Perceived stress and wound healing in people living with hard-to-heal wounds: a cohort study

Abstract

Aim: To identify and analyze the relationship between perceived stress, healing, and other clinical variables in people with hard-to-heal wounds treated in an Enterostomal Therapy outpatient clinic. Methods: Observational and prospective secondary cohort study approved by the ethics committee. Data were collected during 2-6 appointments, through interviews, wound examinations, and chart reviews, using tools on REDCap app such as sociodemographic and clinical forms, the Brief Pain Inventory (sensitivity and interference in life score), McGill Pain multidimensional Questionnaire, Bates-Jensen Wound Assessment (severity score 13-65), and Perceived Stress Scale. Analyses included hypothesis testing, Pearson correlations, and mixed-effects regression models. Results: Among 32 patients, 75% had lower-limb wounds, averaging 4.5 years in duration, with a mean wound severity score of 37.5. Delayed wound healing was identified in 21.9% of patients across the appointments. In a weak correlation, it was found that the greater the perceived stress, the greater the wound severity score. However, perceived stress alone did not predict wound healing longitudinally. In a moderate correlation, the shorter the duration of the wound, the greater the perceived stress and the lower the perceived coping. In addition, patients with delayed wound healing and longer wound duration had higher perceived coping scores. Furthermore, in a moderate correlation, the greater the pain interference, the greater the perceived stress and the lower the perceived coping; the greater the McGill Pain, the greater the perceived stress and distress. Conclusion: Stress is a complex biopsychosocial phenomenon contributing to the clinical outcomes of people with hard-to-heal wounds, together with other variables, mainly pain and wound duration. Higher perceived coping was identified in patients with longer wound duration; however, pain affected it.