Cumulative Life Course Impairment (CLCI): A new concept to characterize persistent patient burden in chronic wounds

Cumulative Life Course Impairment (CLCI) is a theoretical construct referring to the non-reversible burden of a chronic skin disease over time. In some patients and situations, this burden may lead to chronic impairment and missed opportunities and, finally, persisting psychosocial and personal damage.Chronic wounds such as leg ulcers, diabetic or ischemic foot ulcers and pressure ulcers are a heterogeneous group of chronic tissue defects which share the stagnation of wound healing due to an underlying disease. Most patients suffer from marked reductions of quality of life, including pain, physical discomfort, functional limitations, social burden as well as psychological distress. In some countries, a negative socioeconomic impact for the patients is another strain. Most patients complain about the additional burden due to treatment. Given the long period of disease and the even longerlasting comorbidity, chronic wounds can be associated with marked Cumulative Life Course Impairments.It is thus essential to detect any early signs of wound disease and psychosocial burden in patients at risk of chronic wounds. Though specific instruments have not yet been developed for the detection of Cumulative Life Course Impairment in chronic wounds, patients at risk can be identified by using validated disease-specific questionnaires for quality of life. Moreover, in specific situations, psychological evaluation tools can be of additional diagnostic help.