The current status and influencing factors of quality of life of chronic wound patients based on Wound-QoL scale: A cross-sectional study

Abstract

This study aims to establish the current quality of life (QoL) of patients with chronic wounds and identify the factors influencing it. Convenience sampling was employed, and 223 patients with chronic wounds were recruited from a tertiary hospital in Deyang City between April 2023 and January 2024. Patients completed a demographic characteristics questionnaire, the Wound-QoL, the modified Barthel Index, and the Hospital Anxiety and Depression Scale. The impact of chronic wounds on the quality of life of the patients was analyzed through the linear regression analyses. The mean Wound-QoL score was 38.59 ± 10.92, with 4 domains: economic burden, psychological status, physiological status, and daily life, found to significantly influence wound QoL. Logistic regression revealed that the odds of QoL improvement were impacted by various risk factors, and multivariate linear regression identified the most significant ones: a wound area ≥100 cm², wounds located on the lower extremities, baseline anxiety scores of ≥7, and baseline depression scores of ≥7. Conversely, higher modified Barthel Index scores were predictive of poorer QoL (P < .05). These findings highlight that patients with chronic wounds generally exhibit low QoL, which is influenced by wound characteristics, psychological status, and daily activity limitations. Medical professionals should focus on these factors by implementing targeted strategies, including comprehensive wound care, enhancing functional independence, and addressing psychological well-being, to improve QoL and facilitate better wound healing outcomes.

1. Introduction

Chronic wounds represent a substantial medical challenge, defined as wounds in which skin tissue damage occurs due to various causes and deviates from the normal healing trajectory, with healing time exceeding 2 weeks.^[1] These wounds can be broadly classified into diabetic foot ulcers, venous lower extremity ulcers, pressure injuries, and poorly healing postsurgical wounds.^[2] The prevalence of chronic wounds has been increasing due to advancements in societal development and shifts in disease patterns. Consequently, the number of individuals affected by chronic wounds stemming from trauma and various diseases continues to rise.^[3] Chronic wounds currently affect approximately 1% to 2% of the global population.^[4] In the United States alone, over 5.7 million individuals are affected,^[5] while in China, more than 50 million people are affected annually.^[6] This escalating prevalence imposes a significant economic burden on families and healthcare systems, with treatment costs continuing to rise.^[4]

Chronic wounds profoundly affect patients’ physical, psychological, and social well-being, leading to substantial reductions in quality of life (QoL).^[7] The effects of chronic in daily life are shown in Figure 1. As the incidence of chronic wounds continues to grow, the assessment of QoL among affected individuals has become an area of increasing concern for healthcare providers.^[8] QoL is now recognized as a critical parameter for evaluating patient outcomes and the effectiveness of healing processes. While recent years have seen a notable rise in international research focusing on the QoL of patients with chronic wounds, limited studies have investigated QoL and its influencing factors within the context of China.

Figure 1.

Conceptual model of wound-related factors affecting daily life, adapted from Dorothy et al, 2021.

To address this gap, the present study aims to comprehensively evaluate the QoL of individuals with chronic wounds and identify the factors influencing their overall well-being. Understanding these factors will provide valuable insights to inform future interventions, enhance the management and care of chronic wounds, and ultimately improve patient outcomes.

2. Methods

2.1. Research setting

From April 2023 to January 2024, a convenience sampling method was employed to select 230 patients with chronic wounds who visited the wound care clinic of a tertiary hospital in Deyang City.

2.2. Sample size calculation

The sample size was calculated using G*Power 3.1 software, assuming a medium effect size (f² = 0.15), an alpha level of 0.05, power (1–β) of 0.80, and inclusion of up to 10 predictor variables in the regression analysis. The minimum required sample size was estimated to be 118. To account for potential missing or incomplete data, the sample size was increased by approximately 30%, resulting in a target sample of at least 154. Ultimately, 230 patients were enrolled in the study.

2.3. Inclusion and exclusion criteria

The study included patients with diabetic wounds, venous ulcers of the lower limbs, pressure injuries, and wounds with poor healing postsurgery. The inclusion criteria were a diagnosis of chronic wounds lasting more than 14 days, age 18 or older, and voluntary participation with signed informed consent.

The exclusion criteria were acute attacks of other diseases, mental illness or cognitive impairment, and incomplete questionnaire information.

2.4. Ethical consideration

This study was reviewed and approved by the Ethics Committee of Deyang Second People’s Hospital (ref no. DEYL-2022-46) and registered with the Chinese Clinical Trial Registry (ChiCTR) under the trial application number ChiCTR2300072278 (http://www.chictr.org.cn/).

2.5. Research tools

Customized questionnaires to gather patient demographic and clinical data, including gender, age, education, marital status, employment, comorbidities, wound location, type, size, and duration. The Wound-QoL scale, developed by Blome and his team in 2014, evaluates the impact of chronic wounds on patients’ quality of life across 3 dimensions: physiological condition, psychological status, and day-to-day life conditions. The scale uses a Likert scoring scale, with points ranging from 1 to 5.^[9] The scale is brief but rigorous, providing a comprehensive evaluation of chronic wound patients’ quality of life. It has been applied in various countries, including the United States, the UK, Brazil, the Netherlands, Germany, and Australia. The Chinese version was localized in 2022, maintaining its original 17 items. The Barthel Index is a widely used tool for assessing activities of daily living (ADL) capacity. This study used the modified Barthel Index (MBI) to assess patients’ ability to perform daily activities. The MBI consists of 10 core instrumental ADL (IADL) measures and the IADL-7 self-care index. The scale ranges from 0 to 100, with scores indicating severe dependence, moderate, mild, or no dependence. The MBI is easy to complete and reliable, with an internal consistency of 0.94 Cronbach α coefficient.^[10] The Hospital Anxiety and Depression Scale is a widely adopted tool for assessing anxiety and depression in general hospital settings.

2.6. Data collection

The study involved uniformly trained investigators evaluating patients with chronic wounds, using unified instructional language. Patients signed informed consent forms, and the investigators completed questionnaires and assessments. Patients filled in their own questions, with the investigators providing guidance if needed. Questionnaires were distributed and collected, with multiple or missed selections modified or supplemented as needed.

Before analysis, all collected questionnaires were reviewed for completeness. In cases of minor missing data (i.e., fewer than 5% of total responses), the mean substitution method was applied for continuous variables and mode substitution for categorical variables. Questionnaires with more than 10% missing responses (n = 7) were excluded from final analysis to ensure data quality and reliability. Data of 223 patients was proceeded to statistical analysis.

2.7. Statistical analysis

Excel software was used for data entry by 2 team members. Statistical analyses were performed using Statistical Package for Social Sciences (SPSS)® software, version 24.0.^[11] The relevant measurement data involved in this study were expressed as mean ± standard deviation ($\overline{x}\pm \mathrm{S}\mathrm{D}$) if they were consistent with normal distribution and as P50 (P25, P75) if they were not consistent with normal distribution. Count data was expressed as frequency (n) and percentage (%); between groups, independent sample t test, one-way analysis of variance, and nonparametric test were used for comparison; factors with P < .05 in the univariate analysis were entered into the stepwise linear regression model to determine the influencing factors related to the quality of life. P < .05 was considered as a statistically significant difference.

Figure 2 shows an illustration for the methodology used in the study.

Figure 2.

Key elements of study.

3. Results

3.1. Demographics and clinical characteristics of patients with chronic wounds

A total of 230 questionnaires were distributed in this study, and questionnaires with incomplete information were eliminated. Finally, 223 valid questionnaires were recovered, with an effective rate of 96.95%. Among the 223 chronic wound patients included, 129 were male and 94 female; age was (64.26 ± 16.07) years old; 89.7% had a spouse; 41.70% of the chronic wound patients had a primary school education or below; their occupation was mental workers; mainly 75.8% of patients live in cities for a long time; 61.4% of patients have underlying diseases; 84.8% of patients have caregivers; 45.3% have pressure injury wounds; 64.1% of patients use wet healing methods for wound treatment; daily life of patients with chronic wounds. The mobility score was (71.17 ± 23.85); 116 patients (52%) had anxiety scores ≥7 points; 92 patients (41.25%) had depression scores ≥7 points. See Table 1.

Table 1.

Basic situation of chronic wound patients and single-factor analysis affecting the QoL of chronic wound patients (n = 223).

Variables		Frequency (n)		Percentage (%)	Total QoL score	F/T/H statistics (as appropriate)	P
Gender	Male	129		57.85	37.43 ± 9.70	3.106	.064
	Female	94		42.15	40.18 ± 12.30
Age (yr)	18–59	88		39.46	35.67 ± 9.81	8.264	.000
	60–79	99		44.39	39.21 ± 9.89
	≥80	36		16.14	44.03 ± 13.83
Marital status	Not married	23		10.31	39.39 ± 11.59	0.370	.712
	Married	200		89.69	38.50 ± 10.87
Educational qualification	Elementary school and below	93		41.70	39.67 ± 10.43	0.639	.591
	Junior high school	48		21.52	38.06 ± 9.95
	High school/technical secondary school	63		28.25	37.97 ± 11.74
	Undergraduate/college degree and above	19		8.52	36.00 ± 14.82
Profession	Physical work	46		20.63	37.93 ± 9.06	0.107	.899
	Office work	109		48.88	38.72 ± 11.56
	Unemployed	68		30.49	38.84 ± 11.16
Long-term residence	Rural	54		24.22	39.83 ± 12.00	0.959	.339
	Urban	169		75.78	38.20 ± 10.56
Household per capita income (yuan)	<1000	23		10.31	39.91 ± 7.07	2.172	.116
	1000–3000	66		29.60	40.62 ± 11.87
	>3000	134		60.09	37.37 ± 10.88
Caregiver	No	34		15.25	34.24 ± 10.54	-2.556	.011
	Yes	189		84.75	39.38 ± 10.84
Basic illness	Yes	137		61.43	39.97 ± 8.45	4.130	.038
	No	86		38.57	36.67 ± 12.49
Cost of wound treatment reimbursed?	Yes	171		76.68	38.86 ± 10.77	0.000	.508
	No	52		23.32	37.71 ± 11.5
How long the wound lasted (months)	≤1	134		60.09	36.87 ± 10.07	5.524	.005
	1–2	50		22.42	39.66 ± 10.70
	≥2	39		17.49	43.15 ± 12.69
Wound location	Trunk	103		46.19	38.52 ± 10.29	0.928	.397
	Lower limbs	90		40.36	39.43 ± 11.64
	Upper limbs	30		13.45	36.30 ± 10.84
Wound size (cm2)	<25	171		76.68	36.91 ± 9.67	10.026	.000
	25–100	43		19.28	43.35 ± 11.78
	>100	9		4.04	47.78 ± 17.96
Wound type	Diabetic foot wounds	25		11.21	40.44 ± 10.4	4.575	.004
	Pressure injury wound	101		45.29	40.67 ± 10.57
	Surgery related wounds	39		17.49	33.59 ± 10.1
	Others*	58		26.01	37.53 ± 11.32
Wound treatment methods	Desiccation therapy	80		35.87	37.46 ± 12.67	7.306	.249
	Moist healing	143		64.13	39.22 ± 9.81
MBI score	0–40	24		10.76	48.00 (40.00, 57.75)	44.865	.000
	41–60	47		21.08	39.00 (36.00, 45.00)
	61–99	117		52.47	37.00 (31.50, 43.00)
	100	35		15.70	30 (24.00, 35.00)
Hospital Anxiety and Depression Scale	Anxiety score	<7	107	47.98	34.00 ± 8.88	2.436	.000
		≥7	116	52.02	42.83 ± 10.96
	Depression score	<7	131	58.74	29.59 ± 5.88	0.695	.022
		≥7	92	41.26	35.62 ± 7.71

^* Includes arteriovenous ulcers, burns, animal bites, and gout wounds.

3.2. Current status of quality of life of patients with chronic wounds

Based on the Wound-QoL scale analysis (Table 2), the total quality of life score among patients with chronic wounds was 38.59 ± 10.92, indicating a moderate impact on overall well-being. Among the 4 assessed domains, daily life conditions showed the highest mean item score (2.86 ± 0.96), suggesting that chronic wounds most significantly disrupted patients’ functional abilities and routine activities. Psychological condition (2.24 ± 0.76) and physiological condition (2.56 ± 0.77) were also moderately affected, reflecting emotional distress and physical symptoms such as pain and discomfort. The economic burden domain, though assessed with a single item, showed a mean score of 1.96 ± 0.93, indicating financial strain due to wound-related care. These results highlight that chronic wounds impair quality of life across multiple dimensions, with daily life functioning being the most adversely impacted.

Table 2.

Wound-QoL scale scores of patients with chronic wounds (n = 223).

Variables		Scoring range	Frequency	Total score ($\overline{\mathit{x}}\pm \mathbf{S}\mathbf{D}$)	Entries are evenly divided ($\overline{\mathit{x}}\pm \mathbf{S}\mathbf{D}$)
Wound-QoL scale	Physiological condition	5–24	5	10.25 ± 3.09	2.56 ± 0.77
	Psychological condition	5–25	5	11.20 ± 3.80	2.24 ± 0.76
	Daily life functioning	6–30	6	15.18 ± 5.38	2.86 ± 0.96
	Economic burden	1–4	1	1.96 ± 0.93	1.96 ± 0.93
	Total score	17–83	17	38.59 ± 10.92	2.41 ± 0.683

Stratified analysis showed that QoL scores significantly varied by wound duration (P = .005), wound size (P = .000), and wound type (P = .004), but not by wound location (P = .397). Specifically, patients with wounds lasting more than 2 months, wounds larger than 100 cm², and diabetic foot or pressure injuries reported poorer QoL scores (Table 1).

3.3. Single-factor analysis affecting the quality of life of patients with chronic wounds

Demographic and sociological data and chronic wound-related data were used as independent variables in single-factor analysis. In contrast, the total score of the Wound-QoL scale of chronic wound patients was utilized for the dependent variable. A statistically significant difference was identified in age, caregivers, underlying diseases, and wound duration while comparing the total scores of patients on the Wound-QoL scale with the duration of the wound, size of the wound, type of wound, MBI score, and anxiety and depression score was also found to be statistically significant (P < .05) as is evident from Table 2.

3.4. Multiple linear regression analysis of the impact on the quality of life of patients with chronic wounds

Since scale data are used to measure the quality of life of chronic wound patients, multiple linear regression analysis was chosen. The patient’s chronic wound total quality of life was taken as a dependent variable, and we used factors with statistical and clinical significance in the single-factor analysis as independent variables and used them in multiple linear regression analysis. Table 3 shows the variable assignments. Table 4 shows that wound area ≥100 cm², wound location on lower limbs, MBI score, anxiety score ≥7, and depression score ≥7 are factors affecting the quality of life of patients with chronic wounds, and differences are statistically significant (P < .05).

Table 3.

Variable assignment.

Project	Assignment status
Age	18–59 yr (Z1 = 0, Z2 = 0), 60–79 yr (Z1 = 1, Z2 = 0), ≥80 yr (Z1 = 0, Z2 = 1)
Caregiver	None (Z = 0), have (Z = 1)
Basic illness	None (Z = 0), have (Z = 1)
How long the wound lasts?	≤1 mo (Z1 = 0, Z2 = 0), 1–2 mo (Z1 = 1, Z2 = 0), ≥3 mo (Z1 = 0, Z2 = 1)
Wound size	≤25 cm2 (Z1 = 0, Z2 = 0) (25.1–100) cm2 (Z1 = 1, Z2 = 0), ≥100 cm2 (Z1 = 0, Z2 = 1)
Wound type	Diabetic foot wounds (Z1 = 0, Z2 = 0, Z3 = 0), pressure injury wound (Z1 = 1, Z2 = 0, Z3 = 0), surgery related wounds (Z1 = 0, Z2 = 1, Z3 = 0), other (Z1 = 0, Z2 = 0, Z3 = 1)
Wound location	Trunk (Z1 = 0, Z2 = 0), upper limbs (Z1 = 1, Z2 = 0), lower limbs (Z1 = 0, Z2 = 1)
MBI score	(0–40) point (Z1 = 0, Z2 = 0, Z3 = 0), (41–60) point (Z1 = 1, Z2 = 0, Z3 = 0), (60–99) point = (Z1 = 0, Z2 = 1, Z3 = 0), 100 point (Z1 = 0, Z2 = 0, Z3 = 1)
Anxiety score	<7 point (Z = 0), ≥7 point (Z = 1)
Depression score	<7 point (Z = 0), ≥7 point (Z = 1)

Table 4.

Multiple linear regression analysis of the impact on the quality of life of patients with chronic wounds.

		β	SE	t	P	95% CI	VIF
(Constant)		38.172		8.769	.000	[29.589, 46.755]
Age* (yr)
60–79		1.004	0.046	0.620	.536	[‐2.190, 4.199]	1.799
≥80		0.993	0.033	0.444	.657	[‐3.412, 5.397]	1.876
Caregiver†
Yes		1.332	0.044	0.685	.494	[‐2.502, 5.167]	1.357
Basic disease‡
Yes		0.287	0.013	0.185	.853	[‐2.770, 3.345]	1.582
Wound duration§ (months)
1–2		‐1.383	‐0.053	‐0.859	.391	[‐4.557, 1.791]	1.251
≥2		0.374	0.013	0.198	.843	[‐3.343, 4.092]	1.425
Wound size∥ (cm2)
(25.1–100)		2.085	0.075	1.219	.224	[‐1.287, 5.457]	1.264
≥100		8.711	0.157	2.665	.008	[2.265, 15.156]	1.149
Wound type¶
Pressure injury wound		‐1.007	‐0.046	‐0.404	.687	[‐5.921, 3.909]	4.276
Surgery related wounds		‐1.447	‐0.050	‐0.526	.600	[‐6.872, 3.979]	3.035
Other wounds		1.303	0.052	0.516	.606	[‐3.673, 6.279]	3.403
Wound location#
Lower limbs		4.565	0.205	2.718	.007	[1.253, 7.876]	1.885
Upper limbs		1.442	0.045	0.635	.526	[‐3.036, 5.921]	1.668
MBI score**
Moderate dependence		‐6.691	‐0.250	‐2.765	.006	[‐11.462, ‐1.920]	2.705
Mild dependence		‐7.954	‐0.364	‐3.335	.001	[‐12.657, ‐3.251]	3.941
No dependencies required		‐14.022	‐0.468	‐4.671	.000	[‐19.940, ‐8.103]	3.310
Hospital Anxiety and Depression Scale	Anxiety score†† ≥7	3.736	0.171	2.315	.022	[0.553, 6.918]	1.805
	Depression score‡‡ ≥7	5.269	0.238	3.518	.001	[2.315, 8.222]	1.509

R² = 0.382, adjR² = 0.328, F = 7.009, P < .001.

^* Age (18–59) years old.

^† Caregiver is none.

^‡ Primary disease is none.

^§ Wound duration is ≤1 month.

^∥ Wound size ≤ 25 cm².

^¶ Wound type is diabetic foot wound.

^# Wound location is trunk.

^** MBI score is 0–40 points.

^†† Anxiety score <7 points.

^‡‡ Depression score <7 points.

To assess multicollinearity among the independent variables in the multiple linear regression model, the variance inflation factor (VIF) was calculated for each predictor. A commonly accepted threshold for identifying multicollinearity is a VIF value above 10, which indicates a high degree of correlation that could distort the regression estimates. However, VIF > 5 thresholds are also sometimes used to detect moderate multicollinearity. In this study, all VIF values were below 5, with the highest being 4.276, suggesting that multicollinearity was not a concern and that the estimates of the model are stable and interpretable.

4. Discussion

4.1. Applicability of Wound-Qol scale

The Wound-QoL scale, developed in Germany by Professor Blome and his team in 2014,^[12] is a comprehensive tool designed to evaluate the quality of life in patients with chronic wounds. It was created by integrating elements from 3 existing scales: the Freiburg Wound Patient Quality of Life Assessment Scale, the Cardiff Wound Impact Scale, and the Wuerzburg Wound Score. The Wound-QoL scale represents the most recent international advancement in assessing the quality of life in this patient population.

In 2022, Liu and colleagues introduced the Chinese version of the Wound-QoL scale with authorization from Professor Blome.^[13] The adaptation involved collaboration with medical professionals, including doctors, specialized nurses, and deputy chief physicians from the wound repair department. The translation process adhered strictly to the Brislin translation-back-translation method, employing a double translation-back-translation approach to ensure accuracy and cultural relevance. The final Chinese version retains the original scale’s structure, consisting of 17 items across 3 dimensions, and was used to survey the quality of life among chronic wound patients in Guangxi. Analysis of this version demonstrated strong reliability and validity, with a Cronbach α coefficient of 0.96 in this study. The Wound-QoL scale is notable for its concise and user-friendly design, making it a valuable tool for comprehensively assessing the quality of life in chronic wound patients and suitable for clinical application.

4.2. Analysis of the current quality of life of patients with chronic wounds

This study found that the total Wound-QoL score for patients with chronic wounds was 38.59 ± 10.92, which is higher than the scores reported by Liu among patients treated at the wound clinic and ward of the First Affiliated Hospital of Guangxi University of Chinese Medicine.^[13] The relatively low quality of life observed in this study may be attributed to the fact that a significant proportion of the patients (60.5%) were over 60 years old. Previous research has indicated that age significantly impacts the quality of life of patients with chronic wounds. As individuals age, the functionality of their significant organs declines, and their resistance and barrier functions diminish, making them more susceptible to infections and delayed wound healing.^[14] This deterioration results in a decrease in overall quality of life.^[15]

Among the chronic wound patients in this study, 52.2% have a poor quality of life, and 10.2% have an inferior quality of life. The highest impact on overall quality of life was observed in the domain of daily life functioning of the patient, consistent with previously reported findings.^[16] This impact may be attributed to the extent that the wounds restrict the activities of the patient. Wound pain, odor, exudate, and negative emotions influence a patient’s impaired ability to perform their daily activities when affected by chronic wounds.^[4] In light of these findings, medical staff should pay more attention to and work on creating treatment and nursing interventions, as well as individual approaches, related to recurrent clinical symptoms of chronic wounds. Adequate nursing evaluation alongside pharmacological management of symptoms is essential in preventing the consequences of chronic wounds on patients. The overall outcomes of the study are shown in Figure 3.

Figure 3.

Outcomes of the study, including overall QoL scores and recommendations.

4.3. Analysis of factors affecting the quality of life of patients with chronic wounds

The results of multiple linear regression analysis indicated that patients with a wound area ≥100 cm², wounds located on the lower limbs, and those with anxiety or depression scores ≥7 points had significantly higher Wound-QoL scale scores (P ≤ .05), reflecting a worse quality of life. Specifically, a larger wound area was associated with a more significant negative impact on the patient’s quality of life. This finding aligns with the results reported by Wilma.^[17] A larger wound area generally correlates with more severe pain, prolonged healing time, an increased likelihood of infection, and more significant disruption to daily life. These factors contribute to negative emotions and diminish the patient’s quality of life.^[18]

In this study, lower limb wounds such as diabetic foot ulcers, arteriovenous ulcers, and postoperative infected wounds, had a particularly adverse effect on quality of life. This observation is consistent with previous reports in the literature.^[16] The presence of wounds on the lower limbs, coupled with pain, often leads to difficulties in mobility and stair climbing, which can hinder patients’ ability to perform everyday activities like shopping, cleaning, washing, and gardening, as well as their social interactions.^[17] Consequently, this impacts their overall quality of life.

To address these issues, patients should receive professional guidance on using lower limb assistive devices, gait training, and physical therapy during wound treatment. The results from the Hospital Anxiety and Depression Scale demonstrated that anxiety and depression negatively affect the quality of life for patients with chronic wounds. These findings are in line with the Portuguese study by Alves, which highlights how prolonged wound healing can lead to psychological issues such as helplessness and frustration.^[16] The presence of chronic wounds can damage a patient’s self-image, lead to self-rejection or dislike, and foster negative emotions, resulting in interpersonal tension and increased physical strain.^[19] Additionally, anxiety and depression can contribute to sleep disturbances, which further impair the patient’s ability to manage daily activities and significantly reduce quality of life.^[19]

Additionally, this study established a negative relationship between patients’ functional independence, measured by the MBI, and their quality of life according to the Wound-QoL scale. An increase in the MBI tool results in better performance of the daily activity and is associated with a higher mean Wound-QoL scale, which reflects a better quality of life. This relationship can be attributed to chronic wound patients’ limitations, such as pain, odor, and exudation: bathing, toileting, walking, and stair climbing reported reduced quality of life.^[20] A review of the literature reveals that increased mobility facilitates the performance of better self-care and wound care with a consequential impact on physical, psychological, lifestyle, and economic quality of life.^[21]

In summary, factors such as wound area, wound location, the ability to perform daily activities, and levels of anxiety and depression all significantly impact the quality of life for patients with chronic wounds. Improving Quality of life is a critical health outcome and the primary goal of treating and managing chronic wounds. Currently, treatment approach for chronic wound patients in China follows a traditional model that emphasizes wound healing over the overall Quality of life. Effective management of chronic wounds should extend beyond diagnosis, debridement, and dressing changes to address the patient’s physiological and psychological well-being. Therefore, healthcare providers need to focus on the comprehensive needs of these patients. During treatment, they should assess the wound condition, daily functional abilities, and psychological state of the patient and implement targeted treatment plans to enhance wound healing and quality of life. This study, being a cross-sectional survey, includes only a limited number of influencing factors. Future research should involve intervention studies with larger sample sizes to better address and improve the quality of life for patients with chronic wounds.

5. Implications

The present study supports earlier results, stressing that chronicity negatively impacts patients’ quality of life, their ability to carry out chores, pain, odor, and exudate, and negative feelings, which significantly affect daily functioning.

This is a simplified summary of factors jeopardizing the quality of life of patients with chronic wounds; consequently, bigger wound size (≥100 cm²), lower limb lesions, as well as higher AUASI, AUAni ≥ 7. More extensive lesions are associated with worsening of signs and symptoms, including pain and infection, delayed recovery, and interference with everyday living.^[22] This is consistent with prior investigations, which stated that a more significant extent of injury is correlated with an increased degree of post-injury psychological dysfunction and a decreased capability to perform communal activities. Among these, reduced mobility, which is mainly caused by lower limb wounds such as diabetic foot ulcers or postoperative infection, as well as the functional hindrance of discomfort in performing basic daily tasks, seriously affects the quality of life.^[23]

Similarly, we established the psychological impact of chronic wounds manifested by higher levels of anxiety and depression active in depressing quality of life. The persistent nature of chronic wounds may lead to considerable psychological distress, manifesting as anxiety, stress, depression, helplessness and frustration. These factors should be carefully considered in the comprehensive assessment and management of patients with chronic wounds. The patients may acquire bad attitudes toward themselves, feel lonely, and undergo much exertion since they cannot perform routine activities properly. Patients with anxiety and depressive disorder also have sleep disturbances, which will also make these challenges worse.^[24] This work establishes that functional independence by means of the MBI is significantly related to quality of life. Patients with a higher level of activity indicated that they have a better quality of life. In contrast, patients with low functional status indicated a decreased quality of life because of limited mobility and self-care activities.

6. Limitations of the study

This study has several limitations that should be acknowledged. First, the cross-sectional design limits the ability to establish temporal relationships, precludes causal inferences, and makes the findings susceptible to history effects and reverse causality. Second, the use of convenience sampling and restriction of the study to a single geographical area may affect the generalizability of the results to broader or more diverse populations. Third, data collection relied solely on self-reported questionnaires, which may introduce moderate to high levels of response bias. Additionally, important covariates and potential confounding factors, such as socioeconomic status, comorbid conditions, and wound management practices, were not included in the analysis. Notably, no statistical adjustments were made for these confounders during the regression modeling, which may limit the robustness of the observed associations. Future research should consider longitudinal study designs, more representative and multiethnic samples, and analytical approaches that account for a broader range of variables influencing the quality of life in patients with chronic wounds.

7. Conclusion

The findings of this study underscore the substantial impact of chronic wounds on patients’ quality of life, with the most pronounced effects observed in domains related to daily functioning, physiological discomfort, and psychological well-being. Factors such as larger wound size, lower limb wound location, and elevated levels of anxiety and depression were significantly associated with poorer quality of life outcomes. These results highlight the need for an integrated, multidisciplinary approach to chronic wound management that addresses both physical and psychological dimensions of care. The insights gained from this study may inform clinical decision-making and support the development of targeted interventions and policy strategies aimed at improving patient outcomes and optimizing resource allocation in chronic wound care.

Author contributions

Conceptualization: He Chunmei.

Data curation: Zhang Hongying, Chen Lijuan, Tian Miao.

Formal analysis: Xie Jingying, Jiang Hongmei.

Funding acquisition: He Chunmei.

Investigation: Chen Lijuan, Tian Miao.

Methodology: Zhang Hongying, He Yang.

Project administration: Yang Min.

Resources: He Chunmei.

Software: He Yang.

Supervision: He Chunmei.

Validation: Xie Jingying, Jiang Hongmei, He Yang.

Writing – original draft: Hu Jing, Yang Min.

Writing – review & editing: Zhang Hongying, He Chunmei, Chen Lijuan, Tian Miao, Xie Jingying, Jiang Hongmei, Hu Jing, He Yang, Yang Min.