{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T14:12:05Z","timestamp":1765807925578,"version":"3.40.5"},"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2021,6,15]],"date-time":"2021-06-15T00:00:00Z","timestamp":1623715200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Department of Surgery, University of Ottawa"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>There has been limited study of patient-reported outcomes (PROs) in patients at risk of limb loss. Our primary objective was to estimate the prevalence of disability in this patient population using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Materials and methods<\/jats:title>\n<jats:p>We recruited patients referred to a limb-preservation clinic. Patients self-reported their disability status using the 12-domain WHODAS 2.0. Severity of disability in each domain was scored from 1 = none to 5 = extreme and the total normalized to a 100-point scale (total score \u226525 = clinically significant disability). We also asked patients about wound-specific concerns and wound-related discomfort or distress.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>We included 162 patients. Reasons for clinic referral included arterial-insufficient (37.4%), postoperative (25.9%), and mixed etiology (10.8%) wounds. The mean WHODAS 2.0 disability score was 35.0 (standard deviation = 16.0). One-hundred-and-nineteen (73.5%) patients had clinically significant disability. Patients reported they had the greatest difficulty walking a long distance (mean score = 4.2), standing for long periods of time (mean score = 3.6), taking care of household responsibilities (mean score = 2.7), and dealing with the emotional impact of their health problems (mean score = 2.5). In the two-weeks prior to presentation, 87 (52.7%) patients expressed concern over their wound(s) and 90 (55.6%) suffered a moderate amount or great deal of wound-related discomfort or distress. In adjusted ordinary least squares regression models, although WHODAS 2.0 disability scores varied with changes in wound volume (p = 0.03) and total revised photographic wound assessment tool scores (p&lt;0.001), the largest decrease in disability severity was seen in patients with less wound-specific concerns and wound-related discomfort and distress.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Discussion<\/jats:title>\n<jats:p>The majority of people at risk of limb loss report suffering a substantial burden of disability, pain, and wound-specific concerns. Research is needed to further evaluate the WHODAS 2.0 in a multicenter fashion among these patients and determine whether care and interventions may improve their PROs.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0253288","type":"journal-article","created":{"date-parts":[[2021,6,15]],"date-time":"2021-06-15T17:27:34Z","timestamp":1623778054000},"page":"e0253288","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Disability, pain, and wound-specific concerns self-reported by adults at risk of limb loss: A cross-sectional study using the World Health Organization Disability Assessment Schedule 2.0"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6111-6291","authenticated-orcid":true,"given":"Derek J.","family":"Roberts","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sudhir K.","family":"Nagpal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alan J.","family":"Forster","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy","family":"Brandys","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine","family":"Murphy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alison","family":"Jennings","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1614-1911","authenticated-orcid":true,"given":"Shira A.","family":"Strauss","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evgeniya","family":"Vishnyakova","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julie","family":"Lawson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel I.","family":"McIsaac","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,6,15]]},"reference":[{"key":"pone.0253288.ref001","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1053\/j.semvascsurg.2015.09.006","article-title":"Patient-reported outcome measures in vascular surgery","volume":"28","author":"CW Hicks","year":"2015","journal-title":"Semin Vasc Surg"},{"key":"pone.0253288.ref002","doi-asserted-by":"crossref","first-page":"2001","DOI":"10.1093\/eurheartj\/ehu205","article-title":"The importance of patient-reported outcomes: a call for their comprehensive integration in cardiovascular clinical trials","volume":"35","author":"SD Anker","year":"2014","journal-title":"Eur Heart J"},{"key":"pone.0253288.ref003","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1111\/wrr.12683","article-title":"The humanistic and economic burden of chronic wounds: A systematic review","volume":"27","author":"M Olsson","year":"2019","journal-title":"Wound Repair Regen"},{"key":"pone.0253288.ref004","doi-asserted-by":"crossref","first-page":"1413","DOI":"10.1007\/s11136-018-2082-2","article-title":"Health-related quality of life among adults living with diabetic foot ulcers: a meta-analysis","volume":"28","author":"S Khunkaew","year":"2019","journal-title":"Qual Life Res"},{"key":"pone.0253288.ref005","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1111\/jan.13465","article-title":"A systematic review of qualitative research into people\u2019s experiences of living with venous leg ulcers","volume":"74","author":"P Phillips","year":"2018","journal-title":"J Adv Nurs"},{"key":"pone.0253288.ref006","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1016\/j.avsg.2016.05.087","article-title":"Quality of Life in Patients Suffering from Critical Limb Ischemia","volume":"36","author":"SL Steunenberg","year":"2016","journal-title":"Ann Vasc Surg"},{"key":"pone.0253288.ref007","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1016\/j.avsg.2013.01.010","article-title":"Systematic review on health-related quality of life after revascularization and primary amputation in patients with critical limb ischemia","volume":"27","author":"J Bosma","year":"2013","journal-title":"Ann Vasc Surg"},{"key":"pone.0253288.ref008","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1016\/j.ejvs.2014.12.002","article-title":"Assessing the quality of available patient reported outcome measures for intermittent claudication: a systematic review using the COSMIN checklist","volume":"49","author":"AP Conijn","year":"2015","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"pone.0253288.ref009","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1016\/j.jvs.2016.08.097","article-title":"Quality-of-life assessment as an outcomes measure in critical limb ischemia","volume":"65","author":"O Alabi","year":"2017","journal-title":"J Vasc Surg"},{"key":"pone.0253288.ref010","doi-asserted-by":"crossref","first-page":"815","DOI":"10.2471\/BLT.09.067231","article-title":"Developing the World Health Organization Disability Assessment Schedule 2.0","volume":"88","author":"TB Ustun","year":"2010","journal-title":"Bull World Health Organ"},{"key":"pone.0253288.ref011","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1097\/ALN.0000000000000586","article-title":"Measurement of disability-free survival after surgery","volume":"122","author":"MA Shulman","year":"2015","journal-title":"Anesthesiology"},{"key":"pone.0253288.ref012","first-page":"1","volume-title":"International Classification of Functioning, Disability, and Health","author":"World Health Organization","year":"2011"},{"key":"pone.0253288.ref013","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.1016\/j.injury.2015.11.046","article-title":"Psychometric properties of the world health organization disability assessment schedule II -12 Item (WHODAS II) in trauma patients","volume":"47","author":"M Abedzadeh-Kalahroudi","year":"2016","journal-title":"Injury"},{"key":"pone.0253288.ref014","doi-asserted-by":"crossref","first-page":"667","DOI":"10.5535\/arm.2017.41.4.667","article-title":"Is WHODAS 2.0 Useful for Colorectal Cancer Survivors?","volume":"41","author":"HH Lee","year":"2017","journal-title":"Ann Rehabil Med"},{"key":"pone.0253288.ref015","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1016\/j.apmr.2011.08.050","article-title":"The trajectory of physical and mental health from injury to 5 years after multiple trauma: a prospective, longitudinal cohort study","volume":"93","author":"HL Soberg","year":"2012","journal-title":"Arch Phys Med Rehabil"},{"key":"pone.0253288.ref016","doi-asserted-by":"crossref","first-page":"747","DOI":"10.2340\/16501977-1016","article-title":"The World Health Organization Disability Assessment Scale, WHODAS II: reliability and validity in the measurement of activity and participation in a spinal cord injury population","volume":"44","author":"AC Wolf","year":"2012","journal-title":"J Rehabil Med"},{"key":"pone.0253288.ref017","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1007\/s00296-009-1306-8","article-title":"Validation of the World Health Organization disability assessment schedule II (WHODAS-II) in patients with osteoarthritis","volume":"31","author":"S Kutlay","year":"2011","journal-title":"Rheumatol Int"},{"key":"pone.0253288.ref018","doi-asserted-by":"crossref","first-page":"214","DOI":"10.3109\/09638288.2012.690817","article-title":"The reliability and validity of the World Health Organization Disability Assessment Schedule (WHODAS-II) in stroke","volume":"35","author":"AA Kucukdeveci","year":"2013","journal-title":"Disabil Rehabil"},{"key":"pone.0253288.ref019","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1080\/09638280802355262","article-title":"WHODAS II with people after stroke and their relatives","volume":"31","author":"A Schlote","year":"2009","journal-title":"Disabil Rehabil"},{"key":"pone.0253288.ref020","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1186\/1477-7525-8-51","article-title":"Validation of the \"World Health Organization Disability Assessment Schedule, WHODAS-2\" in patients with chronic diseases","volume":"8","author":"O Garin","year":"2010","journal-title":"Health Qual Life Outcomes"},{"key":"pone.0253288.ref021","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"61","author":"E von Elm","year":"2008","journal-title":"J Clin Epidemiol"},{"key":"pone.0253288.ref022","doi-asserted-by":"crossref","first-page":"e1001885","DOI":"10.1371\/journal.pmed.1001885","article-title":"The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement","volume":"12","author":"EI Benchimol","year":"2015","journal-title":"PLoS Med"},{"key":"pone.0253288.ref023","first-page":"20","article-title":"Photographic assessment of the appearance of chronic pressure and leg ulcers","volume":"46","author":"PE Houghton","year":"2000","journal-title":"Ostomy Wound Manage"},{"key":"pone.0253288.ref024","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1097\/01.ASW.0000431329.50869.6f","article-title":"Reliability and validity of the revised photographic wound assessment tool on digital images taken of various types of chronic wounds","volume":"26","author":"N Thompson","year":"2013","journal-title":"Adv Skin Wound Care"},{"key":"pone.0253288.ref025","first-page":"1","volume-title":"Rehm J Measuring Health and Disability: Manual for WHO Disability Assessment Schedule (WHODAS 2.0)","author":"World Health Organization","year":"2010"},{"key":"pone.0253288.ref026","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1016\/j.jvs.2013.08.099","article-title":"Vascular Quality of Life Questionnaire-6 facilitates health-related quality of life assessment in peripheral arterial disease","volume":"59","author":"J Nordanstig","year":"2014","journal-title":"J Vasc Surg"},{"key":"pone.0253288.ref027","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1177\/0272989X09344747","article-title":"Measuring acceptability of clinical decision rules: validation of the Ottawa acceptability of decision rules instrument (OADRI) in four countries","volume":"30","author":"JC Brehaut","year":"2010","journal-title":"Med Decis Making"},{"key":"pone.0253288.ref028","article-title":"Frailty as a Predictor of Death or New Disability After Surgery: A Prospective Cohort Study","author":"DI McIsaac","year":"2018","journal-title":"Ann Surg"},{"key":"pone.0253288.ref029","doi-asserted-by":"crossref","first-page":"1228","DOI":"10.1080\/03610910902859574","article-title":"Using the Standardized Difference to Compare the Prevalence of a Binary Variable Between Two Groups in Observational Research","volume":"38","author":"PC Austin","year":"2009","journal-title":"Communications in Statistics\u2014Simulation and Computation"},{"key":"pone.0253288.ref030","first-page":"119","article-title":"Approximate is better than \"exact\" for interval estimation of binomial proportions","volume":"52","author":"A Agresti","year":"1998","journal-title":"Am Stat"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0253288","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,6,15]],"date-time":"2021-06-15T17:28:12Z","timestamp":1623778092000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0253288"}},"subtitle":[],"editor":[{"given":"Kanhaiya","family":"Singh","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,6,15]]},"references-count":30,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2021,6,15]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0253288","relation":{},"ISSN":["1932-6203"],"issn-type":[{"type":"electronic","value":"1932-6203"}],"subject":[],"published":{"date-parts":[[2021,6,15]]}}}