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Sarno DL, Silver EM, Goldstein R, Frontera WR, Silver JK. Rehabilitation clinical trials in global registries: reporting of participant inclusion by sex, age, race and ethnicity. Disabil Rehabil 2024; 46:2946-2954. [PMID: 37448349 DOI: 10.1080/09638288.2023.2231844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023]
Abstract
PURPOSE Registries of clinical trials exist in part to standardize data for the scientific community. Studies in the United States demonstrated gaps in reporting on ClinicalTrials.gov. The purpose of this cross-sectional study was to evaluate clinical trial participation among global registries. METHODS This study identified registries with results reported and assessed available results for physical and rehabilitation medicine (PRM) diagnosis, intervention, primary outcome, and the International Classification of Functioning, Disability and Health (ICF) categories. Participant characteristics including sex, age, and race/ethnicity were assessed. RESULTS A total of 93 rehabilitation trials from eight registries met inclusion criteria. Most trials included persons with musculoskeletal disorders (50.5%), technology such as robotics (25.8%) and outcomes in ICF category of body functions and structures (54.7%). Sex was reported in 61.3% of trials and varied among registries (0 to 100%). Participation of women in trials showed variability from 0 to 75%. Reporting of age of the participants was not uniform and six registries did not include age in all trials. Information about race/ethnicity was absent in most trials and registries. CONCLUSIONS Based on trials registered with accessible results, these findings may reveal either a gap in reporting results or a lack of trials investigating important PRM diagnoses, interventions, and outcomes.Implications for RehabilitationThis study contributes to the growing body of evidence that there are gaps in standardization of rehabilitation results reported on clinical trials registries.The uniform reporting of results is an important component of advancing rehabilitation science and may be a factor in high-quality study design and improved transparency.
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Affiliation(s)
- Danielle L Sarno
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, Boston, MA, USA
| | - Emily M Silver
- Department of Psychology, University of Chicago, Chicago, IL, USA
| | - Richard Goldstein
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, Boston, MA, USA
| | - Walter R Frontera
- Department of Physical Medicine, Rehabilitation, and Sports Medicine, Department of Physiology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, Boston, MA, USA
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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] [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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Santos E, Chacon KL, Shepler LJ, McMullen KA, Slavin MD, van de Rijn M, Kowalske KJ, Ryan CM, Schneider JC. Balance Impairment in the Burn Population: A Burn Model System National Database Study. EUROPEAN BURN JOURNAL 2024; 5:238-248. [PMID: 39309318 PMCID: PMC11414829 DOI: 10.3390/ebj5030023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/25/2024]
Abstract
Balance is an important component of daily function and impairments can lead to injury and quality-of-life limitations. Balance is not well studied in the burn population. This study examines the frequency of long-term balance impairments and associated factors after a burn injury. The Burn Model System National Database was analyzed. Trouble with balance was self-reported at discharge, 6, 12, 24, and 60 months after injury. Regression analyses examined the associations between demographic and clinical characteristics and balance impairments at 12 months. Of 572 participants, balance impairments were most reported at discharge (40.3%), continuing over 60 months (26.8-36.0%). Those reporting balance impairments (n = 153) were more likely to be older, unemployed, have Medicaid or Medicare, receive inpatient rehabilitation, receive outpatient physical or occupational therapy, have vision problems, have leg or feet burns and swelling, and have foot numbness compared to those without (p ≤ 0.001). Regression analysis demonstrated a 4% increased odds of balance impairment for every increase in year of age (p < 0.001), 71% lower odds if employed at time of injury (p < 0.001), and 140% higher odds if receiving outpatient physical or occupational therapy at 12 months (p = 0.008). Common reports of balance impairments highlight the need for routine screenings to identify burn survivors that may benefit from targeted interventions.
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Affiliation(s)
- Edward Santos
- Department of Physical Medicine and Rehabilitation, Schoen Adams Research Institute, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA 02129, USA
| | - Kaitlyn L. Chacon
- Department of Physical Medicine and Rehabilitation, Schoen Adams Research Institute, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA 02129, USA
| | - Lauren J. Shepler
- Department of Physical Medicine and Rehabilitation, Schoen Adams Research Institute, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA 02129, USA
| | - Kara A. McMullen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98104, USA
| | - Mary D. Slavin
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA 02118, USA
- Rehabilitation Outcomes Center at Spaulding, Spaulding Rehabilitation Hospital, Boston, MA 02129, USA
| | - Marc van de Rijn
- Department of Physical Medicine and Rehabilitation, Schoen Adams Research Institute, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA 02129, USA
| | - Karen J. Kowalske
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX 753890, USA
| | - Colleen M. Ryan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Shriners Hospitals for Children, Harvard Medical School, Boston, MA 02114, USA
| | - Jeffrey C. Schneider
- Department of Physical Medicine and Rehabilitation, Schoen Adams Research Institute, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA 02129, USA
- Rehabilitation Outcomes Center at Spaulding, Spaulding Rehabilitation Hospital, Boston, MA 02129, USA
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Sheckter CC, Holan C, Carrougher G, Orton C, Gibran N, Stewart BT. Higher Out-of-pocket Expenses are Associated with Worse Health-related Quality of Life in Burn Survivors: A Northwest Regional Burn Model System Investigation. J Burn Care Res 2023; 44:1349-1354. [PMID: 37094279 PMCID: PMC11491638 DOI: 10.1093/jbcr/irad058] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Indexed: 04/26/2023]
Abstract
The care required to recover serious burn injuries is costly. In the United States, these costs are often borne by patients. Examining the relationship between out-of-pocket (OOP) costs and health-related quality of life (HRQL) is important to support burn survivors. Financial data from a regional burn center were merged with data in the Burn Model System (BMS) National Database. HRQL outcomes included VA-Rand 12 (VR-12) physical component summary (PCS) and mental component summary (MCS) scores. Participant surveys were conducted at 6-, 12-, and 24-months post-injury. VR-12 scores were evaluated using generalized linear models and adjusted for potential confounders (age, sex, insurance/payer, self-identified race/ethnicity, measures of burn injury severity). 644 participants were included, of which 13% (84) had OOP costs. The percentage of participants with OOP costs was 34% for commercial/private, 22% for Medicare, 8% for other, 4% for self-pay, and 0% for workers' compensation and Medicaid. For participants with OOP expenses, median payments were $875 with an IQR of $368-1728. In addition to markers of burn injury severity, OOP costs were negatively associated with PCS scores at 6-months (coefficient -0.002, P < .001) and 12-months post-injury (coefficient -0.001, P = .004). There were no significant associations with PCS scores at 24 months post-injury or MCS scores at any interval. Participants with commercial/private or Medicare payer had higher financial liability than other payers. Higher OOP expenses were negatively associated with physical HRQL for at least 12 months after injury. Financial toxicity occurs after burn injury and providers should target resources accordingly.
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Affiliation(s)
- Clifford C Sheckter
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University, USA
- Regional Burn Center at Santa Clara Valley Medical Center, Department of Surgery, USA
| | - Cole Holan
- Dell Medical School, The University of Texas, Austin, USA
| | - Gretchen Carrougher
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington, USA
| | - Caitlin Orton
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington, USA
| | - Nicole Gibran
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington, USA
| | - Barclay T Stewart
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington, USA
- Harborview Injury Prevention and Research Center, University of Washington, USA
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Yang J, Tian G, Liu J, Bai H, Yang S, Ran M, Li H, Ma K, Yang S, Fu X. Epidemiology and clinical characteristics of burns in mainland China from 2009 to 2018. BURNS & TRAUMA 2022; 10:tkac039. [PMID: 36196302 PMCID: PMC9519692 DOI: 10.1093/burnst/tkac039] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/20/2022] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Burn injuries place a heavy burden on the global healthcare system. However, there is still a lack of nationwide studies on the epidemiological characteristics of burn patients in mainland China. The present study aims to accurately analyze the clinical characteristics of burn patients by collecting data in mainland China from 2009 to 2018, which will provide effective strategies for healthcare systems and the government in mainland China.
Methods
Patients admitted for burn injuries to 196 hospitals in 31 provinces, autonomous regions and municipalities in mainland China from 2009 to 2018 were included. The data collected included sex, age, month distribution, etiology, region, clinical outcome, injury anatomical location, total burn surface area and mortality. SPSS 19.0 software was used to analyze the data.
Results
From 2009 to 2018, the burn patients were 333,995 (0.76%), which included 222,480 (66.61%) males and 111,515 (33.39%) females. From 2009 to 2018, the number of individuals admitted to hospitals for burns showed a downward trend year by year. The burn patients accounted for the highest proportion of inpatients in 0–10 years (38.10%), followed by 40–50 years (13.14%). The highest cure ratio of burn inpatients was in the 20–30 age group (31 394, 71.53%). Among 31 provinces, autonomous regions and municipalities, the province with the highest proportion of total inpatients caused by burns was Inner Mongolia (4.61%), followed by Zhejiang (3.17%), Hainan (2.88%) and Xinjiang (2.64%). Summer (29.16%) was the season with the highest incidence of burn patients admitted to hospitals, followed by spring (25.6%). Scalding (60.19%) was the most frequent kind of burn treated, followed by fire (20.45%). The patients had multiple burn sites (68.89%) most often, followed by burns on the lower limbs (10.91%). From 0% to 10% total body surface area (TBSA) accounted for the highest ratio (37.19%), followed by 90–100% TBSA (21.74%).
Conclusions
The present study is the first to describe the associated situation and trends of burn patients in mainland China from 2009 to 2018. Our findings will serve as the latest clinical evidence for healthcare planning and prevention efforts in China and other countries.
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Affiliation(s)
- Jie Yang
- PLA General Hospital and PLA Medical College Research Center for Tissue Repair and Regeneration affiliated to the Medical Innovation Research Department, , Beijing, P.R. China 100853
- Department of Dermatology, 4th Medical Center, PLA General Hospital , Beijing, P.R. China 100048
| | - Guanglei Tian
- PLA General Hospital and PLA Medical College Research Center for Tissue Repair and Regeneration affiliated to the Medical Innovation Research Department, , Beijing, P.R. China 100853
| | - Jianchao Liu
- Department of Health Service, PLA General Hospital , Beijing, P.R. China 100853
| | - Huajuan Bai
- Department of Health Service, PLA General Hospital , Beijing, P.R. China 100853
| | - Shuxu Yang
- PLA General Hospital and PLA Medical College Research Center for Tissue Repair and Regeneration affiliated to the Medical Innovation Research Department, , Beijing, P.R. China 100853
- Department of Dermatology, 4th Medical Center, PLA General Hospital , Beijing, P.R. China 100048
| | - Mingzi Ran
- PLA General Hospital and PLA Medical College Research Center for Tissue Repair and Regeneration affiliated to the Medical Innovation Research Department, , Beijing, P.R. China 100853
- Department of Anesthesiology, 4th Medical Center, PLA General Hospital , Beijing, P.R. China 100048
| | - Hongyu Li
- PLA General Hospital and PLA Medical College Research Center for Tissue Repair and Regeneration affiliated to the Medical Innovation Research Department, , Beijing, P.R. China 100853
- Department of Dermatology, 4th Medical Center, PLA General Hospital , Beijing, P.R. China 100048
| | - Kui Ma
- PLA General Hospital and PLA Medical College Research Center for Tissue Repair and Regeneration affiliated to the Medical Innovation Research Department, , Beijing, P.R. China 100853
| | - Siming Yang
- PLA General Hospital and PLA Medical College Research Center for Tissue Repair and Regeneration affiliated to the Medical Innovation Research Department, , Beijing, P.R. China 100853
- Department of Dermatology, 4th Medical Center, PLA General Hospital , Beijing, P.R. China 100048
| | - Xiaobing Fu
- PLA General Hospital and PLA Medical College Research Center for Tissue Repair and Regeneration affiliated to the Medical Innovation Research Department, , Beijing, P.R. China 100853
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