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Jawad AM, Kadhum M, Evans J, Cubitt JJ, Martin N. Recovery of functional independence following major burn: A systematic review. Burns 2024:S0305-4179(24)00049-4. [PMID: 38492981 DOI: 10.1016/j.burns.2024.02.017] [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: 09/29/2023] [Revised: 01/07/2024] [Accepted: 02/21/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Major burn injury, despite advancements in care and prevention, can have a profound impact on long-term morbidity, affecting quality of life and socioeconomic standing. We aim to explore factors predicting recovery of independence, the expected rate and time in majorly burned patients, and the measures of progress used. METHOD A systematic search of four databases (MEDLINE, EMBASE, COCHRANE, CINAHL) was conducted for studies reporting outcomes pertaining to physical ability indicative of independent function in adult (>15 y) cohorts who had suffered a major burn (>20% TBSA) up to 30 years after treatment in a developed specialised burn service. Data extracted included factors affecting rate of and time to achievement of function in five independence domains, as well as the outcome measures used. RESULTS 21 eligible studies were included comprising 1298 major burns survivors with a combined mean age of 39.6 y and a mean TBSA of 25.8%. The most significant recurring factors impacting recovery of independent function were older age, female gender, burn severity, prolonged ICU and hospital admission, preceding mental health conditions, and post-acute psychological issues. Exercise-based rehabilitation conferred benefits on major burn patients even over 2 years following injury. Discharge to independent living from hospital occurred in 27% to 97% of patients, while reported return to work rates varied from 52% to 80%. Burns Specific Health Scale-Brief, Functional Independence Measure, and Physical Composite Score (SF-36) were the most widely used outcome scoring systems. CONCLUSION Major burn survivors have protracted recovery with potential for persistent chronic impairments, remaining consistently below baseline levels of function. Non-modifiable factors such as age and gender, and disease characteristics such as burn size with associated physical, physiological and psychosocial sequelae are contributory. Further research is required to explore achievement of specific milestones of major burn and polytrauma critical care patients, while early targeted rehabilitation addressing physical, psychological, and vocational needs has promising potential benefit.
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Affiliation(s)
- Ali M Jawad
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, UK; Welsh Centre for Burns and Plastic Surgery, Swansea, Wales, UK.
| | - Murtaza Kadhum
- Welsh Centre for Burns and Plastic Surgery, Swansea, Wales, UK
| | - Janine Evans
- Welsh Centre for Burns and Plastic Surgery, Swansea, Wales, UK
| | | | - Niall Martin
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, UK
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2
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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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3
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Mata-Greve F, Wiechman SA, McMullen K, Roaten K, Carrougher GJ, Gibran NS. The relation between satisfaction with appearance and race and ethnicity: A National Institute on Disability, Independent Living, and Rehabilitation Research burn model system study. Burns 2022; 48:345-354. [PMID: 34903410 PMCID: PMC9007822 DOI: 10.1016/j.burns.2021.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/08/2021] [Accepted: 11/05/2021] [Indexed: 12/14/2022]
Abstract
Research supports that people of color in the U.S. have poorer outcomes after burn injury compared to White individuals. The current study sought to explore burn health disparities by testing the relationship between racial and ethnic minority status, a proxy for systemic discrimination due to race and ethnicity, with two key constructs linked to functional outcomes, satisfaction with appearance and social community integration. Participants included 1318 burn survivors from the Burn Model System National Database (mean age = 40.2, SD = 12.7). Participants completed measures of satisfaction with appearance and social community integration at baseline, 6-, 12-, and 24-months after burn injury. Linear regressions revealed that racial and ethnic minority status significantly related to lower satisfaction with appearance and social community integration compared to White individuals at all time points. In addition, satisfaction with appearance continued to significantly relate to greater social community integration even while accounting for race and ethnicity, age, sex, burn size, and physical disability at 6-, 12-, and 24-month time points. Overall, the study supports that racial and ethnic minority burn survivors report greater dissatisfaction with their appearance and lower social community reintegration after burn injury.
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Affiliation(s)
- Felicia Mata-Greve
- VA Puget Sound Health Care System Mental Health, 1660 S Columbian Way, Seattle, WA 98108, USA
| | - Shelley A Wiechman
- University of Washington, Department of Rehabilitation Medicine, 9th Avenue Box 359612, Seattle, WA 98104, USA.
| | - Kara McMullen
- University of Washington, Department of Rehabilitation Medicine, 9th Avenue Box 359612, Seattle, WA 98104, USA
| | - Kimberly Roaten
- University of Texas Southwestern Medical Center, Department of Psychiatry, 5323 Harry Hines Blvd., Dallas, TX 75390, USA
| | - Gretchen J Carrougher
- University of Washington Department of Surgery, 325 9th Avenue; Box 359796, Seattle, WA 98104, USA
| | - Nicole S Gibran
- University of Washington Department of Surgery, 325 9th Avenue; Box 359796, Seattle, WA 98104, USA
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4
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Jones TM, Bhanji A, Ahuja G, Bakhtar R, Cai XC, Garfinkel S, Gerber L, Weinstein AA. Examination of Health Information Needs of Caregivers of and Individuals with Burn Injuries. J Burn Care Res 2021; 43:846-851. [PMID: 34718614 PMCID: PMC9249141 DOI: 10.1093/jbcr/irab211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Burns are a leading cause of trauma worldwide with about 450,000 burn injuries being treated at medical facilities in the United States each year. Finding relevant information on the long-term consequences of burn injuries is a significant challenge for many individuals with burn injuries and their caregivers. This qualitative study aimed to identify how individuals with burn injuries and caregivers of individuals with burn injuries prefer to access and use health information, identify obstacles to accessing useful information, and identify information most needed by burn survivors and caregivers. Participants were recruited through hospital listservs, websites, social media, and word of mouth from across the United States. Semi-structured interviews were conducted with 23 individuals, 12 with burn injuries and 11 caregivers of individuals with burn injuries. Three specific needs were identified: (1) more direction from health professionals in finding health information relevant to burn injuries; (2) more internet-based access points that connect individuals to appropriate support networks; and (3) more support for long-term consequences of burn injuries, specifically with psychological, social, and other chronic physical issues. Participants identified various needs in finding relevant health information, thereby highlighting gaps in current literature and the dissemination of current literature. One potential way to address these deficiencies is to consider user-centered design principles in developing research, by more directly involving individuals with burn injuries and caregivers as part of the research team.
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Affiliation(s)
- Tammie M Jones
- Center for the Study of Chronic Illness and Disability, George Mason University, Fairfax, Virginia, United States of America
| | - Alaanah Bhanji
- Center for the Study of Chronic Illness and Disability, George Mason University, Fairfax, Virginia, United States of America
| | - Gheeta Ahuja
- BS, Howard University, Washington, DC, United States of America
| | - Ramez Bakhtar
- Center for the Study of Chronic Illness and Disability, George Mason University, Fairfax, Virginia, United States of America
| | - Xinsheng Cindy Cai
- American Institutes for Research, Washington, DC, United States of America
| | - Steven Garfinkel
- American Institutes for Research, Washington, DC, United States of America
| | - Lynn Gerber
- Center for the Study of Chronic Illness and Disability, George Mason University, Fairfax, Virginia, United States of America
| | - Ali A Weinstein
- Center for the Study of Chronic Illness and Disability, George Mason University, Fairfax, Virginia, United States of America
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5
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Amtmann D, Bamer A, McMullen K, Ryan CM, Schneider JC, Carrougher GJ, Gibran N. Evaluation of the psychometric properties of the burn specific health scale-brief: A National Institute on Disability, Independent Living, and Rehabilitation Research Burn Model System Study. J Burn Care Res 2021; 43:602-612. [PMID: 34643699 DOI: 10.1093/jbcr/irab190] [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: 11/14/2022]
Abstract
OBJECTIVE The Burn Specific Health Scale-Brief (BSHS-B) is a commonly used burn specific health outcome measure that includes 40 items across nine subscales. The objective of this study was to use both classical and modern psychometric methods to evaluate psychometric properties of the BSHS-B. METHODS Data were collected post burn injury by a multisite federally funded project tracking long term outcomes. We examined dimensionality, local dependence, item fit, and functioning of response categories, homogeneity, and floor and ceiling effects. Items were fit to Item Response Theory models for evaluation. RESULTS A total of 653 adults with burn injury completed the BSHS-B. Factor analyses supported unidimensionality for all subscales, but not for a total score based on all 40 items. All nine of the subscales had significant ceiling effects. Six item pairs displayed local dependence suggesting redundance and 11 items did not fit the Item Response Theory models. At least 15 items have too many response options. CONCLUSIONS Results identified numerous psychometric issues with the BSHS-B. A single summary score should never be used for any purpose. Psychometric properties of the scale need to be improved by removing redundant items, reducing response categories and modifying or deleting problematic items. Additional conceptual work is needed to, at a minimum, revise the work subscale and optimally to revisit and clearly define the constructs measured by all the subscales. Additional items are needed to address ceiling effects.
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Affiliation(s)
- Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Alyssa Bamer
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Kara McMullen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Colleen M Ryan
- Shriners Hospitals for Children - Boston, Boston, MA.,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Spaulding Research Institute, Harvard Medical School, Boston, MA
| | | | - Nicole Gibran
- Department of Surgery, University of Washington Harborview, Seattle, WA
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6
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Sirancova K, Raudenska J, Zajicek R, Dolezal D, Javurkova A. Psychological aspects in early adjustment after severe burn injury. J Burn Care Res 2021; 43:9-15. [PMID: 33677575 DOI: 10.1093/jbcr/irab038] [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: 11/13/2022]
Abstract
Burn injury is one of the most serious traumatic events with possible psychological and psychosocial consequences. Health status perception is one of the main health outcomes. The severity of psychological symptoms does not always correlate with that of the burn injury, suggesting that early screening for psychological vulnerabilities may be beneficial. The aim of our study was to identify the personality, clinical, and sociodemographic characteristics related to patient´s subjective perception of health, depression, and anxiety, in a sample of 52 adult patients with severe burn injury shortly before discharge from specialty Burn clinic. Subjective health perception was predicted by depression (β = -.143, t(47) = -3.94, P < .001) and neuroticism (β = -.106, t(43) = -4.83, P < .001), and it correlated positively with extraversion (r = .2858, P = .0465) and conscientiousness (r = .3663, P = .0096). Depression was predicted by neuroticism (F(1,49) = 18.4; P < .001) and correlated with attachment avoidance (r = .29, P = .0383) and negatively with extraversion (r = -.32, P = .0220). Anxiety was related to attachment anxiety (F(1,49) = 4.25; P = .045), neuroticism (F(1,49) = 15.75; P < .001), and agreeableness (r = -.36, p = .0101). Unemployed patients experienced higher levels of depression and anxiety. This research suggests that personality traits and adult attachment may play an important role in the acute phase of the recovery from a severe burn injury. These findings can be relevant for early intervention and holistic rehabilitation.
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Affiliation(s)
- Katarina Sirancova
- Department of Psychology, Faculty of Arts, Charles University, Prague.,Department of Clinical Psychology, University Hospital FNKV, Prague
| | - Jaroslava Raudenska
- Department of Psychology, Faculty of Arts, Charles University, Prague.,Department of Nursing, 2nd Medical School, Charles University, Prague
| | - Robert Zajicek
- Department of Burns Medicine Faculty Hospital Kralovske Vinohrady and Charles University Third Faculty of Medicine
| | - Daniel Dolezal
- Department of Clinical Psychology, University Hospital FNKV, Prague.,Department of Burns Medicine Faculty Hospital Kralovske Vinohrady and Charles University Third Faculty of Medicine
| | - Alena Javurkova
- Department of Psychology, Faculty of Arts, Charles University, Prague.,Department of Clinical Psychology, University Hospital FNKV, Prague.,Department of Nursing, 2nd Medical School, Charles University, Prague
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Ohrtman EA, Shapiro GD, Simko LC, Dore E, Slavin MD, Saret C, Amaya F, Lomelin-Gascon J, Ni P, Acton A, Marino M, Kazis LE, Ryan CM, Schneider JC. Social Interactions and Social Activities After Burn Injury: A Life Impact Burn Recovery Evaluation (LIBRE) Study. J Burn Care Res 2020; 39:1022-1028. [PMID: 30016442 DOI: 10.1093/jbcr/iry038] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Social interactions and activities are key components of social recovery following burn injuries. The objective of this study is to determine the predictors of these areas of social recovery. This study provides a secondary analysis of a cross-sectional survey of adult burn survivors. The Life Impact Burn Recovery Evaluation-192 was administered to 601 burn survivors for the field-testing of the Life Impact Burn Recovery Evaluation Profile. Survivors aged 18 years and older with injuries ≥5% total BSA or burns to critical areas (hands, feet, face, or genitals) were eligible to participate. Multivariate linear regression analyses were used to determine predictors of the Social Activities and Social Interactions scale scores. A total of 599 people completed the Social Interactions and Social Activities scales. Of these, 77% identified as White Non-Hispanic, 55% were female, 55% were unmarried, and 80% had burns to critical areas. Participants had a mean age of 45 years, a mean time since burn injury of 15 years, and a mean burn size of 41% total BSA. Younger age (P < .01) and being married/living with a significant other (P ≤ .01) were associated with higher Social Activities and Social Interactions scale scores. Individual item responses reveal that survivors had lower scores on items related to participating in outdoor activities (30.4%) or feeling uncomfortable with their appearance (32.4% report dressing to avoid stares). Social interactions and activities are long-term challenges for burn survivors. It is important for clinicians to identify patients who may struggle with social recovery in order to focus on future community-based interventions.
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Affiliation(s)
- Emily A Ohrtman
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gabriel D Shapiro
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Laura C Simko
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Emily Dore
- Department of Health, Law, Policy and Management, Boston University School of Public Health, Massachusetts
| | - Mary D Slavin
- Department of Health, Law, Policy and Management, Boston University School of Public Health, Massachusetts
| | - Cayla Saret
- Department of Health, Law, Policy and Management, Boston University School of Public Health, Massachusetts
| | - Flor Amaya
- Department of Health, Law, Policy and Management, Boston University School of Public Health, Massachusetts
| | - J Lomelin-Gascon
- Department of Health, Law, Policy and Management, Boston University School of Public Health, Massachusetts
| | - Pengsheng Ni
- Department of Health, Law, Policy and Management, Boston University School of Public Health, Massachusetts
| | - Amy Acton
- Phoenix Society for Burn Survivors, Grand Rapids, Michigan
| | - Molly Marino
- Department of Health, Law, Policy and Management, Boston University School of Public Health, Massachusetts
| | - Lewis E Kazis
- Department of Health, Law, Policy and Management, Boston University School of Public Health, Massachusetts
| | - Colleen M Ryan
- Massachusetts General Hospital, Shriners Hospitals for Children, Harvard Medical School, Boston
| | - Jeffrey C Schneider
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
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Chen L, Lee AF, Shapiro GD, Goverman J, Faoro N, Schneider JC, Kazis LE, Ryan CM. The Development and Validity of the Adult Burn Outcome Questionnaire Short Form. J Burn Care Res 2018; 39:771-779. [PMID: 29931275 PMCID: PMC9834984 DOI: 10.1093/jbcr/irx043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Patient Reported Outcome Measures (PROMs) are useful for understanding the health needs and outcomes of the general public. We aim to develop a burn-specific metric-Adult Burn Outcome Questionnaire (ABOQ)-that is brief and can be administered electronically to all burn survivors over the age of 18. The 14-item ABOQ was developed from the already validated Young Adult Burn Outcome Questionnaire (YABOQ) long form. The ABOQ questionnaire, along with Patient-Reported Outcomes Measurement System-10 (PROMIS-10), was administered to 120 outpatient burn survivors at three hospitals. Clinical validity of the ABOQ was measured by testing associations between ABOQ items and burn size, the PROMIS-10 generic items and composite scales using correlational analysis including multivariate canonical analysis. Nine out of 14 ABOQ items were significantly correlated with burn size (correlations ranging from -0.25 to -0.46, P < .01). The canonical correlation between ABOQ and burn size was 0.68 (P = .0002). The overall canonical correlation between two instruments was also significant (P < .0001). At the item level, at least 25% of the variation in each of the five ABOQ items could be explained by PROMIS-10 items and composite scores, while six other items could only be accounted for by less than 15% of the variation. ABOQ short form assessment can be used to efficiently measure burn outcomes across a range of relevant clinical domains with credible validity. A large proportion of the variation in ABOQ scores was not accounted for by PROMIS-10, suggesting that ABOQ provided additional health-related information specifically for the burn population beyond the generic instrument.
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Affiliation(s)
- Liang Chen
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston,Shriners Hospitals for Children – Boston, Massachusetts,Department of Health Law, Policy and Management, Boston University School of Public Health, Massachusetts
| | - Austin F. Lee
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston,Shriners Hospitals for Children – Boston, Massachusetts,School of Insurance and Economics, University of International Business and Economics, Beijing, China,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gabriel D. Shapiro
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
| | - Jeremy Goverman
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston,Shriners Hospitals for Children – Boston, Massachusetts
| | | | - Jeffrey C. Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lewis E. Kazis
- Department of Health Law, Policy and Management, Boston University School of Public Health, Massachusetts
| | - Colleen M. Ryan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston,Shriners Hospitals for Children – Boston, Massachusetts
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Predictors of health-related quality of life after burn injuries: a systematic review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:160. [PMID: 29898757 PMCID: PMC6000969 DOI: 10.1186/s13054-018-2071-4] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 05/17/2018] [Indexed: 01/08/2023]
Abstract
Background Identifying predictors of health-related quality of life (HRQL) following burns is essential for optimization of rehabilitation for burn survivors. This study aimed to systematically review predictors of HRQL in burn patients. Methods Medline, Embase, Web of Science, Cochrane, CINAHL, and Google Scholar were reviewed from inception to October 2016 for studies that investigated at least one predictor of HRQL after burns. The Quality in Prognostic Studies tool was used to assess risk of bias of included studies. Results Thirty-two studies were included. Severity of burns, postburn depression, post-traumatic stress symptoms, avoidance coping, less emotional or social support, higher levels of neuroticism, and unemployment postburn were found to predict a poorer HRQL after burns in multivariable analyses. In addition, weaker predictors included female gender, pain, and a postburn substance use disorder. Risk of bias was generally low in outcome measurement and high in study attrition and study confounding. Conclusions HRQL after burns is affected by the severity of burns and the psychological response to the trauma. Both constructs provide unique information and knowledge that are necessary for optimized rehabilitation. Therefore, both physical and psychological problems require attention months to years after the burn trauma. Electronic supplementary material The online version of this article (10.1186/s13054-018-2071-4) contains supplementary material, which is available to authorized users.
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10
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Spronk I, Legemate C, Oen I, van Loey N, Polinder S, van Baar M. Health related quality of life in adults after burn injuries: A systematic review. PLoS One 2018; 13:e0197507. [PMID: 29795616 PMCID: PMC5967732 DOI: 10.1371/journal.pone.0197507] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 05/03/2018] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES Measurement of health-related quality of life (HRQL) is essential to qualify the subjective burden of burns in survivors. We performed a systematic review of HRQL studies in adult burn patients to evaluate study design, instruments used, methodological quality, and recovery patterns. METHODS A systematic review was performed. Relevant databases were searched from the earliest record until October 2016. Studies examining HRQL in adults after burn injuries were included. Risk of bias was scored using the Quality in Prognostic Studies tool. RESULTS Twenty different HRQL instruments were used among the 94 included studies. The Burn Specific Health Scale-Brief (BSHS-B) (46%), the Short Form-36 (SF-36) (42%) and the EuroQol questionnaire (EQ-5D) (9%) were most often applied. Most domains, both mentally and physically orientated, were affected shortly after burns but improved over time. The lowest scores were reported for the domains 'work' and 'heat sensitivity' (BSHS-B), 'bodily pain', 'physical role limitations' (SF-36), and 'pain/discomfort' (EQ-5D) in the short-term and for 'work' and 'heat sensitivity', 'emotional functioning' (SF-36), 'physical functioning' and 'pain/discomfort' in the long-term. Risk of bias was generally low in outcome measurement and high in study attrition. CONCLUSION Consensus on preferred validated methodologies of HRQL measurement in burn patients would facilitate comparability across studies, resulting in improved insights in recovery patterns and better estimates of HRQL after burns. We recommend to develop a guideline on the measurement of HRQL in burns. Five domains representing a variety of topics had low scores in the long-term and require special attention in the aftermath of burns.
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Affiliation(s)
- Inge Spronk
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
- Department of Public Health, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Catherine Legemate
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, VU University Medical Centre, Amsterdam, the Netherlands
| | - Irma Oen
- Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands
| | - Nancy van Loey
- Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, the Netherlands
- Utrecht University, Department of Clinical Psychology, Utrecht, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Margriet van Baar
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
- Department of Public Health, Erasmus Medical Centre, Rotterdam, the Netherlands
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11
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Garimella R, Koenig HG, Larson DL, Hultman CS. Of These, Faith, Hope, and Love: Assessing and Providing for the Psychosocial and Spiritual Needs of Burn Patients. Clin Plast Surg 2018; 44:893-902. [PMID: 28888314 DOI: 10.1016/j.cps.2017.05.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Burn treatment has grown increasingly advanced and technologically capable. Clinicians must take into account, however, multidimensional patient needs that factor into long-term burn recovery. Important psychosocial factors associated with burn care include psychiatric comorbidities, such as anxiety and depression, healthy family relationships, social support, and community involvement. Spiritual factors and resources, such as time spent praying and/or meditating and access to pastoral services, are also important to consider. Further study is needed to identify specific psychosocial and spiritual needs of patients and to develop interventions or therapies that specifically provide for these needs.
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Affiliation(s)
- Roja Garimella
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Harold G Koenig
- Center for Spirituality, Theology, and Health, Duke University Medical Center, Durham, NC, USA; Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; Ningxia Medical University, Yinchuan, People's Republic of China
| | - David L Larson
- Department of Plastic Surgery, Medical College of Wisconsin, Milwuakee, WI, USA
| | - Charles Scott Hultman
- Center for Spirituality, Theology, and Health, Duke University Medical Center, Durham, NC, USA; Division of Plastic Surgery, NC Jaycee Burn Center, University of North Carolina at Chapel Hill, Suite 7038, Burnett-Womack, Chapel Hill, NC 27599, USA.
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12
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Abstract
The purposes of this study were to translate the brief version of the Burn-Specific Health Scale (BSHS-B) into traditional Chinese (Taiwanese) and to evaluate its psychometric properties to measure quality of life of burn patients in Taiwan. The BSHS-B-Taiwanese was translated and reviewed by an expert committee. Patients were invited to participate in this study while they visited the outpatient burn clinic. One hundred and eight burn patients participated in this study by filling out the BSHS-B-Taiwanese and SF-36 Taiwanese version. Forty-one of 108 patients completed a retest on the BSHS-B-Taiwanese. A ceiling effect was found for psychosocial functioning and all domains of the BSHS-B-Taiwanese. Internal consistency shown by Cronbach's alpha was all above 0.70 except for the interpersonal relationships domain. Of these, Cronbach's alpha ≥0.9 was found in the work, heat sensitivity, and body image domains. Test-retest reliabilities ranged from 0.74 to 0.93 except for the simple activity domain. As for the criterion validity, most of the BSHS-B-Taiwanese version was shown to have fair to moderate correlations with the SF-36-Taiwanese in corresponding domains. The discriminant validity of the BSHS-B-Taiwanese was demonstrated by significant score differences in several domains between subgroups of different severity regarding length of hospital stay and TBSA. Our finding suggests that the BSHS-Taiwanese is generally reliable and valid. A shorter version of BSHS-B-Taiwanese together with a generic instrument, such as SF-36, can be used to measure the quality of life of burn patients in Taiwan.
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Holavanahalli RK, Helm PA, Kowalske KJ. Long-Term Outcomes in Patients Surviving Large Burns: The Musculoskeletal System. J Burn Care Res 2018; 37:243-54. [PMID: 26056761 DOI: 10.1097/bcr.0000000000000257] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The authors have previously described long-term outcomes related to the skin in patients surviving large burns. The objective of this study was to describe the long-term musculoskeletal complications following major burn injury. This is a cross-sectional descriptive study that includes a one-time evaluation of 98 burn survivors (mean age = 47 years; mean TBSA = 57%; and mean time from injury = 17 years), who consented to participate in the study. A comprehensive history and physical examination was conducted by a senior and experienced Physical Medicine and Rehabilitation physician. In addition to completing a Medical Problem Checklist, subjects also completed the Burn-Specific Health Scale (Abbreviated 80 item), a self-report measure used to review the level of functional adaptation. Joint pain, joint stiffness, problems walking or running, fatigue, and weak arms and hands are conditions that continue to be reported at an average of 17 years from the time of burn injury. Seventy-three percent (68 of 93) of the study sample were found to have a limitation of motion and areas most affected were the neck (47%), hands (45%), and axilla (38%). The global (Burn-Specific Health Scale-total) score for the overall sample was 0.78. Subjects with limitation of motion had significant difficulty in areas of mobility, self-care, hand function, and role activities. This study underscores the importance of long-term follow-up care and therapeutic interventions for survivors of major burn injury, as they continue to have significant and persistent burn-related impairments even several years following injury.
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Affiliation(s)
- Radha K Holavanahalli
- From The Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas
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Thananopavarn P, Hill JJ. Rehabilitation of the Complex Burn Patient with Multiple Injuries or Comorbidities. Clin Plast Surg 2017; 44:695-701. [PMID: 28888295 DOI: 10.1016/j.cps.2017.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patients with complex burn injuries require interdisciplinary rehabilitation to maximize their functional recovery. Successful rehabilitation from burn injuries starts with addressing the loss of the protective, mechanical, and cosmetic function of the skin and underlying structures. However, other injuries, particularly to the nervous and musculoskeletal systems, need to be identified and managed as part of the rehabilitation plan. Burn injuries can cause losses of functional mobility, self-care skills, psychological well-being, and community participation, which require comprehensive rehabilitation interventions throughout the recovery process.
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Affiliation(s)
- Paul Thananopavarn
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - James J Hill
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Oh H, Boo S. Quality of life and mediating role of patient scar assessment in burn patients. Burns 2017; 43:1212-1217. [DOI: 10.1016/j.burns.2017.03.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 02/08/2017] [Accepted: 03/15/2017] [Indexed: 11/26/2022]
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Yoder LH, McFall DC, Glaser DN. Quality of life of burn survivors treated in the military burn center. Nurs Outlook 2017; 65:S81-S89. [PMID: 28865914 DOI: 10.1016/j.outlook.2017.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 07/06/2017] [Accepted: 07/11/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND Limited research explains the quality of life (QOL) among burn survivors during post-hospitalization rehabilitation. PURPOSE To determine the QOL of military and civilian burn survivors treated in the military burn center. METHODS In this longitudinal study, QOL was examined in 131 burn survivors (88 civilians; 43 military). Participants completed the Abbreviated Burn Specific Health Scale (BSHS-A) and the Satisfaction with Life Scale (SWLS) over 5 time points post-discharge. DISCUSSION Civilian and military participants reported improved QOL over time on most BSHS-A subscales. Military participants had higher global BSHS-A scores at discharge, but at 6 months plateaued while civilians improved and had higher global BSHS-A scores at 18 months. Scores on the SWLS were consistently higher for military participants than for civilians. CONCLUSION Military versus civilian patients may have different expectations about their ability to rehabilitate. The post-hospitalization period needs to be better understood to develop appropriate QOL interventions.
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Affiliation(s)
- Linda H Yoder
- The University of Texas at Austin School of Nursing, Austin, TX.
| | - D Curk McFall
- The University of Texas at Austin School of Nursing, Austin, TX
| | - Dale N Glaser
- Organizational Psychology Department, Alliant International University, San Diego State University, & Psychology Department, University of San Diego, San Diego, CA
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Druery M, Newcombe PA, Cameron CM, Lipman J. Factors influencing psychological, social and health outcomes after major burn injuries in adults: cohort study protocol. BMJ Open 2017; 7:e017545. [PMID: 28624761 PMCID: PMC5726110 DOI: 10.1136/bmjopen-2017-017545] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION The goal of burn care is that 'the quality of the outcome must be worth the pain of survival'. More research is needed to understand how best to deliver care for patients with burns to achieve this aim. Loss of independence, function as well as loss of income for patients with burns and carers cause a significant burden at both individual and societal levels. Much is being done to advance knowledge in the clinical care field; however, there has been a paucity of research exploring psychosocial outcomes. This paper describes the study background and methods, as implemented in an Australian cohort study of psychosocial outcomes after major burn injuries. METHODS AND ANALYSIS In this inception cohort study, a target sample of 230 participants, aged 18 years or over, admitted to a single statewide burns centre with a burn injury are identified by hospital staff for inclusion. Baseline survey data are collected either in person or by telephone within 28 days of the injury and participants then followed up with telephone interviews at 3, 6 and 12 months postburn. Injury and burns treatment information is collected from medical records. Social support is measured as a predictor variable using the Multidimensional Scale of Perceived Social Support. Outcome data are collected via standardised measures in the domains of Quality of Life (SF-12, EQ-5D, BSHS-B), depression (PHQ-9), post-traumatic stress disorder (PCL-C, PAS), community integration (CIQ-R) and Quality-Adjusted Life Years (EQ-5D). Additional survey questions measure life satisfaction, return to work and public services utilisation at 12 months postinjury. Data analysis methods will include analysis of variance, Pearson correlation and hierarchical multiple regression analyses. ETHICS AND DISSEMINATION Hospital-based and University of Queensland Human Research Ethics Committees have approved the protocol. Results from the study will be disseminated at national and international conferences, in peer-reviewed journals and in a doctoral thesis. TRIAL REGISTRATION NUMBER Australia New Zealand Clinical Trials Registry (ACTRN12616000828426). Retrospectively registered on 23 June 2016; pre-results.
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Affiliation(s)
- Martha Druery
- Burns Trauma and Critical Care Research Centre, University of Queensland, Herston, Australia
| | - Peter A Newcombe
- School of Psychology, University of Queensland, St Lucia, Australia
| | - Cate M Cameron
- Menzies Health Institute Queensland, Griffith University, Meadowbrook, Australia
| | - Jeffrey Lipman
- Burns Trauma and Critical Care Research Centre, University of Queensland, Herston, Australia
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18
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A Systematic Review of Patient-Reported Outcome Measures Used in Adult Burn Research. J Burn Care Res 2017; 38:e521-e545. [DOI: 10.1097/bcr.0000000000000474] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Ahuja RB, Mulay AM, Ahuja A. Assessment of quality of life (QoL) of burn patients in India using BSHS-RBA scale. Burns 2016; 42:639-47. [PMID: 26796242 DOI: 10.1016/j.burns.2015.11.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 11/19/2015] [Accepted: 11/23/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The Burn Specific Health Scale-Brief (BSHS-B) is a popular instrument to measure quality of life (QoL) in burn patients. The current study aims at identifying the prognostic variables for our burn population using the BSHS-RBA (revised, brief and adapted) scale. MATERIALS AND METHODS The study was conducted on 60 post-burn patients using the BSHS-RBA scale. The questionnaire was administered by an interview as majority of patients were illiterate. The socio-demographic and clinical variables were analyzed against domain scores and total scores of the scale, using Mann-Whitney test and Kruskal Wallis test. RESULTS The median age of the sample was 28 years, of which 60% were females. Their median TBSA burn was 30%. The median time since burn at the time of interview was 10 months. Higher scores were noted in the domains of simple abilities and mobility, hand function and interpersonal relationship, while poorer scores were recorded in domains of skin sensitivity and body image. DISCUSSION The mean score in our study was 2.36, which is quite less as compared to reports from high income countries (range: 2.58-3.36). This study provides an insight on an aspect of burn care outcome, which can be reasonably expected in low income countries with the available standard of care. Being a female, presence of hand and face burn, requirement of corrective surgeries and inability to resume work were factors associated with poor QoL. CONCLUSION Strategies to improve QoL of burn patients should target psychological aspects, work rehabilitation (early release of contractures) and skin hypersensitivity (including itching) to derive maximum benefit.
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Affiliation(s)
- Rajeev B Ahuja
- Department of Burns & Plastic Surgery, Lok Nayak Hospital and associated Maulana Azad Medical College, New Delhi, 110 002.
| | - Amit M Mulay
- Department of Burns & Plastic Surgery, Lok Nayak Hospital and associated Maulana Azad Medical College, New Delhi, 110 002
| | - Aarti Ahuja
- Amity Institute of Psychology and Allied Sciences, Amity University, Sector 125, Noida, Uttar Pradesh , 201303, India
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Tang D, Li-Tsang CW, Au RK, Li KC, Yi XF, Liao LR, Cao HY, Feng YN, Liu CS. Functional Outcomes of Burn Patients with or without Rehabilitation in Mainland China. Hong Kong J Occup Ther 2015. [DOI: 10.1016/j.hkjot.2015.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background/Objective To evaluate the functional outcomes of moderate to severe burn patients with and without rehabilitation in terms of self-care performance and quality of life (QOL). Methods Fifty-five patients with total burn surface area of 30% or more were divided into two groups: rehabilitation and conventional care groups. The rehabilitation group underwent comprehensive rehabilitation interventions (e.g., occupational therapy, physiotherapy, and patient and family education) in addition to standard clinical interventions received by the conventional care group. The outcomes included self-care performance (Modified Barthel Index [MBI]), QOL (World Health Organization Quality of Life-BREF), pain and itchiness (Visual Analogue Scale [VAS]), quality of sleep, and mental health (Self-Rating Depression Scale [SDS] and Self-Rating Anxiety Scale) measured before and 3 months after the intervention. Results After the intervention, significant improvements were found in MBI, all dimensions of QOL, pain, and SDS in the rehabilitation group (all p < .05). In the conventional care group, significant improvements were found only in MBI (p < .001), the physical health dimension of QOL (p < .01), and pain (p < .001). Group comparisons showed that the rehabilitation group achieved significantly better outcomes after the intervention in MBI (p < .001), VAS score of itching (p = .009), and the physical health (p = .002), psychological health (p = .021), and social relationships dimensions of QOL (p < .001). Conclusion Patients with moderate to severe burn injuries can benefit from rehabilitation interventions in terms of physical health, mental health, performance of daily living, and QOL.
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Affiliation(s)
- Dan Tang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
- Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou, China
| | - Cecilia W.P. Li-Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Ricky K.C. Au
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Kui-cheng Li
- Department of Occupational Therapy, Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou, China
| | - Xian-feng Yi
- Department of Burn Surgery and Burn Rehabilitation, Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou, China
| | - Lin-rong Liao
- Department of Physiotherapy, Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou, China
| | - Hai-yan Cao
- Department of Occupational Therapy, Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou, China
| | - Ya-nan Feng
- Department of Occupational Therapy, Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou, China
| | - Chuan-shun Liu
- Department of Occupational Therapy, Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou, China
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Murphy ME, Holzer CE, Richardson LM, Epperson K, Ojeda S, Martinez EM, Suman OE, Herndon DN, Meyer WJ. Quality of Life of Young Adult Survivors of Pediatric Burns Using World Health Organization Disability Assessment Scale II and Burn Specific Health Scale-Brief: A Comparison. J Burn Care Res 2015; 36:521-33. [PMID: 25167373 PMCID: PMC4362787 DOI: 10.1097/bcr.0000000000000156] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective was to determine long-term psychological distress and quality of life (QOL) in young adult survivors of pediatric burns using the World Health Organization Disability Assessment Scale II (WHODAS) and the Burn Specific Health Scale-Brief (BSHS-B). Fifty burn survivors 2.5 to 12.5 years postburn (16-21.5 years old; 56% male, 82% Hispanic) completed the WHODAS and BSHS-B. The WHODAS measures health and disability and the BSHS-B measures psychosocial and physical difficulties. Scores were calculated for each instrument, and then grouped by years postburn, TBSA, sex, burn age, and survey age to compare the effects of each. Next, the instruments were compared with each other. The WHODAS disability score mean was 14.4 ± 2.1. BSHS-B domain scores ranged from 3 to 3.7. In general, as TBSA burned increased, QOL decreased. Female burn survivors, survivors burned prior to school entry, and adolescents who had yet to transition into adulthood reported better QOL than their counterparts. In all domains except Participation, the WHODAS consistently identified more individuals with lower QOL than the BSHS-B. Young adult burn survivors' QOL features more disability than their nonburned counterparts, but score in the upper 25% for QOL on the BSHS-B. This analysis revealed the need for long-term psychosocial intervention for survivors with larger TBSA, males, those burned after school entry, and those transitioning into adulthood. Both instruments are useful tools for assessing burn survivors' QOL and both should be given as they discern different individuals. However, the WHODAS is more sensitive than the BSHS-B in identifying QOL issues.
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Affiliation(s)
- Mary Elizabeth Murphy
- From the Shriners Hospitals for Children and University of Texas Medical Branch, Galveston, and University of Colorado Denver-Anschutz Medical Campus, Aurora
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Finlay V, Phillips M, Allison GT, Wood FM, Ching D, Wicaksono D, Plowman S, Hendrie D, Edgar DW. Towards more efficient burn care: Identifying factors associated with good quality of life post-burn. Burns 2015; 41:1397-404. [PMID: 26233899 DOI: 10.1016/j.burns.2015.06.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 06/04/2015] [Accepted: 06/26/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND As minor burn patients constitute the vast majority of a developed nation case-mix, streamlining care for this group can promote efficiency from a service-wide perspective. This study tested the hypothesis that a predictive nomogram model that estimates likelihood of good long-term quality of life (QoL) post-burn is a valid way to optimise patient selection and risk management when applying a streamlined model of care. METHOD A sample of 224 burn patients managed by the Burn Service of Western Australia who provided both short and long-term outcomes was used to estimate the probability of achieving a good QoL defined as 150 out of a possible 160 points on the Burn Specific Health Scale-Brief (BSHS-B) at least six months from injury. A multivariate logistic regression analysis produced a predictive model provisioned as a nomogram for clinical application. A second, independent cohort of consecutive patients (n=106) was used to validate the predictive merit of the nomogram. RESULTS AND DISCUSSION Male gender (p=0.02), conservative management (p=0.03), upper limb burn (p=0.04) and high BSHS-B score within one month of burn (p<0.001) were significant predictors of good outcome at six months and beyond. A Receiver Operating Curve (ROC) analysis demonstrated excellent (90%) accuracy overall. At 80% probability of good outcome, the false positive risk was 14%. The nomogram was validated by running a second ROC analysis of the model in an independent cohort. The analysis confirmed high (86%) overall accuracy of the model, the risk of false positive was reduced to 10% at a lower (70%) probability. This affirms the stability of the nomogram model in different patient groups over time. An investigation of the effect of missing data on sample selection determined that a greater proportion of younger patients with smaller TBSA burns were excluded due to loss to follow up. CONCLUSION For clinicians managing comparable burn populations, the BSWA burns nomogram is an effective tool to assist the selection of patients to a streamlined care pathway with the aim of improving efficiency of service delivery.
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Affiliation(s)
- V Finlay
- Burn Service of Western Australia at Fiona Stanley Hospital, Australia.
| | - M Phillips
- Burn Service of Western Australia at Fiona Stanley Hospital, Australia
| | - G T Allison
- Burn Service of Western Australia at Fiona Stanley Hospital, Australia
| | - F M Wood
- Burn Service of Western Australia at Fiona Stanley Hospital, Australia
| | - D Ching
- Burn Service of Western Australia at Fiona Stanley Hospital, Australia
| | - D Wicaksono
- Burn Service of Western Australia at Fiona Stanley Hospital, Australia
| | - S Plowman
- Burn Service of Western Australia at Fiona Stanley Hospital, Australia; Fiona Wood Foundation, Perth, Western Australia, Australia
| | - D Hendrie
- Burn Service of Western Australia at Fiona Stanley Hospital, Australia
| | - D W Edgar
- Burn Service of Western Australia at Fiona Stanley Hospital, Australia; Fiona Wood Foundation, Perth, Western Australia, Australia; State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; Burn Injury Research Node, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
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Elliott TR, Berry JW, Nguyen HM, Williamson ML, Kalpinski RJ, Underhill AT, Fine PR. Does participation mediate the prospective relationships of impairment, injury severity, and pain to quality of life following burn injury? J Health Psychol 2015; 21:2398-408. [PMID: 25869727 DOI: 10.1177/1359105315577686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We examined the prospective impact of injury severity, functional impairment, and pain on participation in the community and subsequently on life satisfaction and self-rated health of 260 burn survivors 5 years post-discharge. Predictor variables include injury severity and total body surface area burned (assessed during acute care), functional independence (assessed at 12 months post-discharge), pain (assessed at the 24th month), and participation (assessed at the 48th month). Participation predicted life satisfaction and self-rated health. Functional independence and injury severity had significant indirect influences on adjustment via their influence on participation. Pain predicted both outcome variables. Clinical and research implications are discussed.
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Stylianou N, Carr M, Kontopantelis E, Buchan I, Dunn K. Patient outcomes vs. service workload: an analysis of outcomes in the burn service of England and Wales. BMC Health Serv Res 2015; 15:133. [PMID: 25888757 PMCID: PMC4389493 DOI: 10.1186/s12913-015-0813-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 03/23/2015] [Indexed: 02/06/2023] Open
Abstract
Background Patient outcomes in specialist burns units have been used as a metric of care needs and quality. Besides patient factors there are service factors that might influence Length of Stay (LOS) and mortality, e.g. pressure on beds. Although the bed needs of UK hospitals have dropped significantly over the past three decades, with changes in policies and practices, recent reports suggest that hospitals have 90% bed occupancy for 48 weeks of the year. In the UK, the specialist burn injury service is organised so that patients are assessed on arrival at hospital, and those needing admission are found a nearby bed in a suitable unit through the National Burn Bed Bureau. The aim of this study was to investigate the effect on outcomes of service pressures due to shortages of beds. Methods We took an extract of the anonymised patient data from the specialised burn injury database, iBID, and created a new database based on matching that data with bed availability data provided by the national Burn Bed Bureau. Cox proportional hazard modelling was used for analysis to investigate if there is an impact of bed occupancy (a proxy measure of workload) on LOS. Results Cox proportional hazard modelling indicated that half of the services in England and Wales are less likely to discharge a patient if the bed availability is high. Two of the services have abnormally high bed availability and LOS, therefore a model without these two services indicates a general reluctance to discharge patients when beds are available. Conclusions It is possible that the effect we observed is a result of gaming as service providers are paid by the number of admissions. In addition, providers many not all give the same level of accuracy of bed availability information to the NBBB: some may under report availability, for example at times of high pressure on staff. Furthermore, burn services may not empty beds to avoid being filled up by work from other specialties, thus making them unable to admit a burn when referred.
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Affiliation(s)
- Neophytos Stylianou
- Centre for Health Informatics, Institute of population Health, University of Manchester, Manchester, UK.
| | - Matthew Carr
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK.
| | - Evangelos Kontopantelis
- Centre for Health Informatics, Institute of population Health, University of Manchester, Manchester, UK. .,Institute of Population Health, University of Manchester, Manchester, UK.
| | - Iain Buchan
- Centre for Health Informatics, Institute of population Health, University of Manchester, Manchester, UK.
| | - Ken Dunn
- University Hospital South Manchester and Honorary, Centre for Health Informatics, Institute of Population Health, University of Manchester, Manchester, UK.
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Wasiak J, Paul E, Lee SJ, Mahar P, Pfitzer B, Spinks A, Cleland H, Gabbe B. Patterns of recovery over 12 months following a burn injury in Australia. Injury 2014; 45:1459-64. [PMID: 24698152 DOI: 10.1016/j.injury.2014.02.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 01/30/2014] [Accepted: 02/08/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe patients' generic health status and health-related quality of life (HRQoL) 12-months following admission to a state-wide burns service. METHODS A total of 114 injured adults with >10% total body surface area burned (TBSA) or burns less than 10% TBSA to smaller anatomical areas such as the hands and feet participated in this study. Retrospective assessment of pre-burn injury status and prospective assessment of generic health and HRQoL were followed up at 3, 6 and 12-months after injury using the 36-item Short Form Health Survey (SF-36 v.2) and Burns Specific Health Scale-Brief (BSHS-B). The SF-36 v.2 was administered retrospectively during the initial hospital stay to assess pre-injury HRQoL. Changes in instruments scores were assessed using multilevel mixed effects regression models. Mean scores were compared over time and between severity groups as defined by <10%, 10-30% and >30% TBSA. RESULTS For the overall sample, the SF-36 v.2 physical component scale (PCS) score between 3 and 12-months post-burn injury were significantly lower than pre-injury scores (p<0.01), with no significant change over time for the mental component scale (MCS) (p=0.36). Significant %TBSA-burden by time interactions highlighted changes from pre-burn injury in overall PCS (p=0.02), physical functioning (p<0.001) and role-physical (p=0.03), with subscales worse for the TBSA >30% group. With respect to the BSHS-B, significant improvement from 3 to 12-months post-burn injury was seen for the entire sample in simple abilities (p<0.001), hand function (p=0.001), work (p=0.01), and treatment regime (p=0.004) subscales. The TBSA >30% group showed a greater rate of improvement in simple abilities (p=0.01) and hand function (p=0.005) between 3 and 12 months post-burn injury. CONCLUSIONS Whilst certain HRQoL measures improve over the 12-months, in most cases they do not reach pre-morbid levels. Patients face ongoing challenges regarding their physical and psychosocial recovery 12-months post-burn injury with respect to generic health and burn-specific health. These challenges vary at different time periods over the 12-month post-burn period, and may provide windows of opportunity in which to address ongoing issues.
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Affiliation(s)
- J Wasiak
- Victorian Adult Burns Service and School of Public Health and Preventive Medicine, Monash University, The Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia.
| | - E Paul
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, Commercial Road, Melbourne, Australia
| | - S J Lee
- Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Commercial Road, Melbourne, Australia
| | - P Mahar
- Victorian Adult Burns Service, The Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia
| | - B Pfitzer
- Victorian Adult Burns Service, The Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia
| | - A Spinks
- CSIRO Ecosystem Sciences, Queensland, Australia
| | - H Cleland
- Victorian Adult Burns Service, Department of Surgery, Monash University, The Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia
| | - B Gabbe
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, Commercial Road, Melbourne, Australia
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Stavrou D, Weissman O, Tessone A, Zilinsky I, Holloway S, Boyd J, Haik J. Health Related Quality of Life in burn patients – A review of the literature. Burns 2014; 40:788-96. [DOI: 10.1016/j.burns.2013.11.014] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 11/12/2013] [Accepted: 11/22/2013] [Indexed: 12/01/2022]
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Wasiak J, Lee S, Paul E, Mahar P, Pfitzer B, Spinks A, Cleland H, Gabbe B. Predictors of health status and health-related quality of life 12 months after severe burn. Burns 2014; 40:568-74. [DOI: 10.1016/j.burns.2014.01.021] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 12/26/2013] [Accepted: 01/22/2014] [Indexed: 11/29/2022]
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Meirte J, van Loey NEE, Maertens K, Moortgat P, Hubens G, Van Daele U. Classification of quality of life subscales within the ICF framework in burn research: identifying overlaps and gaps. Burns 2014; 40:1353-9. [PMID: 24685352 DOI: 10.1016/j.burns.2014.01.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 12/20/2013] [Accepted: 01/19/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Quality of life (QOL) is one of the leading outcomes in burn care research. This study classifies subscales of common QOL measures within the International Classification of Functioning disability and health (ICF) framework to determine to which extent the measures are complementary or overlapping and to investigate whether the instruments are able to describe the full spectrum of patients' functioning. METHODS A literature search was performed to determine the most frequently used questionnaires in burn research. The subscales of the three mostly used questionnaires were classified within the ICF framework. RESULTS Two generic measures, the Short Form-36 items (SF-36) and the European Quality of Life 5 Dimensions (EQ-5D), and a disease specific measure, the Burn Specific Health Scale-Brief (BSHS-B), were analyzed. The BSHS-B covered most domains and was the only scale that included personal factors. The SF-36 included only one domain in the activity limitations and similar to the EQ-5D no contextual factors were included. Environmental factors were not addressed in the questionnaires, even though these may have an impact on the quality of life in patients with burns. CONCLUSION To capture the full spectrum of dysfunctioning a combination of the BSHS-B with a generic questionnaire seems obligatory. However still some domains of functioning remain uncovered.
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Affiliation(s)
- J Meirte
- Oscare, Organisation for Burns, Scar After-care and Research, Antwerp, Belgium; University of Antwerp, Department of Rehabilitation Sciences and Physiotherapy, Antwerp, Belgium.
| | - N E E van Loey
- Association of Dutch Burn Centres, Department of Behavioural Research, Beverwijk, the Netherlands; Utrecht University, Department of Clinical and Health Psychology, Utrecht, the Netherlands
| | - K Maertens
- Oscare, Organisation for Burns, Scar After-care and Research, Antwerp, Belgium; Vrije Universiteit Brussel, Department of Clinical and Lifespan Psychology, Brussels, Belgium
| | - P Moortgat
- Oscare, Organisation for Burns, Scar After-care and Research, Antwerp, Belgium
| | - G Hubens
- University of Antwerp, Department of Antwerp Surgical Training Anatomy and Research Centre, Antwerp, Belgium
| | - U Van Daele
- University of Antwerp, Department of Rehabilitation Sciences and Physiotherapy, Antwerp, Belgium
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Hussain A, Dunn KW. Accuracy of commercial reporting systems to monitor quality of care in burns. Burns 2014; 40:251-6. [DOI: 10.1016/j.burns.2013.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 06/28/2013] [Accepted: 07/01/2013] [Indexed: 10/26/2022]
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Szczechowicz J, Lewandowski J, Sikorski J. Polish adaptation and validation of burn specific health scale - brief. Burns 2014; 40:1013-8. [PMID: 24556075 DOI: 10.1016/j.burns.2013.11.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 11/27/2013] [Accepted: 11/29/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Burn Specific Health Scale - Brief is a well-described, specific tool to assess health condition (quality of life) of burnt patients. This project was aimed at creating a Polish adaptation and validation of the Burn Specific Health Scale - Brief. METHOD Adaptation of the tool was performed in two stages. The first stage involved translation, back translation, evaluation by a panel of judges and a pre-test of the tool. The second stage consisted of surveying 202 burned patients. Those data were used to conduct a psychometric analysis. Reliability was checked by determining the Cronbach's α internal consistency coefficient and conducting the test-retest procedure (ICC). Content validity was evaluated by a panel of judges. Criterion validity was determined using SF-36. Construct validity was determined using known-groups validation. RESULTS Reliability of the tool, determined using the internal consistency coefficient (Cronbach's α=0.94) and the test-retest procedure (ICC=0.89), proved to be high. Criterion validity, determined using the relationship of results of comparable BSHS-B and SF-36 subscales, obtained a satisfactory level with a correlation of r=0.55-0.89 (p<0.01). Analysis of inter-group differences showed that patients who stayed at a hospital for more than 10 days (p=0.002), patients after surgical intervention (p=0.018), patients with a burn larger than 19% of the TBSA (p=0.01) and patients with 3rd degree burns (p=0.001) have much poorer results than the rest of the subjects. DISCUSSION The Polish version of BSHS-B is a reliable and valid tool for assessing quality of life of burned patients. It may be used to plan the burn treatment process and evaluate its outcomes.
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Affiliation(s)
- Julia Szczechowicz
- University School of Physical Education in Poznan, Department of Locomotor System Rehabilitation, Poland.
| | - Jacek Lewandowski
- University School of Physical Education in Poznan, Department of Locomotor System Rehabilitation, Poland
| | - Jerzy Sikorski
- University of Medical Science in Poznań, Department of Trauma Surgery, Burns and Plastic Surgery, Poland; Burn Treatment Unit of the General Surgery and Multiple Organ Injury Ward of the J. Struś Multi-Specialist City Hospital in Poznań, Poland
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Li DW, Liu WQ, Wang HM, Ying-Sun, Cui L, Zhao FF. The Chinese language version of the abbreviated burn specific health scale: a validation study. Burns 2014; 40:1001-6. [PMID: 24439926 DOI: 10.1016/j.burns.2013.10.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 10/21/2013] [Accepted: 10/23/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Burn Specific Health Scale (BSHS) is designed to measure burn-specific, health-related quality of life (HRQoL). The aim of the present study was to evaluate the reliability and validity of the Chinese version of the abbreviated BSHS (BSHS-A). METHODS The English version of the BSHS-A was translated into Chinese using a standardised procedure. The participants were 457 patients classified into three severity groups (mild, moderate and severe). All patients completed the Chinese BSHS-A questionnaire, the Short Form-36 (SF-36) and the EuroQol 5-Dimensions (EQ-5D). To evaluate clinical utility of the BSHS-A, we used Cronbach's alpha (internal consistency), intraclass correlation coefficients (ICCs; test-retest reliability) and construct validity (using the SF-36 and EQ-5D). RESULTS Cronbach's alpha for all subscales was >0.80, demonstrating high internal consistency of the BSHS-A (Chinese version). The ICC was >0.70 for each patient group. Strong correlations were observed between the BSHS-A and SF-36 and EQ-5D scales. Neither floor nor ceiling effects were found. CONCLUSION The present study demonstrated that the BSHS-A (Chinese version) has good psychometric properties, showing suitable internal consistency and test-retest reliability. The BSHS-A may, thus, be useful for assessing HRQoL in Chinese burn victims. However, adaptations may be required to reduce its length.
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Affiliation(s)
- Dong-Wen Li
- Department of Nursing, Military General Hospital of Chengdou Region, 270# Rongdou Avenue, Chengdou 610083, China
| | - Wen-Qing Liu
- Department of Nursing, Military General Hospital of Chengdou Region, 270# Rongdou Avenue, Chengdou 610083, China.
| | - Hong-Mei Wang
- Department of Nursing, Military General Hospital of Chengdou Region, 270# Rongdou Avenue, Chengdou 610083, China
| | - Ying-Sun
- Department of Nursing, Military General Hospital of Chengdou Region, 270# Rongdou Avenue, Chengdou 610083, China
| | - Lin Cui
- Department of Nursing, Military General Hospital of Chengdou Region, 270# Rongdou Avenue, Chengdou 610083, China
| | - Fang-Fang Zhao
- Nursing Department of NanTong University, 9# Qixiu Road, Nantong 226001, China
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Abstract
Burn care is an area which has advanced relentlessly over the past decades with improved survival and quality of survival. However, there are many challenges which overshadow the successes. The translation of what we know into clinical practice remains a challenge due to issues on many levels from overcoming personal opinion to resource allocation. We live in a time of exponential increase in knowledge in diverse areas which could be harnessed to improve the lives of those suffering burn injuries. Breaking down silos in education training and research remain challenging and again the allocation of resource is key. Ultimately when the goal is “One World One Standard of Burn Care” the greatest challenge is in education with specific reference to burn injury prevention and first aid.
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Affiliation(s)
- Fiona M Wood
- Burns Service of Western Australia; Burn Injury Research Unit, University of Western Australia, Australia
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Sexuality in burn victims: an integrative literature review. Burns 2013; 40:552-61. [PMID: 24332436 DOI: 10.1016/j.burns.2013.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 10/08/2013] [Accepted: 11/12/2013] [Indexed: 01/23/2023]
Abstract
AIMS To analyze and synthesize knowledge concerning sexuality in adult burn victims through an integrative literature review. METHOD Two researchers independently searched six electronic databases (PUBMED, LILACS, ISI Web of Science, PSYCINFO, CINAHL and EMBASE) and also performed a hand search using the following descriptors, in different combinations: burn, sexuality, gender identity, sexual behavior and sexual factors, in order to identify the articles published in English, Portuguese or Spanish, in the last 20 years. A total of 1781 articles were found and 22 were selected based on the inclusion and exclusion criteria. RESULTS The findings were organized into two categories that influence sexuality: (1) studies where the main purpose was to assess sexuality in burn victims; (2) studies that indirectly assess sexuality. CONCLUSION The synthesis of the knowledge concerning sexuality in burn victims showed that sexual dysfunction can be related to the younger ages, TBSA > 20%, burns on the genitalia and on exposed areas, prolonged length of hospital stay, avoidance coping, and mental disorders. The multidisciplinary team should be prepared to integrate sexuality as an important variable in the continuing treatment of burn patients.
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Ricci H, Gonçalves N, Gallani MC, Ciol MA, Dantas RAS, Rossi LA. Assessment of the health status in Brazilian burn victims five to seven months after hospital discharge. Burns 2013; 40:616-23. [PMID: 24290853 DOI: 10.1016/j.burns.2013.09.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 08/19/2013] [Accepted: 09/18/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate health status, impact of event, anxiety, and depression in burn victims at five-to-seven months after hospital discharge, and to explore the association between those variables with age, body surface area burn (BSA), sex, and marital status. METHODS Cross-sectional study involving 73 adults who were interviewed for general health status (BSHS-R), impact of event (IES), and anxiety and depression (HADS). RESULTS Participants were mostly men (68.5%), with mean age 38.4 years (SD = 14.5), and mean hospital length of stay (LOS) 24.5 days (SD = 25.3). Mean scores were: 128.1 (SD = 18.9) for BSHS-R, 62.1(SD = 35.8) for IES, 5.5 (SD = 4.1) for anxiety, and 3.9 (SD = 3.9) for depression. Health status was highly and inversely correlated with impact of event, depression, anxiety, LOS, number of surgeries, and BSA. Men and women differed in the BSHS-R affect and body image domains, and depression. Individuals with larger BSA reported worse scores for BSHS-R (work domain). CONCLUSION Burn victims reported good health status on average, which was negatively correlated with reported depression, anxiety, impact of event, LOS, number of operations, and BSA. These findings suggest that general health might be improved by interventions that target modifiable behavioral factors, such as support groups and cognitive behavioral therapies.
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Affiliation(s)
- Hermínia Ricci
- University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, SP, Brazil.
| | - Natália Gonçalves
- Interunit Nursing Doctoral program, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, SP, Brazil.
| | | | - Márcia A Ciol
- Rehabilitation Medicine Department, School of Medicine, University of Washington, Seattle, WA, USA.
| | - Rosana A S Dantas
- General and Specialized Nursing Department, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, SP, Brazil.
| | - Lídia Aparecida Rossi
- General and Specialized Nursing Department, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, SP, Brazil.
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Zhang LJ, Cao J, Feng P, Huang J, Lu J, Lu XY, Xia ZF. Influencing factors of the quality of life in Chinese burn patients: Investigation with adapted Chinese version of the BSHS-B. Burns 2013; 40:731-6. [PMID: 24280529 DOI: 10.1016/j.burns.2013.09.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 09/01/2013] [Accepted: 09/22/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The study aims to evaluate the quality of life (QOL) in burn patients in China and find out principal influencing factors, so as to provide evidence for interventions. METHODS A total of 271 burn patients in three major burn units in China were asked to fill in the adapted Chinese version (ACV) of the Burn Specific Health Scale-Brief (ACV BSHS-B) in order to seek out the principal influencing factors in combination with a self-designed demographic and disease condition questionnaire. Multivariable linear regression was used to analyse the principal influencing factors. RESULTS The findings showed that there were seven principal influencing factors for the overall ACV BSHS-B score. They were: percent total body surface area (TBSA) burned (with the standardised regression coefficient being -0.594), burn area of lower limber (0.241), itch level (-0.227), pain level (-0.220), gender (0.217), mechanical ventilation (0.216) and hand deformity (-0.141). CONCLUSION QOL decreased in burn patients to different degrees depending on the intensity of burns. With a better understanding of influencing factors of burn patients' QOL, the medical and nursing staff can take specific countermeasures to help patients gain a higher QOL.
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Affiliation(s)
- Ling-Juan Zhang
- Nursing Department, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Jie Cao
- Anesthesiology Department, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Ping Feng
- Burn Center, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Juan Huang
- Nursing Department, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Jian Lu
- Department of Medical Statistics, Second Military Medical University, Shanghai 200433, China
| | - Xiao-Ying Lu
- Nursing Department, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Zhao-Fan Xia
- Burn Center, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
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12-month generic health status and psychological distress outcomes following an Australian natural disaster experience: 2009 Black Saturday Wildfires. Injury 2013; 44:1443-7. [PMID: 23021367 DOI: 10.1016/j.injury.2012.08.060] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Accepted: 08/29/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe the generic health status, health-related quality of life and psychological distress over a 12-month period of burns patients affected by the 2009 Black Saturday Wildfires. DESIGN SETTING AND PARTICIPANTS Cohort study with retrospective assessment of pre-injury status and prospective assessment of physical and psychosocial functioning in the Black Saturday Wildfires burns patients across time. Generic health status and burn specific quality of life using the 36-item Short Form Health Survey (SF-36) and Burn Specific Health Scale (BSHS) were collected at three, six and twelve months post-burn injury. In addition, similar time points were used to measure level of psychological distress and the presence of pain using the Kessler-10 questionnaire (K-10) and the McGill Pain Questionnaire. RESULTS At 12 months post-injury, patients reported a mean 16.4 (standard error, SE: 3.2) reduction in physical health and a 5.3 (SE 2.5) reduction in mental health scores of the SF-36 as compared to their pre-injury scores, with significant decreases observed in the "bodily pain", "physical functioning", "role physical" and "vitality" subscales. High levels of psychological distress and persistent pain were experienced, with no significant changes during the study period to the overall burns specific quality of life. CONCLUSIONS Even 12 months post-burn injury, patients affected by the 2009 Victorian Wildfires still experienced a significant reduction in generic health, increased psychological distress and persistent pain. The need for early and ongoing identification of physical and psychosocial impairments during hospital admission and upon discharge could be helpful to establish systematic interdisciplinary goals for long-term rehabilitation after severe burn injury.
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Enhancing the clinical utility of the burn specific health scale-brief: not just for major burns. Burns 2013; 40:328-36. [PMID: 24045070 DOI: 10.1016/j.burns.2013.07.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 07/01/2013] [Accepted: 07/05/2013] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Like many other Western burn services, the proportion of major to minor burns managed at Royal Perth Hospital (RPH) is in the order of 1:10. The Burn Specific Health Scale-Brief (BSHS-B) is an established measure of recovery after major burn, however its performance and validity in a population with a high volume of minor burns is uncertain. Utilizing the tool across burns of all sizes would be useful in service wide clinical practice. AIM This study was designed to examine the reliability and validity of the BSHS-B across a sample of mostly minor burn patients. METHOD BSHS-B scores of patients, obtained between January 2006 and February 2013 and stored on a secure hospital database were collated and analyzed Cronbach's alpha, factor analysis, logistic regression and longitudinal regression were used to examine reliability and validity of the BSHS-B. RESULTS Data from 927 burn patients (2031 surveys) with a mean % total burn surface area (TBSA) of 6.7 (SD 10.0) were available for analysis. The BSHS-B demonstrated excellent reliability with a Cronbach's alpha of 0.95. First and second order factor analyses reduced the 40 item scale to four domains: Work; Affect and Relations; Physical Function; Skin Involvement, as per the established construct. TBSA, length of stay and burn surgery all predicted burn specific health in the first three months of injury (p<0.001, p<0.001, p=0.03). BSHS-B whole scale and domain scores showed significant improvement over 24 months from burn (p<0.001). DISCUSSION The results from this study show that the structure and performance of the BSHS-B in a burn population consisting of 90% minor burns is consistent with that demonstrated in major burns. CONCLUSION The BSHS-B can be employed to track and predict recovery after burns of all sizes to assist the provision of targeted burn care.
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Hussain A, Choukairi F, Dunn K. Predicting survival in thermal injury: A systematic review of methodology of composite prediction models. Burns 2013; 39:835-50. [DOI: 10.1016/j.burns.2012.12.010] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 11/13/2012] [Accepted: 12/06/2012] [Indexed: 12/26/2022]
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Hussain A, Dunn KW. Predicting length of stay in thermal burns: a systematic review of prognostic factors. Burns 2013; 39:1331-40. [PMID: 23768707 DOI: 10.1016/j.burns.2013.04.026] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 03/14/2013] [Accepted: 04/23/2013] [Indexed: 01/07/2023]
Abstract
BACKGROUND Continued improvement in all aspects of the management of thermal injury has resulted in marked improvements in the traditionally reported outcome of mortality. This has resulted in the search for alternative parameters that can be monitored to indicate the performance of burn services. Length of stay (LOS) in hospitalised burn patients has long been considered reflective of injury-associated morbidity, cost and the quality of care, which can be monitored consistently across services. AIM We undertook a systematic review of published literature pertaining to LOS prognostication in thermal burns to identify the relevant factors, quantify the risk associated with these factors and identify predictive prognostic models. METHODS Electronic searches were performed on MEDLINE, CINHAL, EMBASE, Web of Science, the Cochrane collection and a general web search was performed using Google. The searches were complemented by a manual search of the contents of leading burns journals. Quality of the studies included in the review was evaluated against published standards for prognostic studies. RESULTS Fourteen studies were included in the review after meeting the inclusion/exclusion criteria. Age and %TBSA were the strongest predictors of LOS in these studies. Other significant predictors included % full thickness burn, female gender, inhalation injury, surgery including escharotomy and the depth of burn. Nine studies reported multivariate models for predicting LOS in patients sustaining thermal injury. None of these models were validated and the goodness-of-fit statistic (R2) ranged from 0.15 to 0.75. CONCLUSION This review has demonstrated that %TBSA and age are the best predictors of LOS in published literature. Current prognostic models do not explain a significant proportion of variation in LOS.
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Affiliation(s)
- Amer Hussain
- University Hospital South Manchester, Southmoor Road, Manchester M23 9LT, United Kingdom.
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Öster C, Willebrand M, Ekselius L. Burn-specific health 2 years to 7 years after burn injury. J Trauma Acute Care Surg 2013; 74:1119-24; discussion 1124. [PMID: 23511154 DOI: 10.1097/ta.0b013e318283cca0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Knowledge concerning the pattern of recovery and predictors of burn-specific health years after burn injury is limited, and these factors were therefore assessed with a disease-specific instrument, the Burn Specific Health Scale-Brief. METHODS Consecutive adult burn patients were prospectively included during hospitalization and assessed at 3, 6, and 12 months as well as at 2 years to 7 years (4.6 years on average) after burn. Data concerning injury characteristics, sociodemographic variables, psychiatric disorders, and burn-specific health were obtained. RESULTS Burn-specific health improved over time, from 6 months to the final assessment after burn. At 2 years to 7 years after burn, most problems were reported in the subscales heat sensitivity, body image, and work. The regression analyses revealed that length of stay, any preburn psychiatric disorder, major depression, and posttraumatic stress disorder 12 months after burn were predictors of long-term burn-specific health in the affect and relations domain, whereas time since injury, length of stay, and major depression 12 months after burn predicted outcome in the skin involvement domain. Predictors for the subscale work were length of stay, working at the time of injury, and posttraumatic stress disorder at 12 months. CONCLUSION This study underscores that significant improvement in postburn health can be expected even later than 2 years after injury. Furthermore, the results imply that both preburn factors and factors identified 1 year after burn have impact on burn-specific health after several years. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Caisa Öster
- Department of Neuroscience Psychiatry, Uppsala University, Uppsala, Sweden.
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Koljonen V, Laitila M, Sintonen H, Roine RP. Health-related quality of life of hospitalized patients with burns-comparison with general population and a 2-year follow-up. Burns 2013; 39:451-7. [PMID: 23313018 DOI: 10.1016/j.burns.2012.07.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 07/28/2012] [Accepted: 07/31/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Health-related quality of life (HRQoL) has gained increasing interest as an important indicator of adaptation after a burn injury. Our objective was to compare HRQoL of medium severity hospitalized burn victims with no need for intensive care treatment with that of the general population. METHODS The 15D HRQoL questionnaire at discharge, and 6, 12 and 24 months thereafter. RESULTS 44 patients filled in the baseline questionnaire between June 2007 and December 2009. At discharge the mean (SD) HRQoL score (on a scale of 0-1) of the patients was worse in comparison with that of the general population (0.839 (0.125) vs. 0.936 (0.071)), p<0.001. The most striking differences (p<0.001) were seen on the dimensions of sleeping, usual activities, discomfort and symptoms, and sexual activity. At the 2-year follow-up the mean HRQoL score had increased from 0.835 (0.121) to 0.856 (0.149), but the difference was not statistically significant. Of the dimensions, moving and usual activities improved statistically significantly. CONCLUSIONS HRQoL of patients hospitalized for treatment of burns is, at discharge, compromised compared with that of the general population. During follow-up HRQoL showed slight improvement but remained at a clearly lower level.
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Affiliation(s)
- Virve Koljonen
- Department of Plastic Surgery, Helsinki University Central Hospital, Helsinki Finland, P.O. Box 266, 00029 HUS, Finland.
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Treatment of Patients With Severe Burns—Costs and Health-Related Quality of Life Outcome. J Burn Care Res 2013; 34:e318-25. [DOI: 10.1097/bcr.0b013e3182779c90] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gaucher S, Duchange N, Jarraya M, Magne J, Rochet JM, Stéphanazzi J, Hervé C, Moutel G. Severe adult burn survivors. What information about skin allografts? Cell Tissue Bank 2012; 14:505-10. [PMID: 23229877 DOI: 10.1007/s10561-012-9350-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Accepted: 01/11/2012] [Indexed: 11/29/2022]
Abstract
During the acute phase of a severe burn, surgery is an emergency. In this situation, human skin allografts constitute an effective temporary skin substitute. However, information about the use of human tissue can not be given to the patients because most of the allografted patients are unconscious due to their injury. This study explored the restitution of information on skin donation to patients who have been skin allografted and who have survived their injury. A qualitative study was conducted due to the limited number of patients in ability to be interviewed according to our medical and psychological criteria. 12 patients who had been treated between 2002 and 2008 were interviewed. Our results show that 10 of them ignored that they had received skin allografts. One of the two patients who knew that they had received allografts knew that skin had been harvested from deceased donor. All patients expressed that there is no information that should not be delivered. They also expressed their relief to have had the opportunity to discuss their case and at being informed during their interview. Their own experience impacted their view in favor of organ and tissue donation.
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Affiliation(s)
- Sonia Gaucher
- Laboratoire d'éthique médicale et médecine légale, Université Paris Descartes, Sorbonne Paris Cité, EA 4569, 45 rue des Saints-Pères, 75006, Paris, France,
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Grisbrook T, Reid S, Edgar D, Wallman K, Wood F, Elliott C. Exercise training to improve health related quality of life in long term survivors of major burn injury: A matched controlled study. Burns 2012; 38:1165-73. [DOI: 10.1016/j.burns.2012.03.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 02/24/2012] [Accepted: 03/21/2012] [Indexed: 12/29/2022]
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Effects of a hospital based Wellness and Exercise program on quality of life of children with severe burns. Burns 2012; 39:599-609. [PMID: 22985974 DOI: 10.1016/j.burns.2012.08.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 08/13/2012] [Accepted: 08/21/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To examine the effect of a 12-week Wellness and Exercise (W&E) program on the quality of life of pediatric burn survivors with burns of ≥40% total body surface area. We hypothesized this comprehensive regimen would improve physical and psychosocial outcomes. METHODS Children were recruited for participation upon their discharge from the ICU. They were not taking anabolic/cardiovascular agents. Seventeen children participated in the W&E group and 14 children in the Standard of Care (SOC) group. Quality of life was assessed with the Child Health Questionnaire (CHQ) at discharge and 3 months. Children completed the CHQ-CF 87 and caregivers completed the CHQ-PF 28. RESULTS The mean age of children in the W&E group was 14.07±3.5 years and mean TBSA was 58±11.8%. The mean age of children in the SOC group was 13.9±3.1 years and mean TBSA was 49±7.8%. ANOVA did not reveal statistically significant differences between the groups. Matched paired t-tests revealed that parents with children in the W&E group reported significant improvements with their children's physical functioning, role/social physical functioning, mental health, overall physical and psychosocial functioning after exercise. CONCLUSIONS These results are clinically relevant in that a comprehensive W&E program may be beneficial in promoting physical and psychosocial outcomes.
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Ling-Juan Z, Jie C, Jian L, Xiao-Ying L, Ping F, Zhao-Fan X, Jian-Ling H, Juan H, Feng Z, Tao L. Development of quality of life scale in Chinese burn patients: cross-cultural adaptation process of burn-specific health scale - brief. Burns 2012; 38:1216-23. [PMID: 22703730 DOI: 10.1016/j.burns.2012.03.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 03/18/2012] [Accepted: 03/26/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE This study was designed to develop and test a Chinese burn patient-specific quality of life (QOL) scale based on the burn-specific health scale - brief (BSHS - B) to provide an effective assessment tool to measure quality of life in Chinese burn patients. METHOD Delphi method was used after the translation, back translation and pre-commissioning tests of BSHS - B, to amend the description of the items for cultural adaptation. The adapted Chinese version (ACV) of the BSHS - B was tested for internal consistency and validity of construct on a group of 271 burn patients from three major burn units in China. RESULTS Thirty-eight items within six domains of ACV BSHS-B were developed with scoring '0-4' in each item. The mean total score for our study group was 98.36 (standard deviation (S.D.)=37.86), ranging from 13 to 150. The total Cronbach's alpha value was 0.97 and total split-half reliability was 0.98, demonstrating that the internal consistency of the ACV was very high. Pearson correlations among the six domains of ACV BSHS - B were statistically significant. Exploratory factor analysis results showed that the six-factor function explained 78.30% of total variance; each entry in the corresponding domain had a factor-loading value higher than 0.4, indicating that the scale has a good validity. CONCLUSION The ACV of the BSHS - B showed good reliability and validity, and can be used as a tool for assessing the QOL in Chinese burn patients.
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Affiliation(s)
- Zhang Ling-Juan
- Nursing Department, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
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Pishnamazi Z, Rejeh N, Heravi-Karimooi M, Vaismoradi M. Validation of the Persian version of the Burn Specific Health Scale-Brief. Burns 2012; 39:162-7. [PMID: 22683143 DOI: 10.1016/j.burns.2012.05.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2011] [Revised: 04/23/2012] [Accepted: 05/06/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND The Burns Specific Health Scale-Brief (BSHS-B) is easy to apply, can be self-administered, and is considered a suitable instrument to measure general health and the physical, mental, and social aspects of burn victims' life. AIM The purpose of this study was to translate and culturally adapt the BSHS-B into the Persian language and to investigate its psychometric properties. METHODS The BSHS-B was translated and adapted for Iranian patients. 200 patients (94.34%) filled out the questionnaire. The psychometric properties of the scale, including its internal consistency, test-retest reliability, and construct validity through the known-groups technique were evaluated. RESULTS The Cronbach's alpha coefficient of total scores of the questionnaire was 0.94, demonstrating reasonable internal consistency of the instrument. The test-retest coefficients were reported to be between 0.81 and 0.96. The scale's construct validity was statistically significant. Principal components' factor analysis was used to derive an instrument called the Burn Specific Health Scale-Brief in eight domains. The domains described patients' functions in terms of "Heat sensitivity", "Affect", "Hand function & simple abilities", "Treatment regimens", "Work", "Sexuality", "Interpersonal relationships", and "Body image". CONCLUSIONS The reliability and validity of the adapted version of the BSHS-Brief was shown to be satisfactory. Thus, it can be used to investigate quality of life of Iranian patients suffering from burn.
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Affiliation(s)
- Zahra Pishnamazi
- Department of Nursing, Faculty of Nursing and Midwifery, Shahed University, Tehran, Iran.
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Abstract
Advances in burn care in recent decades have resulted in a growing population of burn survivors and an increased need for inpatient rehabilitation. Burn survivors who require inpatient rehabilitation typically experience severe and complicated injuries. The purpose of this study is to examine burn rehabilitation outcomes and their predictor variables. Data are obtained from the Uniform Data System for Medical Rehabilitation from 2002 to 2007. Inclusion criterion is primary diagnosis of burn injury. Predictor variables include demographic, medical, and facility data. Outcome measures are length of stay efficiency, FIM® gain, community discharge, and FIM® discharge of at least 78. Linear and logistic regression analyses are used to determine significant predictors of outcomes. There are 2920 patients who meet inclusion criteria. The mean age of the population is 51 years, 33% of the population is female, 73% is Caucasian, and 40% are married. The median TBSA decile is 20 to 29%. The population exhibits a mean FIM® gain of 28 and length of stay efficiency of 2.1. A majority of the population is discharged to the community (76%) and has a FIM® discharge of at least 78 (81%). Significant predictors of outcomes in burn rehabilitation include age, FIM® admission, onset days, employment status, and marital status. Inpatient rehabilitation is critical to community reintegration of burn survivors. Survivors who are young, married, employed, and higher functioning at the time of admission to rehabilitation demonstrate the best outcomes. This research will help assess the rehabilitation potential of burn survivors and inform resource allocation.
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