Identification of symptom clusters in patients with chronic venous leg ulcers

Edwards, Helen, Finlayson, Kathleen, Skerman, Helen, Alexander, Kimberly, Miaskowski, Christine, Aouizerat, Bradley, & Gibb, Michelle (2014) Identification of symptom clusters in patients with chronic venous leg ulcers. Journal of Pain and Symptom Management, 47(5), pp. 867-875.

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Patients with venous leg ulcers experience multiple symptoms, including pain, depression, and discomfort from lower leg inflammation and wound exudate. Some of these symptoms impair wound healing and decrease quality of life (QOL). The presence of co-occurring symptoms may have a negative effect on these outcomes. The identification of symptom clusters could potentially lead to improvements in symptom management and QOL.


To identify the prevalence and severity of common symptoms and the occurrence of symptom clusters in patients with venous leg ulcers.


For this secondary analysis, data on sociodemographic characteristics, medical history, venous history, ulcer and lower limb clinical characteristics, symptoms, treatments, healing, and QOL were analyzed from a sample of 318 patients with venous leg ulcers who were recruited from hospital outpatient and community nursing clinics for leg ulcers. Exploratory factor analysis was used to identify symptom clusters.


Almost two-thirds (64%) of the patients experienced four or more concurrent symptoms. The most frequent symptoms were sleep disturbance (80%), pain (74%), and lower limb swelling (67%). Sixty percent of patients reported three or more symptoms at a moderate-to-severe level of intensity (e.g., 78% reported disturbed sleep frequently or always; the mean pain severity score was 49 of 100, SD 26.5). Exploratory factor analysis identified two symptom clusters: pain, depression, sleep disturbance, and fatigue; and swelling, inflammation, exudate, and fatigue.


Two symptom clusters were identified in this sample of patients with venous leg ulcers. Further research is needed to verify these symptom clusters and to evaluate their effect on patient outcomes.

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9 citations in Scopus
12 citations in Web of Science®
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ID Code: 60839
Item Type: Journal Article
Refereed: Yes
Keywords: venous leg ulcers, symptom clusters, pain, fatigue
DOI: 10.1016/j.jpainsymman.2013.06.003
ISSN: 0885-3924
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > NURSING (111000)
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Current > Schools > School of Nursing
Copyright Owner: Copyright 2014 U.S. Cancer Pain Relief Committee.
Copyright Statement: This is the author’s version of a work that was accepted for publication in Journal of Pain and Symptom Management. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Journal of Pain and Symptom Management, [in press, (2013)] DOI: 10.1016/j.jpainsymman.2013.06.003
Deposited On: 19 Jun 2013 00:35
Last Modified: 21 Nov 2014 04:43

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