Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006; 3:(2)77-101

Cipolletta S, Amicucci L. Illness trajectories in patients suffering from leg ulcers: A qualitative study. J Health Psychol. 2017; 22:(7)932-942

Cipolletta S, Gris F. Older people's lived perspectives of social isolation during the first-wave covid-19 pandemic in Italy. International Journal of Environmental Research and Public Health. 2021; 18:(22)

Cipolletta S, Ortu MC. Covid-19: common constructions of the pandemic and their implications. J Constr Psych. 2021; 34:(3)278-294

Cipolletta S, Gammino GR, Palmieri A. Illness trajectories in patients with amyotrophic lateral sclerosis: how illness progression is related to life narratives and interpersonal relationships. J Clin Nurs. 2017; 26:(23-24)5033-5043

Cipolletta S, Entilli L, Filisetti S. Uncertainty, shock and anger: recent loss experiences of first-wave COVID-19 pandemic in Italy. J Community Appl Soc Psychol. 2022; 32:(5)983-997

Cunha N, Campos S, Cabete J. Chronic leg ulcers disrupt patients' lives: A study of leg ulcer-related life changes and quality of life. Br J Community Nurs. 2017; 22:S30-S37

Dissemond J, Bültemann A, Gerber V, Jäger B, Kröger K, Münter C. Diagnosis and treatment of chronic wounds: current standards of Germany's Initiative for Chronic Wounds e. V. J Wound Care. 2017; 26:(12)727-732

Douglas KM. COVID-19 conspiracy theories. Group Processes & Intergroup Relations. 2021; 24:(2)270-275

Finlayson KJ, Parker CN, Miller C Predicting the likelihood of venous leg ulcer recurrence: the diagnostic accuracy of a newly developed risk assessment tool. Int Wound J. 2018; 15:(5)686-694

Flick U. An introduction to qualitative research.London: Sage Publications Ltd; 2009

Glaser BG, Strauss AL. Time for dying.New Jersey: Aldine Transaction; 1968

Green J, Jester R, McKinley R, Pooler A. Chronic venous leg ulcer care: Putting the patient at the heart of leg ulcer care. Part 1: Exploring the consultation. Br J Community Nurs. 2018; 23:S30-S38

Hopkins A. Disrupted lives: Investigating coping strategies for non-healing leg ulcers. Br J Nursing. 2004; 13:(9)556-563

Kelly GA. The psychology of personal constructs.New York, NY: Norton; 1955

Kouris A, Armyra K, Christodoulou C Quality of life psychosocial characteristics in Greek patients with leg ulcers: a case control study. Int Wound J. 2016; 13:(5)744-747

Louvardi M, Pelekasis P, Chrousos GP, Darviri C. Mental health in chronic disease patients during the COVID-19 quarantine in Greece. Palliat Support Care. 2020; 18:(4)394-399

Martinengo L, Olsson M, Bajpai R Prevalence of chronic wounds in the general population: systematic review and meta-analysis of observational studies. Ann Epidemiol. 2019; 29:8-15

Phillips P, Lumley E, Duncan R A systematic review of qualitative research into people's experiences of living with venous leg ulcers. J Adv Nurs. 2018; 74:(3)550-563

Probst S, Bobbink P, Séchaud L, Buehrer Skinner M. Venous leg ulcer recurrences – the relationship to self-efficacy, social support and quality of life – A mixed method study. J Adv Nurs. 2021; 77:(1)367-375

Ruseckaite R, Richards C, Rutherford C A conceptual framework of patient-reported outcomes in people with venous leg ulcers. Wound Repair Regen. 2020; 28:(3)355-363

Sallustro M, Florio A. The impact of COVID-19 pandemic on vascular leg ulcers. International Journal of Low Extremity Wounds. 2021; 21:(4)

Shanthanna H, Strand NH, Provenzano DA Caring for patients with pain during the COVID-19 pandemic: consensus recommendations from an international expert panel. Anaesthesia. 2020; 75:(7)935-944

Tinelli G, Sica S, Guarnera G, Pitocco D, Tshomba Y. Wound care during covid-19 pandemic. Ann Vasc Surg. 2020; 68:93-94

Todhunter J. Understanding the differential diagnosis of leg ulcers: focus on atypical ulcers. Journal of Community Nursing. 2019; 33:(1)29-37

Tollow P, Ogden J. The importance of relationships in treatment for chronic leg ulceration. J Health Psychol. 2019; 24:(13)1839-1849

Tomaino SCM, Cipolletta S, Kostova Z, Todorova I. Stories of life during the first wave of the covid-19 pandemic in italy: a qualitative study. Int J Environ Res Public Health. 2021; 18:(14)

Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007; 19:(6)349-357

Torri E, Sbrogiò LG, Di Rosa E, Cinquetti S, Francia F, Ferro A. Italian public health response to the covid-19 pandemic: case report from the field, insights and challenges for the department of prevention. Int J Environ Res Public Health. 2020; 17:(10)

Weller CD, Richards C, Turnour L, Team V. Venous leg ulcer management in Australian primary care: patient and clinician perspectives. Int J Nurs Stud. 2021; 113

Yardley L. Dilemmas in qualitative health research. Psychol Health. 2000; 15:(2)215-228

Patient experiences of people with leg ulcers during the COVID-19 pandemic

22 June 2023
Volume 32 · Issue 12



The COVID-19 pandemic affected the care of people with chronic leg ulcers (CLUs).


To understand how people with CLUs perceived illness, health care and the public health emergency during the second wave of the COVID-19 pandemic.


Twenty people attending a wound care clinic in Northern Italy participated in semi-structured interviews and a thematic analysis was conducted using the software Atlas.ti 9.


Results show that most of the participants evaluated their healthcare experience as positive but differed in their perceptions of the changes brought about by the pandemic according to their varied illness experiences and perceived social support. Participants were grouped in four trajectories that provided insight into the construction of personalised support strategies for people with CLUs.


These results may help inform healthcare interventions and policies in the care of long-term conditions such as CLUs during a widespread emergency in future.

Chronic wounds (also referred to as hard-to-heal wounds) usually describes those that do not heal within 8 weeks. However, there are certain types of ulcers that are considered ‘chronic’ from their very beginning, such as venous and arterial leg ulcers or diabetic foot and pressure ulcers (Dissemond et al, 2017). Chronic leg ulcers (CLUs) have an estimated prevalence of 1.51 per 1000 people (Martinengo et al, 2019) and the most common types of leg ulcers are venous (80%) and arterial (15%); atypical ulcers related to other causes are rarer (5%) (Todhunter, 2019). CLUs are difficult to heal and tend to be recurrent, especially those of venous aetiology (Finlayson et al, 2018).

CLUs can have a moderate (Cunha et al, 2017) to high (Kouris et al, 2016) impact on people's quality of life due to both pain (Probst et al, 2021) and significant restrictions to daily activities (Ruseckaite et al, 2020). Pain tends to be exacerbated during the night, leading to considerable difficulty in sleeping for patients, increasing the debilitation caused by the illness (Green et al, 2018; Phillips et al, 2018; Ruseckaite et al, 2020). Pain varies in type, intensity and duration: for some patients it is more or less constant, while others have described alternating periods without pain and moments of sudden onset without apparent precipitating factors (Phillips et al, 2018). Furthermore, restrictions to daily living are mainly caused by pain and walking difficulties, but also by the use of compression bandaging that restricts movement (Green et al, 2018; Phillips et al, 2018) and by frequent appointments at the wound clinic to receive routine care (Weller et al, 2021). Restrictions to daily activities can also impact on the ability to perform and to maintain personal hygiene, and can limit the choice of clothing and footwear (Phillips et al, 2018). In addition, CLUs may produce malodorous exudate that can cause embarrassment and shame, leading people to avoid interactions with others, resulting in social isolation (Ruseckaite et al, 2020). Depressive aspects (Green et al, 2018) related to prolonged healing time and the idea of the impossibility of complete recovery (Ruseckaite et al, 2020) may be present in patients with leg ulcers, with some expressing anxiety related to fear of falling or injury, which may increase the risk of ulcer recurrence (Green et al, 2018; Phillips et al, 2018; Ruseckaite et al, 2020).

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content