verifying the quality of the scientific evidence, screening of the studies included in the integrative review (IR) was carried out according to PRISMA(1212 Galvão TF, Pansani TSA, Harrad D. Main items to report Systematic reviews and meta-analyzes: the recommendation PRISMA. Epidemiol Serv Saúde [Internet]. 2015 [cited 2017 Jun 07]; 24(2):335-42. Available from: http://www.scielo.br/pdf/ress/v24n2/2237-9622-ress-24-02-00335.pdf
http://www.scielo.br/pdf/ress/v24n2/2237...
) guidelines and level of evidence(1111 Stillwell SB, Fineout-Overhoult E, Melnyk BM, Williamson KM. Searching for the evidence: strategies to help you conduct a successful search. Am J Nurs[Internet]. 2010 [cited 2017 May 18]; 110(5):41-7. Available from: http://www.nursingcenter.com/nursingcenter_redesign/media/EBP/AJNseries/Searching.pdf
http://www.nursingcenter.com/nursingcent...
), as described in Chart 1.

The following classification was considered to evaluate the level of evidence(1111 Stillwell SB, Fineout-Overhoult E, Melnyk BM, Williamson KM. Searching for the evidence: strategies to help you conduct a successful search. Am J Nurs[Internet]. 2010 [cited 2017 May 18]; 110(5):41-7. Available from: http://www.nursingcenter.com/nursingcenter_redesign/media/EBP/AJNseries/Searching.pdf
http://www.nursingcenter.com/nursingcent...
): Level I, resulting from systematic reviews or meta-analysis; Level II, obtained by means of randomized controlled trials; Level III, derived from non-randomized control studies with a good design; Level IV, resulting from case-control studies or cohort studies; Level V, obtained by means of systematic reviews of qualitative or descriptive studies; Level VI, resulting from qualitative or descriptive studies; and Level VII, with evidence deriving from the opinions of authorities or reports of committees of experts.

After checking the quality of the scientific evidence, regarding the year of publication, it was found that one article was from 2012(1313 Salomé GM, Ferreira LM. Quality of life in patients with venous ulcers treated with Unna's boot compressive therapy. Rev Bras Cir Plást[Internet]. 2012 [cited 2017 Jun 05]; 27(3):466-71. Available from: http://www.scielo.br/pdf/rbcp/v27n3/en_24.pdf
http://www.scielo.br/pdf/rbcp/v27n3/en_2...
), four from 2013(1414 Dias TYAF, Costa IKF, Liberato SMD, Souza AJG, Mendes FRP, Torres GV. Quality of life for venous ulcer patients: a comparative study in Brazil/Portugal. O Braz J Nurs[Internet]. 2013 [cited 2017 Jun 05]; 12(2):491-500. Available from: http://www.objnursing.uff.br/index.php/nursing/article/view/4344/pdf
http://www.objnursing.uff.br/index.php/n...

15 Lopes CR, Figueiredo M, Ávila AM, Soares LMBM, Dionisio VC. Evaluation of limitations of venous ulcers in legs. J Vasc Bras[Internet]. 2013 [cited 2017 Jun 05]; 12(1):5-9. Available from: http://www.scielo.br/pdf/jvb/v12n1/en_03.pdf
http://www.scielo.br/pdf/jvb/v12n1/en_03...

16 Dias TYAF, Costa IKF, Salvetti MG, Mendes CKTT, Torres GV. Influences of health care services and clinical characteristics on the quality of life of patients with venous ulcer. Acta Paul Enferm[Internet]. 2013 [cited 2017 Jun 05]; 26(6):529-34. Available from: http://www.scielo.br/pdf/ape/v26n6/en_04.pdf
http://www.scielo.br/pdf/ape/v26n6/en_04...
-1717 Saraiva DMRF, Bandarra AJF, Agostinho ES, Pereira NMM, Lopes TS. Quality of life of service users with chronic venous ulcers. Referência[Internet]. 2013 [cited 2017 Jun 05]; 3(10):109-18. Available from: http://www.scielo.mec.pt/pdf/ref/vserIIIn10/serIIIn10a13.pdf
http://www.scielo.mec.pt/pdf/ref/vserIII...
), six from 2014(1818 Dias TYAF, Costa IKF, Melo MDM, Torres SMSGSO, Maia EMC, Torres GV. Quality of life assessment of patients with and without venous ulcer. Rev Latino-Am Enfermagem[Internet]. 2014 [cited 2017 Jun 05]; 22(4):576-81. Available from: http://www.scielo.br/pdf/rlae/v22n4/0104-1169-rlae-22-04-00576.pdf
http://www.scielo.br/pdf/rlae/v22n4/0104...

19 Lozano SFS, Marinel JR, Carrasco EC, González RJP, Escudero RJR, Sánchez IN, et al. Venous leg ulcer in the context of chronic venous disease. Phlebol[Internet]. 2014 [cited 2017 Jun 05]; 29(4):220-6. Available from: http://journals.sagepub.com/doi/pdf/10.1177/0268355513480489
http://journals.sagepub.com/doi/pdf/10.1...

20 Torres GV, Balduino LSC, Costa IKF, Mendes FRP, Vasconcelos QLDAQ. Comparison of quality of life domains in patientswith venous ulcer. Rev Enferm UERJ[Internet]. 2014 [cited 2017 Jun 05]; 22(1):57-64. Available from: http://www.facenf.uerj.br/v22n1/v22n1a09.pdf
http://www.facenf.uerj.br/v22n1/v22n1a09...

21 Wachholz PA, Masuda PY, Nascimento DC, Taira CMH, Cleto NG. Quality of life profile and correlated factors in chronic leg ulcer patients in the mid-west of São Paulo State, Brazil. An Bras Dermatol[Internet]. 2014 [cited 2017 Jun 05]; 89(1):73-81. Available from: http://www.scielo.br/pdf/abd/v89n1/0365-0596-abd-89-01-0073.pdf
http://www.scielo.br/pdf/abd/v89n1/0365-...

22 Finlayson KJ, Courtney MD, Gibb MA, O'Brien JA, Parker CN, Edwards HE. The effectiveness of a four-layer compression bandage system in comparison with class 3 compression hosiery on healing and quality of life in patients with venous leg ulcers: a randomized controlled trial. Int Wound J[Internet]. 2014 [cited 2017 Jun 05]; 11:21-7. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1742-481X. 2012.01033.x/epdf
http://onlinelibrary.wiley.com/doi/10.11...
-2323 Salomé GM, Blanes L, Ferreira LM. The impact of skin grafting on the quality of life and self-esteem of patients with venous leg ulcers. World J Surg[Internet]. 2014 [cited 2017 Jun 05]; 38:233-40. Available from: https://link.springer.com/article/10.1007/s00268-013-2228-x
https://link.springer.com/article/10.100...
), two from 2015(2424 Sell BT, Souza MV, Martins T, Amante LN. Quality of life of pacients with vasculogenic ulcers according to Ferrans and Powers: wounds. J Health Sci[Internet]. 2015 [cited 2017 Jun 06]; 17(3):160-4. Available from: http://www.pgsskroton.com.br/seer/index.php/JHealthSci/article/view/3062/2849
http://www.pgsskroton.com.br/seer/index....
-2525 Tracz E, Zamojska E, Modrzejewski A, Zaborski D, Grzesiak W. Quality of life in patients with venous stasis ulcers and others with advanced venous insufficiency. Holist Nurs Pract[Internet]. 2015 [cited 2017 Jun 06]; 29(2):96-102. Available from: https://insights.ovid.com/pubmed?pmid=25658932
https://insights.ovid.com/pubmed?pmid=25...
), and one from 2016(2626 Araújo RO, Silva DC, Souto RQ, Marconato AMP, Costa IKF, Torres GV. Impact of varicose ulcers on the quality of life of persons receiving primary care. Aquichan[Internet]. 2016 [cited 2017 Jun 06]; 16(1):56-66. Available from: http://www.scielo.org.co/pdf/aqui/v16n1/v16n1a07.pdf
http://www.scielo.org.co/pdf/aqui/v16n1/...
). With regard to language, seven publications were in Portuguese(1313 Salomé GM, Ferreira LM. Quality of life in patients with venous ulcers treated with Unna's boot compressive therapy. Rev Bras Cir Plást[Internet]. 2012 [cited 2017 Jun 05]; 27(3):466-71. Available from: http://www.scielo.br/pdf/rbcp/v27n3/en_24.pdf
http://www.scielo.br/pdf/rbcp/v27n3/en_2...
,1515 Lopes CR, Figueiredo M, Ávila AM, Soares LMBM, Dionisio VC. Evaluation of limitations of venous ulcers in legs. J Vasc Bras[Internet]. 2013 [cited 2017 Jun 05]; 12(1):5-9. Available from: http://www.scielo.br/pdf/jvb/v12n1/en_03.pdf
http://www.scielo.br/pdf/jvb/v12n1/en_03...

16 Dias TYAF, Costa IKF, Salvetti MG, Mendes CKTT, Torres GV. Influences of health care services and clinical characteristics on the quality of life of patients with venous ulcer. Acta Paul Enferm[Internet]. 2013 [cited 2017 Jun 05]; 26(6):529-34. Available from: http://www.scielo.br/pdf/ape/v26n6/en_04.pdf
http://www.scielo.br/pdf/ape/v26n6/en_04...
-1717 Saraiva DMRF, Bandarra AJF, Agostinho ES, Pereira NMM, Lopes TS. Quality of life of service users with chronic venous ulcers. Referência[Internet]. 2013 [cited 2017 Jun 05]; 3(10):109-18. Available from: http://www.scielo.mec.pt/pdf/ref/vserIIIn10/serIIIn10a13.pdf
http://www.scielo.mec.pt/pdf/ref/vserIII...
,2020 Torres GV, Balduino LSC, Costa IKF, Mendes FRP, Vasconcelos QLDAQ. Comparison of quality of life domains in patientswith venous ulcer. Rev Enferm UERJ[Internet]. 2014 [cited 2017 Jun 05]; 22(1):57-64. Available from: http://www.facenf.uerj.br/v22n1/v22n1a09.pdf
http://www.facenf.uerj.br/v22n1/v22n1a09...
,2424 Sell BT, Souza MV, Martins T, Amante LN. Quality of life of pacients with vasculogenic ulcers according to Ferrans and Powers: wounds. J Health Sci[Internet]. 2015 [cited 2017 Jun 06]; 17(3):160-4. Available from: http://www.pgsskroton.com.br/seer/index.php/JHealthSci/article/view/3062/2849
http://www.pgsskroton.com.br/seer/index....
,2626 Araújo RO, Silva DC, Souto RQ, Marconato AMP, Costa IKF, Torres GV. Impact of varicose ulcers on the quality of life of persons receiving primary care. Aquichan[Internet]. 2016 [cited 2017 Jun 06]; 16(1):56-66. Available from: http://www.scielo.org.co/pdf/aqui/v16n1/v16n1a07.pdf
http://www.scielo.org.co/pdf/aqui/v16n1/...
), five were in English(1919 Lozano SFS, Marinel JR, Carrasco EC, González RJP, Escudero RJR, Sánchez IN, et al. Venous leg ulcer in the context of chronic venous disease. Phlebol[Internet]. 2014 [cited 2017 Jun 05]; 29(4):220-6. Available from: http://journals.sagepub.com/doi/pdf/10.1177/0268355513480489
http://journals.sagepub.com/doi/pdf/10.1...
,2121 Wachholz PA, Masuda PY, Nascimento DC, Taira CMH, Cleto NG. Quality of life profile and correlated factors in chronic leg ulcer patients in the mid-west of São Paulo State, Brazil. An Bras Dermatol[Internet]. 2014 [cited 2017 Jun 05]; 89(1):73-81. Available from: http://www.scielo.br/pdf/abd/v89n1/0365-0596-abd-89-01-0073.pdf
http://www.scielo.br/pdf/abd/v89n1/0365-...

22 Finlayson KJ, Courtney MD, Gibb MA, O'Brien JA, Parker CN, Edwards HE. The effectiveness of a four-layer compression bandage system in comparison with class 3 compression hosiery on healing and quality of life in patients with venous leg ulcers: a randomized controlled trial. Int Wound J[Internet]. 2014 [cited 2017 Jun 05]; 11:21-7. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1742-481X. 2012.01033.x/epdf
http://onlinelibrary.wiley.com/doi/10.11...
-2323 Salomé GM, Blanes L, Ferreira LM. The impact of skin grafting on the quality of life and self-esteem of patients with venous leg ulcers. World J Surg[Internet]. 2014 [cited 2017 Jun 05]; 38:233-40. Available from: https://link.springer.com/article/10.1007/s00268-013-2228-x
https://link.springer.com/article/10.100...
,2525 Tracz E, Zamojska E, Modrzejewski A, Zaborski D, Grzesiak W. Quality of life in patients with venous stasis ulcers and others with advanced venous insufficiency. Holist Nurs Pract[Internet]. 2015 [cited 2017 Jun 06]; 29(2):96-102. Available from: https://insights.ovid.com/pubmed?pmid=25658932
https://insights.ovid.com/pubmed?pmid=25...
), and two were available in three languages, which were: Portuguese, Spanish, and English(1414 Dias TYAF, Costa IKF, Liberato SMD, Souza AJG, Mendes FRP, Torres GV. Quality of life for venous ulcer patients: a comparative study in Brazil/Portugal. O Braz J Nurs[Internet]. 2013 [cited 2017 Jun 05]; 12(2):491-500. Available from: http://www.objnursing.uff.br/index.php/nursing/article/view/4344/pdf
http://www.objnursing.uff.br/index.php/n...
,1818 Dias TYAF, Costa IKF, Melo MDM, Torres SMSGSO, Maia EMC, Torres GV. Quality of life assessment of patients with and without venous ulcer. Rev Latino-Am Enfermagem[Internet]. 2014 [cited 2017 Jun 05]; 22(4):576-81. Available from: http://www.scielo.br/pdf/rlae/v22n4/0104-1169-rlae-22-04-00576.pdf
http://www.scielo.br/pdf/rlae/v22n4/0104...
).

Regarding the databases, there was a prevalence of articles that discussed the quality of life in patients with chronic venous ulcers as indexed in multiple databases. This prevalence was related to LILACS (n=09) (1313 Salomé GM, Ferreira LM. Quality of life in patients with venous ulcers treated with Unna's boot compressive therapy. Rev Bras Cir Plást[Internet]. 2012 [cited 2017 Jun 05]; 27(3):466-71. Available from: http://www.scielo.br/pdf/rbcp/v27n3/en_24.pdf
http://www.scielo.br/pdf/rbcp/v27n3/en_2...

14 Dias TYAF, Costa IKF, Liberato SMD, Souza AJG, Mendes FRP, Torres GV. Quality of life for venous ulcer patients: a comparative study in Brazil/Portugal. O Braz J Nurs[Internet]. 2013 [cited 2017 Jun 05]; 12(2):491-500. Available from: http://www.objnursing.uff.br/index.php/nursing/article/view/4344/pdf
http://www.objnursing.uff.br/index.php/n...

15 Lopes CR, Figueiredo M, Ávila AM, Soares LMBM, Dionisio VC. Evaluation of limitations of venous ulcers in legs. J Vasc Bras[Internet]. 2013 [cited 2017 Jun 05]; 12(1):5-9. Available from: http://www.scielo.br/pdf/jvb/v12n1/en_03.pdf
http://www.scielo.br/pdf/jvb/v12n1/en_03...
-1616 Dias TYAF, Costa IKF, Salvetti MG, Mendes CKTT, Torres GV. Influences of health care services and clinical characteristics on the quality of life of patients with venous ulcer. Acta Paul Enferm[Internet]. 2013 [cited 2017 Jun 05]; 26(6):529-34. Available from: http://www.scielo.br/pdf/ape/v26n6/en_04.pdf
http://www.scielo.br/pdf/ape/v26n6/en_04...
,1818 Dias TYAF, Costa IKF, Melo MDM, Torres SMSGSO, Maia EMC, Torres GV. Quality of life assessment of patients with and without venous ulcer. Rev Latino-Am Enfermagem[Internet]. 2014 [cited 2017 Jun 05]; 22(4):576-81. Available from: http://www.scielo.br/pdf/rlae/v22n4/0104-1169-rlae-22-04-00576.pdf
http://www.scielo.br/pdf/rlae/v22n4/0104...
,2020 Torres GV, Balduino LSC, Costa IKF, Mendes FRP, Vasconcelos QLDAQ. Comparison of quality of life domains in patientswith venous ulcer. Rev Enferm UERJ[Internet]. 2014 [cited 2017 Jun 05]; 22(1):57-64. Available from: http://www.facenf.uerj.br/v22n1/v22n1a09.pdf
http://www.facenf.uerj.br/v22n1/v22n1a09...
-2121 Wachholz PA, Masuda PY, Nascimento DC, Taira CMH, Cleto NG. Quality of life profile and correlated factors in chronic leg ulcer patients in the mid-west of São Paulo State, Brazil. An Bras Dermatol[Internet]. 2014 [cited 2017 Jun 05]; 89(1):73-81. Available from: http://www.scielo.br/pdf/abd/v89n1/0365-0596-abd-89-01-0073.pdf
http://www.scielo.br/pdf/abd/v89n1/0365-...
,2424 Sell BT, Souza MV, Martins T, Amante LN. Quality of life of pacients with vasculogenic ulcers according to Ferrans and Powers: wounds. J Health Sci[Internet]. 2015 [cited 2017 Jun 06]; 17(3):160-4. Available from: http://www.pgsskroton.com.br/seer/index.php/JHealthSci/article/view/3062/2849
http://www.pgsskroton.com.br/seer/index....
,2626 Araújo RO, Silva DC, Souto RQ, Marconato AMP, Costa IKF, Torres GV. Impact of varicose ulcers on the quality of life of persons receiving primary care. Aquichan[Internet]. 2016 [cited 2017 Jun 06]; 16(1):56-66. Available from: http://www.scielo.org.co/pdf/aqui/v16n1/v16n1a07.pdf
http://www.scielo.org.co/pdf/aqui/v16n1/...
), Web of Science (n=07)(1616 Dias TYAF, Costa IKF, Salvetti MG, Mendes CKTT, Torres GV. Influences of health care services and clinical characteristics on the quality of life of patients with venous ulcer. Acta Paul Enferm[Internet]. 2013 [cited 2017 Jun 05]; 26(6):529-34. Available from: http://www.scielo.br/pdf/ape/v26n6/en_04.pdf
http://www.scielo.br/pdf/ape/v26n6/en_04...

17 Saraiva DMRF, Bandarra AJF, Agostinho ES, Pereira NMM, Lopes TS. Quality of life of service users with chronic venous ulcers. Referência[Internet]. 2013 [cited 2017 Jun 05]; 3(10):109-18. Available from: http://www.scielo.mec.pt/pdf/ref/vserIIIn10/serIIIn10a13.pdf
http://www.scielo.mec.pt/pdf/ref/vserIII...
-1818 Dias TYAF, Costa IKF, Melo MDM, Torres SMSGSO, Maia EMC, Torres GV. Quality of life assessment of patients with and without venous ulcer. Rev Latino-Am Enfermagem[Internet]. 2014 [cited 2017 Jun 05]; 22(4):576-81. Available from: http://www.scielo.br/pdf/rlae/v22n4/0104-1169-rlae-22-04-00576.pdf
http://www.scielo.br/pdf/rlae/v22n4/0104...
,2121 Wachholz PA, Masuda PY, Nascimento DC, Taira CMH, Cleto NG. Quality of life profile and correlated factors in chronic leg ulcer patients in the mid-west of São Paulo State, Brazil. An Bras Dermatol[Internet]. 2014 [cited 2017 Jun 05]; 89(1):73-81. Available from: http://www.scielo.br/pdf/abd/v89n1/0365-0596-abd-89-01-0073.pdf
http://www.scielo.br/pdf/abd/v89n1/0365-...

22 Finlayson KJ, Courtney MD, Gibb MA, O'Brien JA, Parker CN, Edwards HE. The effectiveness of a four-layer compression bandage system in comparison with class 3 compression hosiery on healing and quality of life in patients with venous leg ulcers: a randomized controlled trial. Int Wound J[Internet]. 2014 [cited 2017 Jun 05]; 11:21-7. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1742-481X. 2012.01033.x/epdf
http://onlinelibrary.wiley.com/doi/10.11...
-2323 Salomé GM, Blanes L, Ferreira LM. The impact of skin grafting on the quality of life and self-esteem of patients with venous leg ulcers. World J Surg[Internet]. 2014 [cited 2017 Jun 05]; 38:233-40. Available from: https://link.springer.com/article/10.1007/s00268-013-2228-x
https://link.springer.com/article/10.100...
,2626 Araújo RO, Silva DC, Souto RQ, Marconato AMP, Costa IKF, Torres GV. Impact of varicose ulcers on the quality of life of persons receiving primary care. Aquichan[Internet]. 2016 [cited 2017 Jun 06]; 16(1):56-66. Available from: http://www.scielo.org.co/pdf/aqui/v16n1/v16n1a07.pdf
http://www.scielo.org.co/pdf/aqui/v16n1/...
), CUIDEN Plus (n=05)(1616 Dias TYAF, Costa IKF, Salvetti MG, Mendes CKTT, Torres GV. Influences of health care services and clinical characteristics on the quality of life of patients with venous ulcer. Acta Paul Enferm[Internet]. 2013 [cited 2017 Jun 05]; 26(6):529-34. Available from: http://www.scielo.br/pdf/ape/v26n6/en_04.pdf
http://www.scielo.br/pdf/ape/v26n6/en_04...

17 Saraiva DMRF, Bandarra AJF, Agostinho ES, Pereira NMM, Lopes TS. Quality of life of service users with chronic venous ulcers. Referência[Internet]. 2013 [cited 2017 Jun 05]; 3(10):109-18. Available from: http://www.scielo.mec.pt/pdf/ref/vserIIIn10/serIIIn10a13.pdf
http://www.scielo.mec.pt/pdf/ref/vserIII...
-1818 Dias TYAF, Costa IKF, Melo MDM, Torres SMSGSO, Maia EMC, Torres GV. Quality of life assessment of patients with and without venous ulcer. Rev Latino-Am Enfermagem[Internet]. 2014 [cited 2017 Jun 05]; 22(4):576-81. Available from: http://www.scielo.br/pdf/rlae/v22n4/0104-1169-rlae-22-04-00576.pdf
http://www.scielo.br/pdf/rlae/v22n4/0104...
,2222 Finlayson KJ, Courtney MD, Gibb MA, O'Brien JA, Parker CN, Edwards HE. The effectiveness of a four-layer compression bandage system in comparison with class 3 compression hosiery on healing and quality of life in patients with venous leg ulcers: a randomized controlled trial. Int Wound J[Internet]. 2014 [cited 2017 Jun 05]; 11:21-7. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1742-481X. 2012.01033.x/epdf
http://onlinelibrary.wiley.com/doi/10.11...
,2626 Araújo RO, Silva DC, Souto RQ, Marconato AMP, Costa IKF, Torres GV. Impact of varicose ulcers on the quality of life of persons receiving primary care. Aquichan[Internet]. 2016 [cited 2017 Jun 06]; 16(1):56-66. Available from: http://www.scielo.org.co/pdf/aqui/v16n1/v16n1a07.pdf
http://www.scielo.org.co/pdf/aqui/v16n1/...
), Scopus (n=04)(1616 Dias TYAF, Costa IKF, Salvetti MG, Mendes CKTT, Torres GV. Influences of health care services and clinical characteristics on the quality of life of patients with venous ulcer. Acta Paul Enferm[Internet]. 2013 [cited 2017 Jun 05]; 26(6):529-34. Available from: http://www.scielo.br/pdf/ape/v26n6/en_04.pdf
http://www.scielo.br/pdf/ape/v26n6/en_04...
,1818 Dias TYAF, Costa IKF, Melo MDM, Torres SMSGSO, Maia EMC, Torres GV. Quality of life assessment of patients with and without venous ulcer. Rev Latino-Am Enfermagem[Internet]. 2014 [cited 2017 Jun 05]; 22(4):576-81. Available from: http://www.scielo.br/pdf/rlae/v22n4/0104-1169-rlae-22-04-00576.pdf
http://www.scielo.br/pdf/rlae/v22n4/0104...
,2525 Tracz E, Zamojska E, Modrzejewski A, Zaborski D, Grzesiak W. Quality of life in patients with venous stasis ulcers and others with advanced venous insufficiency. Holist Nurs Pract[Internet]. 2015 [cited 2017 Jun 06]; 29(2):96-102. Available from: https://insights.ovid.com/pubmed?pmid=25658932
https://insights.ovid.com/pubmed?pmid=25...
-2626 Araújo RO, Silva DC, Souto RQ, Marconato AMP, Costa IKF, Torres GV. Impact of varicose ulcers on the quality of life of persons receiving primary care. Aquichan[Internet]. 2016 [cited 2017 Jun 06]; 16(1):56-66. Available from: http://www.scielo.org.co/pdf/aqui/v16n1/v16n1a07.pdf
http://www.scielo.org.co/pdf/aqui/v16n1/...
), BDNF (n=02)(1616 Dias TYAF, Costa IKF, Salvetti MG, Mendes CKTT, Torres GV. Influences of health care services and clinical characteristics on the quality of life of patients with venous ulcer. Acta Paul Enferm[Internet]. 2013 [cited 2017 Jun 05]; 26(6):529-34. Available from: http://www.scielo.br/pdf/ape/v26n6/en_04.pdf
http://www.scielo.br/pdf/ape/v26n6/en_04...
,1818 Dias TYAF, Costa IKF, Melo MDM, Torres SMSGSO, Maia EMC, Torres GV. Quality of life assessment of patients with and without venous ulcer. Rev Latino-Am Enfermagem[Internet]. 2014 [cited 2017 Jun 05]; 22(4):576-81. Available from: http://www.scielo.br/pdf/rlae/v22n4/0104-1169-rlae-22-04-00576.pdf
http://www.scielo.br/pdf/rlae/v22n4/0104...
), and MEDLINE (n=02)(1818 Dias TYAF, Costa IKF, Melo MDM, Torres SMSGSO, Maia EMC, Torres GV. Quality of life assessment of patients with and without venous ulcer. Rev Latino-Am Enfermagem[Internet]. 2014 [cited 2017 Jun 05]; 22(4):576-81. Available from: http://www.scielo.br/pdf/rlae/v22n4/0104-1169-rlae-22-04-00576.pdf
http://www.scielo.br/pdf/rlae/v22n4/0104...
-1919 Lozano SFS, Marinel JR, Carrasco EC, González RJP, Escudero RJR, Sánchez IN, et al. Venous leg ulcer in the context of chronic venous disease. Phlebol[Internet]. 2014 [cited 2017 Jun 05]; 29(4):220-6. Available from: http://journals.sagepub.com/doi/pdf/10.1177/0268355513480489
http://journals.sagepub.com/doi/pdf/10.1...
).

The selected studies were developed in the following countries: Brazil (n=8)(1313 Salomé GM, Ferreira LM. Quality of life in patients with venous ulcers treated with Unna's boot compressive therapy. Rev Bras Cir Plást[Internet]. 2012 [cited 2017 Jun 05]; 27(3):466-71. Available from: http://www.scielo.br/pdf/rbcp/v27n3/en_24.pdf
http://www.scielo.br/pdf/rbcp/v27n3/en_2...
,1515 Lopes CR, Figueiredo M, Ávila AM, Soares LMBM, Dionisio VC. Evaluation of limitations of venous ulcers in legs. J Vasc Bras[Internet]. 2013 [cited 2017 Jun 05]; 12(1):5-9. Available from: http://www.scielo.br/pdf/jvb/v12n1/en_03.pdf
http://www.scielo.br/pdf/jvb/v12n1/en_03...
-1616 Dias TYAF, Costa IKF, Salvetti MG, Mendes CKTT, Torres GV. Influences of health care services and clinical characteristics on the quality of life of patients with venous ulcer. Acta Paul Enferm[Internet]. 2013 [cited 2017 Jun 05]; 26(6):529-34. Available from: http://www.scielo.br/pdf/ape/v26n6/en_04.pdf
http://www.scielo.br/pdf/ape/v26n6/en_04...
,1818 Dias TYAF, Costa IKF, Melo MDM, Torres SMSGSO, Maia EMC, Torres GV. Quality of life assessment of patients with and without venous ulcer. Rev Latino-Am Enfermagem[Internet]. 2014 [cited 2017 Jun 05]; 22(4):576-81. Available from: http://www.scielo.br/pdf/rlae/v22n4/0104-1169-rlae-22-04-00576.pdf
http://www.scielo.br/pdf/rlae/v22n4/0104...
,2121 Wachholz PA, Masuda PY, Nascimento DC, Taira CMH, Cleto NG. Quality of life profile and correlated factors in chronic leg ulcer patients in the mid-west of São Paulo State, Brazil. An Bras Dermatol[Internet]. 2014 [cited 2017 Jun 05]; 89(1):73-81. Available from: http://www.scielo.br/pdf/abd/v89n1/0365-0596-abd-89-01-0073.pdf
http://www.scielo.br/pdf/abd/v89n1/0365-...
,2323 Salomé GM, Blanes L, Ferreira LM. The impact of skin grafting on the quality of life and self-esteem of patients with venous leg ulcers. World J Surg[Internet]. 2014 [cited 2017 Jun 05]; 38:233-40. Available from: https://link.springer.com/article/10.1007/s00268-013-2228-x
https://link.springer.com/article/10.100...
-2424 Sell BT, Souza MV, Martins T, Amante LN. Quality of life of pacients with vasculogenic ulcers according to Ferrans and Powers: wounds. J Health Sci[Internet]. 2015 [cited 2017 Jun 06]; 17(3):160-4. Available from: http://www.pgsskroton.com.br/seer/index.php/JHealthSci/article/view/3062/2849
http://www.pgsskroton.com.br/seer/index....
,2626 Araújo RO, Silva DC, Souto RQ, Marconato AMP, Costa IKF, Torres GV. Impact of varicose ulcers on the quality of life of persons receiving primary care. Aquichan[Internet]. 2016 [cited 2017 Jun 06]; 16(1):56-66. Available from: http://www.scielo.org.co/pdf/aqui/v16n1/v16n1a07.pdf
http://www.scielo.org.co/pdf/aqui/v16n1/...
), Portugal (n=01)(1717 Saraiva DMRF, Bandarra AJF, Agostinho ES, Pereira NMM, Lopes TS. Quality of life of service users with chronic venous ulcers. Referência[Internet]. 2013 [cited 2017 Jun 05]; 3(10):109-18. Available from: http://www.scielo.mec.pt/pdf/ref/vserIIIn10/serIIIn10a13.pdf
http://www.scielo.mec.pt/pdf/ref/vserIII...
), Spain (n=01)(1919 Lozano SFS, Marinel JR, Carrasco EC, González RJP, Escudero RJR, Sánchez IN, et al. Venous leg ulcer in the context of chronic venous disease. Phlebol[Internet]. 2014 [cited 2017 Jun 05]; 29(4):220-6. Available from: http://journals.sagepub.com/doi/pdf/10.1177/0268355513480489
http://journals.sagepub.com/doi/pdf/10.1...
), Australia (n=01)(2222 Finlayson KJ, Courtney MD, Gibb MA, O'Brien JA, Parker CN, Edwards HE. The effectiveness of a four-layer compression bandage system in comparison with class 3 compression hosiery on healing and quality of life in patients with venous leg ulcers: a randomized controlled trial. Int Wound J[Internet]. 2014 [cited 2017 Jun 05]; 11:21-7. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1742-481X. 2012.01033.x/epdf
http://onlinelibrary.wiley.com/doi/10.11...
), and Poland (n=01)(2525 Tracz E, Zamojska E, Modrzejewski A, Zaborski D, Grzesiak W. Quality of life in patients with venous stasis ulcers and others with advanced venous insufficiency. Holist Nurs Pract[Internet]. 2015 [cited 2017 Jun 06]; 29(2):96-102. Available from: https://insights.ovid.com/pubmed?pmid=25658932
https://insights.ovid.com/pubmed?pmid=25...
), with two articles having been developed in a partnership between Brazil and Portugal(1414 Dias TYAF, Costa IKF, Liberato SMD, Souza AJG, Mendes FRP, Torres GV. Quality of life for venous ulcer patients: a comparative study in Brazil/Portugal. O Braz J Nurs[Internet]. 2013 [cited 2017 Jun 05]; 12(2):491-500. Available from: http://www.objnursing.uff.br/index.php/nursing/article/view/4344/pdf
http://www.objnursing.uff.br/index.php/n...
,2020 Torres GV, Balduino LSC, Costa IKF, Mendes FRP, Vasconcelos QLDAQ. Comparison of quality of life domains in patientswith venous ulcer. Rev Enferm UERJ[Internet]. 2014 [cited 2017 Jun 05]; 22(1):57-64. Available from: http://www.facenf.uerj.br/v22n1/v22n1a09.pdf
http://www.facenf.uerj.br/v22n1/v22n1a09...
). Regarding summarization of the methodological characteristics of the selected articles, the data collected and shown in Charts 1 and 2 indicated that 100% (n=14) of the selected material presented a quantitative approach, with a prevalence of the evidence(1111 Stillwell SB, Fineout-Overhoult E, Melnyk BM, Williamson KM. Searching for the evidence: strategies to help you conduct a successful search. Am J Nurs[Internet]. 2010 [cited 2017 May 18]; 110(5):41-7. Available from: http://www.nursingcenter.com/nursingcenter_redesign/media/EBP/AJNseries/Searching.pdf
http://www.nursingcenter.com/nursingcent...
) at Level VI (n=09)(1313 Salomé GM, Ferreira LM. Quality of life in patients with venous ulcers treated with Unna's boot compressive therapy. Rev Bras Cir Plást[Internet]. 2012 [cited 2017 Jun 05]; 27(3):466-71. Available from: http://www.scielo.br/pdf/rbcp/v27n3/en_24.pdf
http://www.scielo.br/pdf/rbcp/v27n3/en_2...
-1414 Dias TYAF, Costa IKF, Liberato SMD, Souza AJG, Mendes FRP, Torres GV. Quality of life for venous ulcer patients: a comparative study in Brazil/Portugal. O Braz J Nurs[Internet]. 2013 [cited 2017 Jun 05]; 12(2):491-500. Available from: http://www.objnursing.uff.br/index.php/nursing/article/view/4344/pdf
http://www.objnursing.uff.br/index.php/n...
,1616 Dias TYAF, Costa IKF, Salvetti MG, Mendes CKTT, Torres GV. Influences of health care services and clinical characteristics on the quality of life of patients with venous ulcer. Acta Paul Enferm[Internet]. 2013 [cited 2017 Jun 05]; 26(6):529-34. Available from: http://www.scielo.br/pdf/ape/v26n6/en_04.pdf
http://www.scielo.br/pdf/ape/v26n6/en_04...

17 Saraiva DMRF, Bandarra AJF, Agostinho ES, Pereira NMM, Lopes TS. Quality of life of service users with chronic venous ulcers. Referência[Internet]. 2013 [cited 2017 Jun 05]; 3(10):109-18. Available from: http://www.scielo.mec.pt/pdf/ref/vserIIIn10/serIIIn10a13.pdf
http://www.scielo.mec.pt/pdf/ref/vserIII...
-1818 Dias TYAF, Costa IKF, Melo MDM, Torres SMSGSO, Maia EMC, Torres GV. Quality of life assessment of patients with and without venous ulcer. Rev Latino-Am Enfermagem[Internet]. 2014 [cited 2017 Jun 05]; 22(4):576-81. Available from: http://www.scielo.br/pdf/rlae/v22n4/0104-1169-rlae-22-04-00576.pdf
http://www.scielo.br/pdf/rlae/v22n4/0104...
,2020 Torres GV, Balduino LSC, Costa IKF, Mendes FRP, Vasconcelos QLDAQ. Comparison of quality of life domains in patientswith venous ulcer. Rev Enferm UERJ[Internet]. 2014 [cited 2017 Jun 05]; 22(1):57-64. Available from: http://www.facenf.uerj.br/v22n1/v22n1a09.pdf
http://www.facenf.uerj.br/v22n1/v22n1a09...
-2121 Wachholz PA, Masuda PY, Nascimento DC, Taira CMH, Cleto NG. Quality of life profile and correlated factors in chronic leg ulcer patients in the mid-west of São Paulo State, Brazil. An Bras Dermatol[Internet]. 2014 [cited 2017 Jun 05]; 89(1):73-81. Available from: http://www.scielo.br/pdf/abd/v89n1/0365-0596-abd-89-01-0073.pdf
http://www.scielo.br/pdf/abd/v89n1/0365-...
,2424 Sell BT, Souza MV, Martins T, Amante LN. Quality of life of pacients with vasculogenic ulcers according to Ferrans and Powers: wounds. J Health Sci[Internet]. 2015 [cited 2017 Jun 06]; 17(3):160-4. Available from: http://www.pgsskroton.com.br/seer/index.php/JHealthSci/article/view/3062/2849
http://www.pgsskroton.com.br/seer/index....
,2626 Araújo RO, Silva DC, Souto RQ, Marconato AMP, Costa IKF, Torres GV. Impact of varicose ulcers on the quality of life of persons receiving primary care. Aquichan[Internet]. 2016 [cited 2017 Jun 06]; 16(1):56-66. Available from: http://www.scielo.org.co/pdf/aqui/v16n1/v16n1a07.pdf
http://www.scielo.org.co/pdf/aqui/v16n1/...
), followed by Level IV (n=02)(1515 Lopes CR, Figueiredo M, Ávila AM, Soares LMBM, Dionisio VC. Evaluation of limitations of venous ulcers in legs. J Vasc Bras[Internet]. 2013 [cited 2017 Jun 05]; 12(1):5-9. Available from: http://www.scielo.br/pdf/jvb/v12n1/en_03.pdf
http://www.scielo.br/pdf/jvb/v12n1/en_03...
,1919 Lozano SFS, Marinel JR, Carrasco EC, González RJP, Escudero RJR, Sánchez IN, et al. Venous leg ulcer in the context of chronic venous disease. Phlebol[Internet]. 2014 [cited 2017 Jun 05]; 29(4):220-6. Available from: http://journals.sagepub.com/doi/pdf/10.1177/0268355513480489
http://journals.sagepub.com/doi/pdf/10.1...
), Level II (n=01)(2222 Finlayson KJ, Courtney MD, Gibb MA, O'Brien JA, Parker CN, Edwards HE. The effectiveness of a four-layer compression bandage system in comparison with class 3 compression hosiery on healing and quality of life in patients with venous leg ulcers: a randomized controlled trial. Int Wound J[Internet]. 2014 [cited 2017 Jun 05]; 11:21-7. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1742-481X. 2012.01033.x/epdf
http://onlinelibrary.wiley.com/doi/10.11...
), Level III (n=01)(2323 Salomé GM, Blanes L, Ferreira LM. The impact of skin grafting on the quality of life and self-esteem of patients with venous leg ulcers. World J Surg[Internet]. 2014 [cited 2017 Jun 05]; 38:233-40. Available from: https://link.springer.com/article/10.1007/s00268-013-2228-x
https://link.springer.com/article/10.100...
), and Level VII (n=01)(2525 Tracz E, Zamojska E, Modrzejewski A, Zaborski D, Grzesiak W. Quality of life in patients with venous stasis ulcers and others with advanced venous insufficiency. Holist Nurs Pract[Internet]. 2015 [cited 2017 Jun 06]; 29(2):96-102. Available from: https://insights.ovid.com/pubmed?pmid=25658932
https://insights.ovid.com/pubmed?pmid=25...
).

With regard to the most frequently adopted verbs in the description of the objectives, a prevalence of the verb “to compare” was found (n=04)(1414 Dias TYAF, Costa IKF, Liberato SMD, Souza AJG, Mendes FRP, Torres GV. Quality of life for venous ulcer patients: a comparative study in Brazil/Portugal. O Braz J Nurs[Internet]. 2013 [cited 2017 Jun 05]; 12(2):491-500. Available from: http://www.objnursing.uff.br/index.php/nursing/article/view/4344/pdf
http://www.objnursing.uff.br/index.php/n...
,1818 Dias TYAF, Costa IKF, Melo MDM, Torres SMSGSO, Maia EMC, Torres GV. Quality of life assessment of patients with and without venous ulcer. Rev Latino-Am Enfermagem[Internet]. 2014 [cited 2017 Jun 05]; 22(4):576-81. Available from: http://www.scielo.br/pdf/rlae/v22n4/0104-1169-rlae-22-04-00576.pdf
http://www.scielo.br/pdf/rlae/v22n4/0104...
,2020 Torres GV, Balduino LSC, Costa IKF, Mendes FRP, Vasconcelos QLDAQ. Comparison of quality of life domains in patientswith venous ulcer. Rev Enferm UERJ[Internet]. 2014 [cited 2017 Jun 05]; 22(1):57-64. Available from: http://www.facenf.uerj.br/v22n1/v22n1a09.pdf
http://www.facenf.uerj.br/v22n1/v22n1a09...
,2222 Finlayson KJ, Courtney MD, Gibb MA, O'Brien JA, Parker CN, Edwards HE. The effectiveness of a four-layer compression bandage system in comparison with class 3 compression hosiery on healing and quality of life in patients with venous leg ulcers: a randomized controlled trial. Int Wound J[Internet]. 2014 [cited 2017 Jun 05]; 11:21-7. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1742-481X. 2012.01033.x/epdf
http://onlinelibrary.wiley.com/doi/10.11...
), followed by the verbs “to evaluate” (n=03)(1313 Salomé GM, Ferreira LM. Quality of life in patients with venous ulcers treated with Unna's boot compressive therapy. Rev Bras Cir Plást[Internet]. 2012 [cited 2017 Jun 05]; 27(3):466-71. Available from: http://www.scielo.br/pdf/rbcp/v27n3/en_24.pdf
http://www.scielo.br/pdf/rbcp/v27n3/en_2...
,1717 Saraiva DMRF, Bandarra AJF, Agostinho ES, Pereira NMM, Lopes TS. Quality of life of service users with chronic venous ulcers. Referência[Internet]. 2013 [cited 2017 Jun 05]; 3(10):109-18. Available from: http://www.scielo.mec.pt/pdf/ref/vserIIIn10/serIIIn10a13.pdf
http://www.scielo.mec.pt/pdf/ref/vserIII...
,2323 Salomé GM, Blanes L, Ferreira LM. The impact of skin grafting on the quality of life and self-esteem of patients with venous leg ulcers. World J Surg[Internet]. 2014 [cited 2017 Jun 05]; 38:233-40. Available from: https://link.springer.com/article/10.1007/s00268-013-2228-x
https://link.springer.com/article/10.100...
), “to verify” (n=02)(1616 Dias TYAF, Costa IKF, Salvetti MG, Mendes CKTT, Torres GV. Influences of health care services and clinical characteristics on the quality of life of patients with venous ulcer. Acta Paul Enferm[Internet]. 2013 [cited 2017 Jun 05]; 26(6):529-34. Available from: http://www.scielo.br/pdf/ape/v26n6/en_04.pdf
http://www.scielo.br/pdf/ape/v26n6/en_04...
,2424 Sell BT, Souza MV, Martins T, Amante LN. Quality of life of pacients with vasculogenic ulcers according to Ferrans and Powers: wounds. J Health Sci[Internet]. 2015 [cited 2017 Jun 06]; 17(3):160-4. Available from: http://www.pgsskroton.com.br/seer/index.php/JHealthSci/article/view/3062/2849
http://www.pgsskroton.com.br/seer/index....
), “to analyze” (n=02)(2525 Tracz E, Zamojska E, Modrzejewski A, Zaborski D, Grzesiak W. Quality of life in patients with venous stasis ulcers and others with advanced venous insufficiency. Holist Nurs Pract[Internet]. 2015 [cited 2017 Jun 06]; 29(2):96-102. Available from: https://insights.ovid.com/pubmed?pmid=25658932
https://insights.ovid.com/pubmed?pmid=25...
-2626 Araújo RO, Silva DC, Souto RQ, Marconato AMP, Costa IKF, Torres GV. Impact of varicose ulcers on the quality of life of persons receiving primary care. Aquichan[Internet]. 2016 [cited 2017 Jun 06]; 16(1):56-66. Available from: http://www.scielo.org.co/pdf/aqui/v16n1/v16n1a07.pdf
http://www.scielo.org.co/pdf/aqui/v16n1/...
), “to correlate” (n=01)(1515 Lopes CR, Figueiredo M, Ávila AM, Soares LMBM, Dionisio VC. Evaluation of limitations of venous ulcers in legs. J Vasc Bras[Internet]. 2013 [cited 2017 Jun 05]; 12(1):5-9. Available from: http://www.scielo.br/pdf/jvb/v12n1/en_03.pdf
http://www.scielo.br/pdf/jvb/v12n1/en_03...
), “to determine” (n=01)(1919 Lozano SFS, Marinel JR, Carrasco EC, González RJP, Escudero RJR, Sánchez IN, et al. Venous leg ulcer in the context of chronic venous disease. Phlebol[Internet]. 2014 [cited 2017 Jun 05]; 29(4):220-6. Available from: http://journals.sagepub.com/doi/pdf/10.1177/0268355513480489
http://journals.sagepub.com/doi/pdf/10.1...
), and “to identify” (n=1)(2121 Wachholz PA, Masuda PY, Nascimento DC, Taira CMH, Cleto NG. Quality of life profile and correlated factors in chronic leg ulcer patients in the mid-west of São Paulo State, Brazil. An Bras Dermatol[Internet]. 2014 [cited 2017 Jun 05]; 89(1):73-81. Available from: http://www.scielo.br/pdf/abd/v89n1/0365-0596-abd-89-01-0073.pdf
http://www.scielo.br/pdf/abd/v89n1/0365-...
), these being in accordance with studies with a quantitative approach.

With regard to the instrument used to evaluate quality of life as shown in Chart 1, a prevalence of Short Form-36 (SF-36) was found in the studies. This instrument was used in seven studies(1313 Salomé GM, Ferreira LM. Quality of life in patients with venous ulcers treated with Unna's boot compressive therapy. Rev Bras Cir Plást[Internet]. 2012 [cited 2017 Jun 05]; 27(3):466-71. Available from: http://www.scielo.br/pdf/rbcp/v27n3/en_24.pdf
http://www.scielo.br/pdf/rbcp/v27n3/en_2...

14 Dias TYAF, Costa IKF, Liberato SMD, Souza AJG, Mendes FRP, Torres GV. Quality of life for venous ulcer patients: a comparative study in Brazil/Portugal. O Braz J Nurs[Internet]. 2013 [cited 2017 Jun 05]; 12(2):491-500. Available from: http://www.objnursing.uff.br/index.php/nursing/article/view/4344/pdf
http://www.objnursing.uff.br/index.php/n...

15 Lopes CR, Figueiredo M, Ávila AM, Soares LMBM, Dionisio VC. Evaluation of limitations of venous ulcers in legs. J Vasc Bras[Internet]. 2013 [cited 2017 Jun 05]; 12(1):5-9. Available from: http://www.scielo.br/pdf/jvb/v12n1/en_03.pdf
http://www.scielo.br/pdf/jvb/v12n1/en_03...
-1616 Dias TYAF, Costa IKF, Salvetti MG, Mendes CKTT, Torres GV. Influences of health care services and clinical characteristics on the quality of life of patients with venous ulcer. Acta Paul Enferm[Internet]. 2013 [cited 2017 Jun 05]; 26(6):529-34. Available from: http://www.scielo.br/pdf/ape/v26n6/en_04.pdf
http://www.scielo.br/pdf/ape/v26n6/en_04...
,1818 Dias TYAF, Costa IKF, Melo MDM, Torres SMSGSO, Maia EMC, Torres GV. Quality of life assessment of patients with and without venous ulcer. Rev Latino-Am Enfermagem[Internet]. 2014 [cited 2017 Jun 05]; 22(4):576-81. Available from: http://www.scielo.br/pdf/rlae/v22n4/0104-1169-rlae-22-04-00576.pdf
http://www.scielo.br/pdf/rlae/v22n4/0104...
,2020 Torres GV, Balduino LSC, Costa IKF, Mendes FRP, Vasconcelos QLDAQ. Comparison of quality of life domains in patientswith venous ulcer. Rev Enferm UERJ[Internet]. 2014 [cited 2017 Jun 05]; 22(1):57-64. Available from: http://www.facenf.uerj.br/v22n1/v22n1a09.pdf
http://www.facenf.uerj.br/v22n1/v22n1a09...
,2323 Salomé GM, Blanes L, Ferreira LM. The impact of skin grafting on the quality of life and self-esteem of patients with venous leg ulcers. World J Surg[Internet]. 2014 [cited 2017 Jun 05]; 38:233-40. Available from: https://link.springer.com/article/10.1007/s00268-013-2228-x
https://link.springer.com/article/10.100...
), followed by the instruments: Cardiff Wound Impact Schedule (n=01)(1717 Saraiva DMRF, Bandarra AJF, Agostinho ES, Pereira NMM, Lopes TS. Quality of life of service users with chronic venous ulcers. Referência[Internet]. 2013 [cited 2017 Jun 05]; 3(10):109-18. Available from: http://www.scielo.mec.pt/pdf/ref/vserIIIn10/serIIIn10a13.pdf
http://www.scielo.mec.pt/pdf/ref/vserIII...
); Short Form 12 Health Survey (n=1)(1919 Lozano SFS, Marinel JR, Carrasco EC, González RJP, Escudero RJR, Sánchez IN, et al. Venous leg ulcer in the context of chronic venous disease. Phlebol[Internet]. 2014 [cited 2017 Jun 05]; 29(4):220-6. Available from: http://journals.sagepub.com/doi/pdf/10.1177/0268355513480489
http://journals.sagepub.com/doi/pdf/10.1...
); Dermatology Life Quality Index (n=1)(2121 Wachholz PA, Masuda PY, Nascimento DC, Taira CMH, Cleto NG. Quality of life profile and correlated factors in chronic leg ulcer patients in the mid-west of São Paulo State, Brazil. An Bras Dermatol[Internet]. 2014 [cited 2017 Jun 05]; 89(1):73-81. Available from: http://www.scielo.br/pdf/abd/v89n1/0365-0596-abd-89-01-0073.pdf
http://www.scielo.br/pdf/abd/v89n1/0365-...
); Quality of Life Index (n=1)(2222 Finlayson KJ, Courtney MD, Gibb MA, O'Brien JA, Parker CN, Edwards HE. The effectiveness of a four-layer compression bandage system in comparison with class 3 compression hosiery on healing and quality of life in patients with venous leg ulcers: a randomized controlled trial. Int Wound J[Internet]. 2014 [cited 2017 Jun 05]; 11:21-7. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1742-481X. 2012.01033.x/epdf
http://onlinelibrary.wiley.com/doi/10.11...
); Ferrans and Powers Quality of Life Index-Wound Version (n=1)(2424 Sell BT, Souza MV, Martins T, Amante LN. Quality of life of pacients with vasculogenic ulcers according to Ferrans and Powers: wounds. J Health Sci[Internet]. 2015 [cited 2017 Jun 06]; 17(3):160-4. Available from: http://www.pgsskroton.com.br/seer/index.php/JHealthSci/article/view/3062/2849
http://www.pgsskroton.com.br/seer/index....
); Quality of Life Survey-WHOQOL 100 (n=1)(1515 Lopes CR, Figueiredo M, Ávila AM, Soares LMBM, Dionisio VC. Evaluation of limitations of venous ulcers in legs. J Vasc Bras[Internet]. 2013 [cited 2017 Jun 05]; 12(1):5-9. Available from: http://www.scielo.br/pdf/jvb/v12n1/en_03.pdf
http://www.scielo.br/pdf/jvb/v12n1/en_03...
); and Charing Cross Venous Ulcer Questionnaire (n=1)(2626 Araújo RO, Silva DC, Souto RQ, Marconato AMP, Costa IKF, Torres GV. Impact of varicose ulcers on the quality of life of persons receiving primary care. Aquichan[Internet]. 2016 [cited 2017 Jun 06]; 16(1):56-66. Available from: http://www.scielo.org.co/pdf/aqui/v16n1/v16n1a07.pdf
http://www.scielo.org.co/pdf/aqui/v16n1/...
).

The instrument SF-36 evaluates issues such as functional capacity, limitation due to physical aspect, pain, general health condition, vitality, social aspects, emotional aspect, and mental health. The Cardiff Wound Impact Schedule evaluates well-being, physical symptoms and daily life, social life, and quality of life in general. The Short Form 12 Health Survey (SF-12) evaluates physical function, physical aspect, pain, general health, vitality, social function, emotional aspect, and mental health. The Dermatology Life Quality Index (DLQI) evaluates issues regarding symptoms and feelings, activities of daily living, leisure, work and school, personal relationships, and treatment.

The Quality of Life Index measures dimensions regarding activities, daily life, health support, and psychological perspectives. The Ferrans and Powers Quality of Life Index-Wound Version evaluates issues regarding socioeconomic, family, psychological/spiritual, health, and functioning aspects. The instrument Quality of Life Survey-WHOQOL 100 evaluates physical and psychological issues, level of independence, social relationships, environment, and spiritual/religion/personal beliefs aspects. The instrument Charing Cross Venous Ulcer Questionnaire evaluates household activities, social interaction, emotional state, and aesthetics.

DISCUSSION

During the selection of potential bibliographies and the full reading of the articles, data categorization was carried out. This step considered the similarities among the materials selected. The following three categories emerged, which enabled the discussion of the theme: “The importance of assessing quality of life in patients with chronic venous ulcers”; “Difficulties, limitations, and feelings regarding patients with chronic venous ulcers”; and “What must be done for the improvement of quality of life in patients with chronic venous ulcers.”

The importance of assessing quality of life in patients with chronic venous ulcers

Chronic venous ulcers cause several changes in patients' lives due to pain, difficulty of locomotion, exudate, odor, and other aspects. These can lead to mood swings and changes in family relationships and social conviviality(1313 Salomé GM, Ferreira LM. Quality of life in patients with venous ulcers treated with Unna's boot compressive therapy. Rev Bras Cir Plást[Internet]. 2012 [cited 2017 Jun 05]; 27(3):466-71. Available from: http://www.scielo.br/pdf/rbcp/v27n3/en_24.pdf
http://www.scielo.br/pdf/rbcp/v27n3/en_2...
), thus making activities of daily living and social activities depend on how patients are feeling.

Activities of daily living such as going up or down stairs, moving around the house, standing up without support, bathing, and dressing(1414 Dias TYAF, Costa IKF, Liberato SMD, Souza AJG, Mendes FRP, Torres GV. Quality of life for venous ulcer patients: a comparative study in Brazil/Portugal. O Braz J Nurs[Internet]. 2013 [cited 2017 Jun 05]; 12(2):491-500. Available from: http://www.objnursing.uff.br/index.php/nursing/article/view/4344/pdf
http://www.objnursing.uff.br/index.php/n...
,1818 Dias TYAF, Costa IKF, Melo MDM, Torres SMSGSO, Maia EMC, Torres GV. Quality of life assessment of patients with and without venous ulcer. Rev Latino-Am Enfermagem[Internet]. 2014 [cited 2017 Jun 05]; 22(4):576-81. Available from: http://www.scielo.br/pdf/rlae/v22n4/0104-1169-rlae-22-04-00576.pdf
http://www.scielo.br/pdf/rlae/v22n4/0104...
) tend to bring negative repercussions to patients who, in general, also suffer from balance and walking difficulties(99 Joaquim FL, Camacho ACLF, Sabóia VM, Santos RC, Santos LSF, Nogueira GA. Impact of home visits on the functional capacity of patients with venous ulcers. Rev Bras Enferm[Internet]. 2016 [cited 2017 May 18]; 69(3):439-47. Available from: http://www.scielo.br/pdf/reben/v69n3/en_0034-7167-reben-69-03-0468.pdf
http://www.scielo.br/pdf/reben/v69n3/en_...
). Therefore, consequences of the pathological process lead to limitations and changes that impact quality of life and psychosocial and motor aspects, thus promoting restrictions on activities of daily living(1515 Lopes CR, Figueiredo M, Ávila AM, Soares LMBM, Dionisio VC. Evaluation of limitations of venous ulcers in legs. J Vasc Bras[Internet]. 2013 [cited 2017 Jun 05]; 12(1):5-9. Available from: http://www.scielo.br/pdf/jvb/v12n1/en_03.pdf
http://www.scielo.br/pdf/jvb/v12n1/en_03...
).

Chronic venous ulcers compromise patients' lives regarding functional capacity, limitations due to physical aspects, pain, general health condition, vitality, social aspects, emotional aspects, and mental health(1414 Dias TYAF, Costa IKF, Liberato SMD, Souza AJG, Mendes FRP, Torres GV. Quality of life for venous ulcer patients: a comparative study in Brazil/Portugal. O Braz J Nurs[Internet]. 2013 [cited 2017 Jun 05]; 12(2):491-500. Available from: http://www.objnursing.uff.br/index.php/nursing/article/view/4344/pdf
http://www.objnursing.uff.br/index.php/n...
). Therefore, assessment of the quality of life of patients with chronic venous ulcers is of utmost importance, because this is a response indicator of the wound's healing process(1313 Salomé GM, Ferreira LM. Quality of life in patients with venous ulcers treated with Unna's boot compressive therapy. Rev Bras Cir Plást[Internet]. 2012 [cited 2017 Jun 05]; 27(3):466-71. Available from: http://www.scielo.br/pdf/rbcp/v27n3/en_24.pdf
http://www.scielo.br/pdf/rbcp/v27n3/en_2...
). In addition, it provides indicators of which aspects may compromise the perception that patients present due to the pathology, and which feelings emerge based on this perception of living with the wound.

Difficulties, limitations, and feelings of patients with chronic venous ulcers

Patients with chronic venous ulcers present difficulties in performing simple activities of daily living. Wounds affecting the lower limbs interfere with locomotion, causing several limitations, thus forcing patients who live with the wounds to reorganize their daily activities. In addition, they feel dependent on others(1818 Dias TYAF, Costa IKF, Melo MDM, Torres SMSGSO, Maia EMC, Torres GV. Quality of life assessment of patients with and without venous ulcer. Rev Latino-Am Enfermagem[Internet]. 2014 [cited 2017 Jun 05]; 22(4):576-81. Available from: http://www.scielo.br/pdf/rlae/v22n4/0104-1169-rlae-22-04-00576.pdf
http://www.scielo.br/pdf/rlae/v22n4/0104...
) due to the etiology, pain associated with the ulcer, length of time from beginning of the wound, and severity of the depressive symptoms(2121 Wachholz PA, Masuda PY, Nascimento DC, Taira CMH, Cleto NG. Quality of life profile and correlated factors in chronic leg ulcer patients in the mid-west of São Paulo State, Brazil. An Bras Dermatol[Internet]. 2014 [cited 2017 Jun 05]; 89(1):73-81. Available from: http://www.scielo.br/pdf/abd/v89n1/0365-0596-abd-89-01-0073.pdf
http://www.scielo.br/pdf/abd/v89n1/0365-...
).

The difficulty in committing to/remaining at work, in addition to difficulties in performing daily and social activities, lead to repercussions due to physical restrictions, pain, and the psychological, emotional, and social implications caused by the wound(2020 Torres GV, Balduino LSC, Costa IKF, Mendes FRP, Vasconcelos QLDAQ. Comparison of quality of life domains in patientswith venous ulcer. Rev Enferm UERJ[Internet]. 2014 [cited 2017 Jun 05]; 22(1):57-64. Available from: http://www.facenf.uerj.br/v22n1/v22n1a09.pdf
http://www.facenf.uerj.br/v22n1/v22n1a09...
). Consequently, limitations resulting from the wounds become big obstacles for the performance of activities of daily living, as well as for clinical follow-up, because patients present difficulties in traveling to healthcare services(2727 Green J, Jester R, Mckinley A, Pooler S, Mason S, Redsell S. A new quality of life consultation template for patients with venous leg ulceration. J Wound Care[Internet]. 2015 [cited 2017 Jun 06]; 24(3):140-8. Available from: http://www.magonlinelibrary.com/doi/pdf/10.12968/jowc.2015.24.3.140
http://www.magonlinelibrary.com/doi/pdf/...
).

Another fact that is worth mentioning is the high amount of resources needed for the treatment(1919 Lozano SFS, Marinel JR, Carrasco EC, González RJP, Escudero RJR, Sánchez IN, et al. Venous leg ulcer in the context of chronic venous disease. Phlebol[Internet]. 2014 [cited 2017 Jun 05]; 29(4):220-6. Available from: http://journals.sagepub.com/doi/pdf/10.1177/0268355513480489
http://journals.sagepub.com/doi/pdf/10.1...
). Although public healthcare networks offer treatment, patients tend to allocate substantial resources to pay for medication/coverage, and when they are absent from work or are early retired because of the wound, they start reflecting on expenses and tend to abandon treatment to cover their own and their families' subsistence.

Chronic venous ulcers, in addition to physical changes and financial charges, bring implications of psychological and social context, extended to family and social spheres, thus showing the complexity of this problem(1616 Dias TYAF, Costa IKF, Salvetti MG, Mendes CKTT, Torres GV. Influences of health care services and clinical characteristics on the quality of life of patients with venous ulcer. Acta Paul Enferm[Internet]. 2013 [cited 2017 Jun 05]; 26(6):529-34. Available from: http://www.scielo.br/pdf/ape/v26n6/en_04.pdf
http://www.scielo.br/pdf/ape/v26n6/en_04...
). Consequently, chronic venous ulcers bring feelings of anxiety and depression disorders to patients, which tend to cause delays in the healing process of wounds from acute conditions(2222 Finlayson KJ, Courtney MD, Gibb MA, O'Brien JA, Parker CN, Edwards HE. The effectiveness of a four-layer compression bandage system in comparison with class 3 compression hosiery on healing and quality of life in patients with venous leg ulcers: a randomized controlled trial. Int Wound J[Internet]. 2014 [cited 2017 Jun 05]; 11:21-7. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1742-481X. 2012.01033.x/epdf
http://onlinelibrary.wiley.com/doi/10.11...
). Therefore, promoting psychological well-being to patients is necessary for the improvement of their clinical condition.

Unemployment/early retirement that affect patients who experience the wound, pain, functional limitations, feeling of frustration, odor, and aesthetic aspect that discourage interaction. This can lead to social isolation, lack of strength, concerns, low self-esteem, self-concept(2323 Salomé GM, Blanes L, Ferreira LM. The impact of skin grafting on the quality of life and self-esteem of patients with venous leg ulcers. World J Surg[Internet]. 2014 [cited 2017 Jun 05]; 38:233-40. Available from: https://link.springer.com/article/10.1007/s00268-013-2228-x
https://link.springer.com/article/10.100...
), and physical and social safety(2525 Tracz E, Zamojska E, Modrzejewski A, Zaborski D, Grzesiak W. Quality of life in patients with venous stasis ulcers and others with advanced venous insufficiency. Holist Nurs Pract[Internet]. 2015 [cited 2017 Jun 06]; 29(2):96-102. Available from: https://insights.ovid.com/pubmed?pmid=25658932
https://insights.ovid.com/pubmed?pmid=25...
). These are issues that also reflect the feelings of patients with venous ulcers, thus impacting quality of life, which suggests that care must address all life aspects of these patients.

What must be done for the improvement of quality of life in patients with chronic venous ulcers

For improvement of the quality of life of patients with venous ulcers, therapies must be optimized, doubts that may emerge must be clarified, and activities that relieve tensions and promote well-being and autonomy to patients and their families must be provided, through the adoption of best practice that ensures coherence and solidity to the care provided during the treatment process(1717 Saraiva DMRF, Bandarra AJF, Agostinho ES, Pereira NMM, Lopes TS. Quality of life of service users with chronic venous ulcers. Referência[Internet]. 2013 [cited 2017 Jun 05]; 3(10):109-18. Available from: http://www.scielo.mec.pt/pdf/ref/vserIIIn10/serIIIn10a13.pdf
http://www.scielo.mec.pt/pdf/ref/vserIII...
).

The nursing area has an important role in the care provided to these patients regarding therapeutic procedures that involve assessment of the diagnosis and healing process, as well as in the prevention of harm related to the pathology. This prevention must occur by means of the development/application of new technical interventions in nursing care and healthcare with the aim of recovery and rehabilitation of both patients and families involved in the care process.

Therefore, nurses who provide care to this population must be attentive to the evolution of the disease and seek the prevention of other wounds, recurrences, and the appropriate treatment for the healing of the wound, with the aim of reducing damage that the clinical condition promotes in the quality of life of these patients(1818 Dias TYAF, Costa IKF, Melo MDM, Torres SMSGSO, Maia EMC, Torres GV. Quality of life assessment of patients with and without venous ulcer. Rev Latino-Am Enfermagem[Internet]. 2014 [cited 2017 Jun 05]; 22(4):576-81. Available from: http://www.scielo.br/pdf/rlae/v22n4/0104-1169-rlae-22-04-00576.pdf
http://www.scielo.br/pdf/rlae/v22n4/0104...
). For this purpose, care must be focused not only on the wounds, but also on the patients who live with them, by intervening in the factors that compromise quality of life(2020 Torres GV, Balduino LSC, Costa IKF, Mendes FRP, Vasconcelos QLDAQ. Comparison of quality of life domains in patientswith venous ulcer. Rev Enferm UERJ[Internet]. 2014 [cited 2017 Jun 05]; 22(1):57-64. Available from: http://www.facenf.uerj.br/v22n1/v22n1a09.pdf
http://www.facenf.uerj.br/v22n1/v22n1a09...
).

During care, healthcare professionals usually do not ask about patients' concerns and complaints. They do not discuss them and there are no changes in the care process in order to resolve and minimize patients' concerns.

Nursing professionals must provide patients with comprehensive care, because patients with chronic venous ulcers are impaired in both bio-psycho-spiritual and socioeconomic aspects. Thus, professionals must be attentive to notice patients' weaknesses and intervene appropriately, not only focusing on clinical diagnoses, but also encouraging patients to face the difficulties resulting from their clinical condition, and providing them with comfort and well-being for possible improvement in their quality of life(1313 Salomé GM, Ferreira LM. Quality of life in patients with venous ulcers treated with Unna's boot compressive therapy. Rev Bras Cir Plást[Internet]. 2012 [cited 2017 Jun 05]; 27(3):466-71. Available from: http://www.scielo.br/pdf/rbcp/v27n3/en_24.pdf
http://www.scielo.br/pdf/rbcp/v27n3/en_2...
).

One study selected during the search(2424 Sell BT, Souza MV, Martins T, Amante LN. Quality of life of pacients with vasculogenic ulcers according to Ferrans and Powers: wounds. J Health Sci[Internet]. 2015 [cited 2017 Jun 06]; 17(3):160-4. Available from: http://www.pgsskroton.com.br/seer/index.php/JHealthSci/article/view/3062/2849
http://www.pgsskroton.com.br/seer/index....
) showed that, to improve the quality of life of these patients, updates of guidelines and protocols for the care of this type of wound are of the utmost importance, in addition to investments to improve quality of care by training multidisciplinary teams and providing health education for professionals and family members/caregivers.

Based on the abovementioned study, the importance of clinical conduct in the treatment of chronic venous insufficiency stands out, because signs and symptoms of the disease are directly associated with the impairment of quality of life in the population affected. Therefore, it is of utmost importance that the care provided to patients with chronic venous ulcers presents a drug therapy approach, topical therapy with local coverage, promotion of exudate control through the use or not of compression therapies, control of secondary infections, and prevention of recurrences(44 Barbosa JAG, Campos LMN. Guidelines for the treatment of venous ulcer. Enferm Glob[Internet]. 2010 [cited 2017 May 18]; 20:1-13. Available from: http://scielo.isciii.es/pdf/eg/n20/pt_revision2.pdf
http://scielo.isciii.es/pdf/eg/n20/pt_re...
) by means of post-healing follow-up by an angiologist. In addition, identification of specificities demanded by each patient are important, because patients who present wounds for a longer time tend to present a greater impairment of quality of life compared to those who live with the wounds for less than one year(2626 Araújo RO, Silva DC, Souto RQ, Marconato AMP, Costa IKF, Torres GV. Impact of varicose ulcers on the quality of life of persons receiving primary care. Aquichan[Internet]. 2016 [cited 2017 Jun 06]; 16(1):56-66. Available from: http://www.scielo.org.co/pdf/aqui/v16n1/v16n1a07.pdf
http://www.scielo.org.co/pdf/aqui/v16n1/...
).

The adoption of educational support for patients is also necessary, because low education level was shown in the present study as one of the factors that influences quality of life. This influence may be related to the lack of understanding of health recommendations, which tends to compromise the clinical conducts adopted and consequently lead to post-healing process recurrences. Therefore, the use of strategies based on education and health regarding patients' education level is of utmost importance, so that they are able to understand the clinical conduct adopted and actively participate as protagonists in their recovery process.

Study limitations

The current study presented as a limitation the fact that the research was based on articles from 2007 to 2016, and the articles selected with the criteria adopted were from 2012 to 2016. This may be related to the databases adopted for the development of the study.

Contributions to the nursing, healthcare, or public policy areas

The main contribution of the present study to the scientific research field in venous ulcers and the nursing area was to identify the factors that affect the quality of life of patients with chronic venous ulcers and the dimensions affected, namely those related to functional capacity, physical aspect, pain, general health condition, vitality, social aspects, emotional aspects, and mental health. These findings become especially relevant because impairment of quality of life will impact what patients feel about themselves and about presenting wounds, considering that these wounds significantly affect the performance of daily work and leisure activities.

These reflections enable professional improvement and the adoption of new healthcare interventions aimed at the recovery and rehabilitation of patients and their families.

CONCLUSION

The present study enabled an analysis of the impact of chronic venous ulcers on patients' quality of life, because the results identified that these wounds negatively impact on patients' integrality (bio-psycho-spiritual) and their socioeconomic sphere.

Therefore, patients with chronic venous ulcers must receive care based on kindness and sensible listening, in addition to emotional and psychological support during their treatment.

The development of the following assessment studies are recommended: strategies for the reduction in damages regarding venous ulcers on patients' quality of life; evaluation of the repercussions of psychological follow-up of patients on the healing process; and comparison of the assessment instruments regarding quality of life, with the aim to identify the best tool to measure the impacts of chronic venous ulcers' wounds.

ACKNOLEDGEMENT

To Colegio Doctoral Tordesillas de Enfermería for enabling the development of the present study through the partnership between the Fluminense Federal University (Brazil) and the Granada University (Spain), as well as the universities involved.

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Publication Dates

  • Publication in this collection
    Jul-Aug 2018

History

  • Received
    16 July 2017
  • Accepted
    25 Nov 2017
Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
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