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Boersma-van Dam E, Spronk I, Hofland HWC, Van Loey NEE. Gender differences in relation to stigmatization and depressive symptoms after burns. Burns 2024; 50:1662-1670. [PMID: 38637258 DOI: 10.1016/j.burns.2024.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVES The aim of this study was to investigate the moderating role of gender in the relationship between burn severity, perceived stigmatization and depressive symptoms at multiple time points postburn. MATERIALS AND METHODS This multi-center study included data from two cohorts. Cohort 1 consisted of 215 burn survivors, participating in a longitudinal study with measures at 3 and 12 months postburn. Cohort 2 consisted of 180 burn survivors cross-sectionally assessed at 5 - 7 years postburn. Both cohorts completed self-reported measures of perceived stigmatization and depressive symptoms. The number of acute surgeries (i.e., no surgery, 1 surgery or 2 or more surgeries) was used as indicator of burn severity. Relations between number of surgeries, depressive symptoms, and perceived stigmatization, including possible indirect effects, were evaluated with gender-specific path models. RESULTS In both men and women, number of surgical operations was related to higher levels of depressive symptoms and perceived stigmatization at 3 months after burn. In women, number of operations was still directly related to both constructs at 12 months after burn, which was cross-sectionally confirmed in the 5-7 years after burn cohort. In men, from 3 to 12 months after burn, depressive symptoms and perceived stigmatization were bidirectionally related, and, through these effects, number of surgeries was indirectly related to both outcomes. In the cross-sectional 5-7 years after burn cohort, number of operations was related to stigma but not to depressive symptoms of men. CONCLUSION Number of operations had a different effect on psychosocial adaptation of male and female burn survivors. In women, a persistent direct link from number of operations to both depressive symptoms and perceived stigmatization was found over time. In men, the effect of number of operations was most evident in the short-term, after which perceived stigmatization and depressive symptoms became interrelated. This indicates that burn severity remains a factor of significance in psychological adjustment in women, whereas in men, this significance seems to decrease over time.
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Affiliation(s)
- Elise Boersma-van Dam
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands; Association of Dutch Burn Centres, Beverwijk, the Netherlands.
| | - Inge Spronk
- Association of Dutch Burn Centres, Beverwijk, the Netherlands; Dutch Burns Foundation, Beverwijk, the Netherlands; Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
| | | | - Nancy E E Van Loey
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
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2
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Katsu A, Mackenzie L, Elliott JM, Mackey M, Tyack Z. Return-to-employment for working-aged adults after burn injury: A mixed methods scoping review. Work 2024:WOR230148. [PMID: 38578910 DOI: 10.3233/wor-230148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND This scoping review aimed to identify the barriers, facilitators and benefits of returning to work following burn injury, outcome measures used, management strategies, and models of care. OBJECTIVE To provide a comprehensive overview about working-aged adults returning to their preinjury employment after burn injury. METHODS We followed a pre-determined scoping review protocol to search MEDLINE, CINAHL, Embase, PsycINFO, PubMed, Scopus, CCRCT and CDSR databases between 2000 to December 2023. Papers reporting primary data from previously employed adults with cutaneous burn injuries were included. RESULTS In all, 90 articles met the review criteria. Return-to-work was both an outcome goal and process of recovery from burn injury. Physical and psychological impairments were identified barriers. Job accommodations and modifications were important for supporting the transition from hospital to workplace. Employment status and quality of life sub-scales were used to measure return-to-work. CONCLUSIONS Consistent definitions of work and measurements of return-to-employment after burn injury are priorities for future research. Longitudinal studies are more likely to capture the complexity of the return-to-employment process, its impact on work participation and changes in employment over time. The social context of work may assist or hinder return-to-work more than physical environmental constraints. Equitable vocational support systems would help address disparities in vocational rehabilitation services available after burn injury.
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Affiliation(s)
- Akane Katsu
- Discipline of Occupational Therapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Lynette Mackenzie
- Discipline of Occupational Therapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - James M Elliott
- The Kolling Institute, Northern Sydney Local Health District, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Martin Mackey
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Zephanie Tyack
- Australian Centre for Health Services Innovation (AusHSI), Centre for Healthcare Transformation and School of Public Health and Social Work, Queensland University of Technology, Australia
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3
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Katsu A, Mackenzie L, Tyack Z, Mackey M. Understanding return-to-employment experiences after burns: Qualitative scoping review findings. Aust Occup Ther J 2024; 71:113-131. [PMID: 37990624 DOI: 10.1111/1440-1630.12915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/21/2023] [Accepted: 10/25/2023] [Indexed: 11/23/2023]
Abstract
INTRODUCTION Participation in work and employment is a milestone of adulthood. People returning to work after burn injury may have physical, psychological, social, and environmental barriers to overcome in order to resume their pre-injury employment. The aim of this paper is to evaluate qualitative findings regarding return-to-employment after burn injury. METHODS A qualitative synthesis was conducted based on the qualitative findings of an earlier mixed methods review. A pre-determined scoping review protocol was used in the earlier review to search MEDLINE, CINAHL, Embase, PsycINFO, PubMed, Scopus, CCRCT, and CDSR databases between 2000 and Aug 2021. Any papers presenting qualitative data from previously employed adults with cutaneous burn injuries were included. FINDINGS A total of 20 papers with qualitative data on return-to-employment after burn injury were found. Only six included studies focused on return-to-employment outcomes and the remaining studies reporting on quality of life and life experiences after burn injury. Common themes included impairments that develop and change over time; occupational identity and meaning; temporal aspects of burn recovery; burn rehabilitation services and interventions; attitudes, knowledge and support of service providers; workplace environments supporting work re-engagement after burn injury; usefulness of work accommodations; family and social supports, individuals attributes that influence re-engaging in employment; and accepting and rebuilding. CONCLUSION Resumption of work after burn injury is regarded as a key marker of recovery for working-aged adults by burn survivors and burn care professionals. Support at transition points during the burn recovery process and peer-led programmes were important. However, limited information currently exists regarding clinical practices, service gaps, and understanding of return-to-employment outcomes after burn injury.
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Affiliation(s)
- Akane Katsu
- Discipline of Occupational Therapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Lynette Mackenzie
- Discipline of Occupational Therapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Zephanie Tyack
- Australian Centre for Health Services Research, Faculty of Health, Queensland University of Technology, QLD, Australia
| | - Martin Mackey
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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4
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Nosanov LB, Gibson ALF. The Need for Diversity, Equity, and Inclusion in the Examination of Sexual Life Issues After Partners' Burn Injuries. J Burn Care Res 2023; 44:1258. [PMID: 37423709 DOI: 10.1093/jbcr/irad091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Affiliation(s)
- Lauren B Nosanov
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Angela L F Gibson
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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David S, Roy N, Lundborg CS, Wärnberg MG, Solomon H. 'Coming home does not mean that the injury has gone'-exploring the lived experience of socioeconomic and quality of life outcomes in post-discharge trauma patients in urban India. Glob Public Health 2022; 17:3022-3042. [PMID: 35129081 DOI: 10.1080/17441692.2022.2036217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Trauma results in long-term socioeconomic outcomes that affect quality of life (QOL) after discharge. However, there is limited research on the lived experience of these outcomes and QOL from low - and middle-income countries. The aim of this study was to explore the different socioeconomic and QOL outcomes that trauma patients have experienced during their recovery. We conducted semi-structured qualitative interviews of 21 adult trauma patients between three to eight months after discharge from two tertiary-care public hospitals in Mumbai, India. We performed thematic analysis to identify emerging themes within the range of different experiences of the participants across gender, age, and mechanism of injury. Three themes emerged in the analysis. Recovery is incomplete-even up to eight months post discharge, participants had needs unmet by the healthcare system. Recovery is expensive-participants struggled with a range of direct and indirect costs and had to adopt coping strategies. Recovery is intersocial-post-discharge socioeconomic and QOL outcomes of the participants were shaped by the nature of social support available and their sociodemographic characteristics. Provisioning affordable and accessible rehabilitation services, and linkages with support groups may improve these outcomes. Future research should look at the effect of age and gender on these outcomes.
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Affiliation(s)
- Siddarth David
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Doctors For You, Mumbai, India
| | - Nobhojit Roy
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,WHO Collaborating Centre for Research in Surgical care delivery in LMICs, BARC Hospital, Mumbai, India
| | | | - Martin Gerdin Wärnberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden
| | - Harris Solomon
- Department of Cultural Anthropology and the Duke Global Health Institute, Duke University, Durham, NC, USA
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6
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Ross EE, Colbath RA, Yu J, Munabi N, Gillenwater TJ, Yenikomshian HA. Peer Support Groups: Identifying Disparities to Improve Participation. J Burn Care Res 2022; 43:1019-1023. [PMID: 35781574 PMCID: PMC9435488 DOI: 10.1093/jbcr/irac086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
Disparities in psychosocial outcomes after burn injury exist in patients from racial or ethnic minority groups in the United States. Peer support groups can help patients with many psychosocial aspects of recovery from burns; however, access to such support among patients of racial and ethnic minority or low socioeconomic groups are unknown. The present study examined participation rates in outpatient peer support within this patient population. Patients attending outpatient clinic at an urban safety-net hospital and regional burn center with a majority minority patient population were asked about participation in burn survivor group, interest in joining a group, and given validated survey questions about managing emotions and social interactions since injury. Current or past participation in peer support was low (4.2%), and 30.3% of patients not already in support group were interested in joining. Interest in future participation in peer support was highest among Hispanic patients (37.0%) and lowest among Black patients (0%). Logistic regression models demonstrated that increased total body surface area burned, hospital length of stay, and need for surgical intervention were associated with interest in joining or having joined a peer support group. Effectiveness of management of emotions and social interactions were not associated with interest in joining peer support in the future. These findings demonstrate a considerable difference between levels of interest and participation in peer support within this population. Improving access to and education about benefits of peer support in underresourced communities may help to address the variation in psychosocial outcomes of patients across racial or ethnic minority groups recovering from burns.
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Affiliation(s)
- Erin E Ross
- From the Keck School of Medicine, University of SouthernCalifornia, Los Angeles, CA, USA
| | - Rachel A Colbath
- From the Keck School of Medicine, University of SouthernCalifornia, Los Angeles, CA, USA
| | - Jeremy Yu
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of SouthernCalifornia, Los Angeles, CA, USA
| | - Naikhoba Munabi
- Division of Plastic Surgery, Keck School of Medicine, University of SouthernCalifornia, Los Angeles, CA, USA
| | - T Justin Gillenwater
- Division of Plastic Surgery, Keck School of Medicine, University of SouthernCalifornia, Los Angeles, CA, USA
| | - Haig A Yenikomshian
- Division of Plastic Surgery, Keck School of Medicine, University of SouthernCalifornia, Los Angeles, CA, USA
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7
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Mediators and moderators of the relationship between body image and community integration among burn survivors. Burns 2022; 48:932-940. [PMID: 34930643 DOI: 10.1016/j.burns.2021.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/12/2021] [Accepted: 11/29/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Due to medical advances, care for patients that experience burns has shifted from saving life to improving quality of life. Reintegrating into the community and maintain body image satisfaction may be difficult after a severe burn. Several studies have analyzed these two variables independently, but none have addressed a potential interrelationship. AIM To investigate the indirect or direct relationship of body image and community integration, potentially mediated or moderated by social stigma, symptoms of depression, symptoms of post-traumatic stress disorder (PTSD), or posttraumatic growth. METHODS Data from the Burn Models Systems (BMS) Database between the years 2014 and 2020, patients who were at least 18 years of age and who had completed questionnaires that measured body image satisfaction, attitudes of community integration, perceived social stigma, and symptoms of depression, symptoms of PTSD, and posttraumatic growth were used to analyze potential mediators and moderators of the relationship between body image and community integration using multivariable linear regression models and structural equation modeling. RESULTS Social stigma, symptoms of depression, and symptoms of PTSD were determined to completely mediate the association of body image and community integration. Posttraumatic growth did not mediate this association. Social stigma, symptoms of depression, symptoms of PTSD, and posttraumatic growth did not moderate the relationship between body image and community integration. CONCLUSION The finding that symptoms of distress and social stigma account for the relationship between body image satisfaction and community integration support the potential for interventions that ameliorate distress to improve community integration and quality of life in people recovering from burn injuries.
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David SD, Aroke A, Roy N, Solomon H, Lundborg CS, Gerdin Wärnberg M. Measuring socioeconomic outcomes in trauma patients up to one year post-discharge: A systematic review and meta-analysis. Injury 2022; 53:272-285. [PMID: 34706829 DOI: 10.1016/j.injury.2021.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 09/30/2021] [Accepted: 10/08/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Trauma accounts for nearly one-tenth of the global disability-adjusted life-years, a large proportion of which is seen in low- and middle-income countries (LMICs). Trauma can affect employment opportunities, reduce social participation, be influenced by social support, and significantly reduce the quality of life (QOL) among survivors. Research typically focuses on specific trauma sub-groups. This dispersed knowledge results in limited understanding of these outcomes in trauma patients as a whole across different populations and settings. We aimed to assess and provide a systematic overview of current knowledge about return-to-work (RTW), participation, social support, and QOL in trauma patients up to one year after discharge. METHODS We undertook a systematic review of the literature published since 2010 on RTW, participation, social support, and QOL in adult trauma populations, up to one year from discharge, utilizing the most commonly used measurement tools from three databases: MEDLINE, EMBASE, and the Cochrane Library. We performed a meta-analysis based on the type of outcome, tool for measurement, and the specific effect measure as well as assessed the methodological quality of the included studies. RESULTS A total of 43 articles were included. More than one-third (36%) of patients had not returned to work even a year after discharge. Those who did return to work took more than 3 months to do so. Trauma patients reported receiving moderate social support. There were no studies reporting social participation among trauma patients using the inclusion criteria. The QOL scores of the trauma patients did not reach the population norms or pre-injury levels even a year after discharge. Older adults and females tended to have poorer outcomes. Elderly individuals and females were under-represented in the studies. More than three-quarters of the included studies were from high-income countries (HICs) and had higher methodological quality. CONCLUSION RTW and QOL are affected by trauma even a year after discharge and the social support received was moderate, especially among elderly and female patients. Future studies should move towards building more high-quality evidence from LMICs on long-term socioeconomic outcomes including social support, participation and unpaid work.
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Affiliation(s)
- Siddarth Daniels David
- Health Systems and Policy, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Doctors For You, Mumbai, India.
| | - Anna Aroke
- Doctors For You, Mumbai, India; WHO Collaborating Centre for Research in Surgical care delivery in LMICs, BARC Hospital, Mumbai, India
| | - Nobhojit Roy
- Health Systems and Policy, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; WHO Collaborating Centre for Research in Surgical care delivery in LMICs, BARC Hospital, Mumbai, India
| | - Harris Solomon
- Department of Cultural Anthropology and the Duke Global Health Institute, Duke University, USA
| | - Cecilia Stålsby Lundborg
- Health Systems and Policy, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Martin Gerdin Wärnberg
- Health Systems and Policy, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Function, Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden
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9
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Hemmati Maslakpak M, Ajoudani F, Lotfi M, Alinejad V. Society, family, and individual characteristics as double-edged swords in the social reintegration of Iranian female survivors from unintentional severe burns: a qualitative study of enablers and barriers. BMC WOMENS HEALTH 2021; 21:339. [PMID: 34560875 PMCID: PMC8464107 DOI: 10.1186/s12905-021-01481-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/16/2021] [Indexed: 11/24/2022]
Abstract
Background Reintegrating to society is a significant challenge during burn survivors’ rehabilitation. Aim This study aims to describe what Iranian female survivors from unintentional severe burns experience as enablers and barriers of social reintegration (SR). Methods Fourteen adult female burn survivors whose burns were unintentional participated in this qualitative study. Data were gathered through semi-structured face-to-face or telephone interviews and analyzed using inductive content analysis. Results Thirteen subcategories and six categories were emerged. Categories and subcategories of enablers content area were as follows: positive impact of society on SR (normal treatment of society, instrumental support), positive impact of family on SR (magnifying personal abilities assets, empathy and emotional support), and positive impact of personal characteristics on SR (coping with others stares, right to have a normal social life). Categories and subcategories of Barriers content area were as follows: negative impact of society on SR (being questioned in public, incorrect judgment about intent of burns, burns as a contagious disease), negative impact of family on SR (embarrassment of appearing in public with the survivor, family mistrust), and negative impact of intra-personal factors on SR (exaggeration of the post-burn changes, being over-sensitive to the others looks). From the deep interpretation of the data two overarching themes were emerged: “acceptance of the new normal by the society and the individual” and “being encompassed by misconceptions and mistreatments”.
Conclusions Society, family and the individual characteristics have a dual role to play in the success of social reintegration in Iranian female unintentional burn survivors.
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Affiliation(s)
| | - Fardin Ajoudani
- School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran.
| | - Mojgan Lotfi
- Sina Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahid Alinejad
- Patient Safety Research Centre, Urmia University of Medical Sciences, Urmia, Iran
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10
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Wolfe AE, Stockly OR, Abouzeid C, Rodríguez-Mercedes SL, Flores LE, Carrougher GJ, Gibran NS, Holavanahalli R, McMullen K, Trinh NH, Zafonte R, Silver JK, Ryan CM, Schneider JC. Burn model system national longitudinal database representativeness by race, ethnicity, gender, and age. PM R 2021; 14:452-461. [PMID: 33886159 DOI: 10.1002/pmrj.12618] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/23/2021] [Accepted: 04/05/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Representativeness of research populations impacts the ability to extrapolate findings. The Burn Model System (BMS) National Database is one of the largest prospective, longitudinal, multi-center research repositories collecting patient-reported outcomes after burn injury. OBJECTIVE To assess if the BMS Database is representative of the population that is eligible to participate. DESIGN Data on adult burn survivors who were eligible for the BMS Database from 2015 to 2019 were analyzed. SETTING Not applicable. PARTICIPANTS Burn survivors treated at BMS centers meeting eligibility criteria for the BMS Database. Eligibility for the database is based on burn size and receipt of autografting surgery. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) Race, ethnicity, gender, and age were compared between individuals who did and did not enroll. Regression analysis examined the correlation between demographic characteristics and study enrollment. Additional regression analysis examined the association between enrollment and the intersection of race, ethnicity, and gender. RESULTS A total of 982 adult burn survivors were eligible for the BMS database during the study period. Of those who were eligible, 72.1% Enrolled and 27.9% were Not Enrolled. The Enrolled group included more female and more younger survivors compared to the Not Enrolled group. In regression analyses, Black/African American burn survivors were less likely and individuals identifying as female were more likely to enroll in the BMS Database. Furthermore, White men and women were more likely to enroll compared to Black/African American men and women, and non-Hispanic/Latino men were more likely to enroll compared to Hispanic/Latino men. CONCLUSIONS This study found differences in BMS Database enrollment by race, ethnicity, and gender. Further research is warranted to investigate causes for the disparities found in this study. In addition, strategies are needed to improve enrollment to ensure future representativeness.
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Affiliation(s)
- Audrey E Wolfe
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA.,Spaulding Rehabilitation Institute, Boston, Massachusetts, USA
| | - Olivia R Stockly
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA.,Spaulding Rehabilitation Institute, Boston, Massachusetts, USA
| | - Cailin Abouzeid
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA.,Spaulding Rehabilitation Institute, Boston, Massachusetts, USA
| | | | - Laura E Flores
- College of Allied Health Professionals, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | | | - Nicole S Gibran
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Radha Holavanahalli
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Nhi-Ha Trinh
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA.,Spaulding Rehabilitation Institute, Boston, Massachusetts, USA
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA.,Spaulding Rehabilitation Institute, Boston, Massachusetts, USA.,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Colleen M Ryan
- Shriners Hospitals for Children - Boston, Boston, Massachusetts, USA.,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA.,Spaulding Rehabilitation Institute, Boston, Massachusetts, USA
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11
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Spronk I, Van Loey NEE, van der Vlies CH, Haagsma JA, Polinder S, van Baar ME. Activity impairment, work status, and work productivity loss in adults 5-7 years after burn injuries. J Burn Care Res 2021; 43:256-262. [PMID: 33693704 PMCID: PMC8737115 DOI: 10.1093/jbcr/irab047] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
An important aspect of the rehabilitation of burn patients is social participation, including daily activities and work. Detailed information on long-term activity impairment and employment is scarce. Therefore, we investigated activity impairment, work status, and work productivity loss in adults 5–7 years following burn injuries, and investigated associations with burn-specific health-related quality of life (HRQL) domains. Adult participants completed the Work Productivity and Activity Impairment General Health questionnaire and the Burn Specific Health Scale-brief (BSHS-B) 5–7 years post-burn. Outcomes were compared between participants with mild/intermediate and severe burns (>20% total body surface area burned). Seventy-six (36%) of the 213 participants experienced some degree of activity impairment due to burn-related problems 5–7 years post-burn. Seventy percent of the population was employed; 12% of them experienced work productivity loss due to burn-related problems. Nineteen percent reported changes in their work situation (partly) because of the burn injury. A higher proportion of participants with severe burns had activity impairments (56% vs 29%; P = .001) and work productivity loss (26% vs 8%; P < .001) compared to participants with mild/intermediate burns. Activity impairment and work productivity loss were both associated with burn-related work problems and lower mood, measured with the BSHS-B. In conclusion, a substantial part of the study population experienced activity impairment and work productivity loss, was unemployed, and/or reported changes in their work situation due to their injury. Particularly patients with severe burns reported productivity loss and had lower employment rates. This subscribes the importance of addressing work-related functioning in the rehabilitation of burn patients.
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Affiliation(s)
- Inge Spronk
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands.,Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
| | - Nancy E E Van Loey
- Association of Dutch Burn Centres, Department Behavioural Research, Beverwijk, the Netherlands.,Utrecht University, Department Clinical Psychology, Utrecht, the Netherlands
| | - Cornelis H van der Vlies
- Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands.,Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Juanita A Haagsma
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
| | - Suzanne Polinder
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
| | - Margriet E van Baar
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands.,Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
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12
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Ohrtman EA, Shapiro GD, Wolfe AE, Trinh NHT, Ni P, Acton A, Slavin MD, Ryan CM, Kazis LE, Schneider JC. Sexual activity and romantic relationships after burn injury: A Life Impact Burn Recovery Evaluation (LIBRE) study. Burns 2020; 46:1556-1564. [PMID: 32948357 DOI: 10.1016/j.burns.2020.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/10/2020] [Accepted: 01/16/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Engaging in healthy sexual activity and romantic relationships are important but often neglected areas of post-burn rehabilitation. The degree to which persons with burn injuries engage in sexual activity and romantic relationships is not well understood. This study examined demographic and clinical characteristics predicting engagement in sexual activity and romantic relationships in a sample of adult burn survivors compared to a general United States sample. METHODS Data for the adult burn survivor sample were from 601 adult burn survivors who participated in field-testing for the calibration of the Life Impact Burn Recovery Evaluation (LIBRE) Profile, a burn-specific instrument assessing social participation on six scales including sexual activity and romantic relationships. Comparison data were obtained from a general population sample of 2000 adults through sample matching. Demographic predictors of sexual activity and romantic relationship status were examined in each sample using modified Poisson regression analyses. Clinical predictors of engaging in sexual activity and romantic relationships were also examined in the LIBRE sample. RESULTS Participants were slightly more likely to report being sexually active in the adult burn survivor sample than in the general sample (65% vs. 57%, p < 0.01). There was not a significant difference in romantic relationship status between the two samples (64% vs. 62%, p = 0.31). In multivariable regression analyses, men in both samples were more likely to report being in a sexual relationship (RR in LIBRE sample = 1.23, 95% CI 1.08-1.39; RR in general sample = 1.10, 95% CI 1.02-1.18). Participants in both samples who were not working were less likely to report being sexually active or in a romantic relationship (RRs ranging from 0.73 to 0.83, p < 0.05 for all estimates). In the adult burn survivor sample, respondents with hand burns were more likely to report being sexually active and in a romantic relationship (RR = 1.16, 95% CI 1.01-1.33). Time since burn injury, burn size, and burns to other critical areas were not significantly associated with either outcome in adjusted analyses. CONCLUSIONS The likelihood of engaging in sexual activity and romantic relationships is similar among adult burn survivors and the comparison group representing a general United States sample of adults. Further research addressing sexual activity and romantic relationships after burn injuries will help to foster better patient-clinician dialogue, pinpoint barriers, design interventions, and allocate appropriate resources.
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Affiliation(s)
- Emily A Ohrtman
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States
| | - Gabriel D Shapiro
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Audrey E Wolfe
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States
| | - Nhi-Ha T Trinh
- Massachusetts General Hospital, Boston, MA, United States
| | - Pengsheng Ni
- Boston University School of Public Health, Boston, MA, United States
| | - Amy Acton
- The Phoenix Society for Burn Survivors, Grand Rapids, MI, United States
| | - Mary D Slavin
- Boston University School of Public Health, Boston, MA, United States
| | - Colleen M Ryan
- Massachusetts General Hospital, Boston, MA, United States; Shriners Hospital for Children - Boston, Harvard Medical School, Boston, MA, United States
| | - Lewis E Kazis
- Boston University School of Public Health, Boston, MA, United States
| | - Jeffrey C Schneider
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States.
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13
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Pham TN, Goldstein R, Carrougher GJ, Gibran NS, Goverman J, Esselman PC, Kazis LE, Ryan CM, Schneider JC. The impact of discharge contracture on return to work after burn injury: A Burn Model System investigation. Burns 2020; 46:539-545. [PMID: 32088093 DOI: 10.1016/j.burns.2020.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/22/2020] [Accepted: 02/06/2020] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Despite many advances in burn care, the development of extremity contracture remains a common and vexing problem. Extremity contractures have been documented in up to one third of severely burned patients at discharge. However, little is known about the long-term impact of these contractures. The purpose of this study was to examine the association of extremity contractures with employment after burn injury. METHODS We obtained data from the Burn Model System database from 1994 to 2003. We included in the study cohort all adult patients who were working prior to injury and identified those discharged with and without a contracture in one of the major extremity joints (shoulder, elbow, wrist, hip, knee and ankle). We classified contracture severity according to mild, moderate and severe categories. We performed descriptive analyses and predictive modeling to identify injury and patient factors associated with return to work (RTW) at 6, 12, and 24 months. RESULTS A total of 1,203 participant records met criteria for study inclusion. Of these, 415 (35%) had developed a contracture at discharge; 9% mild, 12% moderate, and 14% severe. Among 801 (67%) participants who had complete data at 6 months after discharge, 70% of patients without contracture had returned to work compared to 45% of patients with contractures (p < 0.001). RTW increased at each subsequent follow-up time point for the contracture group, however, it remained significantly lower than in no-contracture group (both p < 0.01). In multivariable analyses, female sex, non-Caucasian ethnicity, larger burn size, alcohol abuse, number of in-hospital operations, amputation, and in-hospital complications were associated with a lower likelihood of employment. In adjusted analyses, discharge contracture was associated with a lower probability of RTW at all 3 time points, although its impact significantly diminished at 24 months. CONCLUSIONS This study indicates an association between discharge contracture and reduced employment 6, 12 and 24 months after burn injury. Among many other identified patient, injury, and hospitalization related factors that are barriers to RTW, the presence of a contracture at discharge adds a significant reintegration burden for working-age burn patients.
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Affiliation(s)
- Tam N Pham
- UW Medicine Regional Burn Center, Department of Surgery, University of Washington, United States.
| | - Richard Goldstein
- Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, United States
| | - Gretchen J Carrougher
- UW Medicine Regional Burn Center, Department of Surgery, University of Washington, United States
| | - Nicole S Gibran
- UW Medicine Regional Burn Center, Department of Surgery, University of Washington, United States
| | - Jeremy Goverman
- Shriners Hospitals for Children-Boston, Department of Surgery, Harvard Medical School, United States
| | - Peter C Esselman
- Department of Rehabilitation Medicine, University of Washington, United States
| | - Lewis E Kazis
- Department of Health Law and Policy and Management, Boston University School of Public Health, United States
| | - Colleen M Ryan
- Shriners Hospitals for Children-Boston, Department of Surgery, Harvard Medical School, United States
| | - Jeffrey C Schneider
- Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, United States
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14
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Abstract
Burn injuries are under-appreciated injuries that are associated with substantial morbidity and mortality. Burn injuries, particularly severe burns, are accompanied by an immune and inflammatory response, metabolic changes and distributive shock that can be challenging to manage and can lead to multiple organ failure. Of great importance is that the injury affects not only the physical health, but also the mental health and quality of life of the patient. Accordingly, patients with burn injury cannot be considered recovered when the wounds have healed; instead, burn injury leads to long-term profound alterations that must be addressed to optimize quality of life. Burn care providers are, therefore, faced with a plethora of challenges including acute and critical care management, long-term care and rehabilitation. The aim of this Primer is not only to give an overview and update about burn care, but also to raise awareness of the ongoing challenges and stigmata associated with burn injuries.
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Affiliation(s)
- Marc G Jeschke
- Ross Tilley Burn Center, Department of Surgery, Sunnybrook Health Science Center, Toronto, Ontario, Canada.
- Departments of Surgery and Immunology, University of Toronto, Toronto, Ontario, Canada.
| | - Margriet E van Baar
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, Netherlands
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, Netherlands
| | - Mashkoor A Choudhry
- Burn and Shock Trauma Research Institute, Alcohol Research Program, Stritch School of Medicine, Loyola University Chicago Health Sciences Division, Maywood, IL, USA
| | - Kevin K Chung
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Nicole S Gibran
- Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Sarvesh Logsetty
- Departments of Surgery and Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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15
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Spronk I, Van Loey NEE, Sewalt C, Nieboer D, Renneberg B, Moi AL, Oster C, Orwelius L, van Baar ME, Polinder S. Recovery of health-related quality of life after burn injuries: An individual participant data meta-analysis. PLoS One 2020; 15:e0226653. [PMID: 31923272 PMCID: PMC6953837 DOI: 10.1371/journal.pone.0226653] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/29/2019] [Indexed: 01/23/2023] Open
Abstract
Background A prominent outcome measure within burn care is health related quality of life (HRQL). Until now, no model for long-term recovery of HRQL exists for adult burn patients which requires large samples with repeated measurements. Re-use and the combination of existing data is a way to achieve larger data samples that enable the estimation of long-term recovery models. The aim of this secondary data analysis was to assess the recovery of HRQL after a burn injury over time. Methods and findings Data from ten European studies on generic HRQL assessed in adult burn patients (either with the EQ-5D or SF-36) from five different countries were merged into one dataset. SF-36 outcomes were transformed into EQ-5D outcomes. A 24-month recovery of HRQL (EQ-5D utility) was modeled using a linear mixed-effects model and adjusted for important patient and burn characteristics. Subgroups of patients with mild and intermediate burns (≤20% total body surface area (TBSA) burned) and with major burns (>20% TBSA burned) were compared. The combined database included 1687 patients with a mean age of 43 (SD 15) years and a median %TBSA burned of 9% (IQR 4–18). There was large improvement in HRQL up to six months after burns, and HRQL remained relatively stable afterwards (studied up to 24 months post burn). However, the estimated EQ-5D utility scores remained below the norm scores of the general population. In this large sample, females, patients with a long hospital stay and patients with major burns had a delayed and worse recovery. The proportion of patients that reported problems for the EQ-5D dimensions ranged from 100% (pain/discomfort at baseline in patients with major burns) to 10% (self-care ≥3 months after injury in patients with mild and intermediate burns). After 24 months, both subgroups of burn patients did not reach the level of the general population in the dimensions pain/discomfort and anxiety/depression, and patients with major burns in the dimension usual activities. A main limitation of the study includes that the variables in the model were limited to age, gender, %TBSA, LOS and time since burn as these were the only variables available in all datasets. Conclusions The 24-month recovery model can be used in clinical practice to inform patients on expected HRQL outcomes and provide clinicians insights into the expected recovery of HRQL. In this way, a delayed recovery can be recognized in an early stage and timely interventions can be started in order to improve patient outcomes. However, external validation of the developed model is needed before implementation into clinical practice. Furthermore, our study showed the benefit of secondary data usage within the field of burns.
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Affiliation(s)
- Inge Spronk
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, Netherlands
- * E-mail:
| | - Nancy E. E. Van Loey
- Association of Dutch Burn Centres, Department Behavioural Research, Beverwijk, the Netherlands
- Utrecht University, Department Clinical Psychology, Utrecht, the Netherlands
| | - Charlie Sewalt
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
| | - Daan Nieboer
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
| | - Babette Renneberg
- Freie Universität Berlin, Department of Clinical Psychology and Psychotherapy, Berlin, Germany
| | - Asgjerd Litleré Moi
- Western Norway University of Applied Sciences, Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Bergen, Norway
- National Burn Centre, Haukeland University Hospital, Department of Plastic, Hand and Reconstructive Surgery, Bergen, Norway
| | - Caisa Oster
- Uppsala University, Department of Neuroscience, Psychiatry, Sweden
| | - Lotti Orwelius
- Linköping University, Department of Anaesthesiology and Intensive Care, and Department of Clinical and Experimental Medicine, Linköping, Sweden
| | - Margriet E. van Baar
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
| | - Suzanne Polinder
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
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16
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Zhang X, Liu Y, Deng X, Deng C, Pan Y, Hu A. The Correlation Between Quality of Life and Acceptability of Disability in Patients With Facial Burn Scars. Front Bioeng Biotechnol 2019; 7:329. [PMID: 31799248 PMCID: PMC6868048 DOI: 10.3389/fbioe.2019.00329] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 10/29/2019] [Indexed: 12/21/2022] Open
Abstract
The purpose of our research is to understand the status of the quality of life and level of disability acceptance in patients with facial burn scars and to explore the correlation between quality of life and disability acceptance and how to improve nursing care for these patients. Patients with facial burn scars were investigated in an outpatient clinic of tertiary hospitals from September 2015 to February 2016. A cross-sectional survey was conducted. The questionnaires used included demographic data and investigations using the burn scars table, Burn-Specific Health Scale-Brief (BSHS-B), and acceptance disability scale (ADS). Differences between participants in terms of demographic characteristics, quality of life, and disability acceptance were assessed using two-tailed independent t-tests. The total score of quality of life and disability acceptance in facial burn scar patients was 137.06 ± 17.05 and 185.68 ± 23.74, respectively. The results of Spearman correlation analysis showed that the overall quality of life score of facial burn scar patients was positively correlated with disability acceptance (r = 0.245, p = 0.007). The quality of life of facial burn scar patients will improve with the improvement of disability acceptance level. Therefore, medical staff can improve the quality of life of patients by improving their disability acceptance level.
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Affiliation(s)
- Xiuni Zhang
- Department of Trauma and Orthopaedics, Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Yuan Liu
- Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaohong Deng
- Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chengsong Deng
- Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yunfeng Pan
- Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ailing Hu
- Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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17
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Spronk I, Polinder S, van Loey NE, van der Vlies CH, Pijpe A, Haagsma JA, van Baar ME. Health related quality of life 5–7 years after minor and severe burn injuries: a multicentre cross-sectional study. Burns 2019; 45:1291-1299. [DOI: 10.1016/j.burns.2019.03.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 03/26/2019] [Indexed: 10/26/2022]
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18
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Spronk I, Polinder S, Haagsma JA, Nieuwenhuis M, Pijpe A, van der Vlies CH, Middelkoop E, van Baar ME. Patient-reported scar quality of adults after burn injuries: A five-year multicenter follow-up study. Wound Repair Regen 2019; 27:406-414. [PMID: 30793408 PMCID: PMC6850449 DOI: 10.1111/wrr.12709] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 02/12/2019] [Indexed: 12/28/2022]
Abstract
Scar formation is an important adverse consequence of burns. How patients appraise their scar quality is often studied shortly after sustaining the injury, but information in the long‐term is scarce. Our aim was, therefore, to evaluate long‐term patient‐reported quality of burn scars. Adults with a burn center admission of ≥1 day between August 2011 and September 2012 were invited to complete a questionnaire on long‐term consequences of burns. We enriched this sample with patients with severe burns (>20% total body surface area [TBSA] burned or TBSA full thickness >5%) treated between January 2010 and March 2013. Self‐reported scar quality was assessed with the Patient Scale of the Patient and Observer Scar Assessment Scale (POSAS). Patients completed this scale for their—in their opinion—most severe scar ≥5 years after burns. This study included 251 patients with a mean %TBSA burned of 10%. The vast majority (91.4%) reported at least minor differences with normal skin (POSAS item score ≥2) on one or more scar characteristics and 78.9% of the patients’ overall opinion was that their scar deviated from normal skin. Patients with severe burns had higher POSAS scores, representing worse scar quality, than patients with mild/intermediate burns, except for color, which was high in both groups. A longer hospital stay predicted reduced scar quality (both mean POSAS and mean overall opinion of the scar) in multivariate analyses. In addition, female gender was also associated with a poorer overall opinion of the scar. In conclusion, this study provides new insights in long‐term scar quality. Scars differed from normal skin in a large part of the burn population more than 5 years after burns, especially in those with severe burns. Female gender is associated with a poorer patients’ overall opinion of their scar, which may be an indication of gender differences in perception of scar quality after burns.
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Affiliation(s)
- Inge Spronk
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, The Netherlands.,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Juanita A Haagsma
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marianne Nieuwenhuis
- Association of Dutch Burn Centres, Martini Hospital, Groningen, The Netherlands.,Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anouk Pijpe
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Burn Centre, Red Cross Hospital, Beverwijk, The Netherlands
| | - Cornelis H van der Vlies
- Burn Centre, Maasstad Hospital, Rotterdam, The Netherlands.,Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Esther Middelkoop
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, The Netherlands
| | - Margriet E van Baar
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, The Netherlands.,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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