Health-related quality of life among adults living with diabetic foot ulcers: a meta-analysis

  • Saneh KhunkaewEmail author
  • Ritin Fernandez
  • Jenny Sim



To undertake a systematic review of the literature to investigate the HRQOL among adults living with DFUs.


A systematic search of the medical and nursing/health content databases including MEDLINE, CINAHL, and PsycINFO was conducted up to November 2018. The methodological quality of each study was assessed independently by all authors using the Joanna Briggs Institute checklist. Data analysis was conducted using the Comprehensive Meta-analysis software. All analyses were performed using random-effects models and heterogeneity was quantified.


A total of 12 studies were included in the review. Overall, the HRQOL of participants in the studies was poor on four of eight subscales in the SF-36: physical functioning (mean = 42.75, SE 1.5); role physical (mean = 20.61, SE 3.4); general health (mean = 39.52, SE 1.7); and vitality (mean = 45.73, SE 2.8). In addition, presence of pain, high levels of C-reactive protein (> 10 mg/L), ulcer size > 5 cm2, Ankle Brachial Index < 0.9, high glycosylated haemoglobin and body mass index > 25 kg/m2 were associated with poorer HRQOL in people with DFUs.


This review has provided evidence indicating that people with DFUs have a significantly lower HRQOL. Evidence-based interventions to improve the HRQOL in this group of people is needed.


Health-related quality of life Diabetic foot ulcers Nursing Meta-analysis 



Funding to undertake this study was provided by the Thai government as part of a PhD project.

Compliance with ethical standards

Conflict of interest

There is no conflict of interest.

Ethical approval

Ethical approval was not required for conducting this systematic review.

Informed consent

Informed consent was not required for conducting this systematic review.


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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.School of Nursing, Faculty of Science, Medicine and HealthUniversity of WollongongWollongongAustralia
  2. 2.Centre for Research in Nursing and HealthSt George HospitalKogarahAustralia

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