Impact of venous ulcers on patients' quality of life: an integrative review

Joaquim, Fabiana Lopes; Silva, Rose Mary Costa Rosa Andrade; Garcia-Caro, Maria Paz; Cruz-Quintana, Francisco; Pereira, Eliane Ramos

doi:10.1590/0034-7167-2017-0516

ABSTRACT

Objective:

To analyze knowledge gathered about the impact of venous ulcers on patients' quality of life.

Method:

Systematic bibliographic review study with an integrative approach. Databases of MEDLINE, LILACS, IBECS, CINAHL Complete, Web of Science, Scopus, and CUIDEN Plus were used for selection with the PICOT guiding criteria, through the DeCS and MeSH: adult, aged, varicose ulcer, and quality of life, in Portuguese, Spanish, and English. The inclusion criteria were: full original articles available in the databases selected with adherence to the theme in Portuguese, Spanish, and English, published from 2007 to 2016.

Results:

The sample included 14 national and international articles with different methodological approaches and investigative contexts, published from 2012 to 2016.

Conclusion:

Chronic venous ulcers act on patients' bio-psycho-social-spiritual and socioeconomic spheres, having a negative impact on their quality of life.

Descriptors:
Varicose Ulcer; Quality of Life; Adult; Aged; Review

RESUMEN

Objetivo:

Analizar las producciones de conocimiento sobre el impacto de las úlceras venosas en la calidad de vida de los pacientes.

Método:

Estudio de revisión bibliográfica sistemática, tipo integrativa. Para la selección, se utilizaron las bases de datos MEDLINE; LILACS; IBECS; CINAHL Complete; Web of Science; Scopus y CUIDEN Plus, con criterios orientadores PICOT; mediante DECs y MeSH: adulto, anciano, úlcera varicosa y calidad de vida, en portugués, español e inglés. Fueron criterios de inclusión: artículos originales integralmente disponibles en las citadas bases, referentes a la temática, en idiomas Portugués, Español e Inglés, publicados entre los años 2007 y 2016.

Resultados:

La muestra incluyó 14 artículos nacionales e internacionales con diversos abordajes metodológicos y contextos de investigación, en publicaciones realizadas desde 2012 hasta 2016.

Conclusión:

Las úlceras venosas crónicas actúan sobre las esferas biopsicoespiritual y socioeconómica de los pacientes, con repercusiones negativas en la calidad de vida.

Descriptores:
Úlcera Varicosa; Calidad de Vida; Adulto; Anciano; Revisión

RESUMO

Objetivo:

analisar as produções de conhecimento sobre o impacto das úlceras venosas na qualidade de vida dos pacientes. Método: estudo de revisão bibliográfica sistemática, do tipo integrativa. Utilizaram-se, para seleção, as bases de dados MEDLINE; LILACS; IBECS; CINAHL Complete; Web of Science; Scopus e CUIDEN Plus, pelos critérios orientadores PICOT; através do DECs e MeSH: adulto, idoso, úlcera varicosa e qualidade de vida, nos idiomas português, espanhol e inglês. Os critérios de inclusão foram: artigos originais disponibilizados na íntegra, nas bases de dados selecionadas, com aderência à temática nos idiomas Português, Espanhol e Inglês, publicados entre os anos de 2007 e 2016.

Resultados:

a amostra incluiu 14 artigos nacionais e internacionais com diversas abordagens metodológicas e contextos investigativos, publicados entre os anos de 2012 e 2016.

Conclusão:

as úlceras venosas crônicas atuam sobre as esferas biopsicoespiritual e socioeconômica dos pacientes, repercutindo negativamente sobre a qualidade de vida.

Descritores:
Úlcera Varicosa; Qualidade de Vida; Adulto; Idoso; Revisão

INTRODUCTION

Increases in the life expectancy lead to a rise in the incidence of chronic diseases, which results in specific practices of healthcare professionals for the promotion of care, with the purpose of reducing the impact of these pathologies on the patients affected, as well as providing them with quality of life⁽¹1 Nunes HJM, Queirós PJP. Patient with stroke: hospital discharge planning, functionality and quality of life. Rev Bras Enferm[Internet]. 2017 [cited 2017 May 17]; 70(2):433-42. Available from: http://www.scielo.br/pdf/reben/v70n2/0034-7167-reben-70-02-0415.pdf
http://www.scielo.br/pdf/reben/v70n2/003... ⁾.

In this context, non-communicable chronic diseases are included that, in terms of presenting high incidence and prevalence rates, may lead to patient disability and premature mortality. Because these issues are related to the illness process, they must be understood and interpreted by healthcare professionals, in order to achieve satisfactory results from the care provided. Chronic venous ulcers are found among the noncommunicable diseases that affect the population.

According to the Scottish Intercollegiate Guidelines Network⁽²2 Scottish Intercollegiate Guidelines Network. Management of chronic venous leg ulcers: a national clinical guideline. Edinburgh: Scottish Intercollegiate Guidelines Network [Internet]. 2010 [cited 2017 May 17];1-46. Available from: http://www.sign.ac.uk/assets/sign120.pdf
http://www.sign.ac.uk/assets/sign120.pdf... ⁾, venous ulcers are the most severe wounds found in chronic venous insufficiency syndrome of the lowers limbs, and are thus characterized as a public health issue⁽³3 Belczack SQ, Gornati VC, Aun R, Sincos IR, Fragoso H. Treatment of varicose ulcer of the lower limbs by surgery and Unna boot: savings for the Brazilian healthcare system. Einstein[Internet]. 2011 [cited 2017 May 17]; 9(3):377-85. Available from: http://www.scielo.br/pdf/eins/v9n3/1679-4508-eins-9-3-0377.pdf
http://www.scielo.br/pdf/eins/v9n3/1679-... ⁾. Epidemiological data indicate that these wounds represent approximately 80% to 90% of leg ulcer cases⁽⁴4 Barbosa JAG, Campos LMN. Guidelines for the treatment of venous ulcer. Enferm Glob[Internet]. 2010 [cited 2017 May 18]; 20:1-13. Available from: http://scielo.isciii.es/pdf/eg/n20/pt_revision2.pdf
http://scielo.isciii.es/pdf/eg/n20/pt_re... ^-⁵5 Asociación Española de Enfermería Vascular y Heridas. Guía de práctica clínica: Consenso sobre úlceras vasculares y pie diabético. Sevilla: AEEVH [Internet]. 2014 [cited 2017 May 18]; 2:1-90. Available from: https://www.aeev.net/pdf/AEEV%2035%20.pdf
https://www.aeev.net/pdf/AEEV%2035%20.pd... ⁾.

The clinical condition of venous ulcers in the population affected causes difficulties associated with activities of daily living, due to pain, depression, loss of self-esteem, social isolation, work incapacity, and hospitalizations or outpatient consultations⁽⁶6 Evangelista DG, Magalhães ERM, Moretão DIC, Stival MM, Lima LR. Impact of chronic wounds in the quality of life for users of family health strategy. Rev Enferm Centro O Min[Internet]. 2012 [cited 2018 Jul 18]; 2(2):254-63. Available from: http://www.seer.ufsj.edu.br/index.php/recom/article/download/15/308
http://www.seer.ufsj.edu.br/index.php/re... ⁾. Social reclusion and feelings of shame are also seen in the population affected, due to aesthetic changes and clinical/functional disorders caused by ulcerative wounds⁽⁷7 Silva FAA, Moreira TMM. Sociodemografic and clinical characteristics of customers with venous leg ulcer. Rev Enferm UERJ[Internet]. 2011 [cited 2017 May 18]; 19(3):468-72. Available from: http://www.facenf.uerj.br/v19n3/v19n3a22.pdf
http://www.facenf.uerj.br/v19n3/v19n3a22... ⁾. In addition to this, living with the disease tends to lead to discrimination and, in most cases, to lack of support from family members and friends, thus affecting these patients' quality of life.

Therefore, promoting the quality of life of this population is of utmost importance. The recommendations of the World Health Organization defines quality of life as “individuals' perception that their needs are being met or that opportunities to achieve their happiness and self-fulfillment are being denied, regardless of their physical health condition or social and economic situation”⁽⁸8 OMS. Promoción de la Salud. Glossario. Genebra: OMS; 1998.⁾.

The present study is related to the overall healthcare area, which is responsible for intervening in issues and situations related to the population's health in general or to that of a specified group. It is relevant for presenting the issue of quality of life associated with chronic venous ulcers, because this pathology causes fear; anxiety; the expectation of a loss of well-being; limitation; impediment to the practice of activities of daily living; and social and professional restrictions. Thus it leads to high social and economic costs⁽⁹9 Joaquim FL, Camacho ACLF, Sabóia VM, Santos RC, Santos LSF, Nogueira GA. Impact of home visits on the functional capacity of patients with venous ulcers. Rev Bras Enferm[Internet]. 2016 [cited 2017 May 18]; 69(3):439-47. Available from: http://www.scielo.br/pdf/reben/v69n3/en_0034-7167-reben-69-03-0468.pdf
http://www.scielo.br/pdf/reben/v69n3/en_... ⁾.

OBJECTIVE

To analyze knowledge gathered about the impact of chronic venous ulcers on patients' quality of life.

METHOD

Study design

The methodology adopted for the development of the present study was a systematic bibliographic review with an integrative approach. This methodology allows for scientific knowledge to be systemized so that researchers are able to come close to the theme to be studied, outline an overview on scientific productions on the theme with its evolution over time, and envision the possibilities of research⁽¹⁰10 Mendes KDS, Silveira RCCP, Galvão CM. Integrative literature review: a research method to incorporate evidence in health care and nursing. Texto Contexto Enferm[Internet]. 2008 [cited 2017 May 18]; 17(4):758-764. Available from: http://www.scielo.br/pdf/tce/v17n4/18.pdf
http://www.scielo.br/pdf/tce/v17n4/18.pd... ⁾.

This type of review is developed by following the next six steps: identification of the theme and selection of the research question; establishment of inclusion and exclusion criteria for sample selection; identification of preselected and selected studies; categorization; analysis and interpretation of the results; and presentation of the review⁽¹⁰10 Mendes KDS, Silveira RCCP, Galvão CM. Integrative literature review: a research method to incorporate evidence in health care and nursing. Texto Contexto Enferm[Internet]. 2008 [cited 2017 May 18]; 17(4):758-764. Available from: http://www.scielo.br/pdf/tce/v17n4/18.pdf
http://www.scielo.br/pdf/tce/v17n4/18.pd... ⁾.

The integrative systematic review was initially developed with the identification of the research theme, which was the quality of life in patients with chronic venous ulcers. Next, the research question was defined, which was the impact of chronic venous ulcers in patients' quality of life. From this definition, the study's guiding question was established, based on the PICOT strategy, which presents prognosis or prediction as a question for its formulation, in which “P” indicates who or which people, “I” shows how the pathology influences the prognosis, “C” compares the influence of the prognosis in the absence of the pathology, “O” shows the influence of the pathological prognosis on what will be studied, and “T” indicates the influence of the prognosis over time⁽¹¹11 Stillwell SB, Fineout-Overhoult E, Melnyk BM, Williamson KM. Searching for the evidence: strategies to help you conduct a successful search. Am J Nurs[Internet]. 2010 [cited 2017 May 18]; 110(5):41-7. Available from: http://www.nursingcenter.com/nursingcenter_redesign/media/EBP/AJNseries/Searching.pdf
http://www.nursingcenter.com/nursingcent... ⁾. Therefore, the guiding question of the present study based on the PICOT strategy was: “Which factors influence the quality of life of adult and aged patients with venous ulcers during their treatment?” This is shown in Figure 1:

Figure 1
Illustrative diagram of the guiding question's development process

Data source

The search was undertaken in the following databases: MEDLINE (Medical Literature Analysis and Retrieval System Online); LILACS (Latin American and Caribbean Literature on Health Sciences); IBECS (Spanish Bibliographical Index of Health Sciences); BDENF (Nursing Database); CINAHL Complete (Cumulative Index to Nursing and Allied Health Literature); Web of Science; Scopus; and CUIDEN Plus.

Data collection and organization

The search strategy adopted was the use of descriptors and the Boolean operators “OR” and “AND.” Descriptors relevant to the theme were selected based on the PICOT strategy and identified through DeCS and MeSH, namely: adult; aged; varicose ulcer; and quality of life. Therefore, these descriptors in Portuguese, Spanish, and English were used for the articles' search.

The inclusion criteria adopted for the search were: full original articles available in the selected databases that presented adherence to the theme in Portuguese, Spanish, and English, published from 2007 to 2016, with the aim of identifying evidence on the theme published within the last 10 years. The search was undertaken during May 2017.

The exclusion criteria adopted were scientific productions that only presented abstracts, and publications related to the validation of questionnaires.

The search with descriptors associated with Boolean operators enabled the identification of preselected studies (Figure 2).

Figure 2
Illustrative diagram of the methodological development for the identification of preselected studies and selection of the studies to be included in the review

After the identification of preselected studies (n=213), the reading of the publications' titles, abstracts, and descriptors was carried out by two independent reviewers to verify their adequacy to the theme and relevance to be selected and included in the review (Figure 2), in order to proceed with the articles' full reading for categorization, analysis, and interpretation of the results, and presentation of the review.

The reading of the preselected material led to the exclusion of 184 publications because they: were related to the validation of questionnaires (LILACS: n=01/Web of Science: n=02); only presented the abstract (CINAHL: n=03/Web of Science: n= 04/Scopus: n= 02); or did not present adherence to the theme (n=169). These articles were related to: therapy approaches in the healing process (LILACS: n=09/IBECS: n=01/BDENF: n=07/CINAHL: n=23/Web of Science: n=69/Scopus: n=37/CUIDEN Plus: n=19); assessment of depression symptoms (LILACS: n=04); preliminary note (LILACS: n=01); and integrative review (MEDLINE: n=01/BDENF: 01).

Twenty-nine articles published from 2012 to 2016 were selected. Of these, six were available 15 times in two or more databases. Therefore, these publications were excluded from the review. Consequently, at the end of the bibliographical survey, 14 articles were obtained for full reading to proceed with categorization, analysis, and interpretation of the results; and presentation of the review.

It is worth mentioning that the search was based on articles published from 2007 to 2016. However, the reading of the selected material showed that articles published from 2007 to 2011 that met the inclusion criteria, did not effectively approach the theme quality of life, but rather issues related to procedures and care that improved quality of life, according to the authors, without describing and discussing dimensions that led to improvement.

Data analysis

Data analysis was carried out by means of a summarization of the methodological characteristics of the articles selected, with the goal of achieving the objective of the study. The data collected were described and organized in tables with information regarding PRISMA⁽¹²12 Galvão TF, Pansani TSA, Harrad D. Main items to report Systematic reviews and meta-analyzes: the recommendation PRISMA. Epidemiol Serv Saúde [Internet]. 2015 [cited 2017 Jun 07]; 24(2):335-42. Available from: http://www.scielo.br/pdf/ress/v24n2/2237-9622-ress-24-02-00335.pdf
http://www.scielo.br/pdf/ress/v24n2/2237... ⁾ guidelines and level of evidence⁽¹¹11 Stillwell SB, Fineout-Overhoult E, Melnyk BM, Williamson KM. Searching for the evidence: strategies to help you conduct a successful search. Am J Nurs[Internet]. 2010 [cited 2017 May 18]; 110(5):41-7. Available from: http://www.nursingcenter.com/nursingcenter_redesign/media/EBP/AJNseries/Searching.pdf
http://www.nursingcenter.com/nursingcent... ⁾ (Chart 1); as well as references, objectives, method, participants, instrument, factors that influence quality of life, and dimensions affected (Chart 2).

Thumbnail

Chart 1
Screening of the studies included in the IR, according to PRISMA⁽¹²12 Galvão TF, Pansani TSA, Harrad D. Main items to report Systematic reviews and meta-analyzes: the recommendation PRISMA. Epidemiol Serv Saúde [Internet]. 2015 [cited 2017 Jun 07]; 24(2):335-42. Available from: http://www.scielo.br/pdf/ress/v24n2/2237-9622-ress-24-02-00335.pdf
http://www.scielo.br/pdf/ress/v24n2/2237... ⁾ guidelines and level of evidence⁽¹³13 Salomé GM, Ferreira LM. Quality of life in patients with venous ulcers treated with Unna's boot compressive therapy. Rev Bras Cir Plást[Internet]. 2012 [cited 2017 Jun 05]; 27(3):466-71. Available from: http://www.scielo.br/pdf/rbcp/v27n3/en_24.pdf
http://www.scielo.br/pdf/rbcp/v27n3/en_2... ⁾

Thumbnail

Chart 2
Description of the studies included in the integrative review according to reference, objectives, method, participants, instrument, factors that influence quality of life, and dimensions affected

RESULTS

The search in the databases initially resulted in 213 articles, of which 14 were included⁽¹³13 Salomé GM, Ferreira LM. Quality of life in patients with venous ulcers treated with Unna's boot compressive therapy. Rev Bras Cir Plást[Internet]. 2012 [cited 2017 Jun 05]; 27(3):466-71. Available from: http://www.scielo.br/pdf/rbcp/v27n3/en_24.pdf
http://www.scielo.br/pdf/rbcp/v27n3/en_2...

14 Dias TYAF, Costa IKF, Liberato SMD, Souza AJG, Mendes FRP, Torres GV. Quality of life for venous ulcer patients: a comparative study in Brazil/Portugal. O Braz J Nurs[Internet]. 2013 [cited 2017 Jun 05]; 12(2):491-500. Available from: http://www.objnursing.uff.br/index.php/nursing/article/view/4344/pdf
http://www.objnursing.uff.br/index.php/n...

15 Lopes CR, Figueiredo M, Ávila AM, Soares LMBM, Dionisio VC. Evaluation of limitations of venous ulcers in legs. J Vasc Bras[Internet]. 2013 [cited 2017 Jun 05]; 12(1):5-9. Available from: http://www.scielo.br/pdf/jvb/v12n1/en_03.pdf
http://www.scielo.br/pdf/jvb/v12n1/en_03...

16 Dias TYAF, Costa IKF, Salvetti MG, Mendes CKTT, Torres GV. Influences of health care services and clinical characteristics on the quality of life of patients with venous ulcer. Acta Paul Enferm[Internet]. 2013 [cited 2017 Jun 05]; 26(6):529-34. Available from: http://www.scielo.br/pdf/ape/v26n6/en_04.pdf
http://www.scielo.br/pdf/ape/v26n6/en_04...

17 Saraiva DMRF, Bandarra AJF, Agostinho ES, Pereira NMM, Lopes TS. Quality of life of service users with chronic venous ulcers. Referência[Internet]. 2013 [cited 2017 Jun 05]; 3(10):109-18. Available from: http://www.scielo.mec.pt/pdf/ref/vserIIIn10/serIIIn10a13.pdf
http://www.scielo.mec.pt/pdf/ref/vserIII...

18 Dias TYAF, Costa IKF, Melo MDM, Torres SMSGSO, Maia EMC, Torres GV. Quality of life assessment of patients with and without venous ulcer. Rev Latino-Am Enfermagem[Internet]. 2014 [cited 2017 Jun 05]; 22(4):576-81. Available from: http://www.scielo.br/pdf/rlae/v22n4/0104-1169-rlae-22-04-00576.pdf
http://www.scielo.br/pdf/rlae/v22n4/0104...

19 Lozano SFS, Marinel JR, Carrasco EC, González RJP, Escudero RJR, Sánchez IN, et al. Venous leg ulcer in the context of chronic venous disease. Phlebol[Internet]. 2014 [cited 2017 Jun 05]; 29(4):220-6. Available from: http://journals.sagepub.com/doi/pdf/10.1177/0268355513480489
http://journals.sagepub.com/doi/pdf/10.1...

20 Torres GV, Balduino LSC, Costa IKF, Mendes FRP, Vasconcelos QLDAQ. Comparison of quality of life domains in patientswith venous ulcer. Rev Enferm UERJ[Internet]. 2014 [cited 2017 Jun 05]; 22(1):57-64. Available from: http://www.facenf.uerj.br/v22n1/v22n1a09.pdf
http://www.facenf.uerj.br/v22n1/v22n1a09...

21 Wachholz PA, Masuda PY, Nascimento DC, Taira CMH, Cleto NG. Quality of life profile and correlated factors in chronic leg ulcer patients in the mid-west of São Paulo State, Brazil. An Bras Dermatol[Internet]. 2014 [cited 2017 Jun 05]; 89(1):73-81. Available from: http://www.scielo.br/pdf/abd/v89n1/0365-0596-abd-89-01-0073.pdf
http://www.scielo.br/pdf/abd/v89n1/0365-...

22 Finlayson KJ, Courtney MD, Gibb MA, O'Brien JA, Parker CN, Edwards HE. The effectiveness of a four-layer compression bandage system in comparison with class 3 compression hosiery on healing and quality of life in patients with venous leg ulcers: a randomized controlled trial. Int Wound J[Internet]. 2014 [cited 2017 Jun 05]; 11:21-7. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1742-481X. 2012.01033.x/epdf
http://onlinelibrary.wiley.com/doi/10.11...

23 Salomé GM, Blanes L, Ferreira LM. The impact of skin grafting on the quality of life and self-esteem of patients with venous leg ulcers. World J Surg[Internet]. 2014 [cited 2017 Jun 05]; 38:233-40. Available from: https://link.springer.com/article/10.1007/s00268-013-2228-x
https://link.springer.com/article/10.100...

24 Sell BT, Souza MV, Martins T, Amante LN. Quality of life of pacients with vasculogenic ulcers according to Ferrans and Powers: wounds. J Health Sci[Internet]. 2015 [cited 2017 Jun 06]; 17(3):160-4. Available from: http://www.pgsskroton.com.br/seer/index.php/JHealthSci/article/view/3062/2849
http://www.pgsskroton.com.br/seer/index....

25 Tracz E, Zamojska E, Modrzejewski A, Zaborski D, Grzesiak W. Quality of life in patients with venous stasis ulcers and others with advanced venous insufficiency. Holist Nurs Pract[Internet]. 2015 [cited 2017 Jun 06]; 29(2):96-102. Available from: https://insights.ovid.com/pubmed?pmid=25658932
https://insights.ovid.com/pubmed?pmid=25... ^-²⁶26 Araújo RO, Silva DC, Souto RQ, Marconato AMP, Costa IKF, Torres GV. Impact of varicose ulcers on the quality of life of persons receiving primary care. Aquichan[Internet]. 2016 [cited 2017 Jun 06]; 16(1):56-66. Available from: http://www.scielo.org.co/pdf/aqui/v16n1/v16n1a07.pdf
http://www.scielo.org.co/pdf/aqui/v16n1/... ⁾ in the review. With the aim of verifying the quality of the scientific evidence, screening of the studies included in the integrative review (IR) was carried out according to PRISMA⁽¹²12 Galvão TF, Pansani TSA, Harrad D. Main items to report Systematic reviews and meta-analyzes: the recommendation PRISMA. Epidemiol Serv Saúde [Internet]. 2015 [cited 2017 Jun 07]; 24(2):335-42. Available from: http://www.scielo.br/pdf/ress/v24n2/2237-9622-ress-24-02-00335.pdf
http://www.scielo.br/pdf/ress/v24n2/2237... ⁾ guidelines and level of evidence⁽¹¹11 Stillwell SB, Fineout-Overhoult E, Melnyk BM, Williamson KM. Searching for the evidence: strategies to help you conduct a successful search. Am J Nurs[Internet]. 2010 [cited 2017 May 18]; 110(5):41-7. Available from: http://www.nursingcenter.com/nursingcenter_redesign/media/EBP/AJNseries/Searching.pdf
http://www.nursingcenter.com/nursingcent... ⁾, as described in Chart 1.

The following classification was considered to evaluate the level of evidence⁽¹¹11 Stillwell SB, Fineout-Overhoult E, Melnyk BM, Williamson KM. Searching for the evidence: strategies to help you conduct a successful search. Am J Nurs[Internet]. 2010 [cited 2017 May 18]; 110(5):41-7. Available from: http://www.nursingcenter.com/nursingcenter_redesign/media/EBP/AJNseries/Searching.pdf
http://www.nursingcenter.com/nursingcent... ⁾: Level I, resulting from systematic reviews or meta-analysis; Level II, obtained by means of randomized controlled trials; Level III, derived from non-randomized control studies with a good design; Level IV, resulting from case-control studies or cohort studies; Level V, obtained by means of systematic reviews of qualitative or descriptive studies; Level VI, resulting from qualitative or descriptive studies; and Level VII, with evidence deriving from the opinions of authorities or reports of committees of experts.

After checking the quality of the scientific evidence, regarding the year of publication, it was found that one article was from 2012⁽¹³13 Salomé GM, Ferreira LM. Quality of life in patients with venous ulcers treated with Unna's boot compressive therapy. Rev Bras Cir Plást[Internet]. 2012 [cited 2017 Jun 05]; 27(3):466-71. Available from: http://www.scielo.br/pdf/rbcp/v27n3/en_24.pdf
http://www.scielo.br/pdf/rbcp/v27n3/en_2... ⁾, four from 2013⁽¹⁴14 Dias TYAF, Costa IKF, Liberato SMD, Souza AJG, Mendes FRP, Torres GV. Quality of life for venous ulcer patients: a comparative study in Brazil/Portugal. O Braz J Nurs[Internet]. 2013 [cited 2017 Jun 05]; 12(2):491-500. Available from: http://www.objnursing.uff.br/index.php/nursing/article/view/4344/pdf
http://www.objnursing.uff.br/index.php/n...

15 Lopes CR, Figueiredo M, Ávila AM, Soares LMBM, Dionisio VC. Evaluation of limitations of venous ulcers in legs. J Vasc Bras[Internet]. 2013 [cited 2017 Jun 05]; 12(1):5-9. Available from: http://www.scielo.br/pdf/jvb/v12n1/en_03.pdf
http://www.scielo.br/pdf/jvb/v12n1/en_03...

16 Dias TYAF, Costa IKF, Salvetti MG, Mendes CKTT, Torres GV. Influences of health care services and clinical characteristics on the quality of life of patients with venous ulcer. Acta Paul Enferm[Internet]. 2013 [cited 2017 Jun 05]; 26(6):529-34. Available from: http://www.scielo.br/pdf/ape/v26n6/en_04.pdf
http://www.scielo.br/pdf/ape/v26n6/en_04... ^-¹⁷17 Saraiva DMRF, Bandarra AJF, Agostinho ES, Pereira NMM, Lopes TS. Quality of life of service users with chronic venous ulcers. Referência[Internet]. 2013 [cited 2017 Jun 05]; 3(10):109-18. Available from: http://www.scielo.mec.pt/pdf/ref/vserIIIn10/serIIIn10a13.pdf
http://www.scielo.mec.pt/pdf/ref/vserIII... ⁾, six from 2014⁽¹⁸18 Dias TYAF, Costa IKF, Melo MDM, Torres SMSGSO, Maia EMC, Torres GV. Quality of life assessment of patients with and without venous ulcer. Rev Latino-Am Enfermagem[Internet]. 2014 [cited 2017 Jun 05]; 22(4):576-81. Available from: http://www.scielo.br/pdf/rlae/v22n4/0104-1169-rlae-22-04-00576.pdf
http://www.scielo.br/pdf/rlae/v22n4/0104...

19 Lozano SFS, Marinel JR, Carrasco EC, González RJP, Escudero RJR, Sánchez IN, et al. Venous leg ulcer in the context of chronic venous disease. Phlebol[Internet]. 2014 [cited 2017 Jun 05]; 29(4):220-6. Available from: http://journals.sagepub.com/doi/pdf/10.1177/0268355513480489
http://journals.sagepub.com/doi/pdf/10.1...

20 Torres GV, Balduino LSC, Costa IKF, Mendes FRP, Vasconcelos QLDAQ. Comparison of quality of life domains in patientswith venous ulcer. Rev Enferm UERJ[Internet]. 2014 [cited 2017 Jun 05]; 22(1):57-64. Available from: http://www.facenf.uerj.br/v22n1/v22n1a09.pdf
http://www.facenf.uerj.br/v22n1/v22n1a09...

21 Wachholz PA, Masuda PY, Nascimento DC, Taira CMH, Cleto NG. Quality of life profile and correlated factors in chronic leg ulcer patients in the mid-west of São Paulo State, Brazil. An Bras Dermatol[Internet]. 2014 [cited 2017 Jun 05]; 89(1):73-81. Available from: http://www.scielo.br/pdf/abd/v89n1/0365-0596-abd-89-01-0073.pdf
http://www.scielo.br/pdf/abd/v89n1/0365-...

22 Finlayson KJ, Courtney MD, Gibb MA, O'Brien JA, Parker CN, Edwards HE. The effectiveness of a four-layer compression bandage system in comparison with class 3 compression hosiery on healing and quality of life in patients with venous leg ulcers: a randomized controlled trial. Int Wound J[Internet]. 2014 [cited 2017 Jun 05]; 11:21-7. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1742-481X. 2012.01033.x/epdf
http://onlinelibrary.wiley.com/doi/10.11... ^-²³23 Salomé GM, Blanes L, Ferreira LM. The impact of skin grafting on the quality of life and self-esteem of patients with venous leg ulcers. World J Surg[Internet]. 2014 [cited 2017 Jun 05]; 38:233-40. Available from: https://link.springer.com/article/10.1007/s00268-013-2228-x
https://link.springer.com/article/10.100... ⁾, two from 2015⁽²⁴24 Sell BT, Souza MV, Martins T, Amante LN. Quality of life of pacients with vasculogenic ulcers according to Ferrans and Powers: wounds. J Health Sci[Internet]. 2015 [cited 2017 Jun 06]; 17(3):160-4. Available from: http://www.pgsskroton.com.br/seer/index.php/JHealthSci/article/view/3062/2849
http://www.pgsskroton.com.br/seer/index.... ^-²⁵25 Tracz E, Zamojska E, Modrzejewski A, Zaborski D, Grzesiak W. Quality of life in patients with venous stasis ulcers and others with advanced venous insufficiency. Holist Nurs Pract[Internet]. 2015 [cited 2017 Jun 06]; 29(2):96-102. Available from: https://insights.ovid.com/pubmed?pmid=25658932
https://insights.ovid.com/pubmed?pmid=25... ⁾, and one from 2016⁽²⁶26 Araújo RO, Silva DC, Souto RQ, Marconato AMP, Costa IKF, Torres GV. Impact of varicose ulcers on the quality of life of persons receiving primary care. Aquichan[Internet]. 2016 [cited 2017 Jun 06]; 16(1):56-66. Available from: http://www.scielo.org.co/pdf/aqui/v16n1/v16n1a07.pdf
http://www.scielo.org.co/pdf/aqui/v16n1/... ⁾. With regard to language, seven publications were in Portuguese⁽¹³13 Salomé GM, Ferreira LM. Quality of life in patients with venous ulcers treated with Unna's boot compressive therapy. Rev Bras Cir Plást[Internet]. 2012 [cited 2017 Jun 05]; 27(3):466-71. Available from: http://www.scielo.br/pdf/rbcp/v27n3/en_24.pdf
http://www.scielo.br/pdf/rbcp/v27n3/en_2... ^,¹⁵15 Lopes CR, Figueiredo M, Ávila AM, Soares LMBM, Dionisio VC. Evaluation of limitations of venous ulcers in legs. J Vasc Bras[Internet]. 2013 [cited 2017 Jun 05]; 12(1):5-9. Available from: http://www.scielo.br/pdf/jvb/v12n1/en_03.pdf
http://www.scielo.br/pdf/jvb/v12n1/en_03...

16 Dias TYAF, Costa IKF, Salvetti MG, Mendes CKTT, Torres GV. Influences of health care services and clinical characteristics on the quality of life of patients with venous ulcer. Acta Paul Enferm[Internet]. 2013 [cited 2017 Jun 05]; 26(6):529-34. Available from: http://www.scielo.br/pdf/ape/v26n6/en_04.pdf
http://www.scielo.br/pdf/ape/v26n6/en_04... ^-¹⁷17 Saraiva DMRF, Bandarra AJF, Agostinho ES, Pereira NMM, Lopes TS. Quality of life of service users with chronic venous ulcers. Referência[Internet]. 2013 [cited 2017 Jun 05]; 3(10):109-18. Available from: http://www.scielo.mec.pt/pdf/ref/vserIIIn10/serIIIn10a13.pdf
http://www.scielo.mec.pt/pdf/ref/vserIII... ^,²⁰20 Torres GV, Balduino LSC, Costa IKF, Mendes FRP, Vasconcelos QLDAQ. Comparison of quality of life domains in patientswith venous ulcer. Rev Enferm UERJ[Internet]. 2014 [cited 2017 Jun 05]; 22(1):57-64. Available from: http://www.facenf.uerj.br/v22n1/v22n1a09.pdf
http://www.facenf.uerj.br/v22n1/v22n1a09... ^,²⁴24 Sell BT, Souza MV, Martins T, Amante LN. Quality of life of pacients with vasculogenic ulcers according to Ferrans and Powers: wounds. J Health Sci[Internet]. 2015 [cited 2017 Jun 06]; 17(3):160-4. Available from: http://www.pgsskroton.com.br/seer/index.php/JHealthSci/article/view/3062/2849
http://www.pgsskroton.com.br/seer/index.... ^,²⁶26 Araújo RO, Silva DC, Souto RQ, Marconato AMP, Costa IKF, Torres GV. Impact of varicose ulcers on the quality of life of persons receiving primary care. Aquichan[Internet]. 2016 [cited 2017 Jun 06]; 16(1):56-66. Available from: http://www.scielo.org.co/pdf/aqui/v16n1/v16n1a07.pdf
http://www.scielo.org.co/pdf/aqui/v16n1/... ⁾, five were in English⁽¹⁹19 Lozano SFS, Marinel JR, Carrasco EC, González RJP, Escudero RJR, Sánchez IN, et al. Venous leg ulcer in the context of chronic venous disease. Phlebol[Internet]. 2014 [cited 2017 Jun 05]; 29(4):220-6. Available from: http://journals.sagepub.com/doi/pdf/10.1177/0268355513480489
http://journals.sagepub.com/doi/pdf/10.1... ^,²¹21 Wachholz PA, Masuda PY, Nascimento DC, Taira CMH, Cleto NG. Quality of life profile and correlated factors in chronic leg ulcer patients in the mid-west of São Paulo State, Brazil. An Bras Dermatol[Internet]. 2014 [cited 2017 Jun 05]; 89(1):73-81. Available from: http://www.scielo.br/pdf/abd/v89n1/0365-0596-abd-89-01-0073.pdf
http://www.scielo.br/pdf/abd/v89n1/0365-...

22 Finlayson KJ, Courtney MD, Gibb MA, O'Brien JA, Parker CN, Edwards HE. The effectiveness of a four-layer compression bandage system in comparison with class 3 compression hosiery on healing and quality of life in patients with venous leg ulcers: a randomized controlled trial. Int Wound J[Internet]. 2014 [cited 2017 Jun 05]; 11:21-7. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1742-481X. 2012.01033.x/epdf
http://onlinelibrary.wiley.com/doi/10.11... ^-²³23 Salomé GM, Blanes L, Ferreira LM. The impact of skin grafting on the quality of life and self-esteem of patients with venous leg ulcers. World J Surg[Internet]. 2014 [cited 2017 Jun 05]; 38:233-40. Available from: https://link.springer.com/article/10.1007/s00268-013-2228-x
https://link.springer.com/article/10.100... ^,²⁵25 Tracz E, Zamojska E, Modrzejewski A, Zaborski D, Grzesiak W. Quality of life in patients with venous stasis ulcers and others with advanced venous insufficiency. Holist Nurs Pract[Internet]. 2015 [cited 2017 Jun 06]; 29(2):96-102. Available from: https://insights.ovid.com/pubmed?pmid=25658932
https://insights.ovid.com/pubmed?pmid=25... ⁾, and two were available in three languages, which were: Portuguese, Spanish, and English⁽¹⁴14 Dias TYAF, Costa IKF, Liberato SMD, Souza AJG, Mendes FRP, Torres GV. Quality of life for venous ulcer patients: a comparative study in Brazil/Portugal. O Braz J Nurs[Internet]. 2013 [cited 2017 Jun 05]; 12(2):491-500. Available from: http://www.objnursing.uff.br/index.php/nursing/article/view/4344/pdf
http://www.objnursing.uff.br/index.php/n... ^,¹⁸18 Dias TYAF, Costa IKF, Melo MDM, Torres SMSGSO, Maia EMC, Torres GV. Quality of life assessment of patients with and without venous ulcer. Rev Latino-Am Enfermagem[Internet]. 2014 [cited 2017 Jun 05]; 22(4):576-81. Available from: http://www.scielo.br/pdf/rlae/v22n4/0104-1169-rlae-22-04-00576.pdf
http://www.scielo.br/pdf/rlae/v22n4/0104... ⁾.

Regarding the databases, there was a prevalence of articles that discussed the quality of life in patients with chronic venous ulcers as indexed in multiple databases. This prevalence was related to LILACS (n=09) ⁽¹³13 Salomé GM, Ferreira LM. Quality of life in patients with venous ulcers treated with Unna's boot compressive therapy. Rev Bras Cir Plást[Internet]. 2012 [cited 2017 Jun 05]; 27(3):466-71. Available from: http://www.scielo.br/pdf/rbcp/v27n3/en_24.pdf
http://www.scielo.br/pdf/rbcp/v27n3/en_2...

14 Dias TYAF, Costa IKF, Liberato SMD, Souza AJG, Mendes FRP, Torres GV. Quality of life for venous ulcer patients: a comparative study in Brazil/Portugal. O Braz J Nurs[Internet]. 2013 [cited 2017 Jun 05]; 12(2):491-500. Available from: http://www.objnursing.uff.br/index.php/nursing/article/view/4344/pdf
http://www.objnursing.uff.br/index.php/n...

15 Lopes CR, Figueiredo M, Ávila AM, Soares LMBM, Dionisio VC. Evaluation of limitations of venous ulcers in legs. J Vasc Bras[Internet]. 2013 [cited 2017 Jun 05]; 12(1):5-9. Available from: http://www.scielo.br/pdf/jvb/v12n1/en_03.pdf
http://www.scielo.br/pdf/jvb/v12n1/en_03... ^-¹⁶16 Dias TYAF, Costa IKF, Salvetti MG, Mendes CKTT, Torres GV. Influences of health care services and clinical characteristics on the quality of life of patients with venous ulcer. Acta Paul Enferm[Internet]. 2013 [cited 2017 Jun 05]; 26(6):529-34. Available from: http://www.scielo.br/pdf/ape/v26n6/en_04.pdf
http://www.scielo.br/pdf/ape/v26n6/en_04... ^,¹⁸18 Dias TYAF, Costa IKF, Melo MDM, Torres SMSGSO, Maia EMC, Torres GV. Quality of life assessment of patients with and without venous ulcer. Rev Latino-Am Enfermagem[Internet]. 2014 [cited 2017 Jun 05]; 22(4):576-81. Available from: http://www.scielo.br/pdf/rlae/v22n4/0104-1169-rlae-22-04-00576.pdf
http://www.scielo.br/pdf/rlae/v22n4/0104... ^,²⁰20 Torres GV, Balduino LSC, Costa IKF, Mendes FRP, Vasconcelos QLDAQ. Comparison of quality of life domains in patientswith venous ulcer. Rev Enferm UERJ[Internet]. 2014 [cited 2017 Jun 05]; 22(1):57-64. Available from: http://www.facenf.uerj.br/v22n1/v22n1a09.pdf
http://www.facenf.uerj.br/v22n1/v22n1a09... ^-²¹21 Wachholz PA, Masuda PY, Nascimento DC, Taira CMH, Cleto NG. Quality of life profile and correlated factors in chronic leg ulcer patients in the mid-west of São Paulo State, Brazil. An Bras Dermatol[Internet]. 2014 [cited 2017 Jun 05]; 89(1):73-81. Available from: http://www.scielo.br/pdf/abd/v89n1/0365-0596-abd-89-01-0073.pdf
http://www.scielo.br/pdf/abd/v89n1/0365-... ^,²⁴24 Sell BT, Souza MV, Martins T, Amante LN. Quality of life of pacients with vasculogenic ulcers according to Ferrans and Powers: wounds. J Health Sci[Internet]. 2015 [cited 2017 Jun 06]; 17(3):160-4. Available from: http://www.pgsskroton.com.br/seer/index.php/JHealthSci/article/view/3062/2849
http://www.pgsskroton.com.br/seer/index.... ^,²⁶26 Araújo RO, Silva DC, Souto RQ, Marconato AMP, Costa IKF, Torres GV. Impact of varicose ulcers on the quality of life of persons receiving primary care. Aquichan[Internet]. 2016 [cited 2017 Jun 06]; 16(1):56-66. Available from: http://www.scielo.org.co/pdf/aqui/v16n1/v16n1a07.pdf
http://www.scielo.org.co/pdf/aqui/v16n1/... ⁾, Web of Science (n=07)⁽¹⁶16 Dias TYAF, Costa IKF, Salvetti MG, Mendes CKTT, Torres GV. Influences of health care services and clinical characteristics on the quality of life of patients with venous ulcer. Acta Paul Enferm[Internet]. 2013 [cited 2017 Jun 05]; 26(6):529-34. Available from: http://www.scielo.br/pdf/ape/v26n6/en_04.pdf
http://www.scielo.br/pdf/ape/v26n6/en_04...

17 Saraiva DMRF, Bandarra AJF, Agostinho ES, Pereira NMM, Lopes TS. Quality of life of service users with chronic venous ulcers. Referência[Internet]. 2013 [cited 2017 Jun 05]; 3(10):109-18. Available from: http://www.scielo.mec.pt/pdf/ref/vserIIIn10/serIIIn10a13.pdf
http://www.scielo.mec.pt/pdf/ref/vserIII... ^-¹⁸18 Dias TYAF, Costa IKF, Melo MDM, Torres SMSGSO, Maia EMC, Torres GV. Quality of life assessment of patients with and without venous ulcer. Rev Latino-Am Enfermagem[Internet]. 2014 [cited 2017 Jun 05]; 22(4):576-81. Available from: http://www.scielo.br/pdf/rlae/v22n4/0104-1169-rlae-22-04-00576.pdf
http://www.scielo.br/pdf/rlae/v22n4/0104... ^,²¹21 Wachholz PA, Masuda PY, Nascimento DC, Taira CMH, Cleto NG. Quality of life profile and correlated factors in chronic leg ulcer patients in the mid-west of São Paulo State, Brazil. An Bras Dermatol[Internet]. 2014 [cited 2017 Jun 05]; 89(1):73-81. Available from: http://www.scielo.br/pdf/abd/v89n1/0365-0596-abd-89-01-0073.pdf
http://www.scielo.br/pdf/abd/v89n1/0365-...

22 Finlayson KJ, Courtney MD, Gibb MA, O'Brien JA, Parker CN, Edwards HE. The effectiveness of a four-layer compression bandage system in comparison with class 3 compression hosiery on healing and quality of life in patients with venous leg ulcers: a randomized controlled trial. Int Wound J[Internet]. 2014 [cited 2017 Jun 05]; 11:21-7. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1742-481X. 2012.01033.x/epdf
http://onlinelibrary.wiley.com/doi/10.11... ^-²³23 Salomé GM, Blanes L, Ferreira LM. The impact of skin grafting on the quality of life and self-esteem of patients with venous leg ulcers. World J Surg[Internet]. 2014 [cited 2017 Jun 05]; 38:233-40. Available from: https://link.springer.com/article/10.1007/s00268-013-2228-x
https://link.springer.com/article/10.100... ^,²⁶26 Araújo RO, Silva DC, Souto RQ, Marconato AMP, Costa IKF, Torres GV. Impact of varicose ulcers on the quality of life of persons receiving primary care. Aquichan[Internet]. 2016 [cited 2017 Jun 06]; 16(1):56-66. Available from: http://www.scielo.org.co/pdf/aqui/v16n1/v16n1a07.pdf
http://www.scielo.org.co/pdf/aqui/v16n1/... ⁾, CUIDEN Plus (n=05)⁽¹⁶16 Dias TYAF, Costa IKF, Salvetti MG, Mendes CKTT, Torres GV. Influences of health care services and clinical characteristics on the quality of life of patients with venous ulcer. Acta Paul Enferm[Internet]. 2013 [cited 2017 Jun 05]; 26(6):529-34. Available from: http://www.scielo.br/pdf/ape/v26n6/en_04.pdf
http://www.scielo.br/pdf/ape/v26n6/en_04...

17 Saraiva DMRF, Bandarra AJF, Agostinho ES, Pereira NMM, Lopes TS. Quality of life of service users with chronic venous ulcers. Referência[Internet]. 2013 [cited 2017 Jun 05]; 3(10):109-18. Available from: http://www.scielo.mec.pt/pdf/ref/vserIIIn10/serIIIn10a13.pdf
http://www.scielo.mec.pt/pdf/ref/vserIII... ^-¹⁸18 Dias TYAF, Costa IKF, Melo MDM, Torres SMSGSO, Maia EMC, Torres GV. Quality of life assessment of patients with and without venous ulcer. Rev Latino-Am Enfermagem[Internet]. 2014 [cited 2017 Jun 05]; 22(4):576-81. Available from: http://www.scielo.br/pdf/rlae/v22n4/0104-1169-rlae-22-04-00576.pdf
http://www.scielo.br/pdf/rlae/v22n4/0104... ^,²²22 Finlayson KJ, Courtney MD, Gibb MA, O'Brien JA, Parker CN, Edwards HE. The effectiveness of a four-layer compression bandage system in comparison with class 3 compression hosiery on healing and quality of life in patients with venous leg ulcers: a randomized controlled trial. Int Wound J[Internet]. 2014 [cited 2017 Jun 05]; 11:21-7. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1742-481X. 2012.01033.x/epdf
http://onlinelibrary.wiley.com/doi/10.11... ^,²⁶26 Araújo RO, Silva DC, Souto RQ, Marconato AMP, Costa IKF, Torres GV. Impact of varicose ulcers on the quality of life of persons receiving primary care. Aquichan[Internet]. 2016 [cited 2017 Jun 06]; 16(1):56-66. Available from: http://www.scielo.org.co/pdf/aqui/v16n1/v16n1a07.pdf
http://www.scielo.org.co/pdf/aqui/v16n1/... ⁾, Scopus (n=04)⁽¹⁶16 Dias TYAF, Costa IKF, Salvetti MG, Mendes CKTT, Torres GV. Influences of health care services and clinical characteristics on the quality of life of patients with venous ulcer. Acta Paul Enferm[Internet]. 2013 [cited 2017 Jun 05]; 26(6):529-34. Available from: http://www.scielo.br/pdf/ape/v26n6/en_04.pdf
http://www.scielo.br/pdf/ape/v26n6/en_04... ^,¹⁸18 Dias TYAF, Costa IKF, Melo MDM, Torres SMSGSO, Maia EMC, Torres GV. Quality of life assessment of patients with and without venous ulcer. Rev Latino-Am Enfermagem[Internet]. 2014 [cited 2017 Jun 05]; 22(4):576-81. Available from: http://www.scielo.br/pdf/rlae/v22n4/0104-1169-rlae-22-04-00576.pdf
http://www.scielo.br/pdf/rlae/v22n4/0104... ^,²⁵25 Tracz E, Zamojska E, Modrzejewski A, Zaborski D, Grzesiak W. Quality of life in patients with venous stasis ulcers and others with advanced venous insufficiency. Holist Nurs Pract[Internet]. 2015 [cited 2017 Jun 06]; 29(2):96-102. Available from: https://insights.ovid.com/pubmed?pmid=25658932
https://insights.ovid.com/pubmed?pmid=25... ^-²⁶26 Araújo RO, Silva DC, Souto RQ, Marconato AMP, Costa IKF, Torres GV. Impact of varicose ulcers on the quality of life of persons receiving primary care. Aquichan[Internet]. 2016 [cited 2017 Jun 06]; 16(1):56-66. Available from: http://www.scielo.org.co/pdf/aqui/v16n1/v16n1a07.pdf
http://www.scielo.org.co/pdf/aqui/v16n1/... ⁾, BDNF (n=02)⁽¹⁶16 Dias TYAF, Costa IKF, Salvetti MG, Mendes CKTT, Torres GV. Influences of health care services and clinical characteristics on the quality of life of patients with venous ulcer. Acta Paul Enferm[Internet]. 2013 [cited 2017 Jun 05]; 26(6):529-34. Available from: http://www.scielo.br/pdf/ape/v26n6/en_04.pdf
http://www.scielo.br/pdf/ape/v26n6/en_04... ^,¹⁸18 Dias TYAF, Costa IKF, Melo MDM, Torres SMSGSO, Maia EMC, Torres GV. Quality of life assessment of patients with and without venous ulcer. Rev Latino-Am Enfermagem[Internet]. 2014 [cited 2017 Jun 05]; 22(4):576-81. Available from: http://www.scielo.br/pdf/rlae/v22n4/0104-1169-rlae-22-04-00576.pdf
http://www.scielo.br/pdf/rlae/v22n4/0104... ⁾, and MEDLINE (n=02)⁽¹⁸18 Dias TYAF, Costa IKF, Melo MDM, Torres SMSGSO, Maia EMC, Torres GV. Quality of life assessment of patients with and without venous ulcer. Rev Latino-Am Enfermagem[Internet]. 2014 [cited 2017 Jun 05]; 22(4):576-81. Available from: http://www.scielo.br/pdf/rlae/v22n4/0104-1169-rlae-22-04-00576.pdf
http://www.scielo.br/pdf/rlae/v22n4/0104... ^-¹⁹19 Lozano SFS, Marinel JR, Carrasco EC, González RJP, Escudero RJR, Sánchez IN, et al. Venous leg ulcer in the context of chronic venous disease. Phlebol[Internet]. 2014 [cited 2017 Jun 05]; 29(4):220-6. Available from: http://journals.sagepub.com/doi/pdf/10.1177/0268355513480489
http://journals.sagepub.com/doi/pdf/10.1... ⁾.

The selected studies were developed in the following countries: Brazil (n=8)⁽¹³13 Salomé GM, Ferreira LM. Quality of life in patients with venous ulcers treated with Unna's boot compressive therapy. Rev Bras Cir Plást[Internet]. 2012 [cited 2017 Jun 05]; 27(3):466-71. Available from: http://www.scielo.br/pdf/rbcp/v27n3/en_24.pdf
http://www.scielo.br/pdf/rbcp/v27n3/en_2... ^,¹⁵15 Lopes CR, Figueiredo M, Ávila AM, Soares LMBM, Dionisio VC. Evaluation of limitations of venous ulcers in legs. J Vasc Bras[Internet]. 2013 [cited 2017 Jun 05]; 12(1):5-9. Available from: http://www.scielo.br/pdf/jvb/v12n1/en_03.pdf
http://www.scielo.br/pdf/jvb/v12n1/en_03... ^-¹⁶16 Dias TYAF, Costa IKF, Salvetti MG, Mendes CKTT, Torres GV. Influences of health care services and clinical characteristics on the quality of life of patients with venous ulcer. Acta Paul Enferm[Internet]. 2013 [cited 2017 Jun 05]; 26(6):529-34. Available from: http://www.scielo.br/pdf/ape/v26n6/en_04.pdf
http://www.scielo.br/pdf/ape/v26n6/en_04... ^,¹⁸18 Dias TYAF, Costa IKF, Melo MDM, Torres SMSGSO, Maia EMC, Torres GV. Quality of life assessment of patients with and without venous ulcer. Rev Latino-Am Enfermagem[Internet]. 2014 [cited 2017 Jun 05]; 22(4):576-81. Available from: http://www.scielo.br/pdf/rlae/v22n4/0104-1169-rlae-22-04-00576.pdf
http://www.scielo.br/pdf/rlae/v22n4/0104... ^,²¹21 Wachholz PA, Masuda PY, Nascimento DC, Taira CMH, Cleto NG. Quality of life profile and correlated factors in chronic leg ulcer patients in the mid-west of São Paulo State, Brazil. An Bras Dermatol[Internet]. 2014 [cited 2017 Jun 05]; 89(1):73-81. Available from: http://www.scielo.br/pdf/abd/v89n1/0365-0596-abd-89-01-0073.pdf
http://www.scielo.br/pdf/abd/v89n1/0365-... ^,²³23 Salomé GM, Blanes L, Ferreira LM. The impact of skin grafting on the quality of life and self-esteem of patients with venous leg ulcers. World J Surg[Internet]. 2014 [cited 2017 Jun 05]; 38:233-40. Available from: https://link.springer.com/article/10.1007/s00268-013-2228-x
https://link.springer.com/article/10.100... ^-²⁴24 Sell BT, Souza MV, Martins T, Amante LN. Quality of life of pacients with vasculogenic ulcers according to Ferrans and Powers: wounds. J Health Sci[Internet]. 2015 [cited 2017 Jun 06]; 17(3):160-4. Available from: http://www.pgsskroton.com.br/seer/index.php/JHealthSci/article/view/3062/2849
http://www.pgsskroton.com.br/seer/index.... ^,²⁶26 Araújo RO, Silva DC, Souto RQ, Marconato AMP, Costa IKF, Torres GV. Impact of varicose ulcers on the quality of life of persons receiving primary care. Aquichan[Internet]. 2016 [cited 2017 Jun 06]; 16(1):56-66. Available from: http://www.scielo.org.co/pdf/aqui/v16n1/v16n1a07.pdf
http://www.scielo.org.co/pdf/aqui/v16n1/... ⁾, Portugal (n=01)⁽¹⁷17 Saraiva DMRF, Bandarra AJF, Agostinho ES, Pereira NMM, Lopes TS. Quality of life of service users with chronic venous ulcers. Referência[Internet]. 2013 [cited 2017 Jun 05]; 3(10):109-18. Available from: http://www.scielo.mec.pt/pdf/ref/vserIIIn10/serIIIn10a13.pdf
http://www.scielo.mec.pt/pdf/ref/vserIII... ⁾, Spain (n=01)⁽¹⁹19 Lozano SFS, Marinel JR, Carrasco EC, González RJP, Escudero RJR, Sánchez IN, et al. Venous leg ulcer in the context of chronic venous disease. Phlebol[Internet]. 2014 [cited 2017 Jun 05]; 29(4):220-6. Available from: http://journals.sagepub.com/doi/pdf/10.1177/0268355513480489
http://journals.sagepub.com/doi/pdf/10.1... ⁾, Australia (n=01)⁽²²22 Finlayson KJ, Courtney MD, Gibb MA, O'Brien JA, Parker CN, Edwards HE. The effectiveness of a four-layer compression bandage system in comparison with class 3 compression hosiery on healing and quality of life in patients with venous leg ulcers: a randomized controlled trial. Int Wound J[Internet]. 2014 [cited 2017 Jun 05]; 11:21-7. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1742-481X. 2012.01033.x/epdf
http://onlinelibrary.wiley.com/doi/10.11... ⁾, and Poland (n=01)⁽²⁵25 Tracz E, Zamojska E, Modrzejewski A, Zaborski D, Grzesiak W. Quality of life in patients with venous stasis ulcers and others with advanced venous insufficiency. Holist Nurs Pract[Internet]. 2015 [cited 2017 Jun 06]; 29(2):96-102. Available from: https://insights.ovid.com/pubmed?pmid=25658932
https://insights.ovid.com/pubmed?pmid=25... ⁾, with two articles having been developed in a partnership between Brazil and Portugal⁽¹⁴14 Dias TYAF, Costa IKF, Liberato SMD, Souza AJG, Mendes FRP, Torres GV. Quality of life for venous ulcer patients: a comparative study in Brazil/Portugal. O Braz J Nurs[Internet]. 2013 [cited 2017 Jun 05]; 12(2):491-500. Available from: http://www.objnursing.uff.br/index.php/nursing/article/view/4344/pdf
http://www.objnursing.uff.br/index.php/n... ^,²⁰20 Torres GV, Balduino LSC, Costa IKF, Mendes FRP, Vasconcelos QLDAQ. Comparison of quality of life domains in patientswith venous ulcer. Rev Enferm UERJ[Internet]. 2014 [cited 2017 Jun 05]; 22(1):57-64. Available from: http://www.facenf.uerj.br/v22n1/v22n1a09.pdf
http://www.facenf.uerj.br/v22n1/v22n1a09... ⁾. Regarding summarization of the methodological characteristics of the selected articles, the data collected and shown in Charts 1 and 2 indicated that 100% (n=14) of the selected material presented a quantitative approach, with a prevalence of the evidence⁽¹¹11 Stillwell SB, Fineout-Overhoult E, Melnyk BM, Williamson KM. Searching for the evidence: strategies to help you conduct a successful search. Am J Nurs[Internet]. 2010 [cited 2017 May 18]; 110(5):41-7. Available from: http://www.nursingcenter.com/nursingcenter_redesign/media/EBP/AJNseries/Searching.pdf
http://www.nursingcenter.com/nursingcent... ⁾ at Level VI (n=09)⁽¹³13 Salomé GM, Ferreira LM. Quality of life in patients with venous ulcers treated with Unna's boot compressive therapy. Rev Bras Cir Plást[Internet]. 2012 [cited 2017 Jun 05]; 27(3):466-71. Available from: http://www.scielo.br/pdf/rbcp/v27n3/en_24.pdf
http://www.scielo.br/pdf/rbcp/v27n3/en_2... ^-¹⁴14 Dias TYAF, Costa IKF, Liberato SMD, Souza AJG, Mendes FRP, Torres GV. Quality of life for venous ulcer patients: a comparative study in Brazil/Portugal. O Braz J Nurs[Internet]. 2013 [cited 2017 Jun 05]; 12(2):491-500. Available from: http://www.objnursing.uff.br/index.php/nursing/article/view/4344/pdf
http://www.objnursing.uff.br/index.php/n... ^,¹⁶16 Dias TYAF, Costa IKF, Salvetti MG, Mendes CKTT, Torres GV. Influences of health care services and clinical characteristics on the quality of life of patients with venous ulcer. Acta Paul Enferm[Internet]. 2013 [cited 2017 Jun 05]; 26(6):529-34. Available from: http://www.scielo.br/pdf/ape/v26n6/en_04.pdf
http://www.scielo.br/pdf/ape/v26n6/en_04...

17 Saraiva DMRF, Bandarra AJF, Agostinho ES, Pereira NMM, Lopes TS. Quality of life of service users with chronic venous ulcers. Referência[Internet]. 2013 [cited 2017 Jun 05]; 3(10):109-18. Available from: http://www.scielo.mec.pt/pdf/ref/vserIIIn10/serIIIn10a13.pdf
http://www.scielo.mec.pt/pdf/ref/vserIII... ^-¹⁸18 Dias TYAF, Costa IKF, Melo MDM, Torres SMSGSO, Maia EMC, Torres GV. Quality of life assessment of patients with and without venous ulcer. Rev Latino-Am Enfermagem[Internet]. 2014 [cited 2017 Jun 05]; 22(4):576-81. Available from: http://www.scielo.br/pdf/rlae/v22n4/0104-1169-rlae-22-04-00576.pdf
http://www.scielo.br/pdf/rlae/v22n4/0104... ^,²⁰20 Torres GV, Balduino LSC, Costa IKF, Mendes FRP, Vasconcelos QLDAQ. Comparison of quality of life domains in patientswith venous ulcer. Rev Enferm UERJ[Internet]. 2014 [cited 2017 Jun 05]; 22(1):57-64. Available from: http://www.facenf.uerj.br/v22n1/v22n1a09.pdf
http://www.facenf.uerj.br/v22n1/v22n1a09... ^-²¹21 Wachholz PA, Masuda PY, Nascimento DC, Taira CMH, Cleto NG. Quality of life profile and correlated factors in chronic leg ulcer patients in the mid-west of São Paulo State, Brazil. An Bras Dermatol[Internet]. 2014 [cited 2017 Jun 05]; 89(1):73-81. Available from: http://www.scielo.br/pdf/abd/v89n1/0365-0596-abd-89-01-0073.pdf
http://www.scielo.br/pdf/abd/v89n1/0365-... ^,²⁴24 Sell BT, Souza MV, Martins T, Amante LN. Quality of life of pacients with vasculogenic ulcers according to Ferrans and Powers: wounds. J Health Sci[Internet]. 2015 [cited 2017 Jun 06]; 17(3):160-4. Available from: http://www.pgsskroton.com.br/seer/index.php/JHealthSci/article/view/3062/2849
http://www.pgsskroton.com.br/seer/index.... ^,²⁶26 Araújo RO, Silva DC, Souto RQ, Marconato AMP, Costa IKF, Torres GV. Impact of varicose ulcers on the quality of life of persons receiving primary care. Aquichan[Internet]. 2016 [cited 2017 Jun 06]; 16(1):56-66. Available from: http://www.scielo.org.co/pdf/aqui/v16n1/v16n1a07.pdf
http://www.scielo.org.co/pdf/aqui/v16n1/... ⁾, followed by Level IV (n=02)⁽¹⁵15 Lopes CR, Figueiredo M, Ávila AM, Soares LMBM, Dionisio VC. Evaluation of limitations of venous ulcers in legs. J Vasc Bras[Internet]. 2013 [cited 2017 Jun 05]; 12(1):5-9. Available from: http://www.scielo.br/pdf/jvb/v12n1/en_03.pdf
http://www.scielo.br/pdf/jvb/v12n1/en_03... ^,¹⁹19 Lozano SFS, Marinel JR, Carrasco EC, González RJP, Escudero RJR, Sánchez IN, et al. Venous leg ulcer in the context of chronic venous disease. Phlebol[Internet]. 2014 [cited 2017 Jun 05]; 29(4):220-6. Available from: http://journals.sagepub.com/doi/pdf/10.1177/0268355513480489
http://journals.sagepub.com/doi/pdf/10.1... ⁾, Level II (n=01)⁽²²22 Finlayson KJ, Courtney MD, Gibb MA, O'Brien JA, Parker CN, Edwards HE. The effectiveness of a four-layer compression bandage system in comparison with class 3 compression hosiery on healing and quality of life in patients with venous leg ulcers: a randomized controlled trial. Int Wound J[Internet]. 2014 [cited 2017 Jun 05]; 11:21-7. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1742-481X. 2012.01033.x/epdf
http://onlinelibrary.wiley.com/doi/10.11... ⁾, Level III (n=01)⁽²³23 Salomé GM, Blanes L, Ferreira LM. The impact of skin grafting on the quality of life and self-esteem of patients with venous leg ulcers. World J Surg[Internet]. 2014 [cited 2017 Jun 05]; 38:233-40. Available from: https://link.springer.com/article/10.1007/s00268-013-2228-x
https://link.springer.com/article/10.100... ⁾, and Level VII (n=01)⁽²⁵25 Tracz E, Zamojska E, Modrzejewski A, Zaborski D, Grzesiak W. Quality of life in patients with venous stasis ulcers and others with advanced venous insufficiency. Holist Nurs Pract[Internet]. 2015 [cited 2017 Jun 06]; 29(2):96-102. Available from: https://insights.ovid.com/pubmed?pmid=25658932
https://insights.ovid.com/pubmed?pmid=25... ⁾.

With regard to the most frequently adopted verbs in the description of the objectives, a prevalence of the verb “to compare” was found (n=04)⁽¹⁴14 Dias TYAF, Costa IKF, Liberato SMD, Souza AJG, Mendes FRP, Torres GV. Quality of life for venous ulcer patients: a comparative study in Brazil/Portugal. O Braz J Nurs[Internet]. 2013 [cited 2017 Jun 05]; 12(2):491-500. Available from: http://www.objnursing.uff.br/index.php/nursing/article/view/4344/pdf
http://www.objnursing.uff.br/index.php/n... ^,¹⁸18 Dias TYAF, Costa IKF, Melo MDM, Torres SMSGSO, Maia EMC, Torres GV. Quality of life assessment of patients with and without venous ulcer. Rev Latino-Am Enfermagem[Internet]. 2014 [cited 2017 Jun 05]; 22(4):576-81. Available from: http://www.scielo.br/pdf/rlae/v22n4/0104-1169-rlae-22-04-00576.pdf
http://www.scielo.br/pdf/rlae/v22n4/0104... ^,²⁰20 Torres GV, Balduino LSC, Costa IKF, Mendes FRP, Vasconcelos QLDAQ. Comparison of quality of life domains in patientswith venous ulcer. Rev Enferm UERJ[Internet]. 2014 [cited 2017 Jun 05]; 22(1):57-64. Available from: http://www.facenf.uerj.br/v22n1/v22n1a09.pdf
http://www.facenf.uerj.br/v22n1/v22n1a09... ^,²²22 Finlayson KJ, Courtney MD, Gibb MA, O'Brien JA, Parker CN, Edwards HE. The effectiveness of a four-layer compression bandage system in comparison with class 3 compression hosiery on healing and quality of life in patients with venous leg ulcers: a randomized controlled trial. Int Wound J[Internet]. 2014 [cited 2017 Jun 05]; 11:21-7. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1742-481X. 2012.01033.x/epdf
http://onlinelibrary.wiley.com/doi/10.11... ⁾, followed by the verbs “to evaluate” (n=03)⁽¹³13 Salomé GM, Ferreira LM. Quality of life in patients with venous ulcers treated with Unna's boot compressive therapy. Rev Bras Cir Plást[Internet]. 2012 [cited 2017 Jun 05]; 27(3):466-71. Available from: http://www.scielo.br/pdf/rbcp/v27n3/en_24.pdf
http://www.scielo.br/pdf/rbcp/v27n3/en_2... ^,¹⁷17 Saraiva DMRF, Bandarra AJF, Agostinho ES, Pereira NMM, Lopes TS. Quality of life of service users with chronic venous ulcers. Referência[Internet]. 2013 [cited 2017 Jun 05]; 3(10):109-18. Available from: http://www.scielo.mec.pt/pdf/ref/vserIIIn10/serIIIn10a13.pdf
http://www.scielo.mec.pt/pdf/ref/vserIII... ^,²³23 Salomé GM, Blanes L, Ferreira LM. The impact of skin grafting on the quality of life and self-esteem of patients with venous leg ulcers. World J Surg[Internet]. 2014 [cited 2017 Jun 05]; 38:233-40. Available from: https://link.springer.com/article/10.1007/s00268-013-2228-x
https://link.springer.com/article/10.100... ⁾, “to verify” (n=02)⁽¹⁶16 Dias TYAF, Costa IKF, Salvetti MG, Mendes CKTT, Torres GV. Influences of health care services and clinical characteristics on the quality of life of patients with venous ulcer. Acta Paul Enferm[Internet]. 2013 [cited 2017 Jun 05]; 26(6):529-34. Available from: http://www.scielo.br/pdf/ape/v26n6/en_04.pdf
http://www.scielo.br/pdf/ape/v26n6/en_04... ^,²⁴24 Sell BT, Souza MV, Martins T, Amante LN. Quality of life of pacients with vasculogenic ulcers according to Ferrans and Powers: wounds. J Health Sci[Internet]. 2015 [cited 2017 Jun 06]; 17(3):160-4. Available from: http://www.pgsskroton.com.br/seer/index.php/JHealthSci/article/view/3062/2849
http://www.pgsskroton.com.br/seer/index.... ⁾, “to analyze” (n=02)⁽²⁵25 Tracz E, Zamojska E, Modrzejewski A, Zaborski D, Grzesiak W. Quality of life in patients with venous stasis ulcers and others with advanced venous insufficiency. Holist Nurs Pract[Internet]. 2015 [cited 2017 Jun 06]; 29(2):96-102. Available from: https://insights.ovid.com/pubmed?pmid=25658932
https://insights.ovid.com/pubmed?pmid=25... ^-²⁶26 Araújo RO, Silva DC, Souto RQ, Marconato AMP, Costa IKF, Torres GV. Impact of varicose ulcers on the quality of life of persons receiving primary care. Aquichan[Internet]. 2016 [cited 2017 Jun 06]; 16(1):56-66. Available from: http://www.scielo.org.co/pdf/aqui/v16n1/v16n1a07.pdf
http://www.scielo.org.co/pdf/aqui/v16n1/... ⁾, “to correlate” (n=01)⁽¹⁵15 Lopes CR, Figueiredo M, Ávila AM, Soares LMBM, Dionisio VC. Evaluation of limitations of venous ulcers in legs. J Vasc Bras[Internet]. 2013 [cited 2017 Jun 05]; 12(1):5-9. Available from: http://www.scielo.br/pdf/jvb/v12n1/en_03.pdf
http://www.scielo.br/pdf/jvb/v12n1/en_03... ⁾, “to determine” (n=01)⁽¹⁹19 Lozano SFS, Marinel JR, Carrasco EC, González RJP, Escudero RJR, Sánchez IN, et al. Venous leg ulcer in the context of chronic venous disease. Phlebol[Internet]. 2014 [cited 2017 Jun 05]; 29(4):220-6. Available from: http://journals.sagepub.com/doi/pdf/10.1177/0268355513480489
http://journals.sagepub.com/doi/pdf/10.1... ⁾, and “to identify” (n=1)⁽²¹21 Wachholz PA, Masuda PY, Nascimento DC, Taira CMH, Cleto NG. Quality of life profile and correlated factors in chronic leg ulcer patients in the mid-west of São Paulo State, Brazil. An Bras Dermatol[Internet]. 2014 [cited 2017 Jun 05]; 89(1):73-81. Available from: http://www.scielo.br/pdf/abd/v89n1/0365-0596-abd-89-01-0073.pdf
http://www.scielo.br/pdf/abd/v89n1/0365-... ⁾, these being in accordance with studies with a quantitative approach.

With regard to the instrument used to evaluate quality of life as shown in Chart 1, a prevalence of Short Form-36 (SF-36) was found in the studies. This instrument was used in seven studies⁽¹³13 Salomé GM, Ferreira LM. Quality of life in patients with venous ulcers treated with Unna's boot compressive therapy. Rev Bras Cir Plást[Internet]. 2012 [cited 2017 Jun 05]; 27(3):466-71. Available from: http://www.scielo.br/pdf/rbcp/v27n3/en_24.pdf
http://www.scielo.br/pdf/rbcp/v27n3/en_2...

14 Dias TYAF, Costa IKF, Liberato SMD, Souza AJG, Mendes FRP, Torres GV. Quality of life for venous ulcer patients: a comparative study in Brazil/Portugal. O Braz J Nurs[Internet]. 2013 [cited 2017 Jun 05]; 12(2):491-500. Available from: http://www.objnursing.uff.br/index.php/nursing/article/view/4344/pdf
http://www.objnursing.uff.br/index.php/n...

15 Lopes CR, Figueiredo M, Ávila AM, Soares LMBM, Dionisio VC. Evaluation of limitations of venous ulcers in legs. J Vasc Bras[Internet]. 2013 [cited 2017 Jun 05]; 12(1):5-9. Available from: http://www.scielo.br/pdf/jvb/v12n1/en_03.pdf
http://www.scielo.br/pdf/jvb/v12n1/en_03... ^-¹⁶16 Dias TYAF, Costa IKF, Salvetti MG, Mendes CKTT, Torres GV. Influences of health care services and clinical characteristics on the quality of life of patients with venous ulcer. Acta Paul Enferm[Internet]. 2013 [cited 2017 Jun 05]; 26(6):529-34. Available from: http://www.scielo.br/pdf/ape/v26n6/en_04.pdf
http://www.scielo.br/pdf/ape/v26n6/en_04... ^,¹⁸18 Dias TYAF, Costa IKF, Melo MDM, Torres SMSGSO, Maia EMC, Torres GV. Quality of life assessment of patients with and without venous ulcer. Rev Latino-Am Enfermagem[Internet]. 2014 [cited 2017 Jun 05]; 22(4):576-81. Available from: http://www.scielo.br/pdf/rlae/v22n4/0104-1169-rlae-22-04-00576.pdf
http://www.scielo.br/pdf/rlae/v22n4/0104... ^,²⁰20 Torres GV, Balduino LSC, Costa IKF, Mendes FRP, Vasconcelos QLDAQ. Comparison of quality of life domains in patientswith venous ulcer. Rev Enferm UERJ[Internet]. 2014 [cited 2017 Jun 05]; 22(1):57-64. Available from: http://www.facenf.uerj.br/v22n1/v22n1a09.pdf
http://www.facenf.uerj.br/v22n1/v22n1a09... ^,²³23 Salomé GM, Blanes L, Ferreira LM. The impact of skin grafting on the quality of life and self-esteem of patients with venous leg ulcers. World J Surg[Internet]. 2014 [cited 2017 Jun 05]; 38:233-40. Available from: https://link.springer.com/article/10.1007/s00268-013-2228-x
https://link.springer.com/article/10.100... ⁾, followed by the instruments: Cardiff Wound Impact Schedule (n=01)⁽¹⁷17 Saraiva DMRF, Bandarra AJF, Agostinho ES, Pereira NMM, Lopes TS. Quality of life of service users with chronic venous ulcers. Referência[Internet]. 2013 [cited 2017 Jun 05]; 3(10):109-18. Available from: http://www.scielo.mec.pt/pdf/ref/vserIIIn10/serIIIn10a13.pdf
http://www.scielo.mec.pt/pdf/ref/vserIII... ⁾; Short Form 12 Health Survey (n=1)⁽¹⁹19 Lozano SFS, Marinel JR, Carrasco EC, González RJP, Escudero RJR, Sánchez IN, et al. Venous leg ulcer in the context of chronic venous disease. Phlebol[Internet]. 2014 [cited 2017 Jun 05]; 29(4):220-6. Available from: http://journals.sagepub.com/doi/pdf/10.1177/0268355513480489
http://journals.sagepub.com/doi/pdf/10.1... ⁾; Dermatology Life Quality Index (n=1)⁽²¹21 Wachholz PA, Masuda PY, Nascimento DC, Taira CMH, Cleto NG. Quality of life profile and correlated factors in chronic leg ulcer patients in the mid-west of São Paulo State, Brazil. An Bras Dermatol[Internet]. 2014 [cited 2017 Jun 05]; 89(1):73-81. Available from: http://www.scielo.br/pdf/abd/v89n1/0365-0596-abd-89-01-0073.pdf
http://www.scielo.br/pdf/abd/v89n1/0365-... ⁾; Quality of Life Index (n=1)⁽²²22 Finlayson KJ, Courtney MD, Gibb MA, O'Brien JA, Parker CN, Edwards HE. The effectiveness of a four-layer compression bandage system in comparison with class 3 compression hosiery on healing and quality of life in patients with venous leg ulcers: a randomized controlled trial. Int Wound J[Internet]. 2014 [cited 2017 Jun 05]; 11:21-7. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1742-481X. 2012.01033.x/epdf
http://onlinelibrary.wiley.com/doi/10.11... ⁾; Ferrans and Powers Quality of Life Index-Wound Version (n=1)⁽²⁴24 Sell BT, Souza MV, Martins T, Amante LN. Quality of life of pacients with vasculogenic ulcers according to Ferrans and Powers: wounds. J Health Sci[Internet]. 2015 [cited 2017 Jun 06]; 17(3):160-4. Available from: http://www.pgsskroton.com.br/seer/index.php/JHealthSci/article/view/3062/2849
http://www.pgsskroton.com.br/seer/index.... ⁾; Quality of Life Survey-WHOQOL 100 (n=1)⁽¹⁵15 Lopes CR, Figueiredo M, Ávila AM, Soares LMBM, Dionisio VC. Evaluation of limitations of venous ulcers in legs. J Vasc Bras[Internet]. 2013 [cited 2017 Jun 05]; 12(1):5-9. Available from: http://www.scielo.br/pdf/jvb/v12n1/en_03.pdf
http://www.scielo.br/pdf/jvb/v12n1/en_03... ⁾; and Charing Cross Venous Ulcer Questionnaire (n=1)⁽²⁶26 Araújo RO, Silva DC, Souto RQ, Marconato AMP, Costa IKF, Torres GV. Impact of varicose ulcers on the quality of life of persons receiving primary care. Aquichan[Internet]. 2016 [cited 2017 Jun 06]; 16(1):56-66. Available from: http://www.scielo.org.co/pdf/aqui/v16n1/v16n1a07.pdf
http://www.scielo.org.co/pdf/aqui/v16n1/... ⁾.

The instrument SF-36 evaluates issues such as functional capacity, limitation due to physical aspect, pain, general health condition, vitality, social aspects, emotional aspect, and mental health. The Cardiff Wound Impact Schedule evaluates well-being, physical symptoms and daily life, social life, and quality of life in general. The Short Form 12 Health Survey (SF-12) evaluates physical function, physical aspect, pain, general health, vitality, social function, emotional aspect, and mental health. The Dermatology Life Quality Index (DLQI) evaluates issues regarding symptoms and feelings, activities of daily living, leisure, work and school, personal relationships, and treatment.

The Quality of Life Index measures dimensions regarding activities, daily life, health support, and psychological perspectives. The Ferrans and Powers Quality of Life Index-Wound Version evaluates issues regarding socioeconomic, family, psychological/spiritual, health, and functioning aspects. The instrument Quality of Life Survey-WHOQOL 100 evaluates physical and psychological issues, level of independence, social relationships, environment, and spiritual/religion/personal beliefs aspects. The instrument Charing Cross Venous Ulcer Questionnaire evaluates household activities, social interaction, emotional state, and aesthetics.

DISCUSSION

During the selection of potential bibliographies and the full reading of the articles, data categorization was carried out. This step considered the similarities among the materials selected. The following three categories emerged, which enabled the discussion of the theme: “The importance of assessing quality of life in patients with chronic venous ulcers”; “Difficulties, limitations, and feelings regarding patients with chronic venous ulcers”; and “What must be done for the improvement of quality of life in patients with chronic venous ulcers.”

The importance of assessing quality of life in patients with chronic venous ulcers

Chronic venous ulcers cause several changes in patients' lives due to pain, difficulty of locomotion, exudate, odor, and other aspects. These can lead to mood swings and changes in family relationships and social conviviality⁽¹³13 Salomé GM, Ferreira LM. Quality of life in patients with venous ulcers treated with Unna's boot compressive therapy. Rev Bras Cir Plást[Internet]. 2012 [cited 2017 Jun 05]; 27(3):466-71. Available from: http://www.scielo.br/pdf/rbcp/v27n3/en_24.pdf
http://www.scielo.br/pdf/rbcp/v27n3/en_2... ⁾, thus making activities of daily living and social activities depend on how patients are feeling.

Activities of daily living such as going up or down stairs, moving around the house, standing up without support, bathing, and dressing⁽¹⁴14 Dias TYAF, Costa IKF, Liberato SMD, Souza AJG, Mendes FRP, Torres GV. Quality of life for venous ulcer patients: a comparative study in Brazil/Portugal. O Braz J Nurs[Internet]. 2013 [cited 2017 Jun 05]; 12(2):491-500. Available from: http://www.objnursing.uff.br/index.php/nursing/article/view/4344/pdf
http://www.objnursing.uff.br/index.php/n... ^,¹⁸18 Dias TYAF, Costa IKF, Melo MDM, Torres SMSGSO, Maia EMC, Torres GV. Quality of life assessment of patients with and without venous ulcer. Rev Latino-Am Enfermagem[Internet]. 2014 [cited 2017 Jun 05]; 22(4):576-81. Available from: http://www.scielo.br/pdf/rlae/v22n4/0104-1169-rlae-22-04-00576.pdf
http://www.scielo.br/pdf/rlae/v22n4/0104... ⁾ tend to bring negative repercussions to patients who, in general, also suffer from balance and walking difficulties⁽⁹9 Joaquim FL, Camacho ACLF, Sabóia VM, Santos RC, Santos LSF, Nogueira GA. Impact of home visits on the functional capacity of patients with venous ulcers. Rev Bras Enferm[Internet]. 2016 [cited 2017 May 18]; 69(3):439-47. Available from: http://www.scielo.br/pdf/reben/v69n3/en_0034-7167-reben-69-03-0468.pdf
http://www.scielo.br/pdf/reben/v69n3/en_... ⁾. Therefore, consequences of the pathological process lead to limitations and changes that impact quality of life and psychosocial and motor aspects, thus promoting restrictions on activities of daily living⁽¹⁵15 Lopes CR, Figueiredo M, Ávila AM, Soares LMBM, Dionisio VC. Evaluation of limitations of venous ulcers in legs. J Vasc Bras[Internet]. 2013 [cited 2017 Jun 05]; 12(1):5-9. Available from: http://www.scielo.br/pdf/jvb/v12n1/en_03.pdf
http://www.scielo.br/pdf/jvb/v12n1/en_03... ⁾.

Chronic venous ulcers compromise patients' lives regarding functional capacity, limitations due to physical aspects, pain, general health condition, vitality, social aspects, emotional aspects, and mental health⁽¹⁴14 Dias TYAF, Costa IKF, Liberato SMD, Souza AJG, Mendes FRP, Torres GV. Quality of life for venous ulcer patients: a comparative study in Brazil/Portugal. O Braz J Nurs[Internet]. 2013 [cited 2017 Jun 05]; 12(2):491-500. Available from: http://www.objnursing.uff.br/index.php/nursing/article/view/4344/pdf
http://www.objnursing.uff.br/index.php/n... ⁾. Therefore, assessment of the quality of life of patients with chronic venous ulcers is of utmost importance, because this is a response indicator of the wound's healing process⁽¹³13 Salomé GM, Ferreira LM. Quality of life in patients with venous ulcers treated with Unna's boot compressive therapy. Rev Bras Cir Plást[Internet]. 2012 [cited 2017 Jun 05]; 27(3):466-71. Available from: http://www.scielo.br/pdf/rbcp/v27n3/en_24.pdf
http://www.scielo.br/pdf/rbcp/v27n3/en_2... ⁾. In addition, it provides indicators of which aspects may compromise the perception that patients present due to the pathology, and which feelings emerge based on this perception of living with the wound.

Difficulties, limitations, and feelings of patients with chronic venous ulcers

Patients with chronic venous ulcers present difficulties in performing simple activities of daily living. Wounds affecting the lower limbs interfere with locomotion, causing several limitations, thus forcing patients who live with the wounds to reorganize their daily activities. In addition, they feel dependent on others⁽¹⁸18 Dias TYAF, Costa IKF, Melo MDM, Torres SMSGSO, Maia EMC, Torres GV. Quality of life assessment of patients with and without venous ulcer. Rev Latino-Am Enfermagem[Internet]. 2014 [cited 2017 Jun 05]; 22(4):576-81. Available from: http://www.scielo.br/pdf/rlae/v22n4/0104-1169-rlae-22-04-00576.pdf
http://www.scielo.br/pdf/rlae/v22n4/0104... ⁾ due to the etiology, pain associated with the ulcer, length of time from beginning of the wound, and severity of the depressive symptoms⁽²¹21 Wachholz PA, Masuda PY, Nascimento DC, Taira CMH, Cleto NG. Quality of life profile and correlated factors in chronic leg ulcer patients in the mid-west of São Paulo State, Brazil. An Bras Dermatol[Internet]. 2014 [cited 2017 Jun 05]; 89(1):73-81. Available from: http://www.scielo.br/pdf/abd/v89n1/0365-0596-abd-89-01-0073.pdf
http://www.scielo.br/pdf/abd/v89n1/0365-... ⁾.

The difficulty in committing to/remaining at work, in addition to difficulties in performing daily and social activities, lead to repercussions due to physical restrictions, pain, and the psychological, emotional, and social implications caused by the wound⁽²⁰20 Torres GV, Balduino LSC, Costa IKF, Mendes FRP, Vasconcelos QLDAQ. Comparison of quality of life domains in patientswith venous ulcer. Rev Enferm UERJ[Internet]. 2014 [cited 2017 Jun 05]; 22(1):57-64. Available from: http://www.facenf.uerj.br/v22n1/v22n1a09.pdf
http://www.facenf.uerj.br/v22n1/v22n1a09... ⁾. Consequently, limitations resulting from the wounds become big obstacles for the performance of activities of daily living, as well as for clinical follow-up, because patients present difficulties in traveling to healthcare services⁽²⁷27 Green J, Jester R, Mckinley A, Pooler S, Mason S, Redsell S. A new quality of life consultation template for patients with venous leg ulceration. J Wound Care[Internet]. 2015 [cited 2017 Jun 06]; 24(3):140-8. Available from: http://www.magonlinelibrary.com/doi/pdf/10.12968/jowc.2015.24.3.140
http://www.magonlinelibrary.com/doi/pdf/... ⁾.

Another fact that is worth mentioning is the high amount of resources needed for the treatment⁽¹⁹19 Lozano SFS, Marinel JR, Carrasco EC, González RJP, Escudero RJR, Sánchez IN, et al. Venous leg ulcer in the context of chronic venous disease. Phlebol[Internet]. 2014 [cited 2017 Jun 05]; 29(4):220-6. Available from: http://journals.sagepub.com/doi/pdf/10.1177/0268355513480489
http://journals.sagepub.com/doi/pdf/10.1... ⁾. Although public healthcare networks offer treatment, patients tend to allocate substantial resources to pay for medication/coverage, and when they are absent from work or are early retired because of the wound, they start reflecting on expenses and tend to abandon treatment to cover their own and their families' subsistence.

Chronic venous ulcers, in addition to physical changes and financial charges, bring implications of psychological and social context, extended to family and social spheres, thus showing the complexity of this problem⁽¹⁶16 Dias TYAF, Costa IKF, Salvetti MG, Mendes CKTT, Torres GV. Influences of health care services and clinical characteristics on the quality of life of patients with venous ulcer. Acta Paul Enferm[Internet]. 2013 [cited 2017 Jun 05]; 26(6):529-34. Available from: http://www.scielo.br/pdf/ape/v26n6/en_04.pdf
http://www.scielo.br/pdf/ape/v26n6/en_04... ⁾. Consequently, chronic venous ulcers bring feelings of anxiety and depression disorders to patients, which tend to cause delays in the healing process of wounds from acute conditions⁽²²22 Finlayson KJ, Courtney MD, Gibb MA, O'Brien JA, Parker CN, Edwards HE. The effectiveness of a four-layer compression bandage system in comparison with class 3 compression hosiery on healing and quality of life in patients with venous leg ulcers: a randomized controlled trial. Int Wound J[Internet]. 2014 [cited 2017 Jun 05]; 11:21-7. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1742-481X. 2012.01033.x/epdf
http://onlinelibrary.wiley.com/doi/10.11... ⁾. Therefore, promoting psychological well-being to patients is necessary for the improvement of their clinical condition.

Unemployment/early retirement that affect patients who experience the wound, pain, functional limitations, feeling of frustration, odor, and aesthetic aspect that discourage interaction. This can lead to social isolation, lack of strength, concerns, low self-esteem, self-concept⁽²³23 Salomé GM, Blanes L, Ferreira LM. The impact of skin grafting on the quality of life and self-esteem of patients with venous leg ulcers. World J Surg[Internet]. 2014 [cited 2017 Jun 05]; 38:233-40. Available from: https://link.springer.com/article/10.1007/s00268-013-2228-x
https://link.springer.com/article/10.100... ⁾, and physical and social safety⁽²⁵25 Tracz E, Zamojska E, Modrzejewski A, Zaborski D, Grzesiak W. Quality of life in patients with venous stasis ulcers and others with advanced venous insufficiency. Holist Nurs Pract[Internet]. 2015 [cited 2017 Jun 06]; 29(2):96-102. Available from: https://insights.ovid.com/pubmed?pmid=25658932
https://insights.ovid.com/pubmed?pmid=25... ⁾. These are issues that also reflect the feelings of patients with venous ulcers, thus impacting quality of life, which suggests that care must address all life aspects of these patients.

What must be done for the improvement of quality of life in patients with chronic venous ulcers

For improvement of the quality of life of patients with venous ulcers, therapies must be optimized, doubts that may emerge must be clarified, and activities that relieve tensions and promote well-being and autonomy to patients and their families must be provided, through the adoption of best practice that ensures coherence and solidity to the care provided during the treatment process⁽¹⁷17 Saraiva DMRF, Bandarra AJF, Agostinho ES, Pereira NMM, Lopes TS. Quality of life of service users with chronic venous ulcers. Referência[Internet]. 2013 [cited 2017 Jun 05]; 3(10):109-18. Available from: http://www.scielo.mec.pt/pdf/ref/vserIIIn10/serIIIn10a13.pdf
http://www.scielo.mec.pt/pdf/ref/vserIII... ⁾.

The nursing area has an important role in the care provided to these patients regarding therapeutic procedures that involve assessment of the diagnosis and healing process, as well as in the prevention of harm related to the pathology. This prevention must occur by means of the development/application of new technical interventions in nursing care and healthcare with the aim of recovery and rehabilitation of both patients and families involved in the care process.

Therefore, nurses who provide care to this population must be attentive to the evolution of the disease and seek the prevention of other wounds, recurrences, and the appropriate treatment for the healing of the wound, with the aim of reducing damage that the clinical condition promotes in the quality of life of these patients⁽¹⁸18 Dias TYAF, Costa IKF, Melo MDM, Torres SMSGSO, Maia EMC, Torres GV. Quality of life assessment of patients with and without venous ulcer. Rev Latino-Am Enfermagem[Internet]. 2014 [cited 2017 Jun 05]; 22(4):576-81. Available from: http://www.scielo.br/pdf/rlae/v22n4/0104-1169-rlae-22-04-00576.pdf
http://www.scielo.br/pdf/rlae/v22n4/0104... ⁾. For this purpose, care must be focused not only on the wounds, but also on the patients who live with them, by intervening in the factors that compromise quality of life⁽²⁰20 Torres GV, Balduino LSC, Costa IKF, Mendes FRP, Vasconcelos QLDAQ. Comparison of quality of life domains in patientswith venous ulcer. Rev Enferm UERJ[Internet]. 2014 [cited 2017 Jun 05]; 22(1):57-64. Available from: http://www.facenf.uerj.br/v22n1/v22n1a09.pdf
http://www.facenf.uerj.br/v22n1/v22n1a09... ⁾.

During care, healthcare professionals usually do not ask about patients' concerns and complaints. They do not discuss them and there are no changes in the care process in order to resolve and minimize patients' concerns.

Nursing professionals must provide patients with comprehensive care, because patients with chronic venous ulcers are impaired in both bio-psycho-spiritual and socioeconomic aspects. Thus, professionals must be attentive to notice patients' weaknesses and intervene appropriately, not only focusing on clinical diagnoses, but also encouraging patients to face the difficulties resulting from their clinical condition, and providing them with comfort and well-being for possible improvement in their quality of life⁽¹³13 Salomé GM, Ferreira LM. Quality of life in patients with venous ulcers treated with Unna's boot compressive therapy. Rev Bras Cir Plást[Internet]. 2012 [cited 2017 Jun 05]; 27(3):466-71. Available from: http://www.scielo.br/pdf/rbcp/v27n3/en_24.pdf
http://www.scielo.br/pdf/rbcp/v27n3/en_2... ⁾.

One study selected during the search⁽²⁴24 Sell BT, Souza MV, Martins T, Amante LN. Quality of life of pacients with vasculogenic ulcers according to Ferrans and Powers: wounds. J Health Sci[Internet]. 2015 [cited 2017 Jun 06]; 17(3):160-4. Available from: http://www.pgsskroton.com.br/seer/index.php/JHealthSci/article/view/3062/2849
http://www.pgsskroton.com.br/seer/index.... ⁾ showed that, to improve the quality of life of these patients, updates of guidelines and protocols for the care of this type of wound are of the utmost importance, in addition to investments to improve quality of care by training multidisciplinary teams and providing health education for professionals and family members/caregivers.

Based on the abovementioned study, the importance of clinical conduct in the treatment of chronic venous insufficiency stands out, because signs and symptoms of the disease are directly associated with the impairment of quality of life in the population affected. Therefore, it is of utmost importance that the care provided to patients with chronic venous ulcers presents a drug therapy approach, topical therapy with local coverage, promotion of exudate control through the use or not of compression therapies, control of secondary infections, and prevention of recurrences⁽⁴4 Barbosa JAG, Campos LMN. Guidelines for the treatment of venous ulcer. Enferm Glob[Internet]. 2010 [cited 2017 May 18]; 20:1-13. Available from: http://scielo.isciii.es/pdf/eg/n20/pt_revision2.pdf
http://scielo.isciii.es/pdf/eg/n20/pt_re... ⁾ by means of post-healing follow-up by an angiologist. In addition, identification of specificities demanded by each patient are important, because patients who present wounds for a longer time tend to present a greater impairment of quality of life compared to those who live with the wounds for less than one year⁽²⁶26 Araújo RO, Silva DC, Souto RQ, Marconato AMP, Costa IKF, Torres GV. Impact of varicose ulcers on the quality of life of persons receiving primary care. Aquichan[Internet]. 2016 [cited 2017 Jun 06]; 16(1):56-66. Available from: http://www.scielo.org.co/pdf/aqui/v16n1/v16n1a07.pdf
http://www.scielo.org.co/pdf/aqui/v16n1/... ⁾.

The adoption of educational support for patients is also necessary, because low education level was shown in the present study as one of the factors that influences quality of life. This influence may be related to the lack of understanding of health recommendations, which tends to compromise the clinical conducts adopted and consequently lead to post-healing process recurrences. Therefore, the use of strategies based on education and health regarding patients' education level is of utmost importance, so that they are able to understand the clinical conduct adopted and actively participate as protagonists in their recovery process.

Study limitations

The current study presented as a limitation the fact that the research was based on articles from 2007 to 2016, and the articles selected with the criteria adopted were from 2012 to 2016. This may be related to the databases adopted for the development of the study.

Contributions to the nursing, healthcare, or public policy areas

The main contribution of the present study to the scientific research field in venous ulcers and the nursing area was to identify the factors that affect the quality of life of patients with chronic venous ulcers and the dimensions affected, namely those related to functional capacity, physical aspect, pain, general health condition, vitality, social aspects, emotional aspects, and mental health. These findings become especially relevant because impairment of quality of life will impact what patients feel about themselves and about presenting wounds, considering that these wounds significantly affect the performance of daily work and leisure activities.

These reflections enable professional improvement and the adoption of new healthcare interventions aimed at the recovery and rehabilitation of patients and their families.

CONCLUSION

The present study enabled an analysis of the impact of chronic venous ulcers on patients' quality of life, because the results identified that these wounds negatively impact on patients' integrality (bio-psycho-spiritual) and their socioeconomic sphere.

Therefore, patients with chronic venous ulcers must receive care based on kindness and sensible listening, in addition to emotional and psychological support during their treatment.

The development of the following assessment studies are recommended: strategies for the reduction in damages regarding venous ulcers on patients' quality of life; evaluation of the repercussions of psychological follow-up of patients on the healing process; and comparison of the assessment instruments regarding quality of life, with the aim to identify the best tool to measure the impacts of chronic venous ulcers' wounds.

ACKNOLEDGEMENT

To Colegio Doctoral Tordesillas de Enfermería for enabling the development of the present study through the partnership between the Fluminense Federal University (Brazil) and the Granada University (Spain), as well as the universities involved.

REFERENCES

¹
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» http://www.scielo.br/pdf/reben/v70n2/0034-7167-reben-70-02-0415.pdf
²
Scottish Intercollegiate Guidelines Network. Management of chronic venous leg ulcers: a national clinical guideline. Edinburgh: Scottish Intercollegiate Guidelines Network [Internet]. 2010 [cited 2017 May 17];1-46. Available from: http://www.sign.ac.uk/assets/sign120.pdf
» http://www.sign.ac.uk/assets/sign120.pdf
³
Belczack SQ, Gornati VC, Aun R, Sincos IR, Fragoso H. Treatment of varicose ulcer of the lower limbs by surgery and Unna boot: savings for the Brazilian healthcare system. Einstein[Internet]. 2011 [cited 2017 May 17]; 9(3):377-85. Available from: http://www.scielo.br/pdf/eins/v9n3/1679-4508-eins-9-3-0377.pdf
» http://www.scielo.br/pdf/eins/v9n3/1679-4508-eins-9-3-0377.pdf
⁴
Barbosa JAG, Campos LMN. Guidelines for the treatment of venous ulcer. Enferm Glob[Internet]. 2010 [cited 2017 May 18]; 20:1-13. Available from: http://scielo.isciii.es/pdf/eg/n20/pt_revision2.pdf
» http://scielo.isciii.es/pdf/eg/n20/pt_revision2.pdf
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Asociación Española de Enfermería Vascular y Heridas. Guía de práctica clínica: Consenso sobre úlceras vasculares y pie diabético. Sevilla: AEEVH [Internet]. 2014 [cited 2017 May 18]; 2:1-90. Available from: https://www.aeev.net/pdf/AEEV%2035%20.pdf
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» http://www.seer.ufsj.edu.br/index.php/recom/article/download/15/308
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» http://www.facenf.uerj.br/v19n3/v19n3a22.pdf
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» http://www.scielo.br/pdf/reben/v69n3/en_0034-7167-reben-69-03-0468.pdf
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Mendes KDS, Silveira RCCP, Galvão CM. Integrative literature review: a research method to incorporate evidence in health care and nursing. Texto Contexto Enferm[Internet]. 2008 [cited 2017 May 18]; 17(4):758-764. Available from: http://www.scielo.br/pdf/tce/v17n4/18.pdf
» http://www.scielo.br/pdf/tce/v17n4/18.pdf
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Salomé GM, Ferreira LM. Quality of life in patients with venous ulcers treated with Unna's boot compressive therapy. Rev Bras Cir Plást[Internet]. 2012 [cited 2017 Jun 05]; 27(3):466-71. Available from: http://www.scielo.br/pdf/rbcp/v27n3/en_24.pdf
» http://www.scielo.br/pdf/rbcp/v27n3/en_24.pdf
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¹⁶
Dias TYAF, Costa IKF, Salvetti MG, Mendes CKTT, Torres GV. Influences of health care services and clinical characteristics on the quality of life of patients with venous ulcer. Acta Paul Enferm[Internet]. 2013 [cited 2017 Jun 05]; 26(6):529-34. Available from: http://www.scielo.br/pdf/ape/v26n6/en_04.pdf
» http://www.scielo.br/pdf/ape/v26n6/en_04.pdf
¹⁷
Saraiva DMRF, Bandarra AJF, Agostinho ES, Pereira NMM, Lopes TS. Quality of life of service users with chronic venous ulcers. Referência[Internet]. 2013 [cited 2017 Jun 05]; 3(10):109-18. Available from: http://www.scielo.mec.pt/pdf/ref/vserIIIn10/serIIIn10a13.pdf
» http://www.scielo.mec.pt/pdf/ref/vserIIIn10/serIIIn10a13.pdf
¹⁸
Dias TYAF, Costa IKF, Melo MDM, Torres SMSGSO, Maia EMC, Torres GV. Quality of life assessment of patients with and without venous ulcer. Rev Latino-Am Enfermagem[Internet]. 2014 [cited 2017 Jun 05]; 22(4):576-81. Available from: http://www.scielo.br/pdf/rlae/v22n4/0104-1169-rlae-22-04-00576.pdf
» http://www.scielo.br/pdf/rlae/v22n4/0104-1169-rlae-22-04-00576.pdf
¹⁹
Lozano SFS, Marinel JR, Carrasco EC, González RJP, Escudero RJR, Sánchez IN, et al. Venous leg ulcer in the context of chronic venous disease. Phlebol[Internet]. 2014 [cited 2017 Jun 05]; 29(4):220-6. Available from: http://journals.sagepub.com/doi/pdf/10.1177/0268355513480489
» http://journals.sagepub.com/doi/pdf/10.1177/0268355513480489
²⁰
Torres GV, Balduino LSC, Costa IKF, Mendes FRP, Vasconcelos QLDAQ. Comparison of quality of life domains in patientswith venous ulcer. Rev Enferm UERJ[Internet]. 2014 [cited 2017 Jun 05]; 22(1):57-64. Available from: http://www.facenf.uerj.br/v22n1/v22n1a09.pdf
» http://www.facenf.uerj.br/v22n1/v22n1a09.pdf
²¹
Wachholz PA, Masuda PY, Nascimento DC, Taira CMH, Cleto NG. Quality of life profile and correlated factors in chronic leg ulcer patients in the mid-west of São Paulo State, Brazil. An Bras Dermatol[Internet]. 2014 [cited 2017 Jun 05]; 89(1):73-81. Available from: http://www.scielo.br/pdf/abd/v89n1/0365-0596-abd-89-01-0073.pdf
» http://www.scielo.br/pdf/abd/v89n1/0365-0596-abd-89-01-0073.pdf
²²
Finlayson KJ, Courtney MD, Gibb MA, O'Brien JA, Parker CN, Edwards HE. The effectiveness of a four-layer compression bandage system in comparison with class 3 compression hosiery on healing and quality of life in patients with venous leg ulcers: a randomized controlled trial. Int Wound J[Internet]. 2014 [cited 2017 Jun 05]; 11:21-7. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1742-481X. 2012.01033.x/epdf
» http://onlinelibrary.wiley.com/doi/10.1111/j.1742-481X. 2012.01033.x/epdf
²³
Salomé GM, Blanes L, Ferreira LM. The impact of skin grafting on the quality of life and self-esteem of patients with venous leg ulcers. World J Surg[Internet]. 2014 [cited 2017 Jun 05]; 38:233-40. Available from: https://link.springer.com/article/10.1007/s00268-013-2228-x
» https://link.springer.com/article/10.1007/s00268-013-2228-x
²⁴
Sell BT, Souza MV, Martins T, Amante LN. Quality of life of pacients with vasculogenic ulcers according to Ferrans and Powers: wounds. J Health Sci[Internet]. 2015 [cited 2017 Jun 06]; 17(3):160-4. Available from: http://www.pgsskroton.com.br/seer/index.php/JHealthSci/article/view/3062/2849
» http://www.pgsskroton.com.br/seer/index.php/JHealthSci/article/view/3062/2849
²⁵
Tracz E, Zamojska E, Modrzejewski A, Zaborski D, Grzesiak W. Quality of life in patients with venous stasis ulcers and others with advanced venous insufficiency. Holist Nurs Pract[Internet]. 2015 [cited 2017 Jun 06]; 29(2):96-102. Available from: https://insights.ovid.com/pubmed?pmid=25658932
» https://insights.ovid.com/pubmed?pmid=25658932
²⁶
Araújo RO, Silva DC, Souto RQ, Marconato AMP, Costa IKF, Torres GV. Impact of varicose ulcers on the quality of life of persons receiving primary care. Aquichan[Internet]. 2016 [cited 2017 Jun 06]; 16(1):56-66. Available from: http://www.scielo.org.co/pdf/aqui/v16n1/v16n1a07.pdf
» http://www.scielo.org.co/pdf/aqui/v16n1/v16n1a07.pdf
²⁷
Green J, Jester R, Mckinley A, Pooler S, Mason S, Redsell S. A new quality of life consultation template for patients with venous leg ulceration. J Wound Care[Internet]. 2015 [cited 2017 Jun 06]; 24(3):140-8. Available from: http://www.magonlinelibrary.com/doi/pdf/10.12968/jowc.2015.24.3.140
» http://www.magonlinelibrary.com/doi/pdf/10.12968/jowc.2015.24.3.140

Publication Dates

Publication in this collection
Jul-Aug 2018

History

Received
16 July 2017
Accepted
25 Nov 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

[1] ¹
Nunes HJM, Queirós PJP. Patient with stroke: hospital discharge planning, functionality and quality of life. Rev Bras Enferm[Internet]. 2017 [cited 2017 May 17]; 70(2):433-42. Available from: http://www.scielo.br/pdf/reben/v70n2/0034-7167-reben-70-02-0415.pdf
» http://www.scielo.br/pdf/reben/v70n2/0034-7167-reben-70-02-0415.pdf

[2] ²
Scottish Intercollegiate Guidelines Network. Management of chronic venous leg ulcers: a national clinical guideline. Edinburgh: Scottish Intercollegiate Guidelines Network [Internet]. 2010 [cited 2017 May 17];1-46. Available from: http://www.sign.ac.uk/assets/sign120.pdf
» http://www.sign.ac.uk/assets/sign120.pdf

[3] ³
Belczack SQ, Gornati VC, Aun R, Sincos IR, Fragoso H. Treatment of varicose ulcer of the lower limbs by surgery and Unna boot: savings for the Brazilian healthcare system. Einstein[Internet]. 2011 [cited 2017 May 17]; 9(3):377-85. Available from: http://www.scielo.br/pdf/eins/v9n3/1679-4508-eins-9-3-0377.pdf
» http://www.scielo.br/pdf/eins/v9n3/1679-4508-eins-9-3-0377.pdf

[4] ⁴
Barbosa JAG, Campos LMN. Guidelines for the treatment of venous ulcer. Enferm Glob[Internet]. 2010 [cited 2017 May 18]; 20:1-13. Available from: http://scielo.isciii.es/pdf/eg/n20/pt_revision2.pdf
» http://scielo.isciii.es/pdf/eg/n20/pt_revision2.pdf

[5] ⁵
Asociación Española de Enfermería Vascular y Heridas. Guía de práctica clínica: Consenso sobre úlceras vasculares y pie diabético. Sevilla: AEEVH [Internet]. 2014 [cited 2017 May 18]; 2:1-90. Available from: https://www.aeev.net/pdf/AEEV%2035%20.pdf
» https://www.aeev.net/pdf/AEEV%2035%20.pdf

[6] ⁶
Evangelista DG, Magalhães ERM, Moretão DIC, Stival MM, Lima LR. Impact of chronic wounds in the quality of life for users of family health strategy. Rev Enferm Centro O Min[Internet]. 2012 [cited 2018 Jul 18]; 2(2):254-63. Available from: http://www.seer.ufsj.edu.br/index.php/recom/article/download/15/308
» http://www.seer.ufsj.edu.br/index.php/recom/article/download/15/308

[7] ⁷
Silva FAA, Moreira TMM. Sociodemografic and clinical characteristics of customers with venous leg ulcer. Rev Enferm UERJ[Internet]. 2011 [cited 2017 May 18]; 19(3):468-72. Available from: http://www.facenf.uerj.br/v19n3/v19n3a22.pdf
» http://www.facenf.uerj.br/v19n3/v19n3a22.pdf

[8] ⁸
OMS. Promoción de la Salud. Glossario. Genebra: OMS; 1998.

[9] ⁹
Joaquim FL, Camacho ACLF, Sabóia VM, Santos RC, Santos LSF, Nogueira GA. Impact of home visits on the functional capacity of patients with venous ulcers. Rev Bras Enferm[Internet]. 2016 [cited 2017 May 18]; 69(3):439-47. Available from: http://www.scielo.br/pdf/reben/v69n3/en_0034-7167-reben-69-03-0468.pdf
» http://www.scielo.br/pdf/reben/v69n3/en_0034-7167-reben-69-03-0468.pdf

[10] ¹⁰
Mendes KDS, Silveira RCCP, Galvão CM. Integrative literature review: a research method to incorporate evidence in health care and nursing. Texto Contexto Enferm[Internet]. 2008 [cited 2017 May 18]; 17(4):758-764. Available from: http://www.scielo.br/pdf/tce/v17n4/18.pdf
» http://www.scielo.br/pdf/tce/v17n4/18.pdf

[11] ¹¹
Stillwell SB, Fineout-Overhoult E, Melnyk BM, Williamson KM. Searching for the evidence: strategies to help you conduct a successful search. Am J Nurs[Internet]. 2010 [cited 2017 May 18]; 110(5):41-7. Available from: http://www.nursingcenter.com/nursingcenter_redesign/media/EBP/AJNseries/Searching.pdf
» http://www.nursingcenter.com/nursingcenter_redesign/media/EBP/AJNseries/Searching.pdf

[12] ¹²
Galvão TF, Pansani TSA, Harrad D. Main items to report Systematic reviews and meta-analyzes: the recommendation PRISMA. Epidemiol Serv Saúde [Internet]. 2015 [cited 2017 Jun 07]; 24(2):335-42. Available from: http://www.scielo.br/pdf/ress/v24n2/2237-9622-ress-24-02-00335.pdf
» http://www.scielo.br/pdf/ress/v24n2/2237-9622-ress-24-02-00335.pdf

[13] ¹³
Salomé GM, Ferreira LM. Quality of life in patients with venous ulcers treated with Unna's boot compressive therapy. Rev Bras Cir Plást[Internet]. 2012 [cited 2017 Jun 05]; 27(3):466-71. Available from: http://www.scielo.br/pdf/rbcp/v27n3/en_24.pdf
» http://www.scielo.br/pdf/rbcp/v27n3/en_24.pdf

[14] ¹⁴
Dias TYAF, Costa IKF, Liberato SMD, Souza AJG, Mendes FRP, Torres GV. Quality of life for venous ulcer patients: a comparative study in Brazil/Portugal. O Braz J Nurs[Internet]. 2013 [cited 2017 Jun 05]; 12(2):491-500. Available from: http://www.objnursing.uff.br/index.php/nursing/article/view/4344/pdf
» http://www.objnursing.uff.br/index.php/nursing/article/view/4344/pdf

[15] ¹⁵
Lopes CR, Figueiredo M, Ávila AM, Soares LMBM, Dionisio VC. Evaluation of limitations of venous ulcers in legs. J Vasc Bras[Internet]. 2013 [cited 2017 Jun 05]; 12(1):5-9. Available from: http://www.scielo.br/pdf/jvb/v12n1/en_03.pdf
» http://www.scielo.br/pdf/jvb/v12n1/en_03.pdf

[16] ¹⁶
Dias TYAF, Costa IKF, Salvetti MG, Mendes CKTT, Torres GV. Influences of health care services and clinical characteristics on the quality of life of patients with venous ulcer. Acta Paul Enferm[Internet]. 2013 [cited 2017 Jun 05]; 26(6):529-34. Available from: http://www.scielo.br/pdf/ape/v26n6/en_04.pdf
» http://www.scielo.br/pdf/ape/v26n6/en_04.pdf

[17] ¹⁷
Saraiva DMRF, Bandarra AJF, Agostinho ES, Pereira NMM, Lopes TS. Quality of life of service users with chronic venous ulcers. Referência[Internet]. 2013 [cited 2017 Jun 05]; 3(10):109-18. Available from: http://www.scielo.mec.pt/pdf/ref/vserIIIn10/serIIIn10a13.pdf
» http://www.scielo.mec.pt/pdf/ref/vserIIIn10/serIIIn10a13.pdf

[18] ¹⁸
Dias TYAF, Costa IKF, Melo MDM, Torres SMSGSO, Maia EMC, Torres GV. Quality of life assessment of patients with and without venous ulcer. Rev Latino-Am Enfermagem[Internet]. 2014 [cited 2017 Jun 05]; 22(4):576-81. Available from: http://www.scielo.br/pdf/rlae/v22n4/0104-1169-rlae-22-04-00576.pdf
» http://www.scielo.br/pdf/rlae/v22n4/0104-1169-rlae-22-04-00576.pdf

[19] ¹⁹
Lozano SFS, Marinel JR, Carrasco EC, González RJP, Escudero RJR, Sánchez IN, et al. Venous leg ulcer in the context of chronic venous disease. Phlebol[Internet]. 2014 [cited 2017 Jun 05]; 29(4):220-6. Available from: http://journals.sagepub.com/doi/pdf/10.1177/0268355513480489
» http://journals.sagepub.com/doi/pdf/10.1177/0268355513480489

[20] ²⁰
Torres GV, Balduino LSC, Costa IKF, Mendes FRP, Vasconcelos QLDAQ. Comparison of quality of life domains in patientswith venous ulcer. Rev Enferm UERJ[Internet]. 2014 [cited 2017 Jun 05]; 22(1):57-64. Available from: http://www.facenf.uerj.br/v22n1/v22n1a09.pdf
» http://www.facenf.uerj.br/v22n1/v22n1a09.pdf

[21] ²¹
Wachholz PA, Masuda PY, Nascimento DC, Taira CMH, Cleto NG. Quality of life profile and correlated factors in chronic leg ulcer patients in the mid-west of São Paulo State, Brazil. An Bras Dermatol[Internet]. 2014 [cited 2017 Jun 05]; 89(1):73-81. Available from: http://www.scielo.br/pdf/abd/v89n1/0365-0596-abd-89-01-0073.pdf
» http://www.scielo.br/pdf/abd/v89n1/0365-0596-abd-89-01-0073.pdf

[22] ²²
Finlayson KJ, Courtney MD, Gibb MA, O'Brien JA, Parker CN, Edwards HE. The effectiveness of a four-layer compression bandage system in comparison with class 3 compression hosiery on healing and quality of life in patients with venous leg ulcers: a randomized controlled trial. Int Wound J[Internet]. 2014 [cited 2017 Jun 05]; 11:21-7. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1742-481X. 2012.01033.x/epdf
» http://onlinelibrary.wiley.com/doi/10.1111/j.1742-481X. 2012.01033.x/epdf

[23] ²³
Salomé GM, Blanes L, Ferreira LM. The impact of skin grafting on the quality of life and self-esteem of patients with venous leg ulcers. World J Surg[Internet]. 2014 [cited 2017 Jun 05]; 38:233-40. Available from: https://link.springer.com/article/10.1007/s00268-013-2228-x
» https://link.springer.com/article/10.1007/s00268-013-2228-x

[24] ²⁴
Sell BT, Souza MV, Martins T, Amante LN. Quality of life of pacients with vasculogenic ulcers according to Ferrans and Powers: wounds. J Health Sci[Internet]. 2015 [cited 2017 Jun 06]; 17(3):160-4. Available from: http://www.pgsskroton.com.br/seer/index.php/JHealthSci/article/view/3062/2849
» http://www.pgsskroton.com.br/seer/index.php/JHealthSci/article/view/3062/2849

[25] ²⁵
Tracz E, Zamojska E, Modrzejewski A, Zaborski D, Grzesiak W. Quality of life in patients with venous stasis ulcers and others with advanced venous insufficiency. Holist Nurs Pract[Internet]. 2015 [cited 2017 Jun 06]; 29(2):96-102. Available from: https://insights.ovid.com/pubmed?pmid=25658932
» https://insights.ovid.com/pubmed?pmid=25658932

[26] ²⁶
Araújo RO, Silva DC, Souto RQ, Marconato AMP, Costa IKF, Torres GV. Impact of varicose ulcers on the quality of life of persons receiving primary care. Aquichan[Internet]. 2016 [cited 2017 Jun 06]; 16(1):56-66. Available from: http://www.scielo.org.co/pdf/aqui/v16n1/v16n1a07.pdf
» http://www.scielo.org.co/pdf/aqui/v16n1/v16n1a07.pdf

[27] ²⁷
Green J, Jester R, Mckinley A, Pooler S, Mason S, Redsell S. A new quality of life consultation template for patients with venous leg ulceration. J Wound Care[Internet]. 2015 [cited 2017 Jun 06]; 24(3):140-8. Available from: http://www.magonlinelibrary.com/doi/pdf/10.12968/jowc.2015.24.3.140
» http://www.magonlinelibrary.com/doi/pdf/10.12968/jowc.2015.24.3.140

Reference	Abstract	Introduction (Objectives)	Methods (Protocols)	Discussion	Funding		Level of evidence⁽¹¹11 Stillwell SB, Fineout-Overhoult E, Melnyk BM, Williamson KM. Searching for the evidence: strategies to help you conduct a successful search. Am J Nurs[Internet]. 2010 [cited 2017 May 18]; 110(5):41-7. Available from: http://www.nursingcenter.com/nursingcenter_redesign/media/EBP/AJNseries/Searching.pdf http://www.nursingcenter.com/nursingcent... ⁾
Reference	Abstract	Introduction (Objectives)	Methods (Protocols)	Discussion	Yes	No
Salomé GM, Ferreira LM. 2012⁽¹³13 Salomé GM, Ferreira LM. Quality of life in patients with venous ulcers treated with Unna's boot compressive therapy. Rev Bras Cir Plást[Internet]. 2012 [cited 2017 Jun 05]; 27(3):466-71. Available from: http://www.scielo.br/pdf/rbcp/v27n3/en_24.pdf http://www.scielo.br/pdf/rbcp/v27n3/en_2... ⁾	X	X	X	X		X	Nível VI
Dias TYAF et al. 2013⁽¹⁴14 Dias TYAF, Costa IKF, Liberato SMD, Souza AJG, Mendes FRP, Torres GV. Quality of life for venous ulcer patients: a comparative study in Brazil/Portugal. O Braz J Nurs[Internet]. 2013 [cited 2017 Jun 05]; 12(2):491-500. Available from: http://www.objnursing.uff.br/index.php/nursing/article/view/4344/pdf http://www.objnursing.uff.br/index.php/n... ⁾	X	X	X	X		X	Nível VI
Lopes CR et al. 2013⁽¹⁵15 Lopes CR, Figueiredo M, Ávila AM, Soares LMBM, Dionisio VC. Evaluation of limitations of venous ulcers in legs. J Vasc Bras[Internet]. 2013 [cited 2017 Jun 05]; 12(1):5-9. Available from: http://www.scielo.br/pdf/jvb/v12n1/en_03.pdf http://www.scielo.br/pdf/jvb/v12n1/en_03... ⁾	X	X	X	X		X	Nível IV
Dias TYAF et al. 2013⁽¹⁶16 Dias TYAF, Costa IKF, Salvetti MG, Mendes CKTT, Torres GV. Influences of health care services and clinical characteristics on the quality of life of patients with venous ulcer. Acta Paul Enferm[Internet]. 2013 [cited 2017 Jun 05]; 26(6):529-34. Available from: http://www.scielo.br/pdf/ape/v26n6/en_04.pdf http://www.scielo.br/pdf/ape/v26n6/en_04... ⁾	X	X	X	X	X		Nível VI
Saraiva DMRF et al. 2013⁽¹⁷17 Saraiva DMRF, Bandarra AJF, Agostinho ES, Pereira NMM, Lopes TS. Quality of life of service users with chronic venous ulcers. Referência[Internet]. 2013 [cited 2017 Jun 05]; 3(10):109-18. Available from: http://www.scielo.mec.pt/pdf/ref/vserIIIn10/serIIIn10a13.pdf http://www.scielo.mec.pt/pdf/ref/vserIII... ⁾	X	X	X	X		X	Nível VI
Dias TYAF et al. 2014⁽¹⁸18 Dias TYAF, Costa IKF, Melo MDM, Torres SMSGSO, Maia EMC, Torres GV. Quality of life assessment of patients with and without venous ulcer. Rev Latino-Am Enfermagem[Internet]. 2014 [cited 2017 Jun 05]; 22(4):576-81. Available from: http://www.scielo.br/pdf/rlae/v22n4/0104-1169-rlae-22-04-00576.pdf http://www.scielo.br/pdf/rlae/v22n4/0104... ⁾	X	X	X	X		X	Nível VI
Lozano SFS et al. 2014⁽¹⁹19 Lozano SFS, Marinel JR, Carrasco EC, González RJP, Escudero RJR, Sánchez IN, et al. Venous leg ulcer in the context of chronic venous disease. Phlebol[Internet]. 2014 [cited 2017 Jun 05]; 29(4):220-6. Available from: http://journals.sagepub.com/doi/pdf/10.1177/0268355513480489 http://journals.sagepub.com/doi/pdf/10.1... ⁾	X	X	X	X		X	Nível IV
Torres GV et al. 2014⁽²⁰20 Torres GV, Balduino LSC, Costa IKF, Mendes FRP, Vasconcelos QLDAQ. Comparison of quality of life domains in patientswith venous ulcer. Rev Enferm UERJ[Internet]. 2014 [cited 2017 Jun 05]; 22(1):57-64. Available from: http://www.facenf.uerj.br/v22n1/v22n1a09.pdf http://www.facenf.uerj.br/v22n1/v22n1a09... ⁾	X	X	X	X		X	Nível VI
Wachholz PA et al. 2014⁽²¹21 Wachholz PA, Masuda PY, Nascimento DC, Taira CMH, Cleto NG. Quality of life profile and correlated factors in chronic leg ulcer patients in the mid-west of São Paulo State, Brazil. An Bras Dermatol[Internet]. 2014 [cited 2017 Jun 05]; 89(1):73-81. Available from: http://www.scielo.br/pdf/abd/v89n1/0365-0596-abd-89-01-0073.pdf http://www.scielo.br/pdf/abd/v89n1/0365-... ⁾	X	X	X	X		X	Nível VI
Finlayson KJ et al. 2014⁽²²22 Finlayson KJ, Courtney MD, Gibb MA, O'Brien JA, Parker CN, Edwards HE. The effectiveness of a four-layer compression bandage system in comparison with class 3 compression hosiery on healing and quality of life in patients with venous leg ulcers: a randomized controlled trial. Int Wound J[Internet]. 2014 [cited 2017 Jun 05]; 11:21-7. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1742-481X. 2012.01033.x/epdf http://onlinelibrary.wiley.com/doi/10.11... ⁾	X	X	X	X	X		Nível II
Salomé GM et al. 2014⁽²³23 Salomé GM, Blanes L, Ferreira LM. The impact of skin grafting on the quality of life and self-esteem of patients with venous leg ulcers. World J Surg[Internet]. 2014 [cited 2017 Jun 05]; 38:233-40. Available from: https://link.springer.com/article/10.1007/s00268-013-2228-x https://link.springer.com/article/10.100... ⁾	X	X	X	X		X	Nível III
Sell BT et al. 2015⁽²⁴24 Sell BT, Souza MV, Martins T, Amante LN. Quality of life of pacients with vasculogenic ulcers according to Ferrans and Powers: wounds. J Health Sci[Internet]. 2015 [cited 2017 Jun 06]; 17(3):160-4. Available from: http://www.pgsskroton.com.br/seer/index.php/JHealthSci/article/view/3062/2849 http://www.pgsskroton.com.br/seer/index.... ⁾	X	X	X	X		X	Nível VI
Tracz E et al. 2015⁽²⁵25 Tracz E, Zamojska E, Modrzejewski A, Zaborski D, Grzesiak W. Quality of life in patients with venous stasis ulcers and others with advanced venous insufficiency. Holist Nurs Pract[Internet]. 2015 [cited 2017 Jun 06]; 29(2):96-102. Available from: https://insights.ovid.com/pubmed?pmid=25658932 https://insights.ovid.com/pubmed?pmid=25... ⁾	X	X	X	X		X	Nível VII
Araújo RO et al. 2016⁽²⁶26 Araújo RO, Silva DC, Souto RQ, Marconato AMP, Costa IKF, Torres GV. Impact of varicose ulcers on the quality of life of persons receiving primary care. Aquichan[Internet]. 2016 [cited 2017 Jun 06]; 16(1):56-66. Available from: http://www.scielo.org.co/pdf/aqui/v16n1/v16n1a07.pdf http://www.scielo.org.co/pdf/aqui/v16n1/... ⁾	X	X	X	X		X	Nível VI

Reference	Objectives	Method/ Participants/ Instrument	Factors that influence on quality of life	Dimensions affected
Salomé GM, Ferreira LM. Rev Bras Cir Plást. 2012; 27(3): 466-71⁽¹³13 Salomé GM, Ferreira LM. Quality of life in patients with venous ulcers treated with Unna's boot compressive therapy. Rev Bras Cir Plást[Internet]. 2012 [cited 2017 Jun 05]; 27(3):466-71. Available from: http://www.scielo.br/pdf/rbcp/v27n3/en_24.pdf http://www.scielo.br/pdf/rbcp/v27n3/en_2... ⁾.	To evaluate the quality of life of patients with venous ulcers treated with compression therapy with Unna boot.	Clinical, descriptive, and analytical study/50 participants/Short Form-36 (SF-36).	Impaired functional capacity; pain; physical aspect; general health condition.	Social aspect; emotional aspect; vitality; mental health.
Dias TYAF et al. Online Braz J Nurs. 2013; 12 (2): 491-500⁽¹⁴14 Dias TYAF, Costa IKF, Liberato SMD, Souza AJG, Mendes FRP, Torres GV. Quality of life for venous ulcer patients: a comparative study in Brazil/Portugal. O Braz J Nurs[Internet]. 2013 [cited 2017 Jun 05]; 12(2):491-500. Available from: http://www.objnursing.uff.br/index.php/nursing/article/view/4344/pdf http://www.objnursing.uff.br/index.php/n... ⁾.	To compare the quality of life of patients with venous ulcers in Natal, capital city in the state of Rio Grande do Norte, Brazil and Evora, a city in Portugal.	Analytical and comparative study, with a cross-sectional design and quantitative approach of treatment and data analysis/170 participants/SF-36.	Difficulties in performing activities of daily living due to functional capacity impairment.	Functional capacity; pain; general health condition; vitality; social aspect; limitation due to physical aspects; mental health; emotional aspect.
Lopes CR et al. J Vasc Bras. 2013; 12(1): 5-9⁽¹⁵15 Lopes CR, Figueiredo M, Ávila AM, Soares LMBM, Dionisio VC. Evaluation of limitations of venous ulcers in legs. J Vasc Bras[Internet]. 2013 [cited 2017 Jun 05]; 12(1):5-9. Available from: http://www.scielo.br/pdf/jvb/v12n1/en_03.pdf http://www.scielo.br/pdf/jvb/v12n1/en_03... ⁾.	To correlate changes in the quality of life of patients with venous ulcers in lower limbs with muscle activation capacity.	Prospective clinical study, case-control in which the subjects of the study are their own control/10 participants/SF-36.	Significant reduction in the activation of the soleus muscle in both legs due to valvular incompetence, associated or not with a obstructive condition; loss of muscle strength; strength reduction and increase in movements; pain; frustration; work inactivity; lack of willingness to go out.	Emotional aspect; limitation due to physical aspects.
Dias TYAF et al. Acta Paul Enferm. 2013; 26(6): 529-34⁽¹⁶16 Dias TYAF, Costa IKF, Salvetti MG, Mendes CKTT, Torres GV. Influences of health care services and clinical characteristics on the quality of life of patients with venous ulcer. Acta Paul Enferm[Internet]. 2013 [cited 2017 Jun 05]; 26(6):529-34. Available from: http://www.scielo.br/pdf/ape/v26n6/en_04.pdf http://www.scielo.br/pdf/ape/v26n6/en_04... ⁾.	To verify the influence of care and clinical characteristics on the quality of life of patients with venous ulcers (VU).	Cross-sectional study with convenience sample/100 participants/SF-36.	Pain; reduced mobility; financial instability; restrictions in personal life.	Limitation due to physical aspects; functional capacity; vitality; pain; general health condition.
Saraiva DMRF et al. Referência. 2013; 3(10): 109-18⁽¹⁷17 Saraiva DMRF, Bandarra AJF, Agostinho ES, Pereira NMM, Lopes TS. Quality of life of service users with chronic venous ulcers. Referência[Internet]. 2013 [cited 2017 Jun 05]; 3(10):109-18. Available from: http://www.scielo.mec.pt/pdf/ref/vserIIIn10/serIIIn10a13.pdf http://www.scielo.mec.pt/pdf/ref/vserIII... ⁾.	To evaluate the quality of life of patients with chronic venous ulcers.	Cross-sectional quantitative study with a correlational and descriptive approach/66 participants/Cardiff Wound Impact Schedule.	Discouragement with the length of time for healing; fear of “hurting” the wound site; concern about the wound; concern about having further wounds; pain; difficulty in taking bath; problems with the time required to treat the wound; not sleeping well; difficulty in performing activities of daily living; difficulty in enjoying a normal social life; not going out for fear of “hurting” the wound; difficulty in going out and living with other people; marital status; area of residence.	Social life; physical symptoms; daily life; well-being; quality of life in general.
Dias TYAF et al. Rev Latinoam Enferm. 2014; 22(4): 576-81⁽¹⁸18 Dias TYAF, Costa IKF, Melo MDM, Torres SMSGSO, Maia EMC, Torres GV. Quality of life assessment of patients with and without venous ulcer. Rev Latino-Am Enfermagem[Internet]. 2014 [cited 2017 Jun 05]; 22(4):576-81. Available from: http://www.scielo.br/pdf/rlae/v22n4/0104-1169-rlae-22-04-00576.pdf http://www.scielo.br/pdf/rlae/v22n4/0104... ⁾.	To compare the quality of life of patients with chronic venous diseases with and without ulcers and identify the most affected aspects.	Cross-sectional comparative study with a quantitative approach/204 participants/SF-36.	Reduced mobility; poor income; low education level; disturbance in the sleep pattern; pain; chronic diseases.	Functional capacity; limitation due to physical aspects; social aspect; physical aspect.
Lozano SFS et al. Phlebol. 2014; 29(4): 220-6⁽¹⁹19 Lozano SFS, Marinel JR, Carrasco EC, González RJP, Escudero RJR, Sánchez IN, et al. Venous leg ulcer in the context of chronic venous disease. Phlebol[Internet]. 2014 [cited 2017 Jun 05]; 29(4):220-6. Available from: http://journals.sagepub.com/doi/pdf/10.1177/0268355513480489 http://journals.sagepub.com/doi/pdf/10.1... ⁾.	To determine the possible differences in the disease and quality of life (QoL) among group C5 (healed ulcer), group C6 (active ulcer), and group C1 (control).	Multicenter and observational case-control cross-sectional study/449 participants/Short Form 12 Health Survey (SF-12).	Pain; varicose veins; edema; skin pigmentation; inflammation; induration; number of wounds, size of wounds, and length of time of the wounds.	No correlation was found between the scores of total and individual dimensions evaluated with the dimensions affected in the instrument used.
Torres GV et al. Rev Enferm UERJ. 2014; 22(1): 57-64⁽²⁰20 Torres GV, Balduino LSC, Costa IKF, Mendes FRP, Vasconcelos QLDAQ. Comparison of quality of life domains in patientswith venous ulcer. Rev Enferm UERJ[Internet]. 2014 [cited 2017 Jun 05]; 22(1):57-64. Available from: http://www.facenf.uerj.br/v22n1/v22n1a09.pdf http://www.facenf.uerj.br/v22n1/v22n1a09... ⁾.	To compare the dimensions of health-related quality of life (HRQoL) of patients with venous ulcers (VU) admitted at the Onofre Lopes University Hospital (HUOL, as per its acronym in Portuguese), in Natal, capital city of the state of Rio Grande do Norte, Brazil, and in four primary healthcare units in Evora, a city in Portugal.	Comparative and analytical cross-sectional study, with a quantitative approach of data analysis/130 participants/SF-36.	Impaired mobility; limitations and restrictions to perform activities of daily living such as: walking, taking bath, working, traveling, sleeping, and cleaning; difficulty in committing/remaining at work; pain; social activities affected; physical changes; financial costs; psychological, emotional, and social implications.	Functional capacity; physical aspect; general health condition; vitality; social aspects; emotional aspect; mental health; pain.
Wachholz PA et al. An Bras Dermatol. 2014; 89(1): 73-81⁽²¹21 Wachholz PA, Masuda PY, Nascimento DC, Taira CMH, Cleto NG. Quality of life profile and correlated factors in chronic leg ulcer patients in the mid-west of São Paulo State, Brazil. An Bras Dermatol[Internet]. 2014 [cited 2017 Jun 05]; 89(1):73-81. Available from: http://www.scielo.br/pdf/abd/v89n1/0365-0596-abd-89-01-0073.pdf http://www.scielo.br/pdf/abd/v89n1/0365-... ⁾.	To identify the impact of leg ulcers on patients’ quality of life with the use of the Dermatology life Quality Index, and define the main factors correlated to this perception.	Non-probabilistic cross-sectional sample study/41 participants/Dermatology Life Quality Index (DLQI).	Wound etiology; pain related to the ulcer; length of time of the beginning of the wound and severity of the depressive symptoms.	Symptoms and feelings; work and study; size of the wounds; number of wounds; pain.
Finlayson KJ et al. Int Wound J. 2014; 11: 21-7⁽²²22 Finlayson KJ, Courtney MD, Gibb MA, O'Brien JA, Parker CN, Edwards HE. The effectiveness of a four-layer compression bandage system in comparison with class 3 compression hosiery on healing and quality of life in patients with venous leg ulcers: a randomized controlled trial. Int Wound J[Internet]. 2014 [cited 2017 Jun 05]; 11:21-7. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1742-481X. 2012.01033.x/epdf http://onlinelibrary.wiley.com/doi/10.11... ⁾.	To compare the effectiveness of a four-layer compression bandage system and a Class 3 (30-35 mmHg) knit compression system in healing and quality of life results.	Randomized controlled trial/103 participants/Quality of Life Index.	Depression; anxiety; pain.	Activities of daily living; health support; psychological perspectives.
Salomé GM et al. World J Surg. 2014; 38: 233-240⁽²³23 Salomé GM, Blanes L, Ferreira LM. The impact of skin grafting on the quality of life and self-esteem of patients with venous leg ulcers. World J Surg[Internet]. 2014 [cited 2017 Jun 05]; 38:233-40. Available from: https://link.springer.com/article/10.1007/s00268-013-2228-x https://link.springer.com/article/10.100... ⁾.	To evaluate the relationship of quality of life with the health and self-esteem of patients with leg venous ulcers after skin grafts.	Non-randomized multicenter and controlled prospective clinical trial/100 participant/SF-36.	Unemployment; early retirement; low education level; smoking; chronic diseases; pain; chronic venous ulcer wound; functional limitations; frustration; social isolation; wound odor; wound’s aesthetic aspect; sleeping disorder; lack of strength; concerns; frustration; low self-esteem; self-concept.	Functional capacity; limitation due to physical aspect; pain; general health condition; vitality; social aspects; emotional aspect; mental health.
Sell BT et al. Wounds. J Health Sci. 2015; 17(3): 160-4⁽²⁴24 Sell BT, Souza MV, Martins T, Amante LN. Quality of life of pacients with vasculogenic ulcers according to Ferrans and Powers: wounds. J Health Sci[Internet]. 2015 [cited 2017 Jun 06]; 17(3):160-4. Available from: http://www.pgsskroton.com.br/seer/index.php/JHealthSci/article/view/3062/2849 http://www.pgsskroton.com.br/seer/index.... ⁾.	To verify the QoL index of patients with vasculogenic ulcers admitted in a university hospital of the south region of Brazil, through Ferrans and Powers Quality of Life Index-Wound Version.	Descriptive cross-sectional study, with a quantitative approach/31 participants/Ferrans and Powers Quality of Life Index-Wound Version.	Healthcare; pain; friends; financial independence; satisfaction; family happiness.	Health and functioning.
Tracz E et al. Holist Nurs Pract. 2015; 29(2): 96-102⁽²⁵25 Tracz E, Zamojska E, Modrzejewski A, Zaborski D, Grzesiak W. Quality of life in patients with venous stasis ulcers and others with advanced venous insufficiency. Holist Nurs Pract[Internet]. 2015 [cited 2017 Jun 06]; 29(2):96-102. Available from: https://insights.ovid.com/pubmed?pmid=25658932 https://insights.ovid.com/pubmed?pmid=25... ⁾.	To analyze quality of life in patients with advanced chronic venous insufficiency in the context of most used clinical scores for the classification of this disease.	Critical evaluation study/42 participants/Quality of Life Survey-WHOQOL.	Pain and discomfort; self-assessment; mobility; activities of daily living; treatments; capacity to work; interpersonal relationships; social support; sexual activity; physical and mental safety; home environment; financial potential; health and welfare (accessibility and quality); capacity to acquire new skills and information; free time (participation and ability to relax).	Physical, psychological; level of independence; social relationships; environment.
Araújo RO, et al. Aquichan. 2016; 16(1): 56-66⁽²⁶26 Araújo RO, Silva DC, Souto RQ, Marconato AMP, Costa IKF, Torres GV. Impact of varicose ulcers on the quality of life of persons receiving primary care. Aquichan[Internet]. 2016 [cited 2017 Jun 06]; 16(1):56-66. Available from: http://www.scielo.org.co/pdf/aqui/v16n1/v16n1a07.pdf http://www.scielo.org.co/pdf/aqui/v16n1/... ⁾.	To analyze the impact of venous ulcers (VU) on the quality of life (QoL) of users of the primary health care.	Quantitative and descriptive cross-sectional study/101 participants/Charing Cross Venous Ulcer Questionnaire (CCVUQ).	Recurrences; pain; emotional condition impairment; aesthetic; social exclusion and loss of privacy; walking difficulty.	Household activities; social interaction; emotional state; aesthetic.

Brasil

Brasil

Impact of venous ulcers on patients' quality of life: an integrative review

Impacto de las úlceras venosas en la calidad de vida de los pacientes: revisión integrativa

ABSTRACT

Objective:

Method:

Results:

Conclusion:

RESUMEN

Objetivo:

Método:

Resultados:

Conclusión:

RESUMO

Objetivo:

Resultados:

Conclusão:

INTRODUCTION

OBJECTIVE

METHOD

Study design

Data source

Data collection and organization

Data analysis

RESULTS

DISCUSSION

The importance of assessing quality of life in patients with chronic venous ulcers

Difficulties, limitations, and feelings of patients with chronic venous ulcers

What must be done for the improvement of quality of life in patients with chronic venous ulcers

Study limitations

Contributions to the nursing, healthcare, or public policy areas

CONCLUSION

ACKNOLEDGEMENT

REFERENCES

Publication Dates

History