VII. Assessment Tools

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VII. Assessment Tools

Chronic venous disease and quality of life – the time has come to choose a
tool
Burden of venous disease: comparing worldwide and American findings

Armando Mansilha, Portugal


The prevalence and socioeconomic burden of chronic venous disease (CVD) are significant in the USA and Europe, and only increase with older age. The presence of venous symptoms has a marked effect on both the physical and mental health of patients with varicose veins; findings that have been verified with generic and specific quality-of-life tools. CVD is not a cosmetic problem and patients with CVD deserve treatment. The long-term effects of CVD and their related cost are highly preventable, particularly if early diagnosis and treatment are made.

Specific quality-of-life questionnaires: a systematic review

Robert Launois, France


A systematic review of the literature concerning the quality-of-life (QOL) scales used in chronic venous disease (CVD) and leg ulcers was performed in February 2013 to identify the respective advantages and lacunae of existing tools. A research protocol was developed following the PRISMA statement and PICOS criteria. Three databases: EMBASE, CINHAL, and Cochrane were screened without a time window, and the identified references were chronologically ranked. Relevant systematic reviews, randomized trials, comparative studies and psychometric/linguistic validation studies were included. Inclusion criteria were met in 70 of the 511 references, in which nine scales were identified: three for leg ulcers, three for CVD, and three for both. The validation studies were based on face, construct, and group validity, as well as reliability, and responsiveness. Among the specific tools, CIVIQ and VEINES-QOL/Sym were the most validated scales and had the longest iterative validation process. The stability of the factorial structure of the CIVIQ-14 questionnaire was confirmed, as well as the effect of CVD on health-related quality-of-life.

Choosing a quality-of-life instrument to suit your needs

Michael Vasquez, USA


The author concluded that patient-reported outcomes and physician-evaluated clinical signs are complimentary tools, practical, valuable, and proven.

Quality-of-life tools for chronic venous disease: how reliable are they?

Amanda Shepherd, UK


Quality-of-life tools for chronic venous disease are reliable and consistent, well validated, and dependent on data quality and appropriate use. They can be used for evaluating quality-of-life, disease severity, outcomes following intervention, and comparison of treatment modalities. Their use for predicting treatment outcomes and rationing of resources is arguable.

Severity scores, quality-of-life scores, classifications, Villalta scores, etc; a critical review

Cees Wittens, The Netherlands


The main message from this presentation was that we still do not have a reliable instrument to assess the severity of venous disease, the efficacy of treatment, and to evaluate new techniques. Instruments such as the Clinical, Etiological, Anatomical, Pathophysiological (CEAP) classification, the Venous Clinical Severity Score (VCSS), and quality-of-life (QOL) scores have many advantages, but at the same time many important limitations. For example, CEAP is not sensitive to small changes over time, VCSS includes some items that are non-specific for venous disease, QOL tools have weak correlations with generic- and diseasespecific questionnaires, and with QOL and hemodynamic parameters. A truly all round combined QOL Score and clinical tool is still to be created. A reliable instrument to assess venous disease and the results of treatment is also still required.

The intuitive registry solution for Europe

Cees Wittens, The Netherlands


There are contradictions between the results of randomized controlled trials and data from real-life practice. Selection criteria make populations included in randomized controlled trials different from those seen in daily practice. The author suggests that registries are the best tool for representing the real-life situation, for monitoring and improving healthcare, and for collecting epidemiological data. Unfortunately, existing registries such as the Electronic Health Record are imperfect. The author’s team created the Maastricht Registry, which was designed especially for venous patients and allows research data to be obtained automatically from all clinicians. Venous registries such as this could be a good tool to obtain useful data on real-life practice.

Validation of VVSymQTM, a new patient-reported outcome instrument for measuring symptoms in varicose vein patients

Kathleen Gibson, USA


VVSymQTM , a new patient-reported outcome instrument for measuring symptoms in patients with varicose veins, was found to be easy to use, reliable, sensitive to changes in symptoms, and able to measure treatment success from the patient’s perspective.