To describe the affected quality of life dimensions, wound symptoms, and sociodemographic data most frequently encountered in patients with chronic wounds.

Inclusion

Articles published in the last 5 years (2015-2020).

Be published in English, Portuguese and Spanish.

Documents that provide important information on chronic wounds, quality of life and health-related quality of life.

Exclusion

-Articles for which the full text is not accessible.

-Articles, editorials and clinical cases.

Selected databases: The search was carried out in the following databases:

Agris

Virtual Visivility in Health

ProQuest

Springer

Scielo

Quality of life AND chronic injury

Quality of life AND tools

Quality of life AND dimensions

Chronic wounds AND symptoms

Quality of life AND wounds

Quality of life AND diemnsions

Choronic wounds AND symptoms

Quality of life and chronic diseases

Figure 1. Search flowchart

This narrative research poses no risk, as it will be used solely for research purposes, which will be carried out through a literature review, thereby providing new knowledge and results on the investigated topic. It is not a project developed for human beings, so it would not be subject to the Helsinki Declaration, promulgated by the World Medical Association, which takes into account the ethical aspects of experimentation with human beings.

Likewise, the provisions of Law 23 of 1982, which decrees the author's rights, will be taken into account, evidenced in each of the bibliographic references included in the project, and likewise, Resolution 3480 of 1993, which establishes "the scientific, technical and administrative standards for health research," will be complied with.

To respond to the general objective, within the literature, we found that the most affected dimension is the physical dimension, with 80 % of evidence in the articles reviewed with P:0,03, followed by the psychological and social dimensions with 20 % with P:0,04, the most frequent symptom within the literature review with 80 % was pain, but without ignoring that other influential symptoms deteriorate the quality of life of patients with chronic wounds such as foul odor and abundant exudate.

In addition, the average age of the people used for these studies was 61 years; in chronic wounds, the female sex predominates with 51 %; the level of schooling indicates 47,5 % who studied up to elementary school, and 17,4 % were married; the review also concluded that only 7 % of patients have financial resources for wound care and 11,8 % indicated that they are not affiliated to EAPB (benefit plan management company), which directly affects the quality of life of people and correlates with the affected dimensions described above.

On the other hand, it is essential to mention that the articles affirm that the healing of a long-term wound would increase the quality of life, social inclusion, and mental and physical well-being, as well as decrease costs in the health care system, achieving a balance not only for the individual but also for society.

Alburqueque et al.(13) refer that physical deterioration is evidenced because of the injuries of the wound, which impairs their ability to work, contributing to early retirement, unemployment, increased sick leave, and difficulty when moving, causing dependence on these people.

Likewise, Melguizo et al.(14) says that the presence of a chronic injury shows a significant impact on physical functioning by the inability to immobility and difficulty in performing activities of daily living.

Similarly, a study indicate that with time, the presence of disability becomes more pronounced, resulting in difficulty performing activities of daily living, such as personal hygiene, which prevents them from performing tasks like bathing, as they are afraid of wetting their bandages and potentially altering their healing.

This coincides with what a study indicates that chronic wounds impose physical restrictions, affecting mobility and causing difficulty in activities such as bathing, climbing stairs, walking, and dressing.

On the other hand, Lis R et al.(9) states that physical limitations are presented when mobilizing, including the inability to perform activities independently, developing dependence on family members or caregivers, and impacting their workspace and opportunities for growth.

Albuquerque et al.(13) refer that the psychological dimension is affected by the presence of negative thoughts, anxiety, despair, low self-esteem, thoughts of insecurity and worthlessness, developing depression in these people.

Similarly, Melguizo et al.(8) say that at the psychological level, emotions and feelings of crying, despair, anxiety, fear, sadness, nervousness, guilt, and feelings of vulnerability are produced.

This aligns with the statements made by Lorenzo et al.(7) states that the presence of a chronic wound directly affects self-esteem by causing feeling different from others, developing feelings of importance and uneasiness when not seeing the healing of the wound progress, which leads to the deterioration of mental health.

Likewise a study says that negative feelings such as sadness, hopelessness, anxiety, and depression are present in 95 % of patients. Still, they identified that 80 % of people enjoy life, 95 % feel that their life has meaning, 65 % refer that they accept their physical appearance, and 80 % feel satisfied with themselves.

On the other hand, Vera et al.(4) indicates that the psychological dimension is affected by social isolation, fear of what people will say about possessing something strange in their body, decreased self-esteem when seeing physical changes, and increased limitations.

Lorenzo et al.(7) state that at the social level, there is economic wear and tear, as the presence of the wound limits the working life of these individuals.

Likewise, Kapp et al.(11) say that in people with chronic wounds, the social dimension is affected since they tend to avoid contact with other people and therefore abandon their jobs, and in the face of the difficulty of job opportunities, they take behaviors of isolation and inability to interact with the environment due to their health condition.

On the other hand, Lis et al.(9) indicate that the presence of chronic wounds affects the social dimension due to the lack of healing, which leads to isolation because of the embarrassment caused by their physical appearance, unpleasant odor, and abundant wound exudate.

Similarly, a study says that she is affected by not feeling good about herself, seeing her body differently, and not having the capabilities to develop a personal and social life normally.

According to a study says that the social dimension is affected since people with chronic wounds feel incapable and not autonomous in their social circle because of the disability and the dependence that these cause them.

Kapp et al.(11) evidenced the affectation of the emotional dimension, referred to by people as frustration with the health system related to wound treatment, characterized by distrust of health professionals, allergies to bandages, and the use of topical products that do not aid wound healing.

Sommer et al.(12) say that emotionally, people with chronic wounds are intrigued by the healing process that the wound will take; they also present anxiety at not having an answer to what is happening to them and, at the same time, helplessness at being limited in various aspects of their life.

A study indicate that the presence of a chronic wound awakens feelings of struggle for wanting to recover, as well as fear and negative and depressive feelings at the thought of the risk of amputation.

A study evidence that there is a presence of fear for possible complications and uneasiness for recurrence, that is, the reappearance of the wound.

A study says that in people with chronic wounds, there is evidence of low self-esteem, isolation, feelings of handicap, i.e., a physical limitation that hinders the normal development of activities, fear, and anguish.

Vera & Dos Santos.(1), in their study, "Quality of life in patients with chronic wounds: magnitude of changes and predictive factors," state that a significant impact on the family is presented due to the person's dependence and commitment to care towards them.

Kapp et al.(11), in their study, The Quality of Life of people who have chronic Wounds and self-treat indicate that patients with chronic wounds do not have the financial resources for adequate wound care and treatment due to limitations in their work life and physical immobility.

In their study "Quality of life in patients with chronic wounds," indicates that people with chronic wounds often refer to having "faith in God and hope for healing," revealing positive expectations regarding life, as well as religious beliefs acquired throughout their life trajectories.

On the other hand, symptoms were identified by authors such as Vera et al.(4), Alburqueque et al.(5), Melguizo, et al.(8), Lis, et al.(9), Otero et al.(10), Kapp, et al.(11), Gonçalves & Rangel et al.(5) in their studies, agreed that the most frequent symptom in people with chronic wounds is pain, evidenced as severe.

Similarly referred to the foul odor. who reported it as frequent in their studies and observed abundant exudate.

Unlike authors such as Lorenzo et al.(15), Lis et al.(9), Otero et al.(11), and Melguizo et al.(8), who identify symptoms such as infection, intermittent claudication and heaviness in lower limbs, cramps, and pruritus, where all these symptoms influence the physical, emotional, social and psychological condition of people with chronic wounds.

About the most frequent sociodemographic data in people with chronic wounds, the predominance of the female gender is highlighted (51 %), similar to that observed in studies by Alburqueque et al.(13), Lorenzo et al.(15), Melguizo et al.(8), Kapp et al.(11) however, authors such as Lis et al.(9), evidenced the presence of chronic wounds mainly in the male gender.

On the other hand, the mean age found in this review was 61 years, indicating that the presence of chronic wounds is prevalent in the older adult population; these findings are similar to those reported by Alburqueque et al.(13), Lis et al.(9) and Sommer et al.(12), who describe mean ages close to 61 years in their studies.

In addition, the predominant level of schooling in this review is basic primary, along with a low socioeconomic stratum, which coincides with authors such as evidenced the presence of illiteracy in elementary, high school, and college studies. However, all agree that the predominant level of schooling is elementary school, and in terms of socioeconomic level, Melguizo et al.(8) found that in this population, stratum 1 predominates.(21,22,23,24,25)

In turn, in this study, the most frequent marital status is married, which is in agreement with authors such as Vera et al.(4), Alburqueque et al.(5) who identified that these people are married, without a partner, and in free union, with married people predominating.(26,27,28,29,30)

Regarding religion, this review identified that only 1,4 % of the participants belong to a specific religion, which aligns with the findings of Vera et al.(1) In their study: Quality of Life in Patients with Chronic Wounds: magnitude of Changes and Predisposing Factors, where they identified that their participants belong to some religions, but it is not specified to which ones. (31,32,33,34,35)

In addition, the most prevalent occupation among the participants of this review was unemployment, who found among their participants; unemployed, homemakers, dependents, disability pensioners and retirees, where the majority were unemployed.

Taking into account these contributions, we show that there is similarity between what they refer and the results obtained in this research, since the presence of chronic wounds affect the physical, psychological, social, emotional, family, economic and spiritual dimension and likewise influences the presence of symptoms such as pain, foul odor, abundant exudate, infection, intermittent claudication, heaviness of the lower limbs, cramps and itching, evidenced by the presence of decreased mobility due to pain causing limitations in daily life activities, presence of negative feelings, cramps and itching, intermittent claudication, heaviness of lower limbs, cramps and itching, evidenced by the presence of decreased mobility due to pain causing limitations in daily life activities, presence of negative feelings, hopelessness, anxiety, vulnerability and depression, which affects their mental health, embarrassment about their physical appearance and discomfort due to foul odor and abundant exudate, which leads to social isolation, presence of fear, uneasiness, frustration, distrust, feeling of struggle and fear for possible recurrence of the wound, fatigue of family members because of dependence and care they require, inability to work, because of heaviness of lower limbs, cramps and itching, which leads to early retirement and therefore unemployment, causing the lack of income both for subsistence and for the care required by the wound, presence of hope for recovery, trust in God and sometimes fullness with oneself, which hinders the natural development of these people as they experience significant changes both physically and in their emotional state, thus affecting their quality of life.(36,37,38)

On the other hand, and taking into account the findings identified within the most frequent sociodemographic data in people with chronic wounds, the predominance of the female gender is evident, which is due to the daily activities (domestic) that the majority of women perform. Also, the socioeconomic level of the same where it is reported that they belong to stratum 1, the schooling in these people is evident from illiteracy to university, and the marital status also varies; the report of religion is not extensive since the few studies that report it, identify that these people respond that they belong to some religion, as for the occupation of the participants we found from unemployed to retired, their monthly income is one minimum wage or less, most of them do not have an affiliation to any EAPB and do not have economic resources for the care of the wound.

All these findings indicate a vulnerable profile of people with chronic wounds, which leads us to understand that the poor management of these wounds and the difficulties they present, both physical, social, and psychological, as well as the slow, difficult, and limited healing, are factors that lead to problems that affect the life of the individual in all areas, generating a negative impact on the quality of life.

By conducting this research, we were able to identify certain limitations, such as:

Access to review articles is limited due to the limited number of studies conducted in this area.

The literature found belonged to a period greater than 5 years, which prevented us from using this information.

Some studies restrict their visualization, as they do not allow access to full text.

The results of this research allow us to provide recommendations for future research, such as:

The nursing discipline is becoming increasingly involved in conducting studies on the quality of life of individuals with chronic wounds to implement interventions that take into account not only wound care but also the environment in which these individuals live.

Conduct studies focused on comparing the effectiveness of generic and specific assessment instruments to achieve high reliability, thereby offering more specific and comprehensive care that takes into account the unique differences of each person.