In the Cardiff Wound Impact questionnaire used in the final model of regression analysis, presence or absence of antibiotic treatment, independent living ability, and QoL in addition to number of ozone therapy sessions were associated with ozone therapy. Antibiotic therapy and the ability to live independently were inversely proportional to QoL. Ozone therapy for localized to systemic treatment was associated with a higher QoL. The ozone treatment system for systemic plus topical treatment was associated with a higher QoL.
In the SF-36 questionnaire used in the final model regression analysis, level of education, ability to live independently, and QoL in addition to number of ozone therapy sessions were associated with ozone therapy. This means that the ability to live independently and QoL are in direct proportion to level of education. Similar to the Cardiff Wound Impact assessment, ozone therapy for localized to systemic treatment was associated with a higher QoL. The ozone treatment system for systemic plus topical treatment was associated with a higher QoL. The SF-36 questionnaire is divided into 2 parts. The PCS part is related to the physical dimension of QoL, and the MCS part relates to the mental aspect of QoL.
In the PCS, the final model regression analysis showed that, in addition to number of ozone therapy sessions, history of amputation, the ability to live independently, and QoL were associated with ozone therapy. This means that the ability to live independently and QoL has amputation directly and inversely proportional to the QoL. Similar to the previous 2, treatment with ozone locally to systemic treatment was associated with a higher QoL. The ozone treatment system for systemic plus topical treatment was associated with a higher QoL. Here, there was no significant relationship between level of education and QoL.
This means that the ability to live independently and QoL are directly proportionate to level of education. Here, history of amputation was not related to QoL. The change was remarkable in this part of the power relationship between independent living and QoL with QoL psychological than physical strength. Moreover, the types of ozone therapy and QoL in this area had no significant relationship.
A review of the literature revealed that, to the best of the authors’ knowledge, no assessment of QoL in patients treated with ozone has been done. It is estimated that ozone therapy acts through stimulation of the neuroendocrine system. Although the exact mechanism is unclear, an euphoric feeling of liberation is involved. It is proposed that these hormones, including adrenocorticotropic hormone (ACTH), corticotropin-releasing hormone (CRH), cortisol, dehydroepiandrosterone sulfate (DHEAS), growth hormones, endorphins, and neurotransmitters, when injected with ozone-rich blood to the body, are released. Another hypothesis is that, as the results of this study suggest, because ozone therapy is effective in wound healing, this healing enhances QoL for the patients. The relationship between elevated ozone therapy and improved QoL can be attributed to wound healing. However, in the current study, multivariate regression analysis of final recovery or wound healing was not significantly associated with QoL.
Due to the high number of ozone therapy sessions associated with increased QoL, as shown in the current study, the strongest predictor of QoL was number of ozone therapy sessions. Another variable that was directly related to QoL in the current study was the ability to live independently. The ability to live independently with all models of the Cardiff and SF-36 questionnaires had a direct and significant relationship with QoL. This relationship is also evident, and it seems rational. Interestingly, the relationship of these variables is more significant with physical health than with mental health. The relation between physical health and QoL is more powerful both clinically and statistically. Reputable studies have achieved results in line with the current findings. For example, Fortin et al evaluated the relationship between comorbidities and QoL. The greater the number of comorbidities was more individual, he also reduced QoL. In the current study, 2 main questionnaire study was not associated in the final model regression analysis. But the SF-36 divided into 2 physical and mental, although a history of amputation of the mind was not related to the variable part of the beauty of this questionnaire, is a direct connection that after entering the other variables in the regression equation is still significant.
In the current study, despite the fact that number of treatments and QoL were directly associated with ozone, the ozone therapy was inversely associated with QoL. This means that those patients who were only treated locally had a better quality of life than others. At first glance, it seems that treatment with ozone is more severe and QoL is further reduced. The reason for this relationship is the severity of the wounds. The larger wounds, more and more fluid design are needed to systemic therapy, ozone therapy by topical, and systemic treatment to both changes. Thus, it seems that this connection is strongly related to the type of wounds receiving ozone therapy. A case in point is the relationship of ozone therapy with both scale and QoL. It is hypothesized that QoL is even enhanced with ozone protection, because it suggests that ozone can improve mental QoL. The same is the case for antibiotic therapy as seen in the current study.
In the Cardiff questionnaire, antibiotic treatment was inversely related to QoL. Here, too, the problem arises that the wounds are likely more serious and more infectious diseases are treated with antibiotics. The patients also have a lower QoL. Therefore, antibiotic therapies are those that have a lower QoL and the reversed antibiotic treatment and QoL is a false relationship. It is noteworthy that this negative association was significant only in the Cardiff questionnaire; and any components of the SF-36 questionnaire, physical, and psychological regression.
Many studies have examined QoL in Iran as part of their expression is not unpleasant. In this study, the SF-36 questionnaire was used to evaluate QoL. The total mean scores of physical (PCS) and mental (MCS) QoL in these patients were 55.01 and 63.86 points, respectively, corresponding to both of our study are higher (P < .001). Of course, it is known that the participants in the current study were healthy normal citizens of Tehran. In this study, factors that were associated with QoL and health included age, gender, and economic status. Older age, female gender, and weaker economic situation had direct correlations with the physical deterioration of QoL. While that does not play an important role for mental health, age and gender were not significant. In this study, there was no significant relationship between physical or mental QoL in contrast to our study, education or living independently or with family.
As mentioned above, this study was conducted on healthy subjects. Other studies, however, have been conducted on a variety of Iranian patients. For example, one study assessed 101 patients with nonmalignant chronic pain caused by disease recommend the suffering of samples. In it, overall QoL and overall mental health QoL were 43.37 and 46.95, respectively. The study also reported lower overall QoL in older people.[22,23]
Another study examined the QoL of patients with type II diabetes. This study was conducted in 2012 and with a large sample size (n = 3472). It investigated QoL in 3472 Iranian people with type 2 diabetes with a mean age of 59.4 years and the factors related to it.
In this study, unlike the previous two studies, the SF-36 questionnaire was not used; thus, a direct comparison with the scores in the current study was not possible. However, the existence of possible factors affecting the QoL of diabetic patients in this study is remarkable. Overall, female gender, lower education, having a steady job, longer duration of diabetes, hospitalization due to diabetes in the year before the study, diabetic foot ulcers, nephropathy, and retinopathy were factors that had a relationship with a lower QoL. The project researchers concluded that the QoL of diabetic patients in Iran is significantly lower. Ironically, the very existence of diabetic foot ulcers in people is directly and strongly associated with a reduced QoL. In this study, variables such as marital status, type of diabetes (such as untreated, nutritional therapy, lifestyle changes, and drug treatment), city of residence, and cardiovascular diseases had an effect on QoL.
One study published in 2014 investigated 1232 patients who had recently been infected with diabetic foot ulcers. This study with diabetes data gathered from 14 centers in 10 European countries was valid. As in previous studies, the SF-36 questionnaire and the Euro-Qol-5D were used.
Among other factors, patient QoL will be affected by size of the wound, limb ischemia, increased serum levels of CRP, clinical diagnosis of infection, and polyneuropathy, all of which are related to reduced QoL.
To the best of the authors’ knowledge, the current study is the only study that examines the QoL in patients treated with ozone. The sectional nature of the study makes it harder to make a causal link between categorical variables. The small sample size indicates that all relationships between variables are not perfectly efficient. Therefore, it is possible that other relationships between these variables are present in higher sample volumes.
Patients with chronic wounds have considerably decreased QoL and need special care. Medical O3 therapy appears to increase health-related QoL among these patients and could be a valuable therapeutic option. It seems that the application of medical O3 therapy, in addition to its positive effects on the healing process of chronic wounds, can significantly improve and increase QoL in patents. The current study has proven again that O3 therapy can be a safe, efficient, and highly potential therapeutic method for improving QoL in cases with chronic wounds.
Conceptualization: Morteza Izadi, Nematollah Jonaidi-Jafari, Nahid Khalili, Mahboobeh Sadat Hosseine
Data curation: Majedeh Bozorgi, Mohsen Alizadeh Sani
Formal analysis: Nematollah Jonaidi-Jafari, Nahid Khalili, Mahboobeh Sadat Hosseine
Methodology: Majedeh Bozorgi, Mohsen Alizadeh Sani
Project administration: Majedeh Bozorgi, Mohsen Alizadeh Sani
Supervision: Mohsen Alizadeh Sani
Writing– original draft: Morteza Izadi, Nematollah Jonaidi-Jafari, Mohsen Alizadeh Sani, Nahid Khalili, Mahboobeh Sadat Hosseine
Writing – review and editing: Majedeh Bozorgi.
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Keywords:Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.
chronic wounds; ozone-therapy; quality of life