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Stanton E, McMullen K, Won P, Schneider JC, Ryan C, Carrougher G, Kowalske K, Yenikomshian HA. Neuropathic Pain After Burn Injury: A Severe and Common Problem in Recovery. Ann Surg 2024; 279:874-879. [PMID: 37916448 PMCID: PMC10997473 DOI: 10.1097/sla.0000000000006146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
OBJECTIVE The aim of this study was to address the limited understanding of neuropathic pain (NP) among burn survivors by comprehensively examining its prevalence and related factors on a national scale using the Burn Model System (BMS) National Database. BACKGROUND NP is a common but underexplored complaint among burn survivors, greatly affecting their quality of life and functionality well beyond the initial injury. Existing data on NP and its consequences in burn survivors are limited to select single-institution studies, lacking a comprehensive national perspective. METHODS The BMS National Database was queried to identify burn patients responding to NP-related questions at enrollment, 6 months, 12 months, 2 years, and 5 years postinjury. Descriptive statistics and regression analyses were used to explore associations between demographic/clinical characteristics and self-reported NP at different time points. RESULTS There were 915 patients included for analysis. At discharge, 66.5% of patients experienced NP in their burn scars. Those with NP had significantly higher Patient-Reported Outcomes Measurement Information System 29 (PROMIS-29) pain inference, itch, anxiety, depression, and sleep disturbance scores and were less able to partake in social roles. Multiple logistic regression revealed male sex, % total body surface area, and moderate-to-severe pain as predictors of NP at 6 months. At 12 months, % total body surface area and moderate-to-severe pain remained significant predictors, while ethnicity and employment status emerged as significant predictors at 24 months. CONCLUSIONS This study highlights the significant prevalence of NP in burn patients and its adverse impacts on their physical, psychological, and social well-being. The findings underscore the necessity of a comprehensive approach to NP treatment, addressing both physical symptoms and psychosocial factors.
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Affiliation(s)
- Eloise Stanton
- Division of Plastic and Reconstructive Surgery, Keck Medicine of USC, Los Angeles, CA
| | - Kara McMullen
- Burn Model Systems National Data and Statistical Center, University of Washington, Seattle, WA
| | - Paul Won
- Division of Plastic and Reconstructive Surgery, Keck Medicine of USC, Los Angeles, CA
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
| | - Colleen Ryan
- Department of Surgery, Massachusetts General Hospital, Shriners Hospitals for Children®-Boston, Harvard Medical School, Boston, MA
| | - Gretchen Carrougher
- Department of Surgery, UW Medicine Regional Burn Center, University of Washington, Seattle, WA
| | - Karen Kowalske
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX
| | - Haig A Yenikomshian
- Division of Plastic and Reconstructive Surgery, Keck Medicine of USC, Los Angeles, CA
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Won P, Pickering TA, Schneider JC, Kowalske K, Ryan CM, Carrougher GJ, Stewart BT, Yenikomshian HA. Physical and psychosocial outcomes among burn-injured people with heterotopic ossification: A burn model system study. Burns 2024; 50:957-965. [PMID: 38267289 PMCID: PMC11055684 DOI: 10.1016/j.burns.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/10/2024] [Accepted: 01/15/2024] [Indexed: 01/26/2024]
Abstract
INTRODUCTION Heterotopic ossification (HO), or ectopic bone formation in soft tissue, is a not so rare and poorly understood debilitating sequela of burn injury. Individuals developing HO following burn injuries to their hands often experience reductions in mobility, significant contractures, and joint pain. This study identifies demographic characteristics of individuals who develop HO and compares their physical and psychosocial outcomes to the general burn population. METHODS Participant demographics, injury characteristics, and PROMIS-29 scores across three time points (discharge, six- and 12- months after injury) were extracted from the Burn Model System National Longitudinal Database representing participants from 2015-2022. Mixed-effects linear regression models were used to compare PROMIS scores across all three longitudinal measurements. Models were adjusted for age, sex, race/ethnicity, HO status, and burn size. RESULTS Of the 861 participants with data concerning HO, 33 were diagnosed with HO (3.8% of participants). Most participants with HO were male (n = 24, 73%) and had an average age of 40 + /- 13 years. Participants with HO had significantly larger burn size (49 +/-23% Total Body Surface Area (TBSA)) than those without HO (16 +/-17%). Participants with HO reported significantly worse physical function, depression, pain interference and social integration scores than those without HO. After adjusting for covariables, participants with HO continued to report statistically significantly worse physical function than those without HO. Although physical functioning was consistently lower, the two populations did not differ significantly among psychosocial outcome measures. CONCLUSIONS While HO can result in physical limitations, the translation to psychosocial impairments was not evident. Targeted treatment of HO with the goal of maximizing physical function should be a focus of their rehabilitation. LEVEL OF EVIDENCE 2b TYPE OF STUDY: Symptom Prevalence Study.
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Affiliation(s)
- Paul Won
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Trevor A Pickering
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Karen Kowalske
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, TX, USA
| | - Colleen M Ryan
- Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Gretchen J Carrougher
- Department of Surgery, University of Washington, UW Medicine Regional Burn Center at Harborview Medical Center, Seattle, WA, USA
| | - Barclay T Stewart
- Department of Surgery, University of Washington, UW Medicine Regional Burn Center at Harborview Medical Center, Seattle, WA, USA
| | - Haig A Yenikomshian
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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Curry ZA, Andrew MN, Chiang M, Goldstein R, Zafonte R, Ryan CM, Coleman BC, Schneider JC. Examination of pain comorbid diagnoses in the inpatient rehabilitation population across all impairment groups. Am J Phys Med Rehabil 2024:00002060-990000000-00481. [PMID: 38709650 DOI: 10.1097/phm.0000000000002512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
OBJECTIVE Pain is common in inpatient rehabilitation patients; however, the prevalence of pain diagnoses in this population is not well-defined. This study examines comorbid pain diagnoses in inpatient rehabilitation patients across impairment groups. DESIGN Adult inpatient rehabilitation patients discharged from January 2016 through December 2019 were identified in the Uniform Data System for Medical Rehabilitation® database using a literature-established framework containing ICD-10-CM pain diagnoses. Demographic data, clinical data, and pain diagnoses were compared across the 17 rehabilitation impairment groups. RESULTS Of 1,925,002 patients identified, 1,347,239 (70.0%) had at least one ICD-10 pain diagnosis. Over half of all patients in each impairment group had at least one pain diagnosis. The most common pain diagnoses were limb/extremity and joint pain, with variation between impairment groups. Female sex and being in the arthritis, major multiple trauma, and pain syndrome impairment groups were associated with a greater odds of a pain diagnosis. CONCLUSION Over half of all patients in each rehabilitation impairment group have a pain diagnosis, which varies between impairment groups. Due to the high prevalence of pain diagnoses, a new focus on pain management in inpatient rehabilitation patients is needed. Rehabilitation outcomes may also be affected by pain.
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Affiliation(s)
- Zachary A Curry
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Charlestown, MA 02129, USA; Rehabilitation Outcomes Center at Spaulding, Spaulding Rehabilitation, 300 1st Avenue, Charlestown, MA 02129, USA; Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Michael N Andrew
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Charlestown, MA 02129, USA; Rehabilitation Outcomes Center at Spaulding, Spaulding Rehabilitation, 300 1st Avenue, Charlestown, MA 02129, USA; Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Michael Chiang
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Charlestown, MA 02129, USA; Rehabilitation Outcomes Center at Spaulding, Spaulding Rehabilitation, 300 1st Avenue, Charlestown, MA 02129, USA; Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Richard Goldstein
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Charlestown, MA 02129, USA; Rehabilitation Outcomes Center at Spaulding, Spaulding Rehabilitation, 300 1st Avenue, Charlestown, MA 02129, USA
| | - Ross Zafonte
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Charlestown, MA 02129, USA; Rehabilitation Outcomes Center at Spaulding, Spaulding Rehabilitation, 300 1st Avenue, Charlestown, MA 02129, USA; Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Colleen M Ryan
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Department of Surgery, Shriners Children's, 51 Blossom Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Brian C Coleman
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA; Department of Emergency Medicine, Yale School of Medicine, 464 Congress Street, New Haven, CT 06519, USA
| | - Jeffrey C Schneider
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Charlestown, MA 02129, USA; Rehabilitation Outcomes Center at Spaulding, Spaulding Rehabilitation, 300 1st Avenue, Charlestown, MA 02129, USA; Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
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Surette KE, Abouzeid C, Shepler LJ, McMullen KA, Cancio JM, Cancio LC, Hickey SA, Mandell SP, Stewart BT, Wolf SE, Kazis LE, Ryan CM, Schneider JC. Examining the association between military service history and outcomes after burn injury. Burns 2024; 50:59-65. [PMID: 37709564 PMCID: PMC10872572 DOI: 10.1016/j.burns.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/30/2023] [Accepted: 08/10/2023] [Indexed: 09/16/2023]
Abstract
INTRODUCTION The association between military service history and long-term outcomes after burn injury is unknown. This study uses data from the Burn Model System National Database to compare outcomes of individuals with and without self-reported military service history. METHODS Outcome measures were assessed at 12 months after injury including the Veterans Rand-12 Item Health Survey/Short Form-12, Satisfaction With Life Scale, Patient Reported Outcomes Measure Information System 29, 4-D Itch scale, Post Traumatic Stress Disorder Check List - Civilian Version, self-reported Post Traumatic Stress Disorder, and employment status. This study included 675 people with burns of whom 108 reported a history of military service. RESULTS The military service history group was more likely to be older, and male. Those with military service were most likely to be on Medicare insurance and those without military service history were most likely to be on Private Insurance/HMP/PPO. No significant differences were found between those with and without military service history in the outcome measures. CONCLUSIONS Further research should examine differences in outcomes between civilians and those with military service history, including elements of resilience and post traumatic growth.
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Affiliation(s)
- Kate E Surette
- Shriners Children's Hospital-Boston, 51 Blossom St., Boston, MA 02114, United States
| | - Cailin Abouzeid
- Spaulding Rehabilitation Hospital, 300 1st Ave., Charlestown, MA 02129, United States
| | - Lauren J Shepler
- Spaulding Rehabilitation Hospital, 300 1st Ave., Charlestown, MA 02129, United States
| | - Kara A McMullen
- Harborview Medical Center, University of Washington, 325 9th Ave., Seattle, WA 98104, United States
| | - Jill M Cancio
- US Army Institute of Surgical Research, Fort Sam Houston, 3698 Chambers Rd., San Antonio, TX 78234, United States
| | - Leopoldo C Cancio
- US Army Institute of Surgical Research, Fort Sam Houston, 3698 Chambers Rd., San Antonio, TX 78234, United States
| | - Sean A Hickey
- Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, United States
| | - Samuel P Mandell
- University of Texas Southwestern, 5323 Harry Hines Blvd., Dallas, TX 75390, United States
| | - Barclay T Stewart
- Harborview Medical Center, University of Washington, 325 9th Ave., Seattle, WA 98104, United States
| | - Steven E Wolf
- University of Texas Medical Branch, 1302 Mechanic St., Galveston, TX 77550, United States
| | - Lewis E Kazis
- Boston University School of Public Health, 715 Albany St., Boston, MA 02218, United States; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States; Spaulding Rehabilitation Outcomes Center, 300 1st Ave., Charlestown, MA 02129, United States
| | - Colleen M Ryan
- Shriners Children's Hospital-Boston, 51 Blossom St., Boston, MA 02114, United States; Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, United States; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States
| | - Jeffrey C Schneider
- Spaulding Rehabilitation Hospital, 300 1st Ave., Charlestown, MA 02129, United States; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States; Spaulding Rehabilitation Outcomes Center, 300 1st Ave., Charlestown, MA 02129, United States.
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Deng H, Shepler LJ, Chacon KL, Tenney D, Ni P, Stewart BT, Carrougher GJ, Kowalske K, Wolf SE, Slavin MD, Kazis LE, Ryan CM, Schneider JC. Predictors at 6 and 12 Months for Social Participation Outcome at 24 Months in the Adult Burn Injury Population: A Burn Model System National Database Study. Arch Phys Med Rehabil 2024; 105:235-242. [PMID: 37392780 PMCID: PMC10756920 DOI: 10.1016/j.apmr.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 06/15/2023] [Accepted: 06/21/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVE To identify clinical factors (physical and psychological symptoms and post-traumatic growth) that predict social participation outcome at 24-month after burn injury. DESIGN A prospective cohort study based on Burn Model System National Database. SETTING Burn Model System centers. PARTICIPANTS 181 adult participants less than 2 years after burn injury (N=181). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Demographic and injury variables were collected at discharge. Predictor variables were assessed at 6 and 12 months: Post-Traumatic Growth Inventory Short Form (PTGI-SF), Post-Traumatic Stress Disorder Checklist Civilian Version (PCL-C), Patient-Reported Outcomes Measurement Information System (PROMIS-29) Depression, Anxiety, Sleep Disturbance, Fatigue, and Pain Interference short forms, and self-reported Heat Intolerance. Social participation was measured at 24 months using the Life Impact Burn Recovery Evaluation (LIBRE) Social Interactions and Social Activities short forms. RESULTS Linear and multivariable regression models were used to examine predictor variables for social participation outcomes, controlling for demographic and injury variables. For LIBRE Social Interactions, significant predictors included the PCL-C total score at 6 months (β=-0.27, P<.001) and 12 months (β=-0.39, P<.001), and PROMIS-29 Pain Interference at 6 months (β=-0.20, P<.01). For LIBRE Social Activities, significant predictors consisted of the PROMIS-29 Depression at 6 months (β=-0.37, P<.001) and 12 months (β=-0.37, P<.001), PROMIS-29 Pain Interference at 6 months (β=-0.40, P<.001) and 12 months (β=-0.37, P<.001), and Heat Intolerance at 12 months (β=-4.55, P<.01). CONCLUSIONS Post-traumatic stress and pain predicted social interactions outcomes, while depression, pain and heat intolerance predicted social activities outcomes in people with burn injury.
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Affiliation(s)
- Huan Deng
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
| | - Lauren J Shepler
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
| | - Kaitlyn L Chacon
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
| | | | - Pengsheng Ni
- Boston University School of Public Health, Boston, MA
| | - Barclay T Stewart
- The University of Washington, Seattle, WA; Harborview Injury Prevention and Research Center, Seattle, WA
| | | | - Karen Kowalske
- The University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Mary D Slavin
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA; Boston University School of Public Health, Boston, MA; Rehabilitation Outcomes Center at Spaulding, Boston, MA
| | - Lewis E Kazis
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA; Boston University School of Public Health, Boston, MA; Rehabilitation Outcomes Center at Spaulding, Boston, MA
| | - Colleen M Ryan
- Massachusetts General Hospital, Harvard Medical School, Boston, MA; Shriners Hospitals for Children-Boston, Boston, MA
| | - Jeffrey C Schneider
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA; Rehabilitation Outcomes Center at Spaulding, Boston, MA; Massachusetts General Hospital, Harvard Medical School, Boston, MA.
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Patel KF, Ni P, Surette KE, Rencken CA, Rodríguez-Mercedes SL, McGwin MB, Fabia R, Tully C, Warner P, Romanowski KS, Palmieri T, Stoddard FJ, Schneider JC, Kazis LE, Ryan CM. Development of the Preschool Life Impact Burn Recovery Evaluation (PS-LIBRE1-5) Profile. J Burn Care Res 2024; 45:136-144. [PMID: 37703100 PMCID: PMC10872560 DOI: 10.1093/jbcr/irad136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Indexed: 09/14/2023]
Abstract
Physical, social, and psychological outcomes have been identified as relevant to the rehabilitation process of children with burn injuries. Existing legacy measures are limited in item content and only cover a few constructs. Condition-specific outcomes are highly relevant to gauge early growth and development. Computerized adaptive tests (CATs) leveraging advanced psychometric technologies minimize respondent burden. This project developed PS-LIBRE1-5 Profile CAT (Preschool Life Impact Burn Recovery Evaluation) to measure relevant postburn outcomes in children aged one to five. Responses to the field-tested PS-LIBRE1-5 Profile (188 items) were measured on a scale of frequency or ability. Scores were coded from 0 to 4 where higher scores reflected better functioning. Factor analysis identified the items retained in the final item bank of each scale. CAT simulations were conducted to estimate the mean score of each scale. The simulated CAT score and full item bank scores were compared based upon the score range, ceiling and floor effects, and marginal reliabilities. The child mean age was 3.0 ± 1.5 years (n = 500). Average burn size and time since burn injury were 4.2% TBSA and 1.1 years, respectively. Psychometric analysis resulted in eight scales: Physical, Communication and Language, Emotional Wellbeing, Mood, Anxiety, Peer Acceptance, Play, and Peer Relations. Ceiling effects were acceptable at <13% for all scales. Marginal reliabilities of the CATs were credible. The PS-LIBRE1-5 Profile CAT contains 111 items, and is a comprehensive measure that captures physical, communication and language, psychological, and social functioning of preschool burn survivors.
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Affiliation(s)
- Khushbu F Patel
- Shriners Children's Boston, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
| | - Pengsheng Ni
- Boston University School of Public Health, Boston, MA, USA
| | | | | | | | | | - Renata Fabia
- Nationwide Children's Hospital, Columbus, OH, USA
| | - Carrie Tully
- Children's National Hospital, Washington, DC, USA
| | - Petra Warner
- Shriners Children's Ohio, Dayton, OH, USA
- University of Cincinnati, Cincinnati, OH, USA
| | - Kathleen S Romanowski
- Shriners Children's Northern California, Sacramento, CA, USA
- University of California-Davis, Davis, CA, USA
| | - Tina Palmieri
- Shriners Children's Northern California, Sacramento, CA, USA
- University of California-Davis, Davis, CA, USA
| | - Frederick J Stoddard
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jeffrey C Schneider
- Harvard Medical School, Boston, MA, USA
- Spaulding Rehabilitation Hospital, Charlestown, MA, USA
- Spaulding Rehabilitation Outcomes Center, Charlestown, MA, USA
| | - Lewis E Kazis
- Boston University School of Public Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Spaulding Rehabilitation Outcomes Center, Charlestown, MA, USA
| | - Colleen M Ryan
- Shriners Children's Boston, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Bamer AM, McMullen K, Humbert A, Kazis L, Ryan CM, Schneider JC, Stewart BT, Suman OE, Amtmann D. PROMIS-25 Reliability and Validity Among Children Living with Burn Injury: A Burn Model System National Database Study. J Burn Care Res 2023; 44:1419-1427. [PMID: 37101360 PMCID: PMC10600322 DOI: 10.1093/jbcr/irad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Indexed: 04/28/2023]
Abstract
This study examined the reliability and validity of the Patient Reported Outcomes Measurement System (PROMIS)-25, a profile instrument consisting of four-item fixed short forms for six health domains, in children living with burn injury. Data were provided by children participating in a multi-center longitudinal study of outcomes after burn injury. Floor and ceiling effects, unidimensionality, internal consistency, reliability, and differential item functioning (DIF) of the PROMIS-25 Profile v.2.0 were examined. Correlations with other established measures were calculated to assess concurrent validity. Children (n = 256) between the ages of 8-18 years with moderate to severe injury provided responses on PROMIS-25 domains. All PROMIS-25 domains showed high internal consistency. Substantial portions of the sample reported no symptoms (anxiety [58.2%], depressive symptoms [54.6%], fatigue [50.8%], pain [60.1%]). There was a large ceiling effect on peer relationships (46.8%) and physical function mobility (57.5%). One-factor confirmatory factor analyses supported unidimensionality for all domains. Reliability was sufficient for group mean comparisons (>0.8) across at least some trait levels for most domains except fatigue and anxiety. No DIF with respect to burn status was detected when comparing the burn sample to the PROMIS pediatric general U.S. population testing sample. These results provide evidence of reliability and validity of PROMIS-25 scores among children living with burn injury. Reliability of domains was low to moderate and would likely be improved, and ceiling effects reduced for some domains, by administering the PROMIS-37, which includes six items per domain.
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Affiliation(s)
- Alyssa M Bamer
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Kara McMullen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Andrew Humbert
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Lewis Kazis
- Department of Physical Medicine and Rehabilitation, Rehabilitation Outcomes Center (ROC) Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts , USA
- Boston University, School of Public Health, Boston, Massachusetts , USA
| | - Colleen M Ryan
- Shriners Children's Boston, Boston, Massachusetts, USA
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts , USA
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Rehabilitation Outcomes Center (ROC) Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts , USA
| | - Barclay T Stewart
- Department of Surgery, University of Washington Harborview, Seattle, Washington, USA
| | - Oscar E Suman
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
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Deng H, Genovese TJ, Schneider JC. A Narrative Review of Outcomes in Burn Rehabilitation Based on the International Classification of Functioning, Disability, and Health. Phys Med Rehabil Clin N Am 2023; 34:867-881. [PMID: 37806703 PMCID: PMC10560762 DOI: 10.1016/j.pmr.2023.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Burn injury commonly causes long-term physical impairments and psychosocial limitations that impact survivorship. This article uses the World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF) framework to summarize burn rehabilitation outcomes related to body functions and structures and how they relate to activities and participation within the social context. This article will contribute to a better understanding of burn recovery, facilitate the identification of specific and meaningful issues common to burn survivorship that may be under-reported in prior investigations and guide future rehabilitation to advance long-term burn outcomes.
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Affiliation(s)
- Huan Deng
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, 300 1st Avenue, Boston, MA 02129, USA
| | - Timothy J Genovese
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, 300 1st Avenue, Boston, MA 02129, USA
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, 300 1st Avenue, Boston, MA 02129, USA; Rehabilitation Outcomes Center at Spaulding, Boston, MA, USA; Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Galicia KE, Mehta A, Kowalske KJ, Gibran NS, Stewart BT, McMullen K, Wolf SE, Ryan CM, Kubasiak J, Schneider JC. Preliminary Exploration of Long-Term Patient Outcomes After Tracheostomy in Burns: A Burn Model System Study. J Surg Res 2023; 291:221-230. [PMID: 37454428 PMCID: PMC10528102 DOI: 10.1016/j.jss.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/02/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Upper airway management is crucial to burn care. Endotracheal intubation is often performed in the setting of inhalation injury, burns of the face and neck, or large burns requiring significant resuscitation. Tracheostomy may be necessary in patients requiring prolonged ventilatory support. This study compares long-term, patient-reported outcomes in burn patients with and without tracheostomy. MATERIALS AND METHODS Data from the Burn Model System Database, collected from 2013 to 2020, were analyzed. Demographic and clinical data were compared between those with and without tracheostomy. The following patient-reported outcomes, collected at 6-, 12-, and 24-mo follow-up, were analyzed: Veterans RAND 12-Item Health Survey (VR-12), Satisfaction with Life, Community Integration Questionnaire, Patient-Reported Outcomes Measurement Information System 29-Item Profile Measure, employment status, and days to return to work. Regression models and propensity-matched analyses were used to assess the associations between tracheostomy and each outcome. RESULTS Of 714 patients included in this study, 5.5% received a tracheostomy. Mixed model regression analyses demonstrated that only VR-12 Physical Component Summary scores at 24-mo follow-up were significantly worse among those requiring tracheostomy. Tracheostomy was not associated with VR-12 Mental Component Summary, Satisfaction with Life, Community Integration Questionnaire, or Patient-Reported Outcomes Measurement Information System 29-Item Profile Measure scores. Likewise, tracheostomy was not found to be independently associated with employment status or days to return to work. CONCLUSIONS This preliminary exploration suggests that physical and psychosocial recovery, as well as the ability to regain employment, are no worse in burn patients requiring tracheostomy. Future investigations of larger scale are still needed to assess center- and provider-level influences, as well as the influences of various hallmarks of injury severity. Nonetheless, this work should better inform goals of care discussions with patients and families regarding the use of tracheostomy in burn injury.
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Affiliation(s)
- Kevin E Galicia
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois.
| | - Anupama Mehta
- Division of Trauma, Burn, and Surgical Care, Brigham and Women's Hospital, Boston, Massachusetts
| | - Karen J Kowalske
- Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Nicole S Gibran
- Department of Surgery, The University of Washington, Seattle, Washington
| | - Barclay T Stewart
- Department of Surgery, The University of Washington, Seattle, Washington
| | - Kara McMullen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Steven E Wolf
- Division of Burn and Trauma Surgery, University of Texas Medical Branch, Galveston, Texas
| | - Colleen M Ryan
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - John Kubasiak
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Charlestown, Massachusetts
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10
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Abouzeid CA, Santos E, Chacon KL, Ni P, Kelter BM, Gibran NS, Kowalske KJ, Kazis LE, Ryan CM, Schneider JC. Examining the impact of the COVID-19 pandemic on participants in a study of burn outcomes. Burns 2023; 49:1232-1235. [PMID: 37193614 PMCID: PMC10081876 DOI: 10.1016/j.burns.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 04/04/2023] [Indexed: 05/18/2023]
Affiliation(s)
- C A Abouzeid
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Charlestown, MA 02129, USA
| | - E Santos
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Charlestown, MA 02129, USA
| | - K L Chacon
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Charlestown, MA 02129, USA
| | - P Ni
- Department of Health Law, Policy, and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - B M Kelter
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Charlestown, MA 02129, USA
| | - N S Gibran
- Department of Surgery, The University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - K J Kowalske
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - L E Kazis
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Charlestown, MA 02129, USA; Department of Health Law, Policy, and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA; Rehabilitation Outcomes Center at Spaulding, Spaulding Rehabilitation, 300 1st Avenue, Charlestown, MA, 02129, USA
| | - C M Ryan
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Department of Surgery, Shriners Children's, 51 Blossom Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - J C Schneider
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Charlestown, MA 02129, USA; Rehabilitation Outcomes Center at Spaulding, Spaulding Rehabilitation, 300 1st Avenue, Charlestown, MA, 02129, USA; Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
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Wiechman SA, Amtmann D, Bocell FD, McMullen KA, Schneider JC, Rosenberg L, Rosenberg M, Carrougher GJ, Kowalske K, Ryan CM, Stewart BT, Gibran NS. Trajectories of physical health-related quality of life among adults living with burn injuries: A burn model system national database investigation to improve early intervention and rehabilitation service delivery. Rehabil Psychol 2023; 68:313-323. [PMID: 37347905 PMCID: PMC10527858 DOI: 10.1037/rep0000508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
INTRODUCTION Understanding trajectories of recovery in key domains can be used to guide patients, families, and caregivers. The purpose of this study was to describe common trajectories of physical health over time and to examine predictors of these trajectories. METHOD Adults with burn injuries completed self-reported assessments of their health-related quality of life (HRQOL) as measured by the SF-12® Physical Component Summary (PCS) score at distinct time points (preinjury via recall, index hospital discharge, and at 6-, 12-, and 24 months after injury). Growth mixture modeling (GMM) was used to model PCS scores over time. Covariables included burn size, participant characteristics, and scores from the Community Integration Questionnaire (CIQ)/Social Integration portion, Satisfaction With Life Scale (SWLS), and Satisfaction With Appearance Scale (SWAP). RESULTS Data from 939 participants were used for complete-case analysis. Participants were 72% male, 64% non-Hispanic White, with an average age of 44 years and an average burn size of 20% of total body surface area (TBSA). The best fitting model suggested three distinct trajectories (Class 1 through 3) for HRQOL. We titled each Class according to the characteristics of their trajectory. Class 1 (recovering; n = 632), Class 2 (static; n = 77), and Class 3 (weakened; n = 205) reported near average HRQOL preinjury, then reported lower scores at discharge, with Class 1 subsequently improving to preinjury levels and Class 3 improving but not reaching their preinjury quality of life. Class 3 experienced the largest decrease in HRQOL. Class 2 reported the lowest preinjury HRQOL and remained low for the next 2 years, showing minimal change in their HRQOL. CONCLUSIONS These findings emphasize the importance of early universal screening and sustained intervention for those most at risk for low HRQOL following injury. For Class 2 (static), lower than average HRQOL before their injury is a warning. For Class 3 (weakened), if the scores at 6 months show a large decline, then the person is at risk for not regaining their HRQOL by 24 months and thus needs all available interventions to optimize their outcomes. Results of this study provide guidance for how to identify people with burn injury who would benefit from more intensive rehabilitation to help them achieve or regain better HRQOL. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | - Dagmar Amtmann
- Department of Rehabilitation Medicine, Burn Model System National Data and Statistical Center, University of Washington
| | - Fraser D. Bocell
- Department of Rehabilitation Medicine, Burn Model System National Data and Statistical Center, University of Washington
| | - Kara A. McMullen
- Department of Rehabilitation Medicine, Burn Model System National Data and Statistical Center, University of Washington
| | - Jeffrey C. Schneider
- Department of Rehabilitation Medicine, Spaulding Rehabilitation Hospital, Harvard Medical School
| | - Laura Rosenberg
- Shriners Children’s Texas, University of Texas Medical Branch
| | - Marta Rosenberg
- Shriners Children’s Texas, University of Texas Medical Branch
| | | | | | - Colleen M. Ryan
- Department of Surgery, Mass General Surgery, Harvard Medical School
| | - Barclay T. Stewart
- Department of Surgery, Harborview Medical Center, University of Washington
| | - Nicole S. Gibran
- Department of Surgery, Harborview Medical Center, University of Washington
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12
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Galicia KE, Mehta A, Riviello R, Nitzschke S, Bamer A, Gibran NS, Stewart BT, Wolf SE, Ryan CM, Kubasiak J, Schneider JC. The Effect of Distance to Treatment Center on Long-Term Outcomes of Burn Patients. J Burn Care Res 2023; 44:624-630. [PMID: 35939346 PMCID: PMC9905382 DOI: 10.1093/jbcr/irac112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Indexed: 11/13/2022]
Abstract
Geospatial proximity to American Burn Association (ABA)-verified burn centers or self-designated burn care facilities varies across the country. This study evaluates the effect of distance to treatment center on long-term, patient-reported outcomes. Data from the Burn Model System (BMS) National Longitudinal Database were analyzed. Demographic and clinical data were compared between three cohorts stratified by distance to BMS center (<20, 20-49.9, ≥50 miles). Distance to BMS center was calculated as driving distance between discharge and BMS center ZIP code centroids. The following patient-reported outcomes, collected at 12-months follow-up, were examined: Veterans RAND 12-Item Health Survey (VR-12), Satisfaction with Life (SWL) scale, employment status, and days to return to work. Mixed model regression analyses were used to examine the associations between distance to BMS center and each outcome, controlling for demographic and clinical variables. Of 726 patients included in this study, 26.3% and 28.1% were <20 and between 20 and 49.9 miles to a BMS center, respectively; 46.6% were ≥50 miles to a BMS center. Greater distance was associated with white/non-Hispanic race/ethnicity, preinjury employment, flame injury, and larger burn size (P < .001). Regression analyses did not identify significant associations between distance to BMS center and any patient-reported outcomes. This study suggests that patients treated at BMS centers have similar long-term, patient-reported outcomes of physical and psychosocial function, as well as employment, despite centralization of burn care and rehabilitation services. Given a steady decline in the incidence of burn injury, continued concentration of key resources is logical and safe.
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Affiliation(s)
- Kevin E Galicia
- Address correspondence to Kevin E. Galicia, MD, Department of Surgery, Loyola University Medical Center, 2160 S. First Ave, Maywood, IL 60153, USA.
| | - Anupama Mehta
- Division of Trauma, Burn, and Surgical Care, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Robert Riviello
- Division of Trauma, Burn, and Surgical Care, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Stephanie Nitzschke
- Division of Trauma, Burn, and Surgical Care, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Alyssa Bamer
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Nicole S Gibran
- Department of Surgery, The University of Washington, Seattle, Washington, USA
| | - Barclay T Stewart
- Department of Surgery, The University of Washington, Seattle, Washington, USA
| | - Steven E Wolf
- Division of Burn and Trauma Surgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Colleen M Ryan
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - John Kubasiak
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
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13
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Totman AA, Lamm AG, Goldstein R, Giacino JT, Bodien YG, Ryan CM, Schneider JC, Zafonte R. Longitudinal Trends in Severe Traumatic Brain Injury Inpatient Rehabilitation. J Head Trauma Rehabil 2023; 38:E186-E194. [PMID: 36730991 PMCID: PMC10102246 DOI: 10.1097/htr.0000000000000814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The goal of this study is to describe national trends in inpatient rehabilitation facility (IRF) discharges for the most severely disabled cohort of patients with traumatic brain injury (TBI). METHODS Data from the Uniform Data System for Medical Rehabilitation for patients discharged from an IRF between January 1, 2002, and December 31, 2017, with a diagnosis of TBI and an admission Functional Independence Measure of 18, the lowest possible score, were obtained and analyzed. RESULTS Of the 252 112 patients with TBI discharged during the study period, 10 098 met the study criteria. From 2002 to 2017, the number of patients with an IRF admission Functional Independence Measure of 18 following TBI discharged from IRFs annually decreased from 649 to 488, modeled by a negative regression (coefficient = -2.97; P = .001), and the mean age (SD) increased from 43.0 (21.0) to 53.7 (21.3) years (coefficient = 0.70; P < .001). During the study period, the number of patients with the most severe disability on admission to IRF who were discharged annually as a proportion of total patients with TBI decreased from 5.5% to 2.5% (odds ratio = 0.95; P < .001) and their mean length of stay decreased from 41.5 (36.2) to 29.3 (24.9) days (coefficient = -0.83; P < .001]. CONCLUSION The number and proportion of patients with the most severe disability on IRF admission following TBI who are discharged from IRFs is decreasing over time. This may represent a combination of primary prevention, early mortality due to withdrawal of life-sustaining treatment, alternative discharge dispositions, or changes in admitting and reimbursement practices. Furthermore, there has been a decrease in the duration of IRF level care for these individuals, which could ultimately lead to poorer functional outcomes, particularly given the importance of specialized rehabilitative care in this population.
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Affiliation(s)
- Alissa A Totman
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts (Drs Totman, Goldstein, Giacino, Bodien, Ryan, Schneider, and Zafonte); Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts (Drs Totman, Goldstein, Giacino, Bodien, Ryan, Schneider, and Zafonte); Mary Free Bed Rehabilitation Hospital, Grand Rapids, Michigan (Dr Lamm); Massachusetts General Hospital, Boston, Massachusetts (Drs Giacino, Ryan, and Zafonte); Shriners Hospitals for Children, Boston, Massachusetts (Dr Ryan); and Brigham and Women's Hospital, Boston, Massachusetts (Dr Zafonte)
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14
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Martz F, McMullen KA, Carrougher GJ, Bunnell A, Sheckter CC, Wolf SE, Schneider JC, Stewart BT. Impacts of Financial Assistance on Quality of Life Among People Living With Burn Injury: Matched Cohort Analysis of the National Institute on Disability, Independent Living and Rehabilitation Research Burn Model System Database. J Burn Care Res 2023; 44:363-372. [PMID: 35699664 DOI: 10.1093/jbcr/irac079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Indexed: 11/14/2022]
Abstract
Disparities in socioeconomic status and minority status affect the risk of burn injury and the severity of that injury, thus affecting the subsequent cost of care. We aimed to characterize the demographic details surrounding receipt of financial assistance due to burn injury and its relationship with health-related quality of life scores. Participants ≥18 from Burn Model System National Longitudinal Database (BMS) with complete demographic data were included (n = 4330). Nonresponders to financial assistance questions were analyzed separately. The remaining sample (n = 1255) was divided into participants who received financial assistance because of burn injury, those who received no financial assistance, and those who received financial assistance before injury and as a result of injury. A demographic and injury-characteristic comparison was conducted. Health-related quality of life metrics (Satisfaction with Life, Short Form-12/Veterans RAND 12-Item Health Survey, Community Integration Questionnaire Social Component, and the Post-Traumatic Growth Inventory) were analyzed preinjury, then 6-months, 1-year, and 2-years postinjury. A matched cohort analysis compared these scores. When compared to their no financial assistance counterparts, participants receiving financial assistance due to burns were more likely to be minorities (19% vs 14%), have more severe injuries (%TBSA burn 21% vs 10%), and receive workers' compensation (24% vs 9%). They also had lower health-related quality of life scores on all metrics except the post-traumatic growth inventory. Financial assistance may aid in combating disparities in posttraumatic growth scores for participants at the greatest risk of financial toxicity but does not improve other health-related quality of life metrics.
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Affiliation(s)
- Flora Martz
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Kara A McMullen
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington, Seattle, USA.,Department of Rehabilitation Medicine, University of Washington, Seattle, USA
| | - Gretchen J Carrougher
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington, Seattle, USA
| | - Aaron Bunnell
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington, Seattle, USA
| | | | - Steven E Wolf
- Department of Surgery, The University of Texas Medical Branch, Galveston, USA.,Shriners Children's, Texas, Galveston, USA
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Barclay T Stewart
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington, Seattle, USA.,Harborview Injury Prevention and Research Center, Seattle, Washington, USA
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15
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Deng H, Vu KQ, Franco JR, Shepler LJ, Abouzeid CA, Hamner JW, Mercier HW, Taylor JA, Kazis LE, Slavin MD, Ryan CM, Schneider JC. Digital Interventions for Social Participation in Adults with Long-term Physical Conditions: A Systematic Review. J Med Syst 2023; 47:26. [PMID: 36792791 PMCID: PMC9931567 DOI: 10.1007/s10916-023-01914-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 01/20/2023] [Indexed: 02/17/2023]
Abstract
This review aims to identify and evaluate digital interventions for social participation in the growing population of adults with long-term physical conditions. Articles were sourced from MEDLINE, EMBASE, CINAHL and PsycINFO databases using subject headings and keywords related to "social participation" and "digital technology". Studies that adopted digital technology interventions to improve social participation in adults with long-term physical conditions were included. Data on study methodology, participant and digital intervention characteristics, and findings related to social participation were extracted. The search yielded a total of 4646 articles and 14 articles met criteria for final review with five randomized controlled trials, two non-randomized clinical trials and seven one-group pretest-posttest clinical trials. Studies were organized based on the digital intervention strategy implemented to improve social participation: group support (n = 4), individual skill training or counseling (n = 6), education and support (n = 3), and mixed intervention (n = 1). The group support interventions developed a social network among participants through videoconference, app, or virtual reality platform. Three studies reported positive improvements in different aspects of social participation. Individual skill training or counseling mainly utilized phone calls to help participants cope with activity participation and interpersonal relationship issues. Only two studies demonstrated benefits for social participation. The education and support intervention, which used messages and website information to increase participants' knowledge and provide support, showed positive findings in three studies. This review suggests digital interventions for improving social participation in adults with long-term physical conditions are feasible and the effectiveness of different strategies may vary.Registration: This review was prospectively registered on the International Prospective Register of Systematic Reviews (PROSPERO) (registry number: CRD42021254105).
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Affiliation(s)
- Huan Deng
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Boston, MA, 02129, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Kevin Q Vu
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Boston, MA, 02129, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Jessie R Franco
- Department of Rehabilitation Services, Brigham and Women's Hospital, Boston, MA, USA
| | - Lauren J Shepler
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Boston, MA, 02129, USA
| | - Cailin A Abouzeid
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Boston, MA, 02129, USA
| | - J W Hamner
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Boston, MA, 02129, USA
| | - Hannah W Mercier
- Occupational Therapy Program, Stony Brook University, Stony Brook, NY, USA
| | - J Andrew Taylor
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Cardiovascular Research Laboratory, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Lewis E Kazis
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Boston, MA, 02129, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Mary D Slavin
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Boston, MA, 02129, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Colleen M Ryan
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Shriners Hospitals for Children-Boston®, Boston, MA, USA
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Boston, MA, 02129, USA.
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA, USA.
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16
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Bhalla A, Bamer AM, Temes C, Roaten K, Carrougher GJ, Schneider JC, Stoddard FJ, Stewart B, Gibran NS, Wiechman SA. Posttraumatic Stress Disorder Symptom Clusters as Predictors of Pain Interference in Burn Survivors: A Burn Model System National Database Study. J Burn Care Res 2023; 44:27-34. [PMID: 35866527 PMCID: PMC9990905 DOI: 10.1093/jbcr/irac088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Individuals who experience burns are at higher risk of developing posttraumatic stress disorder and chronic pain. A synergistic relationship exists between posttraumatic stress disorder and chronic pain. We sought to evaluate the role of individual posttraumatic stress disorder symptom clusters as predictors of pain interference. We hypothesized that the hyperarousal and emotional numbing symptom clusters would be predictive of pain interference, even when accounting for the other two posttraumatic stress disorder symptom clusters, pain intensity, and other covariates. Multivariate linear regression analyses were completed using data from the Burn Model System National Database. A total of 439 adult participants had complete responses on self-report measures assessing posttraumatic stress disorder symptoms, pain intensity, and pain interference at 6-month after discharge and were included in analyses. Results indicate hyperarousal (B = .10, p = .03) and emotional numbing (B = .13, p = .01) posttraumatic stress disorder symptom clusters were each significantly associated with pain interference, even when accounting for pain intensity (B = .64, p < .001). Results highlight the importance of the emotional numbing and hyperarousal posttraumatic stress disorder symptom clusters in explaining pain interference. Findings suggest that when posttraumatic stress disorder symptoms or chronic pain are present, screening for and treating either condition may be warranted to reduce pain interference. Further, psychological interventions that target emotional numbing and hyperarousal posttraumatic stress disorder symptoms may be fruitful for promoting better coping with chronic pain and reducing pain interference.
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Affiliation(s)
- Arjun Bhalla
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Alyssa M. Bamer
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Christina Temes
- Department of Psychiatry, Massachusetts General Hospital, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kimberly Roaten
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Jeffrey C. Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Spaulding Research Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Frederick J. Stoddard
- Department of Psychiatry, Massachusetts General Hospital, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Barclay Stewart
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Nicole S. Gibran
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Shelley A. Wiechman
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
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17
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Kelter BM, Shepler LJ, Ni P, Kazis LE, Stewart BT, Ryan CM, Schneider JC. Community Socioeconomic Status is Associated With Social Participation Outcomes. J Burn Care Res 2023; 44:222-223. [PMID: 36371723 PMCID: PMC9839542 DOI: 10.1093/jbcr/irac172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Indexed: 11/14/2022]
Affiliation(s)
- Brian M. Kelter
- Mass General Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lauren J. Shepler
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | - Pengsheng Ni
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Lewis E. Kazis
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
- Rehabilitation Outcomes Center at Spaulding, Spaulding Rehabilitation Network, Charlestown, Massachusetts, USA
| | - Barclay T. Stewart
- Department of Surgery, The University of Washington, Seattle, Washington, USA
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
| | - Colleen M. Ryan
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Surgery, Shriners Children’s, Boston, Massachusetts, USA
| | - Jeffrey C. Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Rehabilitation Outcomes Center at Spaulding, Spaulding Rehabilitation Network, Charlestown, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
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18
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Sparling TL, Yih ET, Goldstein R, Slocum CS, Ryan CM, Zafonte R, Schneider JC. Development of a 30-Day Readmission Risk Calculator for the Inpatient Rehabilitation Setting. J Am Med Dir Assoc 2022; 23:1964-1970. [PMID: 36150407 PMCID: PMC9926973 DOI: 10.1016/j.jamda.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/02/2022] [Accepted: 08/08/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Readmission to acute care from the inpatient rehabilitation facility (IRF) setting is potentially preventable and an important target of quality improvement and cost savings. The objective of this study was to develop a risk calculator to predict 30-day all-cause readmissions from the IRF setting. DESIGN Retrospective database analysis using the Uniform Data System for Medical Rehabilitation (UDSMR) from 2015 through 2019. SETTING AND PARTICIPANTS In total, 956 US inpatient rehabilitation facilities and 1,849,768 IRF discharges comprising patients from 14 impairment groups. METHODS Logistic regression models were developed to calculate risk-standardized 30-day all-cause hospital readmission rates for patients admitted to an IRF. Models for each impairment group were assessed using 12 common clinical and demographic variables and all but 4 models included various special variables. Models were assessed for discrimination (c-statistics), calibration (calibration plots), and internal validation (bootstrapping). A readmission risk scoring system was created for each impairment group population and was graphically validated. RESULTS The mean age of the cohort was 68.7 (15.2) years, 50.7% were women, and 78.3% were Caucasian. Medicare was the primary payer for 73.1% of the study population. The final models for each impairment group included between 4 and 13 total predictor variables. Model c-statistics ranged from 0.65 to 0.70. There was good calibration represented for most models up to a readmission risk of 30%. Internal validation of the models using bootstrap samples revealed little bias. Point systems for determining risk of 30-day readmission were developed for each impairment group. CONCLUSIONS AND IMPLICATIONS Multivariable risk factor algorithms based upon administrative data were developed to assess 30-day readmission risk for patients admitted from IRF. This report represents the development of a readmission risk calculator for the IRF setting, which could be instrumental in identifying high risk populations for readmission and targeting resources towards a diverse group of IRF impairment groups.
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Affiliation(s)
- Tawnee L Sparling
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Erika T Yih
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Richard Goldstein
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Chloe S Slocum
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA; Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Colleen M Ryan
- Surgical Services, Shriners Hospitals for Children, Boston, MA, USA; Sumner Redstone Burn Center, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA; Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA; Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Ryan CM, Shapiro GD, Rencken CA, Griggs C, Jeng JC, Hickerson WL, Marino M, Goverman J, Kazis LE, Schneider JC. The Impact of Burn Size on Community Participation: A Life Impact Burn Recovery Evaluation (LIBRE) Study. Ann Surg 2022; 276:1056-1062. [PMID: 33351466 PMCID: PMC8265012 DOI: 10.1097/sla.0000000000004703] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the association of burn size and community participation as measured by the LIBRE Profile. SUMMARY OF BACKGROUND DATA Burn size is an established clinical predictor of survival after burn injury. It is often a factor in guiding decisions surrounding early medical interventions; however, literature is inconclusive on its relationship to quality of life outcomes. METHODS This is a secondary data analysis of a cross-sectional survey of adult burn survivors. Self-reported data were collected between October 2014 and December 2015 from 601 burn survivors aged ≥18 years with ≥5% total body surface area (TBSA) or burns to critical areas. Sociodemographic characteristics were compared between participants with small burns (≤40% TBSA burned) and large burns (>40% TBSA burned). Ordinary least squares regression models examined associations between burn size and LIBRE Profile scale scores with adjustments for sex, current work status, burns to critical areas, and time since burn injury. RESULTS The analytic sample comprised 562 participants with data available for burn size. 42% of respondents had large burns (>40% TBSA burned) and 58% reported smaller burns (TBSA ≤40%). In adjusted regression models, patients with large burns tended to score lower on the Social Activities and Work & Employment scales ( P < 0.05) and higher on the Family & Friends scale ( P < 0.05). Participants with burns >40% TBSA scored lower for several individual items in the Social Activities scale and one item in the Work & Employment scale ( P < 0.05). CONCLUSIONS Increasing burn size was found to be negatively associated with selected items of Work & Employment and Social Activities, but positively associated with aspects of Family & Friend Relationships. Future longitudinal studies are necessary to assess and understand the long-term social impact of burn injuries on adult populations.
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Affiliation(s)
- Colleen M. Ryan
- Department of Surgery, Massachusetts General Hospital, Boston, MA
- Shriners Hospitals for Children – Boston, Boston, MA
- Harvard Medical School, Boston, MA
| | - Gabriel D. Shapiro
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | | | - Cornelia Griggs
- New York Presbyterian/Morgan Stanley Children’s Hospital Department of Pediatric Radiology and Surgery, New York, NY, USA
| | - James C. Jeng
- Nathan Speare Regional Burn Treatment Center, Crozer-Chester Medical Center, Upland, PA
| | | | - Molly Marino
- Quality Measurement and Health Policy Program, RTI International, Waltham, MA
| | - Jeremy Goverman
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Lewis E. Kazis
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA
| | - Jeffrey C. Schneider
- Harvard Medical School, Boston, MA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA
- Spaulding Research Institute, Boston, MA
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20
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Rodríguez-Mercedes SL, Patel KF, Rencken CA, Grant GG, Surette K, Kinney EM, Brady KJ, Slavin MD, Schneider JC, Stoddard FJ, Kazis LE, Ryan CM. Item Pool Development for the School-Aged Life Impact Burn Recovery Evaluation Profile Computerized Adaptive Test: An Observer-Reported Outcome Assessment Measuring the Impact of Burn Injuries in School-Aged Children. J Burn Care Res 2022; 43:1114-1128. [PMID: 34965302 PMCID: PMC9255664 DOI: 10.1093/jbcr/irab247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The transition from early childhood to teen years (5-12) is a critical time of development, which can be made particularly challenging by a burn injury. Assessing postburn recovery during these years is important for improving pediatric survivors' development and health outcomes. Few validated burn-specific measures exist for this age group. The purpose of this study was to generate item pools that will be used to create a future computerized adaptive test (CAT) assessing postburn recovery in school-aged children. Item pool development was guided by the previously developed School-Aged Life Impact Burn Recovery Evaluation (SA-LIBRE5-12) conceptual framework. The item pool development process involved a systematic literature review, extraction of candidate items from existing legacy measures, iterative item review during expert consensus meetings, and parent cognitive interviews. The iterative item review with experts consisted of six rounds. A total of 10 parent cognitive interviews were conducted. The three broad themes of concern were items that needed 1) clarification, needed context, or were vague, 2) age dependence and relevance, and 3) word choice. The cognitive interviews indicated that survey instructions, recall period, item stem, and response choices were interpretable by respondents. Final item pool based on parental feedback consists of 57, 81, and 60 items in physical, psychological, and family and social functioning, respectively. Developed item pools (n = 198) in three domains are consistent with the existing conceptual framework. The next step involves field testing the item pool and calibration using item response theory to develop and validate the SA-LIBRE5-12 CAT Profile.
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Affiliation(s)
| | - Khushbu F. Patel
- Shriners Hospitals for Children – Boston, Boston, MA
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Camerin A. Rencken
- Shriners Hospitals for Children – Boston, Boston, MA
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Gabrielle G. Grant
- University of North Carolina at Chapel Hill, School of Nursing, Hillman Scholars in Nursing Innovation, Chapel Hill, NC
| | - Kate Surette
- Shriners Hospitals for Children – Boston, Boston, MA
| | | | - Keri J.S. Brady
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA
| | - Mary D. Slavin
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA
| | - Jeffrey C. Schneider
- Harvard Medical School, Boston, MA
- Department of Physical Medicine and Rehabilitation, Spaulding Research Institute, Spaulding Rehabilitation Hospital, Boston, MA
| | - Frederick J. Stoddard
- Shriners Hospitals for Children – Boston, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Lewis E. Kazis
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Physical Medicine and Rehabilitation, Spaulding Research Institute, Spaulding Rehabilitation Hospital, Boston, MA
| | - Colleen M. Ryan
- Shriners Hospitals for Children – Boston, Boston, MA
- Department of Surgery, Massachusetts General Hospital, Boston, MA
- Department of Physical Medicine and Rehabilitation, Spaulding Research Institute, Spaulding Rehabilitation Hospital, Boston, MA
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21
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Affiliation(s)
- Juan P Herrera-Escobar
- From Harvard Medical School (J.P.H.-E., J.C.S.), the Department of Surgery, Brigham and Women's Hospital (J.P.H.-E.), and the Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital (J.C.S.), Boston, and the Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown (J.C.S.) - all in Massachusetts
| | - Jeffrey C Schneider
- From Harvard Medical School (J.P.H.-E., J.C.S.), the Department of Surgery, Brigham and Women's Hospital (J.P.H.-E.), and the Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital (J.C.S.), Boston, and the Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown (J.C.S.) - all in Massachusetts
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22
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Deng H, Abouzeid CA, Shepler LJ, Slavin MD, Taylor JA, Mercier HW, Herrera-Escobar JP, Kazis LE, Ryan CM, Schneider JC. Using digital phenotyping to characterize psychosocial trajectories for people with burn injury. Burns 2022; 48:1262-1266. [PMID: 35504767 PMCID: PMC9357168 DOI: 10.1016/j.burns.2022.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 04/18/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Huan Deng
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Cailin A. Abouzeid
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Lauren J. Shepler
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Mary D. Slavin
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - J. Andrew Taylor
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Lewis E. Kazis
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Colleen M. Ryan
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,Shriners Hospitals for Children-Boston®, Boston, MA, USA
| | - Jeffrey C. Schneider
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA,Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,Correspondence to: Spaulding Rehabilitation Hospital, 300 1st Avenue, Boston, MA 02129, USA., (J.C. Schneider)
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23
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Rontoyanni VG, Kudlicki A, Palackic A, Gibran N, Stewart B, Schneider JC, Ryan CM, Murton AJ, Wolf SE, Kowalske K, Suman OE. Strength of association between body mass index and physical function scores in paediatric burn patients: A National Institute on Disability, Independent Living, and Rehabilitation Research Burn Model System study. Burns 2022; 48:824-832. [PMID: 35410694 PMCID: PMC9232948 DOI: 10.1016/j.burns.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/08/2022] [Accepted: 03/03/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Increased body weight has been associated with reduced muscle wasting in the early catabolic phase after a severe burn. Yet, overweight and obese non-burn children often exhibit impaired musculoskeletal function, which may lead to poor physical function (PF). We aimed to determine the association between body mass index (BMI) at discharge and self-reported PF and caregiver proxy-reported PF during recovery of burned children. MATERIALS AND METHODS This is a retrospective multisite longitudinal study in paediatric burn patients ((8-17 y old at time of burn). PF outcome measures were self-reported mobility, proxy-reported mobility, and upper extremity PF evaluated using PROMIS measures at 6-, 12-, and 24-months after injury. Primary exposure variable was BMI-for-age at discharge. RESULTS A total of 118 paediatric patients, aged 11.7 ± 3.3 y, with burns covering 37.6 ± 18.8% of their total body surface area (TBSA) and BMI-for-age of 23.1 ± 5.4 kg/m2 at discharge were analyzed. BMI at discharge was not significantly associated with self-reported mobility scores 6 months after burn (beta coefficient =-0.23, p = 0.31), had a positive effect on mobility at 12 months (beta = 0.46, p = 0.05), and no effect at 24 months after injury (beta=-0.10, p = 0.60), when adjusted for burn size. BMI did not have a significant effect on proxy-reported mobility or upper extremity PF. CONCLUSION A greater BMI at discharge was associated with improved self-reported PF at 12 months after burn but not at 6 months or 24 months, which suggests a faster recovery of PF in paediatric patients of larger body weight. Our data suggests that a larger body weight does not compromise the recovery of PF after burn.
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Affiliation(s)
| | - Andrew Kudlicki
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Alen Palackic
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA,Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Nicole Gibran
- UW Medicine Regional Burn Center, Department of Surgery, University of Washington, Seattle, WA
| | - Barclay Stewart
- UW Medicine Regional Burn Center, Department of Surgery, University of Washington, Seattle, WA,Harborview Injury Prevention & Research Center, Seattle, WA, USA
| | - Jeffrey C. Schneider
- Spaulding Rehabilitation Hospital, Spaulding Research Institute, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Colleen M. Ryan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Shriners Hospital for Children-Boston, Boston, MA, USA
| | - Andrew J. Murton
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Steven E. Wolf
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Karen Kowalske
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Oscar E. Suman
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA,Corresponding author: Oscar E. Suman, PhD, Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0737; Office: 409.772.3889; Fax: 409.747.0966;
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Kelter BM, Shepler LJ, Stewart BT, Wolf SE, Mandell SP, Kazis LE, Ryan CM, Schneider JC. 27 Pain Medication Use at Follow up Is Associated with Long-term Outcomes. J Burn Care Res 2022. [PMCID: PMC8945414 DOI: 10.1093/jbcr/irac012.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Introduction Use of prescription pain medication after burn injury is commonly required. However, little is known about long-term pain medication use and its association with outcomes. Therefore, the purpose of this study is to assess patterns of prescription pain medication use after discharge and the association between these medications and quality of life outcomes. Methods Data from the Burn Model System National Longitudinal Database (2015-2021) were analyzed. Pain medication use was assessed at pre-injury (recall at discharge), discharge (medical record) and follow-up (self-report at 6, 12, and 24 months after injury). Outcome measures included: VR-12 Physical and Mental Component Summary scores (PCS and MCS), Community Integration Questionnaire (CIQ), Posttraumatic Stress Disorder Checklist (PCL), Satisfaction with Life Scale (SWLS), and NeuroQOL Stigma. The population was divided into two groups, those taking and not taking prescription pain medications at one year. Regression analyses examined associations between prescription pain medication use and outcomes at 12 months, controlling for age, gender, race, ethnicity and burn size. Results Of the 645 participants, 15% reported prescription pain medication use prior to their burn. At discharge, 81% reported use of an opioid and 46% reported use of a neuropathic pain medication. At 12 months, 32% of individuals indicated prescription pain medication use. The pain medication group exhibited larger burn size (24.0% vs 15.2%) and longer hospital stays (40.4 vs 25.0 days) than the non-pain medication group (p< 0.0001 for all). Additionally, 25% of individuals who reported pre-injury pain medication use also reported use at 12 months. Regression analyses demonstrated that pain medication use was associated with worse physical health (PCS: coefficient 8.69, p< 0.0001) mental health (MCS: 6.31, p< 0.0001), stigma (NeuroQOL Stigma: 3.91, p< 0.0001), and satisfaction with life (SWLS: -3.66, p< 0.0001) at one year. Additionally, pain medication use was associated with 45% decreased odds of being employed (coefficient 0.55, p=0.029) and approximately 3 times greater odds of having post-traumatic stress disorder at 12 months (coefficient 3.25, p< 0.0001). Conclusions There are significant associations between prescription pain medication use and worse physical, mental and employment outcomes at twelve months. This information may be used to trigger screening and manage long-term recovery outcomes.
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Affiliation(s)
- Brian M Kelter
- Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; University of Washington, Seattle, Washington; University of Texas Medical Branch at Galveston, Galveston, Texas; UT Southwestern, Parkland Regional Burn Center, Dallas, Texas; Boston University School of Public Health, Spaulding Rehabilitation Hospital, Harvard Medical School, Bost
| | - Lauren J Shepler
- Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; University of Washington, Seattle, Washington; University of Texas Medical Branch at Galveston, Galveston, Texas; UT Southwestern, Parkland Regional Burn Center, Dallas, Texas; Boston University School of Public Health, Spaulding Rehabilitation Hospital, Harvard Medical School, Bost
| | - Barclay T Stewart
- Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; University of Washington, Seattle, Washington; University of Texas Medical Branch at Galveston, Galveston, Texas; UT Southwestern, Parkland Regional Burn Center, Dallas, Texas; Boston University School of Public Health, Spaulding Rehabilitation Hospital, Harvard Medical School, Bost
| | - Steven E Wolf
- Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; University of Washington, Seattle, Washington; University of Texas Medical Branch at Galveston, Galveston, Texas; UT Southwestern, Parkland Regional Burn Center, Dallas, Texas; Boston University School of Public Health, Spaulding Rehabilitation Hospital, Harvard Medical School, Bost
| | - Samuel P Mandell
- Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; University of Washington, Seattle, Washington; University of Texas Medical Branch at Galveston, Galveston, Texas; UT Southwestern, Parkland Regional Burn Center, Dallas, Texas; Boston University School of Public Health, Spaulding Rehabilitation Hospital, Harvard Medical School, Bost
| | - Lewis E Kazis
- Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; University of Washington, Seattle, Washington; University of Texas Medical Branch at Galveston, Galveston, Texas; UT Southwestern, Parkland Regional Burn Center, Dallas, Texas; Boston University School of Public Health, Spaulding Rehabilitation Hospital, Harvard Medical School, Bost
| | - Colleen M Ryan
- Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; University of Washington, Seattle, Washington; University of Texas Medical Branch at Galveston, Galveston, Texas; UT Southwestern, Parkland Regional Burn Center, Dallas, Texas; Boston University School of Public Health, Spaulding Rehabilitation Hospital, Harvard Medical School, Bost
| | - Jeffrey C Schneider
- Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; University of Washington, Seattle, Washington; University of Texas Medical Branch at Galveston, Galveston, Texas; UT Southwestern, Parkland Regional Burn Center, Dallas, Texas; Boston University School of Public Health, Spaulding Rehabilitation Hospital, Harvard Medical School, Bost
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25
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McMullen K, Bamer AM, Humbert A, Ryan CM, Schneider JC, Kazis LE, Stewart BT, Suman-Vejas OE, Amtmann D. 80 Validation of PROMIS-25 Among Children Living with Burn Injuries. J Burn Care Res 2022. [PMCID: PMC8945411 DOI: 10.1093/jbcr/irac012.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Introduction Patient-reported outcomes are important for burn injury research and clinical practice. The NIH-funded Patient Reported Outcomes Measurement System (PROMIS)-25 profile has been validated for use in diverse populations of children with many conditions, though not among children living with burn injuries. The purpose of this study was to examine the reliability and validity of PROMIS-25 scores in children living with burn injury. Methods Data were provided by children who were participating in a multi-center longitudinal study of outcomes after burn injury. The PROMIS-25 Profile, which includes 4 items for each domain of physical function mobility, anxiety, depression, fatigue, peer relationships, and pain interference, was evaluated for reliability and validity. Floor and ceiling effects, unidimensionality, internal consistency, and reliability were examined. Correlations with other measures (Post-Traumatic Growth Inventory-Child (PTGI-C), Child PTSD Symptom Scale (CPSS) and Burn Outcome Questionnaire Body Image Scale (BOQBI)) were calculated to assess concurrent validity. Results 256 children living with burn injury who sustained a moderate to severe injury provided responses on PROMIS-25 domains 6 months-10 years post burn. Participants’ age ranged from 8-18 years at time of assessment; mean years since injury was 4.3 (SD 4.1). All PROMIS-25 domains showed high internal consistency (Cronbach’s α=0.90–0.95). Substantial portions of the sample reported no symptoms (anxiety [58.2%], depressive symptoms [54.6%], fatigue [50.8%], pain [60.1%]). There was a large ceiling effect on peer relationships (46.8%) and physical function mobility (57.5%). One-factor confirmatory factor analyses supported unidimensionality for all domains (all CFI >0.98). Reliability was credible for group mean comparisons ( >0.8) across at least some trait levels for all domains except fatigue and anxiety which had low reliability (< 0.8) across the entire trait range. The magnitude and direction of correlations were as anticipated (0.32 for peer relationships and body image; 0.51 for depressive symptoms and PTSD) with the exception of weak negative correlations between PTGI-C and the anxiety and depression domains. Conclusions The results provide some evidence of reliability and validity of PROMIS-25 scores among children living with burn injury. Reliability of all domains was low to moderate and would likely be improved, and ceiling effects reduced, by administering the PROMIS-37, which includes 6 items per domain.
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Affiliation(s)
- Kara McMullen
- University of Washington, Portland, Oregon; University of Washington, Golden, Colorado; University of Washington, Seattle, Washington; Harvard Medical School, Boston, Massachusetts; , Massachusetts; Boston University School of Public Health, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts; University of Washington, Seattle, Washington; U of Texas Medical Branch, G
| | - Alyssa M Bamer
- University of Washington, Portland, Oregon; University of Washington, Golden, Colorado; University of Washington, Seattle, Washington; Harvard Medical School, Boston, Massachusetts; , Massachusetts; Boston University School of Public Health, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts; University of Washington, Seattle, Washington; U of Texas Medical Branch, G
| | - Andrew Humbert
- University of Washington, Portland, Oregon; University of Washington, Golden, Colorado; University of Washington, Seattle, Washington; Harvard Medical School, Boston, Massachusetts; , Massachusetts; Boston University School of Public Health, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts; University of Washington, Seattle, Washington; U of Texas Medical Branch, G
| | - Colleen M Ryan
- University of Washington, Portland, Oregon; University of Washington, Golden, Colorado; University of Washington, Seattle, Washington; Harvard Medical School, Boston, Massachusetts; , Massachusetts; Boston University School of Public Health, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts; University of Washington, Seattle, Washington; U of Texas Medical Branch, G
| | - Jeffrey C Schneider
- University of Washington, Portland, Oregon; University of Washington, Golden, Colorado; University of Washington, Seattle, Washington; Harvard Medical School, Boston, Massachusetts; , Massachusetts; Boston University School of Public Health, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts; University of Washington, Seattle, Washington; U of Texas Medical Branch, G
| | - Lewis E Kazis
- University of Washington, Portland, Oregon; University of Washington, Golden, Colorado; University of Washington, Seattle, Washington; Harvard Medical School, Boston, Massachusetts; , Massachusetts; Boston University School of Public Health, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts; University of Washington, Seattle, Washington; U of Texas Medical Branch, G
| | - Barclay T Stewart
- University of Washington, Portland, Oregon; University of Washington, Golden, Colorado; University of Washington, Seattle, Washington; Harvard Medical School, Boston, Massachusetts; , Massachusetts; Boston University School of Public Health, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts; University of Washington, Seattle, Washington; U of Texas Medical Branch, G
| | - Oscar E Suman-Vejas
- University of Washington, Portland, Oregon; University of Washington, Golden, Colorado; University of Washington, Seattle, Washington; Harvard Medical School, Boston, Massachusetts; , Massachusetts; Boston University School of Public Health, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts; University of Washington, Seattle, Washington; U of Texas Medical Branch, G
| | - Dagmar Amtmann
- University of Washington, Portland, Oregon; University of Washington, Golden, Colorado; University of Washington, Seattle, Washington; Harvard Medical School, Boston, Massachusetts; , Massachusetts; Boston University School of Public Health, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts; University of Washington, Seattle, Washington; U of Texas Medical Branch, G
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26
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Wiechman SA, Bhalla A, Bamer AM, Carrougher GJ, Stewart BT, Gibran NS, Schneider JC, Temes C, Stoddard FJJ, Roaten K. 122 PTSD Symptom Clusters as Predictors of Pain Interference in Burn Survivors. Journal of Burn Care & Research 2022. [PMCID: PMC8945520 DOI: 10.1093/jbcr/irac012.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Introduction Individuals who experience burns are at higher risk of developing post-traumatic stress disorder (PTSD) and chronic pain. There exists a synergistic relationship between PTSD and chronic pain in burn survivors. Theories exist about how aspects of each condition may perpetuate one another, or share underlying mechanisms. Both of these conditions are of relevance to pain-related disability. We sought to examine the role of individual PTSD symptom clusters as predictors of pain interference. We hypothesized that the hyperarousal and emotional numbing symptom clusters would be predictive of pain interference, even when accounting for the other two PTSD symptom clusters, pain intensity, and other covariates (burn size, hospital length of stay, age and gender). Methods Data were analyzed from the Burn Model System National Database. Inclusion criteria required participants to have a moderate to severe burn injury that required surgery for wound closure. Patient-reported outcome data: PTSD Checklist - Civilian, PROMIS-Pain Interference Short Form 4a, and a 0-10 average Pain Intensity item were analyzed at 6-months after injury. Hierarchical linear regression models were fit to examine the impact of PTSD symptom clusters on pain interference over and above that of pain intensity, and standardized betas were calculated (B). Results A total of 439 adult participants had complete responses on the measures of interest (e.g. PTSD symptoms, PROMIS-Pain Interference, and Pain Intensity) and were included in the analysis. Mean age, percent total body surface area burned, and hospital length of stay were 47 years, 18%, and 27 days, respectively. 69% were male and 82% were Caucasian. Results of a linear regression found that hyperarousal (B = .10, p = .03) and emotional numbing (B = .13, p = .01) PTSD symptom clusters were each significant predictors of pain-related disability, even when accounting for pain intensity (B = .64, p < .001). The covariates age, gender, days until discharge, and TBSA were all nonsignificant. The model accounted for 61% of the variance associated with pain-related disability. Conclusions Results highlight the importance of the emotional numbing and hyperarousal PTSD symptom clusters in explaining pain interference. Future evaluations parsing out the longitudinal relationships (i.e., beyond 6-months postburn) between PTSD symptom clusters, pain intensity, and pain interference, as well as evaluating other underlying mechanisms, are warranted.
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Affiliation(s)
- Shelley A Wiechman
- University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Golden, Colorado; Department of Surgery, The University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; , Massachusetts; Massachusetts General Hospital/Spaulding Rehabilitation Hospital, Bosto
| | - Arjun Bhalla
- University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Golden, Colorado; Department of Surgery, The University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; , Massachusetts; Massachusetts General Hospital/Spaulding Rehabilitation Hospital, Bosto
| | - Alyssa M Bamer
- University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Golden, Colorado; Department of Surgery, The University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; , Massachusetts; Massachusetts General Hospital/Spaulding Rehabilitation Hospital, Bosto
| | - Gretchen J Carrougher
- University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Golden, Colorado; Department of Surgery, The University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; , Massachusetts; Massachusetts General Hospital/Spaulding Rehabilitation Hospital, Bosto
| | - Barclay T Stewart
- University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Golden, Colorado; Department of Surgery, The University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; , Massachusetts; Massachusetts General Hospital/Spaulding Rehabilitation Hospital, Bosto
| | - Nicole S Gibran
- University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Golden, Colorado; Department of Surgery, The University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; , Massachusetts; Massachusetts General Hospital/Spaulding Rehabilitation Hospital, Bosto
| | - Jeffrey C Schneider
- University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Golden, Colorado; Department of Surgery, The University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; , Massachusetts; Massachusetts General Hospital/Spaulding Rehabilitation Hospital, Bosto
| | - Christina Temes
- University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Golden, Colorado; Department of Surgery, The University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; , Massachusetts; Massachusetts General Hospital/Spaulding Rehabilitation Hospital, Bosto
| | - Frederick J J Stoddard
- University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Golden, Colorado; Department of Surgery, The University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; , Massachusetts; Massachusetts General Hospital/Spaulding Rehabilitation Hospital, Bosto
| | - Kimberly Roaten
- University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Golden, Colorado; Department of Surgery, The University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; , Massachusetts; Massachusetts General Hospital/Spaulding Rehabilitation Hospital, Bosto
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Shepler LJ, Carrougher GJ, Gibran NS, Kowalske KJ, Stewart BT, Ryan CM, Schneider JC. 73 Associations Between Pre-burn Occupation Type and Employment Outcomes at One Year. J Burn Care Res 2022. [PMCID: PMC8945243 DOI: 10.1093/jbcr/irac012.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction Reintegration into the workforce after burn injury is an important issue for survivors. In a 2012 systematic review, 28% of burn survivors never returned to any form of employment. Although pre-burn employment status is strongly associated with post-burn employment, there are little data on the role of pre-injury occupation type on workplace reintegration. The aim of this project was to assess the impact of occupation type on employment outcomes after burn injury. Methods Data from the National Institute on Disability, Independent Living, and Rehabilitation Research Burn Model System National Longitudinal Database from 2015 to 2021 were used to investigate the association between occupation type and employment outcomes. Occupation type was classified into two groups, Labor and Non-labor, using the U.S. Bureau of Labor Statistics Standard Occupational Classification System. Demographic and clinical data were compared between groups. Mixed regression analyses examined associations between pre-burn occupation type and post-burn employment outcomes (employment at 1 year, days to return to work), controlling for age, gender, race, ethnicity, pre-injury employment, and burn size. Results Of the 600 patients who were employed pre-injury, 247 (41%) identified with a non-labor occupation and 353 (59%) with labor occupations. The Labor group was more male (82% vs. 61%) and Hispanic (23% vs. 6%), younger (mean age 42.1 vs. 48.3 years), less educated (high school or less, 25% vs. 11%) and more likely to have been injured at work (28% vs. 14%) compared to the Non-labor group (p< 0.001 for all comparisons). Changes in occupation were seen from pre-injury to post-injury; 16% of working survivors changed from Non-labor to Labor and 13% from Labor to Non-labor occupation types. For those who did return to work after injury, the average time to return to work was greater for Labor compared to the Non-labor group (150 vs 100 days; p=0.003). Additionally, those in the pre-injury Labor group were less likely to be employed at 12 months compared to the Non-labor group (odds ratio = 0.41; p=0.009). Conclusions Pre-injury occupation type is associated with employment outcomes after injury. Therefore, occupation type can be used to inform vocational reintegration resources, such as vocational rehabilitation programs, to optimize survivor outcomes.
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Affiliation(s)
- Lauren J Shepler
- Spaulding Rehabilitation Hospital, Boston, Massachusetts; Department of Surgery, The University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; Department of Surgery, The University of Texas Southwestern Medical Center, Dallas- Fort worth, Texas; University of Washington, Seattle, Washington; Harvard Medical School, Boston, Massachusetts; , Massachusetts
| | - Gretchen J Carrougher
- Spaulding Rehabilitation Hospital, Boston, Massachusetts; Department of Surgery, The University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; Department of Surgery, The University of Texas Southwestern Medical Center, Dallas- Fort worth, Texas; University of Washington, Seattle, Washington; Harvard Medical School, Boston, Massachusetts; , Massachusetts
| | - Nicole S Gibran
- Spaulding Rehabilitation Hospital, Boston, Massachusetts; Department of Surgery, The University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; Department of Surgery, The University of Texas Southwestern Medical Center, Dallas- Fort worth, Texas; University of Washington, Seattle, Washington; Harvard Medical School, Boston, Massachusetts; , Massachusetts
| | - Karen J Kowalske
- Spaulding Rehabilitation Hospital, Boston, Massachusetts; Department of Surgery, The University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; Department of Surgery, The University of Texas Southwestern Medical Center, Dallas- Fort worth, Texas; University of Washington, Seattle, Washington; Harvard Medical School, Boston, Massachusetts; , Massachusetts
| | - Barclay T Stewart
- Spaulding Rehabilitation Hospital, Boston, Massachusetts; Department of Surgery, The University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; Department of Surgery, The University of Texas Southwestern Medical Center, Dallas- Fort worth, Texas; University of Washington, Seattle, Washington; Harvard Medical School, Boston, Massachusetts; , Massachusetts
| | - Colleen M Ryan
- Spaulding Rehabilitation Hospital, Boston, Massachusetts; Department of Surgery, The University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; Department of Surgery, The University of Texas Southwestern Medical Center, Dallas- Fort worth, Texas; University of Washington, Seattle, Washington; Harvard Medical School, Boston, Massachusetts; , Massachusetts
| | - Jeffrey C Schneider
- Spaulding Rehabilitation Hospital, Boston, Massachusetts; Department of Surgery, The University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; Department of Surgery, The University of Texas Southwestern Medical Center, Dallas- Fort worth, Texas; University of Washington, Seattle, Washington; Harvard Medical School, Boston, Massachusetts; , Massachusetts
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Surette KE, Ni P, Patel KF, Rodríguez-Mercedes SL, Rencken CA, Fabia R, Tully C, Palmieri TL, Romanowski KS, Warner P, Stoddard FJJ, Schneider JC, Kazis LE, Ryan CM. 66 The Association of Burn Size and Global Functioning: A Preschool LIBRE1-5 Study. J Burn Care Res 2022. [PMCID: PMC8946222 DOI: 10.1093/jbcr/irac012.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Introduction Between the ages of one and five, children gain increased mobility and begin to explore their surroundings. This makes them a particularly vulnerable age group for burn-related injuries, which can influence a child’s physical and psychosocial development. Previous research in adult burn survivors associated larger burn size with poorer functional outcomes for social activities. Currently, there are limited data on the association in preschool aged survivors between burn size and functioning. The aim of this study is to understand how demographic characteristics, particularly burn size, correlate with the global functioning items using data from the Preschool-LIBRE1-5 study. Methods The Preschool-LIBRE1-5 was field-tested with 426 parents of burn survivors. Eight global items assessed change in functioning in four domains (physical, psychological, communication & language, and social) compared to pre-burn functioning. Demographic variables included gender, race, age at survey completion, total body surface area burned (TBSA), ethnicity, and pain severity. Post-burn abilities were assessed with “Following the burn injury, my child lost abilities he/she had before the burn injury in…”, measured with a yes or no response and compared to other children without burns with, “Compared to other children in the same age, in general, how would you rate your child’s…”, measured with a 5-point Likert scale ranging from much worse to much better. Multivariate logistic regression with multiple imputation for missing values were used to measure the association between demographic characteristics and global items. Results The population had a mean age at time of burn injury of 1.9 + 1.1 years and mean TBSA% of 4.2 + 8.0. Of the 426 participants, 305 have a TBSA < 5%, 45 have a TBSA between 5%-15% and 45 have a TBSA >15%. Larger TBSA was associated with lower odds of abilities in functional status for all four global functioning items. Adjusted odd ratios with 95% CI’s included communication and language 0.57(0.35,0.93), physical function 0.55(0.37,0.83), social function 0.33(0.2,0.52), and psychological/behavioral function 0.49(0.31,0.75). There was also a negative correlation of larger TBSA with weaker social abilities of the child compared to other children without burns. Conclusions The findings of this study show a negative association between a child’s burn size and parent-reported functioning in the four domains post-burn injury. These findings may help clinicians improve pediatric recovery and rehabilitation.
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Affiliation(s)
- Kate E Surette
- Shriner's Hospitals for Children - Boston, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Children - Boston/MGH, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Seattle, Washington; Nationwide Children's Hospital, Columbus, Ohio; Children's National Ho
| | - Pengsheng Ni
- Shriner's Hospitals for Children - Boston, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Children - Boston/MGH, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Seattle, Washington; Nationwide Children's Hospital, Columbus, Ohio; Children's National Ho
| | - Khushbu F Patel
- Shriner's Hospitals for Children - Boston, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Children - Boston/MGH, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Seattle, Washington; Nationwide Children's Hospital, Columbus, Ohio; Children's National Ho
| | - Silvanys L Rodríguez-Mercedes
- Shriner's Hospitals for Children - Boston, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Children - Boston/MGH, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Seattle, Washington; Nationwide Children's Hospital, Columbus, Ohio; Children's National Ho
| | - Camerin A Rencken
- Shriner's Hospitals for Children - Boston, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Children - Boston/MGH, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Seattle, Washington; Nationwide Children's Hospital, Columbus, Ohio; Children's National Ho
| | - Renata Fabia
- Shriner's Hospitals for Children - Boston, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Children - Boston/MGH, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Seattle, Washington; Nationwide Children's Hospital, Columbus, Ohio; Children's National Ho
| | - Carrie Tully
- Shriner's Hospitals for Children - Boston, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Children - Boston/MGH, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Seattle, Washington; Nationwide Children's Hospital, Columbus, Ohio; Children's National Ho
| | - Tina L Palmieri
- Shriner's Hospitals for Children - Boston, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Children - Boston/MGH, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Seattle, Washington; Nationwide Children's Hospital, Columbus, Ohio; Children's National Ho
| | - Kathleen S Romanowski
- Shriner's Hospitals for Children - Boston, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Children - Boston/MGH, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Seattle, Washington; Nationwide Children's Hospital, Columbus, Ohio; Children's National Ho
| | - Petra Warner
- Shriner's Hospitals for Children - Boston, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Children - Boston/MGH, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Seattle, Washington; Nationwide Children's Hospital, Columbus, Ohio; Children's National Ho
| | - Frederick J J Stoddard
- Shriner's Hospitals for Children - Boston, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Children - Boston/MGH, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Seattle, Washington; Nationwide Children's Hospital, Columbus, Ohio; Children's National Ho
| | - Jeffrey C Schneider
- Shriner's Hospitals for Children - Boston, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Children - Boston/MGH, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Seattle, Washington; Nationwide Children's Hospital, Columbus, Ohio; Children's National Ho
| | - Lewis E Kazis
- Shriner's Hospitals for Children - Boston, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Children - Boston/MGH, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Seattle, Washington; Nationwide Children's Hospital, Columbus, Ohio; Children's National Ho
| | - Colleen M Ryan
- Shriner's Hospitals for Children - Boston, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Children - Boston/MGH, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Seattle, Washington; Nationwide Children's Hospital, Columbus, Ohio; Children's National Ho
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Patel KF, Ni P, Rodríguez-Mercedes SL, Surette KE, Rencken CA, Fabia R, Tully C, Palmieri TL, Romanowski KS, Warner P, Stoddard FJJ, Schneider JC, Kazis LE, Ryan CM. 124 The Relationship Between Social Functioning and Psychological Status: A preschool-libre1-5 Study. J Burn Care Res 2022. [PMCID: PMC8946294 DOI: 10.1093/jbcr/irac012.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction Dallas ages one to five are learning to make friends and interact with peers in situations where their social functioning may have a direct relationship with their mood. Dallas may be isolated from peers during the acute phase of burn recovery and face rejection by their peers during recovery. This could influence their psychological health through feelings of anxiety, loneliness, social withdrawal and/or defiant behavior. This study evaluates the relationship between social and psychological functioning using the data collected from the field-tested Preschool-LIBRE1-5 instrument. Methods Parents of burn survivors (n=426) completed Preschool-LIBRE1-5. Items from the psychological (48 items) and social (37 items) functioning domains were coded on a 5-point Likert scale ranging from 0 (never) to 4 (always) where higher scores denote better functioning. Confirmatory factor analysis was conducted for individual items in the social and psychological domains respectively. Regression model assessed the relationship between the social and psychological domains, controlling for demographic characteristics (gender, race, ethnicity, age at survey completion, burn size, and pain severity). Results Factor analysis identified three factors for social functioning: play, peer relations, and peer rejection. The psychological items confirmed a single factor that included dysregulation (negative behaviors and sleep), externalization (impulsivity and aggression), internalization (general anxiety and depression), and trauma (fear and avoidance). Distress items, also in the internalizing subdomain, weren’t strongly confirmed as part of this single scale. The subdomains with the lowest and highest mean scores in psychological domain were dysregulation (2.68 + 0.58) and depression (3.50 + 0.37), and in social domain were peer relation (2.39 + 0.95) and peer rejection (3.42 + 0.64) respectively. Adjusted regression analysis demonstrate that the social functioning domain has a significant relationship with psychological status (p < 0.004). Conclusions Analysis suggests a significant association between social functioning and psychological status. Results provide a basis for understanding the importance of these domains in relationship to each other.
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Affiliation(s)
- Khushbu F Patel
- Shriners Hospitals for Dallas - Boston/MGH, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Dallas - Boston, Boston, Massachusetts; Shriner's Hospitals for Dallas - Boston, Boston, Massachusetts; Shriners Hospitals for Dallas - Boston, Seattle, Washington; Nationwide Dallas's Hospital, Columbus, Ohio; Dallas's National Hospital, Wash
| | - Pengsheng Ni
- Shriners Hospitals for Dallas - Boston/MGH, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Dallas - Boston, Boston, Massachusetts; Shriner's Hospitals for Dallas - Boston, Boston, Massachusetts; Shriners Hospitals for Dallas - Boston, Seattle, Washington; Nationwide Dallas's Hospital, Columbus, Ohio; Dallas's National Hospital, Wash
| | - Silvanys L Rodríguez-Mercedes
- Shriners Hospitals for Dallas - Boston/MGH, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Dallas - Boston, Boston, Massachusetts; Shriner's Hospitals for Dallas - Boston, Boston, Massachusetts; Shriners Hospitals for Dallas - Boston, Seattle, Washington; Nationwide Dallas's Hospital, Columbus, Ohio; Dallas's National Hospital, Wash
| | - Kate E Surette
- Shriners Hospitals for Dallas - Boston/MGH, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Dallas - Boston, Boston, Massachusetts; Shriner's Hospitals for Dallas - Boston, Boston, Massachusetts; Shriners Hospitals for Dallas - Boston, Seattle, Washington; Nationwide Dallas's Hospital, Columbus, Ohio; Dallas's National Hospital, Wash
| | - Camerin A Rencken
- Shriners Hospitals for Dallas - Boston/MGH, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Dallas - Boston, Boston, Massachusetts; Shriner's Hospitals for Dallas - Boston, Boston, Massachusetts; Shriners Hospitals for Dallas - Boston, Seattle, Washington; Nationwide Dallas's Hospital, Columbus, Ohio; Dallas's National Hospital, Wash
| | - Renata Fabia
- Shriners Hospitals for Dallas - Boston/MGH, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Dallas - Boston, Boston, Massachusetts; Shriner's Hospitals for Dallas - Boston, Boston, Massachusetts; Shriners Hospitals for Dallas - Boston, Seattle, Washington; Nationwide Dallas's Hospital, Columbus, Ohio; Dallas's National Hospital, Wash
| | - Carrie Tully
- Shriners Hospitals for Dallas - Boston/MGH, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Dallas - Boston, Boston, Massachusetts; Shriner's Hospitals for Dallas - Boston, Boston, Massachusetts; Shriners Hospitals for Dallas - Boston, Seattle, Washington; Nationwide Dallas's Hospital, Columbus, Ohio; Dallas's National Hospital, Wash
| | - Tina L Palmieri
- Shriners Hospitals for Dallas - Boston/MGH, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Dallas - Boston, Boston, Massachusetts; Shriner's Hospitals for Dallas - Boston, Boston, Massachusetts; Shriners Hospitals for Dallas - Boston, Seattle, Washington; Nationwide Dallas's Hospital, Columbus, Ohio; Dallas's National Hospital, Wash
| | - Kathleen S Romanowski
- Shriners Hospitals for Dallas - Boston/MGH, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Dallas - Boston, Boston, Massachusetts; Shriner's Hospitals for Dallas - Boston, Boston, Massachusetts; Shriners Hospitals for Dallas - Boston, Seattle, Washington; Nationwide Dallas's Hospital, Columbus, Ohio; Dallas's National Hospital, Wash
| | - Petra Warner
- Shriners Hospitals for Dallas - Boston/MGH, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Dallas - Boston, Boston, Massachusetts; Shriner's Hospitals for Dallas - Boston, Boston, Massachusetts; Shriners Hospitals for Dallas - Boston, Seattle, Washington; Nationwide Dallas's Hospital, Columbus, Ohio; Dallas's National Hospital, Wash
| | - Frederick J J Stoddard
- Shriners Hospitals for Dallas - Boston/MGH, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Dallas - Boston, Boston, Massachusetts; Shriner's Hospitals for Dallas - Boston, Boston, Massachusetts; Shriners Hospitals for Dallas - Boston, Seattle, Washington; Nationwide Dallas's Hospital, Columbus, Ohio; Dallas's National Hospital, Wash
| | - Jeffrey C Schneider
- Shriners Hospitals for Dallas - Boston/MGH, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Dallas - Boston, Boston, Massachusetts; Shriner's Hospitals for Dallas - Boston, Boston, Massachusetts; Shriners Hospitals for Dallas - Boston, Seattle, Washington; Nationwide Dallas's Hospital, Columbus, Ohio; Dallas's National Hospital, Wash
| | - Lewis E Kazis
- Shriners Hospitals for Dallas - Boston/MGH, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Dallas - Boston, Boston, Massachusetts; Shriner's Hospitals for Dallas - Boston, Boston, Massachusetts; Shriners Hospitals for Dallas - Boston, Seattle, Washington; Nationwide Dallas's Hospital, Columbus, Ohio; Dallas's National Hospital, Wash
| | - Colleen M Ryan
- Shriners Hospitals for Dallas - Boston/MGH, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Dallas - Boston, Boston, Massachusetts; Shriner's Hospitals for Dallas - Boston, Boston, Massachusetts; Shriners Hospitals for Dallas - Boston, Seattle, Washington; Nationwide Dallas's Hospital, Columbus, Ohio; Dallas's National Hospital, Wash
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Castillo-Angeles M, Shepler LJ, Carrougher GJ, Gibran NS, Stewart BT, Wolf SE, Kowalske KJ, Ryan CM, Schneider JC, Mehta A. 10 The Impact of Insurance Disparities on Long-term Burn Outcomes: A Burn Model System Investigation. J Burn Care Res 2022. [PMCID: PMC8945741 DOI: 10.1093/jbcr/irac012.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Introduction Access to healthcare and insurance coverage are associated with quality of life, morbidity, and mortality outcomes. However, most studies have only focused on same-admission and short-term outcomes due to the lack of national longitudinal data and there is limited data on this topic in the burn literature. Our aim was to determine the effect of insurance status on long-term outcomes in a national sample of burn patients. Methods This is a retrospective study using the longitudinal Burn Model System National Database from January 2015 to April 2021. The inclusion criteria were all adult patients admitted for burn injury from participating sites. Main outcomes were the physical (PCS) and mental (MCS) health component summary scores of the Veterans RAND 12 (VR-12) score at 6, 12, and 24 months after injury. Multivariable regression was used to examine the association between insurance status and the outcomes, adjusting for demographics (i.e., age, gender, race/ethnicity) and burn injury severity. Results A total of 3,698 burn patients were included. Mean age was 43.39 (SD 15.84) years, 72% were male and 76% were white. Most patients had private/commercial insurance (56.37%), followed by Medicare (14.42%) and Medicaid (13.18%). The remaining 16% were uninsured patients (self-pay or philanthropy). Mean PCS scores were 43.64 (SD 10.87), 45.31 (SD 11.04) and 46.45 (SD 10.65) and Mean MCS scores were 47.80 (SD 12.35), 48.18 (SD 12.30) and 48.44 (SD 12.18) at 6, 12 and 24 months, respectively. In adjusted analyses, Medicaid insurance was associated with worse MCS at 6 months (Coefficient -3.90, p=0.001), and worse PCS at 12 and 24 months (Coefficient -3.09, p=0.004 and Coefficient -4.18, p< 0.001, respectively), compared to uninsured status. Medicare insurance was associated with worse PCS scores at 24 months (Coefficient -3.07, p=0.013). Conclusions Having Medicaid and Medicare insurance was significantly associated with a lower health-related quality of life at long-term follow up, even after adjusting for demographics and burn injury severity. Further studies need to focus on analyzing the reasons for these disparities and developing strategies to improve the quality of life of this subpopulation.
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Affiliation(s)
- Manuel Castillo-Angeles
- Brigham and Women's Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Department of Surgery, The University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; University of Washington, Seattle, Washington; University of Texas Medical Branch at Galveston, Galveston, Texas; Department of Surgery, The University of Texas S
| | - Lauren J Shepler
- Brigham and Women's Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Department of Surgery, The University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; University of Washington, Seattle, Washington; University of Texas Medical Branch at Galveston, Galveston, Texas; Department of Surgery, The University of Texas S
| | - Gretchen J Carrougher
- Brigham and Women's Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Department of Surgery, The University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; University of Washington, Seattle, Washington; University of Texas Medical Branch at Galveston, Galveston, Texas; Department of Surgery, The University of Texas S
| | - Nicole S Gibran
- Brigham and Women's Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Department of Surgery, The University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; University of Washington, Seattle, Washington; University of Texas Medical Branch at Galveston, Galveston, Texas; Department of Surgery, The University of Texas S
| | - Barclay T Stewart
- Brigham and Women's Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Department of Surgery, The University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; University of Washington, Seattle, Washington; University of Texas Medical Branch at Galveston, Galveston, Texas; Department of Surgery, The University of Texas S
| | - Steven E Wolf
- Brigham and Women's Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Department of Surgery, The University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; University of Washington, Seattle, Washington; University of Texas Medical Branch at Galveston, Galveston, Texas; Department of Surgery, The University of Texas S
| | - Karen J Kowalske
- Brigham and Women's Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Department of Surgery, The University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; University of Washington, Seattle, Washington; University of Texas Medical Branch at Galveston, Galveston, Texas; Department of Surgery, The University of Texas S
| | - Colleen M Ryan
- Brigham and Women's Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Department of Surgery, The University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; University of Washington, Seattle, Washington; University of Texas Medical Branch at Galveston, Galveston, Texas; Department of Surgery, The University of Texas S
| | - Jeffrey C Schneider
- Brigham and Women's Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Department of Surgery, The University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; University of Washington, Seattle, Washington; University of Texas Medical Branch at Galveston, Galveston, Texas; Department of Surgery, The University of Texas S
| | - Anupama Mehta
- Brigham and Women's Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Department of Surgery, The University of Washington, Seattle, Washington; University of Washington, Wellfleet, Massachusetts; University of Washington, Seattle, Washington; University of Texas Medical Branch at Galveston, Galveston, Texas; Department of Surgery, The University of Texas S
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Galicia KE, Kubasiak J, Mehta A, Riviello R, Nitzschke S, McMullen K, Gibran NS, Stewart BT, Wolf SE, Ryan CM, Schneider JC. 109 The Impact of Distance to Treatment Center on Long-term Outcomes of Burn Patients. J Burn Care Res 2022. [PMCID: PMC8946174 DOI: 10.1093/jbcr/irac012.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Introduction Geospatial access to American Burn Association (ABA)-verified burn centers or self-designated burn care facilities varies across the country. It is often necessary to transport patients hundreds of miles to provide definitive burn care and rehabilitation services. This study evaluates the impact of distance to treatment center on long-term outcomes of burn patients. Methods Data from the National Institute on Disability, Independent Living, and Rehabilitation Research Burn Model System (BMS) National Database, collected from 2015 to 2019, were analyzed to investigate the impact of distance to BMS center on long-term, patient-reported outcomes. Distance was calculated as driving distance between home zip code centroid and BMS center. Demographic and clinical data were compared between groups by distance from BMS center (< 20, 20-49.9, >50 miles). The following patient-reported outcome measures, collected 12 months after injury, were examined: Veterans Rand 12 Physical Component Summary Score (VR-12 PCS), Veterans Rand 12 Mental Component Summary Score (VR-12 MCS), Satisfaction with Life (SWL), employment status, and days to return to work. Mixed regression model analyses were used to examine the associations between distance to BMS center and each outcome measure, controlling for demographic and clinical variables. Results Of the 726 participants included in this study, 191 (26.3%) and 204 (28.1%) were < 20 and between 20-49.9 miles from a BMS center, respectively; 331 (46.6%) were >50 miles from a BMS center. Greater distance to BMS center was associated with white race/ethnicity (p< 0.001) and employment at time of injury (p=0.001). Greater distance to BMS center was also associated with flame injury (p< 0.001) and larger burn size (p< 0.001). There were no significant differences in length of stay or number of operations between groups. Regression analyses did not identify significant associations between distance to BMS center and VR-12 PCS, VR-12 MCS, SWL, employment at 12 months, or days to return to work. Conclusions After burn injury, patient-reported outcome measures of physical and psychosocial function, as well as employment, do not differ based on distance to BMS center.
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Affiliation(s)
- Kevin E Galicia
- Loyola University Medical Center, Maywood, Illinois; Loyola University Medical Center, Maywood, Illinois; Brigham and Women's Hospital, Quincy, Massachusetts; Brigham and Women's Hospital, Brookline, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts; University of Washington, Portland, Oregon; University of Washington, Wellfleet, Massachusetts; University of Washington, Seattle
| | - John Kubasiak
- Loyola University Medical Center, Maywood, Illinois; Loyola University Medical Center, Maywood, Illinois; Brigham and Women's Hospital, Quincy, Massachusetts; Brigham and Women's Hospital, Brookline, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts; University of Washington, Portland, Oregon; University of Washington, Wellfleet, Massachusetts; University of Washington, Seattle
| | - Anupama Mehta
- Loyola University Medical Center, Maywood, Illinois; Loyola University Medical Center, Maywood, Illinois; Brigham and Women's Hospital, Quincy, Massachusetts; Brigham and Women's Hospital, Brookline, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts; University of Washington, Portland, Oregon; University of Washington, Wellfleet, Massachusetts; University of Washington, Seattle
| | - Robert Riviello
- Loyola University Medical Center, Maywood, Illinois; Loyola University Medical Center, Maywood, Illinois; Brigham and Women's Hospital, Quincy, Massachusetts; Brigham and Women's Hospital, Brookline, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts; University of Washington, Portland, Oregon; University of Washington, Wellfleet, Massachusetts; University of Washington, Seattle
| | - Stephanie Nitzschke
- Loyola University Medical Center, Maywood, Illinois; Loyola University Medical Center, Maywood, Illinois; Brigham and Women's Hospital, Quincy, Massachusetts; Brigham and Women's Hospital, Brookline, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts; University of Washington, Portland, Oregon; University of Washington, Wellfleet, Massachusetts; University of Washington, Seattle
| | - Kara McMullen
- Loyola University Medical Center, Maywood, Illinois; Loyola University Medical Center, Maywood, Illinois; Brigham and Women's Hospital, Quincy, Massachusetts; Brigham and Women's Hospital, Brookline, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts; University of Washington, Portland, Oregon; University of Washington, Wellfleet, Massachusetts; University of Washington, Seattle
| | - Nicole S Gibran
- Loyola University Medical Center, Maywood, Illinois; Loyola University Medical Center, Maywood, Illinois; Brigham and Women's Hospital, Quincy, Massachusetts; Brigham and Women's Hospital, Brookline, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts; University of Washington, Portland, Oregon; University of Washington, Wellfleet, Massachusetts; University of Washington, Seattle
| | - Barclay T Stewart
- Loyola University Medical Center, Maywood, Illinois; Loyola University Medical Center, Maywood, Illinois; Brigham and Women's Hospital, Quincy, Massachusetts; Brigham and Women's Hospital, Brookline, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts; University of Washington, Portland, Oregon; University of Washington, Wellfleet, Massachusetts; University of Washington, Seattle
| | - Steven E Wolf
- Loyola University Medical Center, Maywood, Illinois; Loyola University Medical Center, Maywood, Illinois; Brigham and Women's Hospital, Quincy, Massachusetts; Brigham and Women's Hospital, Brookline, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts; University of Washington, Portland, Oregon; University of Washington, Wellfleet, Massachusetts; University of Washington, Seattle
| | - Colleen M Ryan
- Loyola University Medical Center, Maywood, Illinois; Loyola University Medical Center, Maywood, Illinois; Brigham and Women's Hospital, Quincy, Massachusetts; Brigham and Women's Hospital, Brookline, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts; University of Washington, Portland, Oregon; University of Washington, Wellfleet, Massachusetts; University of Washington, Seattle
| | - Jeffrey C Schneider
- Loyola University Medical Center, Maywood, Illinois; Loyola University Medical Center, Maywood, Illinois; Brigham and Women's Hospital, Quincy, Massachusetts; Brigham and Women's Hospital, Brookline, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts; University of Washington, Portland, Oregon; University of Washington, Wellfleet, Massachusetts; University of Washington, Seattle
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Kelter BM, Shepler LJ, Ni P, Kazis LE, Stewart BT, Ryan CM, Schneider JC. 125 Community Socioeconomic Status Is Associated with Social Participation Outcomes. J Burn Care Res 2022. [PMCID: PMC8945265 DOI: 10.1093/jbcr/irac012.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Introduction Socioeconomic factors are recognized as important social determinants of health. Data however are sparse describing the relationship between socioeconomic status and long term burn outcomes. This study aims to examine associations between community-level socioeconomic status and social participation outcomes in burn survivors. Methods Data was obtained from the Life Impact Burn Recovery Evaluation (LIBRE) Journey study that assesses longitudinal social participation outcomes of community dwelling burn survivors. Subjects were linked to the Distressed Communities Index (DCI), which combines seven indicators into a metric that depicts community economic well-being. Participants were categorized by time since burn (< 5, 5-15, ≥15 years). Linear regression models examined associations between DCI (zip code and county levels) and LIBRE domain scores (Family & Friends, Social Interactions, Social Activities, Work & Employment). Results The study included 314 burn survivors, (mean age 44.1 years; 61.0% female; 48.6% married; 82.8% white). The population was distributed among the time since injury categories (< 5: 35.8%, 5-15: 27.5%, ≥15: 36.7%). Approximately 18% of subjects were categorized in the “at risk” or “distressed” DCI categories. For survivors less than five years from burn, a DCI score increase of 1 standard deviation (worse socioeconomic status) at the zip code level was associated with decreased Family & Friends and Social Activity scores of 2.6 (p=.01) and 2.0 points (p=0.04), respectively (small effect sizes). This relationship was even stronger when controlling for sociodemographic factors. In regression analysis, survivors within the first five years from injury living in “at risk” or “distressed” communities showed worse Family & Friend scores by 6.5 points compared to those living in “prosperous” communities, even after adjusting for age, gender, race, ethnicity, education, and marital status (p=0.04; moderate effect size). There were no significant associations between DCI and LIBRE domain scores for survivors assessed beyond 5 years from injury. Conclusions Social participation outcomes were worse in burn survivors who lived in socioeconomically disadvantaged neighborhoods. Burn survivors who face socioeconomic challenges may need additional support to address social disparities to improve outcomes.
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Affiliation(s)
- Brian M Kelter
- Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Boston University School of Public Health, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts; University of Washington, Seattle, Washington; Harvard Medical School, Boston, Massachusetts
| | - Lauren J Shepler
- Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Boston University School of Public Health, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts; University of Washington, Seattle, Washington; Harvard Medical School, Boston, Massachusetts
| | - Pengsheng Ni
- Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Boston University School of Public Health, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts; University of Washington, Seattle, Washington; Harvard Medical School, Boston, Massachusetts
| | - Lewis E Kazis
- Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Boston University School of Public Health, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts; University of Washington, Seattle, Washington; Harvard Medical School, Boston, Massachusetts
| | - Barclay T Stewart
- Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Boston University School of Public Health, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts; University of Washington, Seattle, Washington; Harvard Medical School, Boston, Massachusetts
| | - Colleen M Ryan
- Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Boston University School of Public Health, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts; University of Washington, Seattle, Washington; Harvard Medical School, Boston, Massachusetts
| | - Jeffrey C Schneider
- Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Boston University School of Public Health, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts; University of Washington, Seattle, Washington; Harvard Medical School, Boston, Massachusetts
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Ashford NK, Oh J, McMullen K, Carrougher GJ, Hickey SA, Ryan CM, Schneider JC, Gibran NS, Stewart BT. 114 Long Term Impact of Hospital Acquired Multi-drug Resistant Organisms on Health-related Quality of Life. J Burn Care Res 2022. [PMCID: PMC8945955 DOI: 10.1093/jbcr/irac012.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction MDROs colonize wounds and cause infections for hospitalized burn patients, which may lead to increased infection risk, wound complications, longer (LOS) and more cost. Little is known about the long-term impacts of MDRO colonization and infection on burn survivors. We aimed to describe the impacts of colonization on long-term health-related quality of life (HRQoL), itch, and pain. Methods Data from adult participants in a multicenter longitudinal outcome study were used. Data was described and χ 2 and Kruskal-Wallis testing was applied to determine differences between the two groups. Outcomes included Veterans RAND 12 (VR-12) physical component summary score (PCS), and PROMIS 29 domains for pain intensity, fatigue, pain interference, physical function, and sleep disturbance. Pruritus was assessed using the 4-D Itch scale for total itch. Multilevel, multiple linear regressions were used for outcome measures at 6 m post-injury. Random effects regression with robust standard errors (SE) were used to evaluate the impacts over time. Results The study included 704 individuals and 92 were MDRO colonized (13%). Colonized patients had larger burns (25% TBSA, IQR 9-45 vs. 8% TBSA, IQR 3–20; p < .001), more operations (4, IQR 2-7 vs. 1, IQR 1-3; p < .001), more grafting (17% TBSA, IQR 3-46 vs. 3% TBSA, IQR 1- 9; p < .001), more ventilator days (2, IQR 0–8 vs. 0 IQR 0-0; p < .001), and longer LOS (34 days, IQR 17 – 64 vs. 16, IQR 9 - 27; p < .001). Adjusting for confounding covariables, such as demographics, colonization was associated with a lower PCS score (OR -0.33, 95% CI -0.68, -0.06; p=.018); a higher fatigue score (OR 0.46, 95% CI 0.13, 0.79; p = .007) and worse itch (OR 0.4, 95% CI -0.01, 0.75; p = .036). There was no association with pain intensity, pain interference, or sleep disturbance. Random effects regression indicated that colonization was associated with lower PCS (OR -5.0, 95% CI -8.60, -1.39; p = .007). Conclusions Impact of colonization extends beyond the immediate hospitalization and likely has long-term effects on HRQoL. Given our observation of lower physical function after MDRO, more granular research on taxa-specific effects, timing of colonization, and interventions are indicated to elucidate the impact on HRQoL.
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Affiliation(s)
- Nathaniel K Ashford
- University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Portland, Oregon; Department of Surgery, The University of Washington, Seattle, Washington; Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; , Massachusetts; University of Washington, Wellfleet, Massachusetts; University of Wa
| | - Jamie Oh
- University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Portland, Oregon; Department of Surgery, The University of Washington, Seattle, Washington; Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; , Massachusetts; University of Washington, Wellfleet, Massachusetts; University of Wa
| | - Kara McMullen
- University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Portland, Oregon; Department of Surgery, The University of Washington, Seattle, Washington; Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; , Massachusetts; University of Washington, Wellfleet, Massachusetts; University of Wa
| | - Gretchen J Carrougher
- University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Portland, Oregon; Department of Surgery, The University of Washington, Seattle, Washington; Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; , Massachusetts; University of Washington, Wellfleet, Massachusetts; University of Wa
| | - Sean A Hickey
- University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Portland, Oregon; Department of Surgery, The University of Washington, Seattle, Washington; Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; , Massachusetts; University of Washington, Wellfleet, Massachusetts; University of Wa
| | - Colleen M Ryan
- University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Portland, Oregon; Department of Surgery, The University of Washington, Seattle, Washington; Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; , Massachusetts; University of Washington, Wellfleet, Massachusetts; University of Wa
| | - Jeffrey C Schneider
- University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Portland, Oregon; Department of Surgery, The University of Washington, Seattle, Washington; Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; , Massachusetts; University of Washington, Wellfleet, Massachusetts; University of Wa
| | - Nicole S Gibran
- University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Portland, Oregon; Department of Surgery, The University of Washington, Seattle, Washington; Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; , Massachusetts; University of Washington, Wellfleet, Massachusetts; University of Wa
| | - Barclay T Stewart
- University of Washington, Seattle, Washington; University of Washington, Seattle, Washington; University of Washington, Portland, Oregon; Department of Surgery, The University of Washington, Seattle, Washington; Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; , Massachusetts; University of Washington, Wellfleet, Massachusetts; University of Wa
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Palackic A, Rontoyanni VG, Branski LK, Duggan RP, Schneider JC, Ryan CM, Kowalske KJ, Gibran NS, Stewart BT, Wolf SE, Suman-Vejas OE, Herndon D. 68 The Association Between Body Mass Index and Physical Function in Adult Burn Survivors. J Burn Care Res 2022. [PMCID: PMC8945842 DOI: 10.1093/jbcr/irac012.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
An area of rehabilitation research in burns is the impact of co-morbidities. Obesity is one of these, is an increasing public health concern, and its role remains controversial regarding burn injury and physical recovery. Our aim was to evaluate associations between body mass index (BMI) as a measure of obesity, at discharge and self-reported physical function (PF) during recovery of adult burn survivors.
Methods
This study included data that was collected by four American Burn Association-verified burn centers, which contribute to the Burn Model System National Database project. The data included BMI obtained at hospital discharge and self-reported Patient-Reported Outcomes Measurement Information System (PROMIS)-29 PF-mobility and upper extremity scores assessed at 6-, 12-, and 24-months after burn. Mixed linear models for repeated measures and regression models were used to assess associations between BMI and PROMIS-29 PF scores over time. Values are expressed as means ± SD. Significance was set at p< 0.05.
Results
A total of 502 adult patients aged 47 ± 16 years were included, with mean total body surface area burned (TBSA) of 17 ± 18 % (range; 1.0-88%) and mean BMI of 23.1 ± 5.4 kg*m-2 (range; 14.0-64.7 kg*m-2). We found no significant effect at 6 months (beta=-0.045, p= 0.54) nor at 12 months after injury (beta=-0.063, p= 0.44) when adjusted for age, burn size, and sex, however, BMI at discharge had a significant negative effect on self-reported mobility scores 24 months after injury (beta=0.218, p=< 0.05).
Conclusions
Increased weight (i.e. BMI) at discharge was negatively associated with PF during recovery. Benefiting from a large sample size, our analysis suggests that long term recovery and restoration of PF in adult burn survivors is compromized by excess body weight.
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Affiliation(s)
- Alen Palackic
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; , Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Surgery, The University of Texas Southwestern Medical Center, Dallas- Fort worth, Texas; University of Wa
| | - Victoria G Rontoyanni
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; , Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Surgery, The University of Texas Southwestern Medical Center, Dallas- Fort worth, Texas; University of Wa
| | - Ludwik K Branski
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; , Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Surgery, The University of Texas Southwestern Medical Center, Dallas- Fort worth, Texas; University of Wa
| | - Robert P Duggan
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; , Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Surgery, The University of Texas Southwestern Medical Center, Dallas- Fort worth, Texas; University of Wa
| | - Jeffrey C Schneider
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; , Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Surgery, The University of Texas Southwestern Medical Center, Dallas- Fort worth, Texas; University of Wa
| | - Colleen M Ryan
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; , Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Surgery, The University of Texas Southwestern Medical Center, Dallas- Fort worth, Texas; University of Wa
| | - Karen J Kowalske
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; , Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Surgery, The University of Texas Southwestern Medical Center, Dallas- Fort worth, Texas; University of Wa
| | - Nicole S Gibran
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; , Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Surgery, The University of Texas Southwestern Medical Center, Dallas- Fort worth, Texas; University of Wa
| | - Barclay T Stewart
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; , Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Surgery, The University of Texas Southwestern Medical Center, Dallas- Fort worth, Texas; University of Wa
| | - Steven E Wolf
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; , Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Surgery, The University of Texas Southwestern Medical Center, Dallas- Fort worth, Texas; University of Wa
| | - Oscar E Suman-Vejas
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; , Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Surgery, The University of Texas Southwestern Medical Center, Dallas- Fort worth, Texas; University of Wa
| | - David Herndon
- University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; University of Texas Medical Branch, Galveston, Texas; , Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Surgery, The University of Texas Southwestern Medical Center, Dallas- Fort worth, Texas; University of Wa
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Patel KF, Rodríguez-Mercedes SL, Grant GG, Rencken CA, Kinney EM, Austen A, Hou C, Brady KJS, Schneider JC, Kazis LE, Ryan CM. Physical, Psychological, and Social Outcomes in Pediatric Burn Survivors Ages 5 to 18 Years: A Systematic Review. J Burn Care Res 2022; 43:343-352. [PMID: 34922361 PMCID: PMC9272085 DOI: 10.1093/jbcr/irab225] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Acute pediatric burn injuries often result in chronic sequelae that affect physical, psychological, and social outcomes. To date, no review has comprehensively reported on the impact of burn injuries across all three domains in school-aged children. The aim of this systematic review was to identify published literature that focuses on the impact of burn injuries on physical, psychological, or social functioning, and report upon the nature of study characteristics and their outcomes. We included literature published after 1980, focusing on burn outcomes in children aged 5 to 18 years. Each eligible study was systematically reviewed and primary outcomes were classified into outcome domains based on existing frameworks. Fifty-eight studies met inclusion criteria, and reported on physical (n = 24), psychological (n = 47), and social (n = 29) domains. The majority of the studies had sample sizes of <100 participants, burn size of <40%, and findings reported by parents and/or burn survivors. Only eight of 107 different measures were used in three or more studies. Parents and burn survivors generally reported better physical and social outcomes and worse psychological functioning compared to non-burn populations. Physical disabilities were associated with psychological and social functioning in several studies. Follow-up data reported improvements across domains. This review demonstrates the importance of physical, psychological, and social status as long-term outcomes in burn survivors. Mixed findings across three outcome domains warrant long-term research. Findings of this review will guide the foundation of comprehensive burn and age-specific instruments to assess burn recovery.
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Affiliation(s)
- Khushbu F. Patel
- Department of Clinical Research, Shriners Hospitals for Children – Boston®, Massachusetts, Massachusetts, USA
- Department of Surgery, Massachusetts General Hospital, Boston, USA
| | | | | | - Camerin A. Rencken
- Department of Clinical Research, Shriners Hospitals for Children – Boston®, Massachusetts, Massachusetts, USA
- Department of Surgery, Massachusetts General Hospital, Boston, USA
| | - Erin M. Kinney
- Department of Clinical Research, Shriners Hospitals for Children – Boston®, Massachusetts, Massachusetts, USA
| | - Amelia Austen
- Department of Clinical Research, Shriners Hospitals for Children – Boston®, Massachusetts, Massachusetts, USA
| | - Carina Hou
- Department of Clinical Research, Shriners Hospitals for Children – Boston®, Massachusetts, Massachusetts, USA
| | - Keri J. S. Brady
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Massachusetts, USA
| | - Jeffrey C. Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Research Institute, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lewis E. Kazis
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Research Institute, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Colleen M. Ryan
- Department of Clinical Research, Shriners Hospitals for Children – Boston®, Massachusetts, Massachusetts, USA
- Department of Surgery, Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Shriners Hospitals for Children – Boston®, Massachusetts, USA
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Deng H, Shepler LJ, Abouzeid C, Hamner JW, Mercier HW, Andrew Taylor J, Kazis LE, Slavin MD, Ryan CM, Schneider JC. 774 Digital Interventions for Social Participation in Adults with Long-term Physical Conditions: A Systematic Review. J Burn Care Res 2022. [PMCID: PMC8945598 DOI: 10.1093/jbcr/irac012.327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
Burn survivors experience significant social participation challenges in their recovery. However, enrolment and compliance with face-to-face interventions for such issues are often limited by time, location, and financial resources. Digital technologies are increasingly utilized in healthcare and provide a flexible, accessible, and low-cost treatment option. Given the sparse literature on this topic in the burn field, this review evaluated digital interventions for social participation in adults with long-term physical conditions to inform future use in the burn population.
Methods
MEDLINE, EMBASE, CINAHL and PsycINFO databases were searched using keywords and Medical Subject Headings (MeSH) terms related to ‘digital intervention’ and ‘social participation’ for studies published in English between January 2010 and May 2021. Studies that adopted digital technology interventions to improve social participation in adults with long-term physical conditions were included. Study quality was evaluated using Oxford Levels of Evidence. Data on study methodology, digital intervention and findings related to social participation were summarized.
Results
The search yielded a total of 4646 articles, of which 158 were full-text screened and 14 met inclusion and exclusion criteria. There were five randomized controlled trials, two non-randomized clinical trials and seven one-group pretest-posttest clinical trials. Twenty-five different measurement tools were utilized to assess social participation and two of them were used twice. Three types of digital interventions were implemented to improve social participation: group support, individual skill training or counselling, and education and support. The group support intervention developed a social network among affected people through videoconference, app, or virtual reality platform (3 of 4 studies with positive results). Individual skill training or counselling utilized phone calls or videoconference to help participants with activity participation and interpersonal relationships (2 of 6 studies with positive results). The education and support intervention used messages and website information to increase participants’ knowledge and provide support (3 of 3 studies with positive results).
Conclusions
This review presents evidence of different digital interventions’ effect on improving social participation in adults with long-term physical conditions. However, the existing literature is limited by the heterogeneity of outcome measures and varied methodology quality that preclude larger generalizations.
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Affiliation(s)
- Huan Deng
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Stony Brook University, Stony Brook, New York; Spaulding Rehabilitation Hospital, Harvard Medical School, Cambridge, Massachusetts; Boston Univ
| | - Lauren J Shepler
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Stony Brook University, Stony Brook, New York; Spaulding Rehabilitation Hospital, Harvard Medical School, Cambridge, Massachusetts; Boston Univ
| | - Callie Abouzeid
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Stony Brook University, Stony Brook, New York; Spaulding Rehabilitation Hospital, Harvard Medical School, Cambridge, Massachusetts; Boston Univ
| | - Jason W Hamner
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Stony Brook University, Stony Brook, New York; Spaulding Rehabilitation Hospital, Harvard Medical School, Cambridge, Massachusetts; Boston Univ
| | - Hannah W Mercier
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Stony Brook University, Stony Brook, New York; Spaulding Rehabilitation Hospital, Harvard Medical School, Cambridge, Massachusetts; Boston Univ
| | - J Andrew Taylor
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Stony Brook University, Stony Brook, New York; Spaulding Rehabilitation Hospital, Harvard Medical School, Cambridge, Massachusetts; Boston Univ
| | - Lewis E Kazis
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Stony Brook University, Stony Brook, New York; Spaulding Rehabilitation Hospital, Harvard Medical School, Cambridge, Massachusetts; Boston Univ
| | - Mary D Slavin
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Stony Brook University, Stony Brook, New York; Spaulding Rehabilitation Hospital, Harvard Medical School, Cambridge, Massachusetts; Boston Univ
| | - Colleen M Ryan
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Stony Brook University, Stony Brook, New York; Spaulding Rehabilitation Hospital, Harvard Medical School, Cambridge, Massachusetts; Boston Univ
| | - Jeffrey C Schneider
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Stony Brook University, Stony Brook, New York; Spaulding Rehabilitation Hospital, Harvard Medical School, Cambridge, Massachusetts; Boston Univ
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Galicia KE, Kubasiak J, Mehta A, Kowalske KJ, Gibran NS, Stewart BT, Wolf SE, Ryan CM, Schneider JC. 83 The Impact of Tracheostomy on Long-term Patient Outcomes: A Burn Model System National Database Study. J Burn Care Res 2022. [PMCID: PMC8945378 DOI: 10.1093/jbcr/irac012.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Introduction Management of the upper airway is crucial to burn care, especially in the setting of inhalation injury or burns to the face or neck. Endotracheal intubation is often performed to secure the airway; however, tracheostomy may be necessary in patients requiring prolonged ventilatory support. This study compares long-term outcomes of burn patients with and without tracheostomy. Methods Data from the Burn Model System National Database, collected from 2013 to 2020, were analyzed. Demographic and clinical data were compared between those with and without tracheostomy. The following patient-reported outcome measures, collected at 6-, 12-, and 24-months, were analyzed: Veterans Rand 12 Physical Component Summary Score (VR-12 PCS), Veterans Rand 12 Mental Component Summary Score (VR-12 MCS), Satisfaction with Life (SWL), Community Integration Questionnaire (CIQ), Patient-Reported Outcomes Measurement Information System (PROMIS-29), employment status, and number of days to return to work. Regression models were used to assess the impact of tracheostomy status on long-term outcome measures, controlling for demographic and clinical variables. Results Of the 714 patients included in this study, 39 (5.46%) received a tracheostomy and 675 (94.54%) did not. The two groups were similar across all demographic data collected. Tracheostomy patients were more likely to have flame injury, inhalation injury, larger burn size, more trips to the operating room, longer hospital stay, and greater number of days on a ventilator (p< 0.001). Regression model analyses demonstrated that tracheostomy was associated with worse VR-12 PCS scores at 6-, 12-, and 24-months (6.6 [95% CI 1.5, 11.8], p=0.012; 11.5 [6.2, 16.8], p< 0.001; 10.8 [4.2, 17.5], p=0.001). Tracheostomy was also associated with worse scores in two PROMIS-29 domains, physical function and pain interference. For physical function, the association was seen at 6-, 12-, and 24-months (7.4 [3.0, 11.8], p=0.001; 9.6 [5.2, 14.0], p< 0.001; 11.3 [5.8, 16.9], p< 0.001). For pain interference, the association was only seen at 12-months (-5.3 [-10.0, -0.55], p=0.029). Conclusions After burn injury, patient-reported outcome measures of physical function and pain interference were significantly worse with tracheostomy.
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Affiliation(s)
- Kevin E Galicia
- Loyola University Medical Center, Maywood, Illinois; Loyola University Medical Center, Maywood, Illinois; Brigham and Women's Hospital, Quincy, Massachusetts; Department of Surgery, The University of Texas Southwestern Medical Center, Dallas- Fort worth, Texas; University of Washington, Wellfleet, Massachusetts; University of Washington, Seattle, Washington; University of Texas Medical Branch at
| | - John Kubasiak
- Loyola University Medical Center, Maywood, Illinois; Loyola University Medical Center, Maywood, Illinois; Brigham and Women's Hospital, Quincy, Massachusetts; Department of Surgery, The University of Texas Southwestern Medical Center, Dallas- Fort worth, Texas; University of Washington, Wellfleet, Massachusetts; University of Washington, Seattle, Washington; University of Texas Medical Branch at
| | - Anupama Mehta
- Loyola University Medical Center, Maywood, Illinois; Loyola University Medical Center, Maywood, Illinois; Brigham and Women's Hospital, Quincy, Massachusetts; Department of Surgery, The University of Texas Southwestern Medical Center, Dallas- Fort worth, Texas; University of Washington, Wellfleet, Massachusetts; University of Washington, Seattle, Washington; University of Texas Medical Branch at
| | - Karen J Kowalske
- Loyola University Medical Center, Maywood, Illinois; Loyola University Medical Center, Maywood, Illinois; Brigham and Women's Hospital, Quincy, Massachusetts; Department of Surgery, The University of Texas Southwestern Medical Center, Dallas- Fort worth, Texas; University of Washington, Wellfleet, Massachusetts; University of Washington, Seattle, Washington; University of Texas Medical Branch at
| | - Nicole S Gibran
- Loyola University Medical Center, Maywood, Illinois; Loyola University Medical Center, Maywood, Illinois; Brigham and Women's Hospital, Quincy, Massachusetts; Department of Surgery, The University of Texas Southwestern Medical Center, Dallas- Fort worth, Texas; University of Washington, Wellfleet, Massachusetts; University of Washington, Seattle, Washington; University of Texas Medical Branch at
| | - Barclay T Stewart
- Loyola University Medical Center, Maywood, Illinois; Loyola University Medical Center, Maywood, Illinois; Brigham and Women's Hospital, Quincy, Massachusetts; Department of Surgery, The University of Texas Southwestern Medical Center, Dallas- Fort worth, Texas; University of Washington, Wellfleet, Massachusetts; University of Washington, Seattle, Washington; University of Texas Medical Branch at
| | - Steven E Wolf
- Loyola University Medical Center, Maywood, Illinois; Loyola University Medical Center, Maywood, Illinois; Brigham and Women's Hospital, Quincy, Massachusetts; Department of Surgery, The University of Texas Southwestern Medical Center, Dallas- Fort worth, Texas; University of Washington, Wellfleet, Massachusetts; University of Washington, Seattle, Washington; University of Texas Medical Branch at
| | - Colleen M Ryan
- Loyola University Medical Center, Maywood, Illinois; Loyola University Medical Center, Maywood, Illinois; Brigham and Women's Hospital, Quincy, Massachusetts; Department of Surgery, The University of Texas Southwestern Medical Center, Dallas- Fort worth, Texas; University of Washington, Wellfleet, Massachusetts; University of Washington, Seattle, Washington; University of Texas Medical Branch at
| | - Jeffrey C Schneider
- Loyola University Medical Center, Maywood, Illinois; Loyola University Medical Center, Maywood, Illinois; Brigham and Women's Hospital, Quincy, Massachusetts; Department of Surgery, The University of Texas Southwestern Medical Center, Dallas- Fort worth, Texas; University of Washington, Wellfleet, Massachusetts; University of Washington, Seattle, Washington; University of Texas Medical Branch at
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Sheckter CC, Carrougher GJ, Wolf SE, Schneider JC, Gibran N, Stewart BT. The Impact of Burn Survivor Preinjury Income and Payer Status on Health-Related Quality of Life. J Burn Care Res 2022; 43:293-299. [PMID: 34519793 PMCID: PMC10026600 DOI: 10.1093/jbcr/irab170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The costs required to provide acute care for patients with serious burn injuries are significant. In the United States, these costs are often shared by patients. However, the impacts of preinjury finances on health-related quality of life (HRQL) have been poorly characterized. We hypothesized that lower income and public payers would be associated with poorer HRQL. Burn survivors with complete data for preinjury personal income and payer status were extracted from the longitudinal Burn Model System National Database. HRQL outcomes were measured with VR-12 scores at 6, 12, and 24 months postinjury. VR-12 scores were evaluated using generalized linear models, adjusting for potential confounders (eg, age, sex, self-identified race, burn injury severity). About 453 participants had complete data for income and payer status. More than one third of BMS participants earned less than $25,000/year (36%), 24% earned $25,000 to 49,000/year, 23% earned $50,000 to 99,000/year, 11% earned $100,000 to 149,000/year, 3% earned $150,000 to 199,000/year, and 4% earned more than $200,000/year. VR-12 mental component summary (MCS) and physical component summary (PCS) scores were highest for those who earned $150,000 to 199,000/year (55.8 and 55.8) and lowest for those who earned less than $25,000/year (49.0 and 46.4). After adjusting for demographics, payer, and burn severity, 12-month MCS and PCS and 24-month PCS scores were negatively associated with Medicare payer (P < .05). Low income was not significantly associated with lower VR-12 scores. There was a peaking relationship between HRQL and middle-class income, but this trend was not significant after adjusting for covariates. Public payers, particularly Medicare, were independently associated with poorer HRQL. The findings might be used to identify those at risk of financial toxicity for targeting assistance during rehabilitation.
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Affiliation(s)
- Clifford C Sheckter
- Department of Surgery, Stanford University, California, USA
- Regional Burn Center at Santa Clara Valley Medical Center, San Jose, California, USA
| | - Gretchen J Carrougher
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington, Seattle, USA
| | - Steven E Wolf
- Shriners Burns Hospital, University of Texas Medical Branch, Galveston, USA
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Spaulding Research Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Nicole Gibran
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington, Seattle, USA
| | - Barclay T Stewart
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington, Seattle, USA
- Harborview Injury Prevention and Research Center, Seattle, Washington, USA
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Martz F, McMullen K, Carrougher GJ, Wolf SE, Schneider JC, Stewart BT, Sheckter CC, Bunnell AE. 77 Impacts of Financial Assistance on Quality of Life Among People Living with Burn Injury. J Burn Care Res 2022. [PMCID: PMC8945823 DOI: 10.1093/jbcr/irac012.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Introduction Financial toxicity negatively impacts recovery after injury. Financial assistance (FA; e.g., disability income, food stamps, low-income housing voucher) may mitigate the impacts of financial toxicity. We aimed to describe FA after burn injury and its association with health-related quality of life (HRQL) and return to work. Methods Data from adult participants participating in a multicenter longitudinal database from 2015 to 2021 were used for complete-case analysis. Participants were separated into two groups: those who received any form of financial assistance due to their burn injury, and those who did not. The cohort and FA were described. Multi-level, mixed-effects, linear regression was performed to assess the associations of FA with VR-12 Physical and Mental Health Component Summary scores (PCS, MCS) and return to work. Lastly, a propensity score analysis matched 3:1 on age, gender, pre-injury PCS and MCS, burn size, length of hospital stay, and the number of operations as a result of burn injury was used to maximally reduce potential confounding. Results The analysis included 1,237 participants [725 who received FA, 512 who did not receive FA (NFA)]. Participants who received FA due to their burn injury were more likely to be younger (median 42 FA vs 48 NFA, p-value < 0.001), racially minoritized (19.2% FA vs 14.3% NFA, p-value < 0.001), have larger injuries (21% FA vs. 10% TBSA NFA, p-value < 0.001), longer hospital stays (median 29.5 days FA vs. 17 days NFA, p-value < 0.001), more days before returning to work (median 220 days FA vs 79 days NFA, p-value < 0.001), and have a workers compensation insurance payer (23.6% FA vs. 9.38% NFA, p-value < 0.001) compared to peers who did not receive FA. The number of participants who received new FA decreased after the 6-month time point: 11% at discharge, 33% at 6 months, and 15% at 12 months. Propensity score analysis demonstrated that receiving FA was associated with lower PCS and MCS scores at all time points and longer time to return to work (Table 1). Conclusions Given that financial toxicity is associated with unsatisfactory recovery after injury, efforts to reduce financial stressors are needed. FA seems somewhat matched to patients with greater recovery challenges (e.g., larger injuries, more complex hospitalizations). Additionally, most patients do not receive FA for a prolonged period (e.g., >6 months). While FA is associated with lower HRQL and longer return to work, these data may represent improvement compared to what people living with burn injury might have experienced without FA and represent unmeasured confounding.
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Affiliation(s)
| | - Kara McMullen
- Oakland University William Beaumont School of Medicine, Southfield, Michigan; University of Washington, Portland, Oregon; Department of Surgery, The University of Washington, Seattle, Washington; University of Texas Medical Branch at Galveston, Galveston, Texas; Massachusetts; University of Washington, Seattle, Washington; Stanford University, Stanford, California; University of Washington, Seatt
| | - Gretchen J Carrougher
- Oakland University William Beaumont School of Medicine, Southfield, Michigan; University of Washington, Portland, Oregon; Department of Surgery, The University of Washington, Seattle, Washington; University of Texas Medical Branch at Galveston, Galveston, Texas; Massachusetts; University of Washington, Seattle, Washington; Stanford University, Stanford, California; University of Washington, Seatt
| | - Steven E Wolf
- Oakland University William Beaumont School of Medicine, Southfield, Michigan; University of Washington, Portland, Oregon; Department of Surgery, The University of Washington, Seattle, Washington; University of Texas Medical Branch at Galveston, Galveston, Texas; Massachusetts; University of Washington, Seattle, Washington; Stanford University, Stanford, California; University of Washington, Seatt
| | - Jeffrey C Schneider
- Oakland University William Beaumont School of Medicine, Southfield, Michigan; University of Washington, Portland, Oregon; Department of Surgery, The University of Washington, Seattle, Washington; University of Texas Medical Branch at Galveston, Galveston, Texas; Massachusetts; University of Washington, Seattle, Washington; Stanford University, Stanford, California; University of Washington, Seatt
| | - Barclay T Stewart
- Oakland University William Beaumont School of Medicine, Southfield, Michigan; University of Washington, Portland, Oregon; Department of Surgery, The University of Washington, Seattle, Washington; University of Texas Medical Branch at Galveston, Galveston, Texas; Massachusetts; University of Washington, Seattle, Washington; Stanford University, Stanford, California; University of Washington, Seatt
| | - Clifford C Sheckter
- Oakland University William Beaumont School of Medicine, Southfield, Michigan; University of Washington, Portland, Oregon; Department of Surgery, The University of Washington, Seattle, Washington; University of Texas Medical Branch at Galveston, Galveston, Texas; Massachusetts; University of Washington, Seattle, Washington; Stanford University, Stanford, California; University of Washington, Seatt
| | - Aaron E Bunnell
- Oakland University William Beaumont School of Medicine, Southfield, Michigan; University of Washington, Portland, Oregon; Department of Surgery, The University of Washington, Seattle, Washington; University of Texas Medical Branch at Galveston, Galveston, Texas; Massachusetts; University of Washington, Seattle, Washington; Stanford University, Stanford, California; University of Washington, Seatt
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Patel KF, Ni P, Rodríguez-Mercedes SL, Surette KE, Rencken CA, Fabia R, Tully C, Palmieri TL, Romanowski KS, Warner P, Stoddard FJJ, Schneider JC, Kazis LE, Ryan CM. 74 The Association Between Burn Injury and Peer Relations: A preschool-libre1-5 Study. J Burn Care Res 2022. [PMCID: PMC8946141 DOI: 10.1093/jbcr/irac012.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Children ages one to five years old are naturally curious and build their personality and social skills through interactions with others. Positive peer relations are especially important after a burn injury as bullying and peer rejection can delay development of social skills. This study assessed the association between burn injuries and burn survivors’ ability to connect with and maintain peer relations in this age group using the Preschool-LIBRE 1-5 (Life Impact Burn Recovery Evaluation). Methods The Preschool-LIBRE1-5 was field-tested with 426 parents of burn survivors. Each item was scored on a 5-point Likert scale ranging from 0 (never) to 4 (always). Data was recoded for selected items such that higher scores denote better functioning. Classic test theory methods were used to assess the peer relation items from a social functioning domain. Individual items and mean scores in the domain were examined. Multiple linear regression analyses (controlling for gender, race and ethnicity, pain severity, burn injury to critical area, burn size, and age at survey completion) measured the association between demographic and clinical characteristics and calculated a peer relation score based on multiple imputation samples. Results The mean age was 3.06 + 1.41 years, mean time since injury of 1.16 + 1.34 years, mean total body surface area (TBSA%) of 4.21 + 7.92, and 55.16% male and 74.18% white. Items from peer relations item pool (n=15) were identified as a unidimensional scale (α=0.92, item-total correlations for all 15 items >0.4, ratio of the 1st and 2nd eigenvalues (8.729/1.287=6.78) = > 4). The mean peer relation score was 2.86 + 0.76. The two items with the lowest and highest score were “My child would ask for things nicely when playing with other children” (x̄ = 2.09) and “My child liked to play near and be with family members and friends (x̄ = 3.59) respectively. Results indicated that age was a significant predictor, such that older age at survey completion was significantly associated with higher peer relation score (β = 0.16, p < 0.0001). With each year of age increase, peer relationship score increased by 0.16 + 0.21 points. Conclusions Preschool-aged burn survivors, as reported by parents, often had the ability to connect with peers through imitation and participating in play activities, and maintained peer relationships well. These findings emphasize the importance of promoting early interventions that build social skills, allowing for positive interactions with peers and improving social functioning in the long-term.
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Affiliation(s)
- Khushbu F Patel
- Shriners Hospitals for Children - Boston/MGH, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Boston, Massachusetts; Shriner's Hospitals for Children - Boston, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Seattle, Washington; Nationwide Children's Hospital, Columbus, Ohio; Children's National Ho
| | - Pengsheng Ni
- Shriners Hospitals for Children - Boston/MGH, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Boston, Massachusetts; Shriner's Hospitals for Children - Boston, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Seattle, Washington; Nationwide Children's Hospital, Columbus, Ohio; Children's National Ho
| | - Silvanys L Rodríguez-Mercedes
- Shriners Hospitals for Children - Boston/MGH, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Boston, Massachusetts; Shriner's Hospitals for Children - Boston, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Seattle, Washington; Nationwide Children's Hospital, Columbus, Ohio; Children's National Ho
| | - Kate E Surette
- Shriners Hospitals for Children - Boston/MGH, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Boston, Massachusetts; Shriner's Hospitals for Children - Boston, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Seattle, Washington; Nationwide Children's Hospital, Columbus, Ohio; Children's National Ho
| | - Camerin A Rencken
- Shriners Hospitals for Children - Boston/MGH, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Boston, Massachusetts; Shriner's Hospitals for Children - Boston, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Seattle, Washington; Nationwide Children's Hospital, Columbus, Ohio; Children's National Ho
| | - Renata Fabia
- Shriners Hospitals for Children - Boston/MGH, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Boston, Massachusetts; Shriner's Hospitals for Children - Boston, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Seattle, Washington; Nationwide Children's Hospital, Columbus, Ohio; Children's National Ho
| | - Carrie Tully
- Shriners Hospitals for Children - Boston/MGH, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Boston, Massachusetts; Shriner's Hospitals for Children - Boston, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Seattle, Washington; Nationwide Children's Hospital, Columbus, Ohio; Children's National Ho
| | - Tina L Palmieri
- Shriners Hospitals for Children - Boston/MGH, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Boston, Massachusetts; Shriner's Hospitals for Children - Boston, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Seattle, Washington; Nationwide Children's Hospital, Columbus, Ohio; Children's National Ho
| | - Kathleen S Romanowski
- Shriners Hospitals for Children - Boston/MGH, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Boston, Massachusetts; Shriner's Hospitals for Children - Boston, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Seattle, Washington; Nationwide Children's Hospital, Columbus, Ohio; Children's National Ho
| | - Petra Warner
- Shriners Hospitals for Children - Boston/MGH, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Boston, Massachusetts; Shriner's Hospitals for Children - Boston, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Seattle, Washington; Nationwide Children's Hospital, Columbus, Ohio; Children's National Ho
| | - Frederick J J Stoddard
- Shriners Hospitals for Children - Boston/MGH, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Boston, Massachusetts; Shriner's Hospitals for Children - Boston, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Seattle, Washington; Nationwide Children's Hospital, Columbus, Ohio; Children's National Ho
| | - Jeffrey C Schneider
- Shriners Hospitals for Children - Boston/MGH, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Boston, Massachusetts; Shriner's Hospitals for Children - Boston, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Seattle, Washington; Nationwide Children's Hospital, Columbus, Ohio; Children's National Ho
| | - Lewis E Kazis
- Shriners Hospitals for Children - Boston/MGH, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Boston, Massachusetts; Shriner's Hospitals for Children - Boston, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Seattle, Washington; Nationwide Children's Hospital, Columbus, Ohio; Children's National Ho
| | - Colleen M Ryan
- Shriners Hospitals for Children - Boston/MGH, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Boston, Massachusetts; Shriner's Hospitals for Children - Boston, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Seattle, Washington; Nationwide Children's Hospital, Columbus, Ohio; Children's National Ho
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Docherty B, Schneider JC. Enlisting healthcare professionals in the campaign against incendiary weapons. Burns 2022; 48:485-486. [PMID: 34903413 DOI: 10.1016/j.burns.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/05/2021] [Indexed: 12/14/2022]
Abstract
AThe exceptionally severe burns caused by incendiary weapons make strengthening international law a humanitarian imperative. Given healthcare professionals' deep understanding of the human cost of burn injuries, they are in a unique position to urge governments to initiate a process to assess the law's shortcomings at a major UN disarmament meeting in December. One way to advocate for such policy change is by signing an open letter from healthcare professionals and burn survivor organizations.
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Affiliation(s)
- Bonnie Docherty
- International Human Rights Clinic, Harvard Law School, and Arms Division, Human Rights Watch, 6 Everett St, 3rd Floor, Cambridge, MA 02138, USA.
| | - Jeffrey C Schneider
- Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, 300 1st Avenue, Charlestown, MA 02129, USA.
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Knowlton SE, Gundersen AI, Reilly JM, Tan CO, Schneider JC, Shih SL. Predictors of Acute Transfer and Mortality Within 6 Months From Admission to an Inpatient Rehabilitation Facility for Patients With Brain Tumors. Arch Phys Med Rehabil 2022; 103:424-429. [PMID: 34762854 PMCID: PMC9446107 DOI: 10.1016/j.apmr.2021.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/29/2021] [Accepted: 10/11/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To obtain useful information for clinicians in evaluating patients with brain tumors for transfer to and subsequent care in inpatient rehabilitation facilities (IRFs). DESIGN Retrospective chart review. SETTING Inpatient rehabilitation facility. PARTICIPANTS A total of 208 adults with either initial or recurrent brain tumors who were admitted to an IRF between January 2017 and December 2018 after an acute hospitalization. INTERVENTIONS None MAIN OUTCOME MEASURES: Transfer from an IRF to an acute care hospital and mortality within 6 months from admission to an IRF. RESULTS Of the 208 patients who met inclusion criteria, 20.2% were transferred to an acute care hospital during the IRF stay, which was associated with prior chemotherapy, steroid use, and laterality of tumor. In total, 36.9% of patients with brain tumors died within 6 months of an IRF admission that was associated with recurrent tumor diagnosis, prior chemotherapy, prior neurosurgical intervention, prior neurostimulant use, use of steroids, isocitrate dehydrogenase and O6-methyl-guanyl-methyl-transferase biomarkers, and laterality and location of tumor. CONCLUSIONS Patients with brain tumors have a notable potential for acute hospital transfer and mortality within 6 months of IRF stay, with several tumor- and treatment-related risk factors. This information can help identify functional goals, identify high risk patients, enable closer clinical monitoring, and facilitate focused care discussions at IRFs.
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Affiliation(s)
- Sasha E. Knowlton
- Spaulding Rehabilitation Hospital, Charlestown, MA, USA,Harvard Medical School, Boston, MA, USA,Massachusetts General Hospital, Boston, MA, USA
| | - Alexandra I. Gundersen
- Spaulding Rehabilitation Hospital, Charlestown, MA, USA,Harvard Medical School, Boston, MA, USA,Massachusetts General Hospital, Boston, MA, USA
| | | | - Can Ozan Tan
- Spaulding Rehabilitation Hospital, Charlestown, MA, USA,Harvard Medical School, Boston, MA, USA,Massachusetts General Hospital, Boston, MA, USA
| | - Jeffrey C. Schneider
- Spaulding Rehabilitation Hospital, Charlestown, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Shirley L. Shih
- Spaulding Rehabilitation Hospital, Charlestown, MA, USA,Harvard Medical School, Boston, MA, USA,Massachusetts General Hospital, Boston, MA, USA
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Kelter BM, Shepler LJ, Ni P, Slavin MD, Acton A, Kazis LE, Ryan CM, Schneider JC. Developing trajectories of social recovery after burn injury: Preliminary results from the LIBRE Journey Study. Burns 2022; 48:460-462. [PMID: 34924225 PMCID: PMC9275732 DOI: 10.1016/j.burns.2021.11.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 12/14/2022]
Affiliation(s)
- Brian M. Kelter
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA; Spaulding Research Institute, Boston, MA, USA
| | - Lauren J. Shepler
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA; Spaulding Research Institute, Boston, MA, USA
| | - Pengsheng Ni
- Boston University School of Public Health, Boston, MA, USA
| | - Mary D. Slavin
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA; Spaulding Research Institute, Boston, MA, USA; Boston University School of Public Health, Boston, MA, USA
| | - Amy Acton
- Phoenix Society for Burn Survivors, Grand Rapids, MI, USA
| | - Lewis E. Kazis
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA; Spaulding Research Institute, Boston, MA, USA; Boston University School of Public Health, Boston, MA, USA
| | - Colleen M. Ryan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Shriners Hospitals for Children - Boston®, Boston, MA, USA
| | - Jeffrey C. Schneider
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA; Spaulding Research Institute, Boston, MA, USA
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Wang BB, Patel KF, Wolfe AE, Wiechman S, McMullen K, Gibran NS, Kowalske K, Meyer WJ, Kazis LE, Ryan CM, Schneider JC. Adolescents with and without head and neck burns: comparison of long-term outcomes in the burn model system national database. Burns 2022; 48:40-50. [PMID: 33975762 PMCID: PMC8526620 DOI: 10.1016/j.burns.2021.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 03/16/2021] [Accepted: 04/12/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Facial burns account for persistent differences in psychosocial functioning in adult burn survivors. Although adolescent burn survivors experience myriad chronic sequelae, little is known about the effect of facial injuries. This study examines differences in long-term outcomes with and without head and neck involvement. METHODS Data collected for 392 burn survivors between 14-17.9 years of age from the Burn Model System National Database (2006-2015) were analyzed. Comparisons were made between two groups based on presence of a head and neck burn (H&N) using the following patient reported outcome measures: Satisfaction with Appearance Scale, Satisfaction with Life Scale, Community Integration Questionnaire, and Short Form-12 Health Survey at 6, 12, and 24 months after injury. Regression analyses were used to assess association between outcome measures and H&N group at 12-months. RESULTS The H&N group had more extensive burns, had longer hospital stays, were more likely to be burned by fire/flame and were more likely to be Hispanic compared to the non-H&N group. Regression analysis found that H&N burn status was associated with worse SWAP scores. No significant associations were found between H&N burn status and other outcome measures. CONCLUSIONS Adolescents with H&N burn status showed significantly worse satisfaction with appearance at 12-months after injury. Future research should examine interventions to help improve body image and coping for adolescent burn survivors with head and neck burns.
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Affiliation(s)
| | - Khushbu F. Patel
- Shriners Hospitals for Children – Boston, Boston, MA United States,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Audrey E. Wolfe
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA, United States
| | - Shelley Wiechman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Kara McMullen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Nicole S. Gibran
- Department of Surgery, University of Washington Harborview, Seattle, WA, United States
| | - Karen Kowalske
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Walter J. Meyer
- Department of Psychiatry, University of Texas Medical Branch, Galveston, TX, United States
| | - Lewis E. Kazis
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, United States
| | - Colleen M. Ryan
- Shriners Hospitals for Children – Boston, Boston, MA United States,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Jeffrey C. Schneider
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA, United States,Corresponding author. (J.C. Schneider)
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45
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Lamm AG, Goldstein R, Slocum CS, Silver JK, Grabowski DC, Schneider JC, Zafonte RD. For-Profit and Not-For-Profit Inpatient Rehabilitation in Traumatic Brain Injury: Analysis of Demographics and Outcomes. Arch Phys Med Rehabil 2022; 103:1051-1052. [PMID: 35093330 DOI: 10.1016/j.apmr.2022.01.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 11/02/2022]
Affiliation(s)
- Adam G Lamm
- Mary Free Bed Rehabilitation Hospital, 235 Wealthy St SE, Grand Rapids, MI
| | - Richard Goldstein
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital / Harvard Medical School, 300 First Avenue, Charlestown, MA
| | - Chloe S Slocum
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital / Harvard Medical School, 300 First Avenue, Charlestown, MA; Massachusetts General Hospital, 55 Fruit Street, Boston, MA
| | - Julie K Silver
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital / Harvard Medical School, 300 First Avenue, Charlestown, MA; Massachusetts General Hospital, 55 Fruit Street, Boston, MA; Brigham & Women's Hospital, 75 Francis Street, Boston, MA
| | - David C Grabowski
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA
| | - Jeffrey C Schneider
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital / Harvard Medical School, 300 First Avenue, Charlestown, MA
| | - Ross D Zafonte
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital / Harvard Medical School, 300 First Avenue, Charlestown, MA; Massachusetts General Hospital, 55 Fruit Street, Boston, MA; Brigham & Women's Hospital, 75 Francis Street, Boston, MA.
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46
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Kelter BM, Wolfe AE, Kazis LE, Ryan CM, Acton A, Slavin MD, Schneider JC. Trajectory Curves for Purposes of Benchmarking and Predicting Clinical Outcomes: A Scoping Review. J Burn Care Res 2022; 43:1095-1104. [PMID: 34986488 PMCID: PMC9255662 DOI: 10.1093/jbcr/irab245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Trajectory curves are valuable tools to benchmark patient health status and predict future outcomes. A longitudinal study is underway to examine social participation after burn injury using the Life Impact Burn Recovery Evaluation (LIBRE) Profile with the goal of developing trajectory curves for specific domains that focus on social reintegration. We conducted a scoping review to inform and understand trajectory curves applied in clinical settings to compare outcomes for an individual to a matched cohort of comparable patients or predicted expected outcomes over time. This scoping review utilized a PubMed search from January 2014 to August 2019 for the following terms: "trajectory curves" or "trajectory models" and "clinic" or "clinical." Only articles that specifically referenced longitudinal and clinical research designs were included in the scoping review. Articles were assessed using standard scoping review methods and categorized based on clinical application of trajectory curves for either benchmarking or prediction. The initial literature review identified 141 manuscripts and 34 met initial inclusion criteria. The reviewed articles support the clinical use of trajectory curves. Findings provide insight into several key determinants involved with the successful development and implementation of trajectory curves in clinical settings. These findings will inform efforts to use the LIBRE Profile to model social participation recovery and assist in developing effective strategies using trajectory curves to promote social reintegration after burn injury.
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Affiliation(s)
- Brian M Kelter
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA,Department of Physical Medicine & Rehabilitation, Spaulding Research Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Audrey E Wolfe
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA,Department of Physical Medicine & Rehabilitation, Spaulding Research Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Lewis E Kazis
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA,Department of Physical Medicine & Rehabilitation, Spaulding Research Institute, Harvard Medical School, Boston, Massachusetts, USA,Department of Health Law, Policy and Management, Boston University School of Public Health, Massachusetts, USA
| | - Colleen M Ryan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA,Department of Surgery, Shriners Hospitals for Children—Boston®, Massachusetts, USA
| | - Amy Acton
- Phoenix Society for Burn Survivors, Grand Rapids, Michigan, USA
| | | | - Jeffrey C Schneider
- Address correspondence to Jeffrey C. Schneider, MD, 300 1st Avenue, Boston, MA 02129, USA.
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47
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McMullen K, Bamer A, Ryan CM, Schneider JC, Gibran N, Stewart BT, Mroz T, Wolf S, Amtmann D. Validation of PROMIS-29 domain scores among adult burn survivors: A National Institute on Disability, Independent Living, and Rehabilitation Research Burn Model System Study. J Trauma Acute Care Surg 2022; 92:213-222. [PMID: 34284470 PMCID: PMC9118559 DOI: 10.1097/ta.0000000000003365] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Patient-reported outcomes are important for understanding recovery after burn injury, benchmarking service delivery and measuring the impact of interventions. Patient-Reported Outcomes Measurement Information System (PROMIS)-29 domains have been validated for use among diverse populations though not among burn survivors. The purpose of this study was to examine validity and reliability of PROMIS-29 scores in this population. METHODS The PROMIS-29 scores of physical function, anxiety, depression, fatigue, sleep disturbance, ability to participate in social roles, and pain interference were evaluated for validity and reliability in adult burn survivors. Unidimensionality, floor and ceiling effects, internal consistency, and reliability were examined. Differential item functioning was used to examine bias with respect to demographic and injury characteristics. Correlations with measures of related constructs (Community Integration Questionnaire, Satisfaction with Life Scale, Post-Traumatic Stress Checklist-Civilian, and Veteran's Rand-12) and known-group differences were examined. RESULTS Eight hundred and seventy-six burn survivors with moderate to severe injury from 6 months to 20 years postburn provided responses on PROMIS-29 domains. Participants' ages ranged from 18 years to 93 years at time of assessment; mean years since injury was 3.4. All PROMIS domain scores showed high internal consistency (Cronbach's α = 0.87-0.97). There was a large ceiling effect on ability to participate in social roles (39.7%) and physical function (43.3%). One-factor confirmatory factor analyses supported unidimensionality (all comparative fit indices >0.95). We found no statistically significant bias (differential item functioning). Reliability was high (>0.9) across trait levels for all domains except sleep, which reached moderate reliability (>0.85). All known-group differences by demographic and clinical characteristics were in the hypothesized direction and magnitude except burn size categories. CONCLUSION The results provide strong evidence for reliability and validity of PROMIS-29 domain scores among adult burn survivors. Reliability of the extreme scores could be increased and the ceiling effects reduced by administering PROMIS-43, which includes six items per domain, or by administering by computerized adaptive testing. LEVEL OF EVIDENCE Diagnostic Test or Criteria, level III.
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Affiliation(s)
- Kara McMullen
- From the Department of Rehabilitation Medicine (K.M., A.B., T.M., D.A.), University of Washington, Seattle, WA; Division of Surgery, Shriners Hospitals for Children-Boston (C.M.R.); Department of Surgery (C.M.R.), Massachusetts General Hospital, Harvard Medical School; Department of Physical Medicine and Rehabilitation (J.C.S.), Spaulding Rehabilitation Hospital, Spaulding Research Institute, Harvard Medical School, Boston, MA; Department of Surgery (N.G., B.T.S.), University of Washington Harborview, Seattle, WA; Harborview Injury Prevention and Research Center (B.T.S.), Seattle, WA; and Department of Surgery, University of Texas Medical Branch (S.W.), Galveston, TX
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48
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Lamm AG, Goldstein R, Slocum CS, Silver JK, Grabowski DC, Schneider JC, Zafonte RD. For-Profit and Not-For-Profit Inpatient Rehabilitation in Traumatic Brain Injury: Analysis of Demographics and Outcomes. Arch Phys Med Rehabil 2021; 103:851-857. [PMID: 34856156 DOI: 10.1016/j.apmr.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To describe differences in traumatic brain injury patient characteristics and outcomes by inpatient rehabilitation facility profit status. DESIGN Retrospective database review utilizing the Uniform Data System for Medical Rehabilitation® (UDSMR). SETTING Inpatient rehabilitation facilities. PARTICIPANTS Individual discharges (n = 53,630) from 877 distinct rehabilitation facilities for calendar years 2016 through 2018. INTERVENTION NA MAIN OUTCOME MEASURES: Patient demographic data (age, race, primary payer source), admission and discharge Functional Independence Measure® (FIM®), FIM® gain, length of stay efficiency, acute hospital readmission from for-profit and not-for-profit IRFs within 30 days, and community discharges by facility profit status. RESULTS Patients at for-profit facilities were significantly older (69.69 vs. 64.12 years), with lower admission FIM® scores (52 vs. 57), shorter lengths of stay (13 vs. 15 days), and higher discharge FIM® scores (88 vs. 86); for-profit facilities had higher rates of community discharges (76.8% vs. 74.6%), but also had higher rates of readmission (10.3% vs. 9.9%). CONCLUSIONS The finding that for-profit facilities admit older patients who are reportedly less functional on admission and more functional on discharge, with higher rates of community discharge but higher readmission rates than not-for-profit facilities is an unexpected and potentially anomalous finding. In general, older, less functional patients who stay for shorter periods of time would not necessarily be expected to make greater functional gains. These differences should be further studied, to determine if differences in patient selection, coding/billing, or other unreported factors underlie these differences.
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Affiliation(s)
- Adam G Lamm
- Mary Free Bed Rehabilitation Hospital, 235 Wealthy St SE, Grand Rapids, MI
| | - Richard Goldstein
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital / Harvard Medical School, 300 First Avenue, Charlestown, MA
| | - Chloe S Slocum
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital / Harvard Medical School, 300 First Avenue, Charlestown, MA; Massachusetts General Hospital, 55 Fruit Street, Boston, MA
| | - Julie K Silver
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital / Harvard Medical School, 300 First Avenue, Charlestown, MA; Massachusetts General Hospital, 55 Fruit Street, Boston, MA; Brigham & Women's Hospital, 75 Francis Street, Boston, MA
| | - David C Grabowski
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA
| | - Jeffrey C Schneider
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital / Harvard Medical School, 300 First Avenue, Charlestown, MA
| | - Ross D Zafonte
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital / Harvard Medical School, 300 First Avenue, Charlestown, MA; Massachusetts General Hospital, 55 Fruit Street, Boston, MA; Brigham & Women's Hospital, 75 Francis Street, Boston, MA.
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49
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Stockly OR, Wolfe AE, Goldstein R, Roaten K, Wiechman S, Trinh NH, Goverman J, Stoddard FJ, Zafonte R, Ryan CM, Schneider JC. Predicting Depression and Post-Traumatic Stress Symptoms Following Burn Injury: A Risk Scoring System. J Burn Care Res 2021; 43:899-905. [PMID: 34751379 DOI: 10.1093/jbcr/irab215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Depression and post-traumatic stress are common psychiatric comorbidities following burn injury. The purpose of this study was to develop an admission scoring system that assesses the risk of development of depression or post-traumatic symptoms in the burn population. This study is a retrospective review of the prospectively collected Burn Model System National Database. Adult burn survivors enrolled from 2014-2018 (n=486) were included. The primary outcome was the presence of depression or post-traumatic stress symptoms at 6, 12, or 24 months post-injury. Logistic regression analysis was used to identify demographic and clinical predictors of depression and post-traumatic stress symptoms. A risk scoring system was then created based on assigning point values to relevant predictor factors. The study population had a mean age of 46.5±15.8 years, mean burn size of 18.3±19.7%, and was 68.3% male. Prior to injury, 71.3% of the population was working, 47.9% were married, and 50.8% had completed more than a high school education. An 8-point risk scoring system was developed using the following predictors of depression or post-traumatic stress symptom development: gender, psychiatric treatment in the past year, graft size, head/neck graft, etiology of injury, and education level. This study is the first to develop a depression and post-traumatic stress symptom risk scoring system for burn injury. This scoring system will aid in identifying burn survivors at high risk of long-term psychiatric symptoms that may be used to improve screening, monitoring, timely diagnosis and interventions.
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Affiliation(s)
- Olivia R Stockly
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA
| | - Audrey E Wolfe
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA
| | - Richard Goldstein
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA
| | - Kimberly Roaten
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX
| | - Shelley Wiechman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Nhi-Ha Trinh
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jeremy Goverman
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Frederick J Stoddard
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA.,Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA.,Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Colleen M Ryan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.,Harvard Medical School, Boston, MA.,Shriners Hospitals for Children-Boston, Boston, MA
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA.,Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
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50
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Grant GG, Brady KJS, Stoddard FJ, Meyer WJ, Romanowski KS, Chang PH, Painting LE, Fowler LA, Nelson JK, Patel KF, Sheldrick RC, Carter A, Sheridan RL, Slavin MD, Warner P, Palmieri TL, Schneider JC, Kazis LE, Ryan CM. Measuring the impact of burn injury on the parent-reported health outcomes of children 1-to-5 years: Item pool development for the Preschool 1-5 Life Impact Burn Recovery Evaluation (LIBRE) Profile. Burns 2021; 47:1511-1524. [PMID: 33832799 PMCID: PMC8711655 DOI: 10.1016/j.burns.2021.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 01/29/2021] [Accepted: 02/03/2021] [Indexed: 11/23/2022]
Abstract
Modern, reliable, and valid outcome measures are essential to understanding the health needs of young children with burn injuries. Burn-specific and age-appropriate legacy assessment tools exist for this population but are hindered by the limitations of existing paper-based instruments. The purpose of this study was to develop item pools comprised of questions appropriate for children aged 1-5 with burn injuries. Item development was based on a framework provided by previous work to develop the Preschool Life Impact Burn Recovery Evaluation (LIBRE) Conceptual Model. The Preschool LIBRE Conceptual Model work established four sub-domains of functioning for children with burns aged 1-5. Item development involved a systematic literature review, a qualitative item review process with clinical experts, and parent cognitive interviews. Four item pools were established: (1) communication and language development; (2) physical functioning; (3) psychological functioning and (4) social functioning for preschool-aged children with burn injuries. We selected and refined candidate items, recall periods, survey instructions, and response option choices through clinical and parental feedback during the qualitative review and cognitive interview processes. Item pools are currently being field-tested as part of the process to calibrate and validate the Preschool1-5 LIBRE Computer Adaptive Test (CAT) Profile.
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Affiliation(s)
- Gabrielle G Grant
- Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Surgery, Massachusetts General Hospital, Boston, MA, United States; University of North Carolina at Chapel Hill, School of Nursing, Hillman Scholars in Nursing Innovation, Chapel Hill, NC, United States
| | - Keri J S Brady
- Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Surgery, Massachusetts General Hospital, Boston, MA, United States; Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States
| | - Frederick J Stoddard
- Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Walter J Meyer
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, TX, United States; Shriners Hospitals for Children - Galveston, Galveston, TX, United States
| | - Kathleen S Romanowski
- Shriners Hospital for Children - Northern California, Sacramento, CA, United States; University of California Davis School of Medicine, Department of Surgery, Division of Burn Surgery, Sacramento, CA, United States
| | | | - Lynda E Painting
- Shriners Hospital for Children - Northern California, Sacramento, CA, United States; University of California Davis School of Medicine, Department of Surgery, Division of Burn Surgery, Sacramento, CA, United States
| | - Laura A Fowler
- Shriners Hospital for Children - Cincinnati, Cincinnati, OH, United States
| | - Judith K Nelson
- Shriners Hospital for Children - Cincinnati, Cincinnati, OH, United States
| | - Khushbu F Patel
- Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Surgery, Massachusetts General Hospital, Boston, MA, United States
| | - R Christopher Sheldrick
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States
| | - Alice Carter
- Department of Psychology, University of Massachusetts - Boston, Boston, MA, United States
| | - Robert L Sheridan
- Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Surgery, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Mary D Slavin
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States
| | - Petra Warner
- Shriners Hospital for Children - Cincinnati, Cincinnati, OH, United States; Department of Surgery, University of Cincinnati, Cincinnati, OH, United States
| | - Tina L Palmieri
- Shriners Hospital for Children - Northern California, Sacramento, CA, United States; University of California Davis School of Medicine, Department of Surgery, Division of Burn Surgery, Sacramento, CA, United States
| | - Jeffrey C Schneider
- Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, United States; Spaulding Research Institute, Boston, MA, United States
| | - Lewis E Kazis
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States
| | - Colleen M Ryan
- Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Surgery, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
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