Development and psychometric evaluation of the U.S. English Wound‐QoL questionnaire to assess health‐related quality of life in people with chronic wounds

Abstract

People with chronic wounds perceive an impaired health‐related quality of life (HRQoL). For the assessment of HRQoL, valid instruments are needed. Therefore, the Wound‐QoL questionnaire was originally developed and psychometrically validated for use in Germany. As the Wound‐QoL is to be used in numerous countries, international versions are required. Therefore, this study aimed to psychometrically validate the U.S. English Wound‐QoL version. Upon translation into U.S. English, psychometric testing was performed based on cross‐sectional data deriving from the U.S. Wound Registry. Besides descriptive statistics, internal consistency and concurrent validity were tested. In addition, a graded response model was used. The sample consisted of 599 people with chronic wounds of different etiologies. Participants were between 18 and 95 years old, mean age was 63.7 (SD = 15.9) years. Gender was distributed almost equally, with 47.4% female patients. High internal consistency, low floor and ceiling effects of the subscales could be largely confirmed. The internal consistency of the global score was excellent, with α > .9. Concurrent validity between the Wound‐QoL and pain, the surface area of the largest wound, total surface area, and total number of active wounds could be confirmed. In contrast, item response theory (IRT) analyses could not fully confirm the factorial model underlying the Wound‐QoL subscales. Furthermore, the items regarding smell and discharge and the items on problems with hitting the wound against something, climbing stairs and feeling dependent on help from others showed a low item information in their belonging dimensions. In conclusion, the newly validated Wound‐QoL is available for HRQoL measurement in people with chronic wounds in the United States. It showed good psychometric properties, demonstrating its reliability and validity. Therefore, the instrument may be used to assess HRQoL in clinical practice. However, IRT analyses showed that the instrument may benefit from future refinement.

Assessing the quality of life of people with chronic wounds by using the cross‐culturally valid and revised Wound‐QoL questionnaire

“…Wound Registry and only routinely collected data was available. 20 As mentioned before, small changes in the Wound-QoL questionnaire were made in Israel and the Netherlands, which implicated a lower quality of the used data. Additionally, the validation studies conducted in Germany and Sweden included patients from specialist centres with expertise in wound management.…”

“…In addition, they must have had the ability to read and understand English language. 20 Practice improvement or quality reporting are exempted from the institutional review boards within the U.S. Wound Registry projects.…”

“…16 Researchers have established the reliability and validity of the frequently used Wound-QoL. 17,18 It was sequentially translated and psychometrically validated into different languages, for example, Dutch, 19 U.S. English, 20 Spanish, 21 Swedish, 22 and Hebrew. 8 Alternative subscale structures have been tested in the Hebrew study.…”

“…In addition, the researchers could not completely confirm the factor structure of the original German version. 20 The development Wound-QoL was concomitant with difficulties during its application in clinical practice. For example, some patients struggled with answering the items on their ability to move around (item 11), climbing stairs (item 12) or being dependent for help on others (item 16).…”

Association of wound genesis on varying aspects of health‐related quality of life in patients with different types of chronic wounds: Results of a cross‐sectional multicentre study

“…The Wound‐QoL questionnaire was published first in 2014 and has been tested for validity, reliability, and feasibility. 4 , 6 , 7 , 8 , 9 , 10 The Wound‐QoL allows assessing the impact of chronic wounds on different aspects of HRQoL, including physical, psychological, and everyday life‐related impairments. Although previous studies have documented significantly impaired HRQoL in chronic wound patients, 11 it remains yet unclear how HRQoL impairment differs depending on wound genesis.…”