Understanding Diabetes-related Foot Ulcers Beyond the Wound Pain, Patient Experiences and Healthcare Encounters

Abstract

Diabetes-related foot ulcers (DFUs) are a severe complication of diabetes associated with amputation and premature mortality. Living with a DFU affects multiple aspects of everyday life. DFU-related pain has been associated with reduced functional ability and psychological distress, yet knowledge about how pain is recognised, assessed and managed in healthcare remains limited. The overall aim of this dissertation is to advance the understanding of DFU as both a clinical condition and a lived experience, with particular focus on DFU-related pain, its impact on everyday life and its recognition and management in clinical practice. The dissertation includes four studies using qualitative and quantitative methods: a systematic review of wound cleansing solutions, two interview studies exploring experiences of living with DFUs and DFU-related pain and a cross-sectional study of DFU-related pain, pain interference, self-rated health, pain management and healthcare encounters. The findings showed that living with a DFU involved ongoing adaptation, uncertainty and restrictions in everyday life. Participants described limitations in mobility, work, social participation and independence, along with concerns about ulcer deterioration, infection and amputation. Participants with DFU-related pain reported substantial pain interference and restrictions in everyday life. Self-rated health was lower among participants with painful DFUs than among those without pain, although the difference was not statistically significant. Although participants reported high ratings of being seen, heard and understood by HCPs in the cross-sectional study, qualitative findings showed that pain and its consequences for everyday life were not always explored or addressed. The systematic review found limited evidence for wound cleansing interventions, with all included studies at high risk of bias and limited attention to pain as an outcome. Living with a DFU extends beyond the ulcer and affects multiple dimensions of everyday life. DFU-related pain constitutes a distinct dimension of living with DFU and should be systematically recognised, assessed and managed as part of routine DFU care