Introduction: Diabetic foot ulcers are a major cause of mortality and havesubstantial economic burden on health care systems.(1) m1 It is estimated that 15%of all diabetic patients will develop afoot ulcer during the course of their lifetime.(2) Of those, 14% to 24% will progress tomajor amputation. Of those who lose one limb, 50% will lose the other limbwithin 3-5 years.
(3) The five-year mortality rate is also high,reaching 50-68% among patients who undergo major lower limb amputation (4,5,6)Additionally,diabetic foot ulcers markedly increase the morbidity in patients with diabetes,leading to an increase in the number of outpatient appointments, emergency roomvisits as well as hospitalization days with greater risks of osteomyelitis andamputation.(7,8,9,10)The Health-Related Quality of Life (HRQoL) of diabetic patients hasbeen widely studied, reaching the conclusion that diabetic foot ulcers negativelyaffects patients’ perceived quality of life and causes a reduction in qualityof life (QoL) due to decreased mobility and consequently the ability to performdaily activities and increasing dependence on others as an adaptation to the change in lifestyle.(11,12) Moreover, the perceived stress linked towound healing or re-ulceration and the fear of foot amputation both increasethe negative mood and lead to sleep disturbance in patients with diabetic footulcers.(13) Reduction of quality of life in suchpatients not only changes the outcome of treatment but also increases healthcare expenditures as a result of the frequent referring to physicians andclinical care settings.(14) Psychologicalcomorbidity such as depression confers additional risks on diabetic patientsresulting in poorer outcomes and poorer self-care. Depression in type 2diabetes had been shown to be associated with twice the rate of first diabeticfoot ulcer over 4-years follow up period and higher rates of amputation.(15)Moreover,depression in patients developing the first diabetic foot ulcer is associatedwith two-fold increase of mortality over 5-years.
(16)There is scarcity of data in Jordan on the impact of diabetescomplications including diabetic foot ulcers on HRQoL. Therefore, our study wasconducted to assess the impact of diabetic foot ulcers on patients’ HRQoL anddetermine its associated factors among Jordanian patients with diabetes. m1Needto order references and keep only recent references