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Ferraz A, Santos M, Pereira MG. Portuguese Validation of the TAPQoL: A Health-Related Quality of Life Instrument for Children Aged 0-6 Years. Eur J Investig Health Psychol Educ 2024; 14:399-410. [PMID: 38391494 PMCID: PMC10888349 DOI: 10.3390/ejihpe14020027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/07/2024] [Accepted: 02/13/2024] [Indexed: 02/24/2024] Open
Abstract
In Portugal, there are few generic and specific instruments to assess health-related quality of life (HRQoL) in children, especially those of preschool age. This study aimed to adapt and validate the Portuguese version of the Preschool Children Quality of Life Questionnaire (TAPQoL) in a community and clinical sample of children aged 0-6 years. The parents of 409 healthy children and 137 children undergoing treatment for burns and acute lymphoblastic leukemia completed the TAPQoL and were assessed on psychological morbidity and family functioning. Exploratory and confirmatory factor analyses were performed, as well as analysis of the psychometric properties as shown by internal consistency measures, convergent validity, and average variance extracted. Confirmatory factor analysis confirmed an 11-factor structure with good psychometric properties. The current version of the TAPQoL is a valid and reliable instrument for assessing HRQoL in Portuguese preschool children in community and clinical settings.
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Affiliation(s)
- Ana Ferraz
- Psychology Research Centre (CIPsi), School of Psychology, University of Minho, 4710-057 Braga, Portugal
| | - Martim Santos
- Psychology Research Centre (CIPsi), School of Psychology, University of Minho, 4710-057 Braga, Portugal
| | - M Graça Pereira
- Psychology Research Centre (CIPsi), School of Psychology, University of Minho, 4710-057 Braga, Portugal
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Belval LN, Cramer MN, Moralez G, Huang DPT M, Watso JC, Fischer M, Crandall CG. Burn size and environmental conditions modify thermoregulatory responses to exercise in burn survivors. J Burn Care Res 2024; 45:227-233. [PMID: 37615621 PMCID: PMC10768759 DOI: 10.1093/jbcr/irad128] [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: 06/08/2023] [Indexed: 08/25/2023]
Abstract
This project tested the hypothesis that burn survivors can perform mild/moderate-intensity exercise in temperate and hot environments without excessive elevations in core body temperature. Burn survivors with low (23 ± 5%TBSA; N = 11), moderate (40 ± 5%TBSA; N = 9), and high (60 ± 8%TBSA; N = 9) burn injuries performed 60 minutes of cycle ergometry exercise (72 ± 15 watts) in a 25°C and 23% relative humidity environment (ie, temperate) and in a 40°C and 21% relative humidity environment (ie, hot). Absolute gastrointestinal temperatures (TGI) and changes in TGI (ΔTGI) were obtained. Participants with an absolute TGI of >38.5°C and/or a ΔTGI of >1.5°C were categorized as being at risk for hyperthermia. For the temperate environment, exercise increased ΔTGI in all groups (low: 0.72 ± 0.21°C, moderate: 0.42 ± 0.22°C, and high: 0.77 ± 0.25°C; all P < .01 from pre-exercise baselines), resulting in similar absolute end-exercise TGI values (P = .19). Importantly, no participant was categorized as being at risk for hyperthermia, based upon the aforementioned criteria. For the hot environment, ΔTGI at the end of the exercise bout was greater for the high group when compared to the low group (P = .049). Notably, 33% of the moderate cohort and 56% of the high cohort reached or exceeded a core temperature of 38.5°C, while none in the low cohort exceeded this threshold. These data suggest that individuals with a substantial %TBSA burned can perform mild/moderate intensity exercise for 60 minutes in temperate environmental conditions without risk of excessive elevations in TGI. Conversely, the risk of excessive elevations in TGI during mild/moderate intensity exercise in a hot environment increases with the %TBSA burned.
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Affiliation(s)
- Luke N Belval
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, TX 75231, USA
| | - Matthew N Cramer
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, TX 75231, USA
| | - Gilbert Moralez
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, TX 75231, USA
- Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Mu Huang DPT
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, TX 75231, USA
- Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Joseph C Watso
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, TX 75231, USA
| | - Mads Fischer
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, DK 1165, Denmark
| | - Craig G Crandall
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, TX 75231, USA
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Palackic A, Rego A, Parry I, Sen S, Branski LK, Hallman TG, Spratt H, Lee JO, Herndon DN, Wolf SE, Suman OE. Effects of Aerobic Exercise in the Intensive Care Unit on Patient-Reported Physical Function and Mental Health Outcomes in Severely Burned Children-A Multicenter Prospective Randomized Trial. J Pers Med 2023; 13:455. [PMID: 36983636 PMCID: PMC10058069 DOI: 10.3390/jpm13030455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/05/2023] Open
Abstract
Severe burns are life-altering and can have lasting effects on patients' physical and mental health. Alterations in physical function, changes in appearance, and psychological disturbances resulting from severe burns are especially concerning in children, as they are still in the early stages of identity formation. Exercise in the nonburn population has been shown to improve quality of life and result in better physical and mental status. However, the effect of early exercise on the quality of life in pediatric burn patients requires more research. METHODS Forty-eight children between the ages of seven and seventeen with ≥30% total body surface area (TBSA) burn were randomized in a 1:2 fashion to receive treatment with standard-of-care (SOC) or standard-of-care plus exercise (SOC+Ex). Surveys administered at admission and discharge collected patient-reported information regarding physical and mental health outcomes. The results are given as means +/- standard deviation. Significance was set at p < 0.05. RESULTS The average age of the SOC and SOC+Ex groups were 12 ± 3 and 13 ± 4 years, respectively. The average %TBSA burned in the SOC and SOC+Ex groups were 54 ± 17 and 48 ± 14, respectively. The SOC+Ex group averaged 10 ± 9 exercise sessions (range of 1 to 38 sessions) with an attendance rate of 25% (10 sessions out of 40 BICU days). Both groups demonstrated significant improvement in patient-reported physical and mental outcomes during hospital admission (p < 0.05) However, additional exercise did not exhibit any additional benefits for measured levels. CONCLUSIONS Our recommendation is for all pediatric patients in the BICU to continue with the SOC and consult with their physician over the benefits of additional aerobic exercise. This study suggests that perhaps there is potential for increasing the amount of exercise that can be administered to pediatric burn survivors beyond SOC as we did not find aerobic exercise to be of any harm to any patients if it is performed properly and under supervision.
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Affiliation(s)
- Alen Palackic
- Department of Surgery, School of Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria
| | - Andrea Rego
- Department of Surgery, School of Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Ingrid Parry
- Department of Surgery, University of California, Davis, CA 95616, USA
| | - Soman Sen
- Department of Surgery, University of California, Davis, CA 95616, USA
| | - Ludwik K. Branski
- Department of Surgery, School of Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Taylor G. Hallman
- Department of Surgery, School of Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Heidi Spratt
- Department of Biostatistics and Data Science, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Jong O. Lee
- Department of Surgery, School of Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - David N. Herndon
- Oxford University Press, Wolters Kluwer N.V., 2400BA Alphen aan den Rijn, The Netherlands
| | - Steven E. Wolf
- Department of Surgery, School of Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Oscar E. Suman
- Department of Surgery, School of Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA
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Potter M, Aaron D, Mumford R, Ward L. An evaluation of clinical psychology input into burns multidisciplinary follow-up clinics. Scars Burn Heal 2023; 9:20595131221141083. [PMID: 36632429 PMCID: PMC9827515 DOI: 10.1177/20595131221141083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Introduction Research highlights the complex psychological needs that patients and their families can face following a burn injury, regardless of the objective severity of the injury and often beyond the timeframe of physical healing. Identification of psychological needs at different stages post-burn recovery is therefore a key role of clinical psychologists working in burn care services. Method This paper presents audit data collected across a two-year period in routine paediatric and adult multidisciplinary team follow-up clinics in a UK burns service. 808 clinical contacts (331 adults, 477 paediatrics) were recorded. Data gathered related to the identification of patient and/or family psychological need and the level of psychology input within clinic. Results For 43% of adult patients and 46% of paediatric patients seen in clinic, some degree of psychological need for the patient and/or family was identified during the consultation. A large majority of concerns related directly to the burn injury. This is consistent with previous research into the psychological impact of burns. Even for patients with no identified psychological needs, psychology presence enabled the opportunity for brief screening, preventative advice or signposting to take place during clinic. Discussion A substantial number of individuals and families presented with some level of psychological concern in relation to a burn injury when attending burns multidisciplinary team follow-up clinics. Conclusion A substantial number of patients and families presented with psychological needs in relation to a burn injury when attending burns MDT follow-up clinics. The presence of Clinical Psychologists at burns MDT follow-up clinics is beneficial for the identification of burns and non-burns related psychological concerns and is a valuable use of psychological resources within a burns service. Lay Summary The Regional Burns Centre holds regular outpatient scar clinics to monitor recovery and healing. As well as the medical professionals, the clinics are joined by Clinical Psychologists who can assess, refer, and support individuals struggling with their burn or scarring on a mental level. Over 15 months, data was collected about patients attending the clinics and the involvement of the psychologists. 43% of adult patients and 46% of paediatric patients were identified as having some psychological need, either related to their burn or to other aspects of their life. This demonstrates the benefits of having psychology presence within scar clinics, as nearly half of the patients seen in clinic received an assessment and further support (such as signposting and referrals to psychological support). Burns staff also felt that psychology presence enhanced conversations and increased collaboration with decision making around treatment.
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Affiliation(s)
- Melissa Potter
- Department of Clinical Health Psychology, Mid Yorkshire
Hospitals NHS Trust, Wakefield, Yorkshire, UK,Melissa Potter, Department of Clinical
Health Psychology, Mid Yorkshire Hospitals NHS Trust, Aberford Road, Wakefield
WF1 4DG, Yorkshire, UK.
| | - David Aaron
- Department of Clinical Health Psychology, Mid Yorkshire
Hospitals NHS Trust, Wakefield, Yorkshire, UK
| | - Rachel Mumford
- Department of Clinical Health Psychology, Mid Yorkshire
Hospitals NHS Trust, Wakefield, Yorkshire, UK
| | - Lucy Ward
- Department of Clinical Health Psychology, Mid Yorkshire
Hospitals NHS Trust, Wakefield, Yorkshire, UK
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Vacuum and Electromagnetic Fields Treatment to Regenerate a Diffuse Mature Facial Scar Caused by Sulfuric Acid Assault. BIOENGINEERING (BASEL, SWITZERLAND) 2022; 9:bioengineering9120799. [PMID: 36551005 PMCID: PMC9774184 DOI: 10.3390/bioengineering9120799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022]
Abstract
Acid attacks are on the rise, and they cause extensive and deep burns, especially on the face. The treatments used to improve the aesthetic, functional and social impact of non-acid scars do not always prove useful for acid scars. This article reports the case of a woman with an extended, mature, acid facial scar, caused by sulfuric acid assault, treated with a recent new procedure that combines the application of vacuum and electromagnetic fields. Before and after the treatment, the aesthetic appearance, and motor function of the face and neck were evaluated, as well as the level of hydration, the amount of sebum, the elasticity, and the pH of the skin. The improvements highlighted after the treatment of the aesthetic and functional characteristics of the face and neck, and of the physical parameters of the skin seemed to indicate that this particular treatment induces tissue regeneration, even in the nerve component. However, it is evident that the rehabilitation pathways of facial wounds and scars must be personalized, and must include continuous psychological support for the patient.
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Jeong WJ, Holavanahalli RK, Kowalske KJ. Evaluation of Kinesiophobia in Survivors of Major Burn Injury. J Burn Care Res 2022; 43:1380-1385. [PMID: 35385580 DOI: 10.1093/jbcr/irac043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Kinesiophobia, the fear of movement and re-injury, has not been described in burn injury survivors. Physical activity is a key component of burn rehabilitation programs. Yet, not all burn survivors exercise at the recommended level. This is an exploratory study examining the association of the demographics and injury characteristics of burn survivors with a fear of movement. The subjective fear of movement was measured using the Tampa Scale for Kinesiophobia (TSK). The TSK score was compared between several demographics and injury characteristics by performing the independent sample t-test. Sixty-six percent of subjects in our study (n=35), reported high levels of kinesiophobia (score 37 or above). The mean scores of the TSK were greater in males (40.7), non-White (43.0), Hispanic/Latino (41.1), age greater than 50 years (42.3), and total body surface area (TBSA) burn of >15% compared to females (36.9), White (38.5), non-Hispanic/Latino (39.3), age 50 years or less (38.1), and TBSA 15% or less (39.4) respectively. However, with the exception of time post injury, none of the mean differences were statistically significant. Subjects who had sustained a burn injury more than 12 months ago showed higher levels of kinesiophobia than the subjects who were injured within 12 months with a mean difference of 7.35 (p=.01). Thus, this study highlights the importance of (i) continued, long-term follow up for burn survivors, and (ii) appropriate educational and treatment interventions to address any underlying existing, new, or emerging medical issues that may contribute to the fear or avoidance of movement.
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Affiliation(s)
- Won J Jeong
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Radha K Holavanahalli
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Karen J Kowalske
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, Texas, U.S.A
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Crandall CG, Cramer MN, Kowalske KJ. Edward F. Adolph Distinguished Lecture. It's more than skin deep: thermoregulatory and cardiovascular consequences of severe burn injuries in humans. J Appl Physiol (1985) 2021; 131:1852-1866. [PMID: 34734782 PMCID: PMC8714984 DOI: 10.1152/japplphysiol.00620.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/27/2021] [Accepted: 11/01/2021] [Indexed: 11/22/2022] Open
Abstract
Each year, within the United States, tens of thousands of individuals are hospitalized for burn-related injuries. The treatment of deep burns often involves skin grafts to accelerate healing and reduce the risk of infection. The grafting procedure results in a physical disruption between the injured and subsequently debrided host site and the skin graft placed on top of that site. Both neural and vascular connections must occur between the host site and the graft for neural modulation of skin blood flow to take place. Furthermore, evaporative cooling from such burn injured areas is effectively absent, leading to greatly impaired thermoregulatory responses in individuals with large portions of their body surface area burned. Hospitalization following a burn injury can last weeks to months, with cardiovascular and metabolic consequences of such injuries having the potential to adversely affect the burn survivor for years postdischarge. With that background, the objectives of this article are to discuss 1) our current understanding of the physiology and associated consequences of skin grafting, 2) the effects of skin grafts on efferent thermoregulatory responses and the associated consequences pertaining to whole body thermoregulation, 3) approaches that may reduce the risk of excessive hyperthermia in burn survivors, 4) the long-term cardiovascular consequences of burn injuries, and 5) the extent to which burn survivors can "normalize" otherwise compromised cardiovascular responses. Our primary objective is to guide the reader toward an understanding that severe burn injuries result in significant physiological consequences that can persist for years after the injury.
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Affiliation(s)
- Craig G Crandall
- University of Texas Southwestern Medical Center and Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas
| | - Matthew N Cramer
- University of Texas Southwestern Medical Center and Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas
| | - Karen J Kowalske
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
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8
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Patterns and predictors of hand functional recovery following pediatric burn injuries: Prospective cohort study. Burns 2021; 48:1863-1873. [PMID: 34974931 DOI: 10.1016/j.burns.2021.11.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/22/2021] [Accepted: 11/22/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe the pattern of hand functional recovery in the first six months following the discharge of children with burn injury, and to identify the predictors affecting this recovery. MATERIALS AND METHODS This was a prospective, comparative, follow-up cohort study in which hand functional outcome, was assessed during 9 months follow-up on 37 children with burn injuries involving the upper extremity with total body service area (TBSA<35%). Thirty-six matched healthy children were participated to compare the differences between children with burn and healthy children regarding the hand functional outcome. Hand function assessments included total active motion (TAM), grip strength and Jebsen Hand Function Test (JHFT) were conducted at hospital discharge, 3, and 6 months follow-up after discharge. RESULTS We found a trend towards an increase in the TAM scores over time (P<0.001), and were excellent in 5.41%, at discharge and increased to 18.92% and 40.54% at 3 and 6-month following discharge. The hand grip strength and JHFT showed significant improvement over time after 6 months (P<0.001). Regression analysis revealed that time to surgery, engagement in rehabilitation services, hand dominance, age and TBSA were the predictors of hand functional recovery and accounted 74% for TAM, 0.79 and 0.86 for total JHFT scores and grip strength. CONCLUSIONS the TAM, grip strength and JHFT were significantly improved after 3-month and these improvements were more evident at 6-month following discharge. Identification of the predictors may help therapists in the development of an effective rehabilitation programs.
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Ohrtman EA, Shapiro GD, Simko LC, Dore E, Slavin MD, Saret C, Amaya F, Lomelin-Gascon J, Ni P, Acton A, Marino M, Kazis LE, Ryan CM, Schneider JC. Social Interactions and Social Activities After Burn Injury: A Life Impact Burn Recovery Evaluation (LIBRE) Study. J Burn Care Res 2020; 39:1022-1028. [PMID: 30016442 DOI: 10.1093/jbcr/iry038] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Social interactions and activities are key components of social recovery following burn injuries. The objective of this study is to determine the predictors of these areas of social recovery. This study provides a secondary analysis of a cross-sectional survey of adult burn survivors. The Life Impact Burn Recovery Evaluation-192 was administered to 601 burn survivors for the field-testing of the Life Impact Burn Recovery Evaluation Profile. Survivors aged 18 years and older with injuries ≥5% total BSA or burns to critical areas (hands, feet, face, or genitals) were eligible to participate. Multivariate linear regression analyses were used to determine predictors of the Social Activities and Social Interactions scale scores. A total of 599 people completed the Social Interactions and Social Activities scales. Of these, 77% identified as White Non-Hispanic, 55% were female, 55% were unmarried, and 80% had burns to critical areas. Participants had a mean age of 45 years, a mean time since burn injury of 15 years, and a mean burn size of 41% total BSA. Younger age (P < .01) and being married/living with a significant other (P ≤ .01) were associated with higher Social Activities and Social Interactions scale scores. Individual item responses reveal that survivors had lower scores on items related to participating in outdoor activities (30.4%) or feeling uncomfortable with their appearance (32.4% report dressing to avoid stares). Social interactions and activities are long-term challenges for burn survivors. It is important for clinicians to identify patients who may struggle with social recovery in order to focus on future community-based interventions.
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Affiliation(s)
- Emily A Ohrtman
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gabriel D Shapiro
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Laura C Simko
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Emily Dore
- Department of Health, Law, Policy and Management, Boston University School of Public Health, Massachusetts
| | - Mary D Slavin
- Department of Health, Law, Policy and Management, Boston University School of Public Health, Massachusetts
| | - Cayla Saret
- Department of Health, Law, Policy and Management, Boston University School of Public Health, Massachusetts
| | - Flor Amaya
- Department of Health, Law, Policy and Management, Boston University School of Public Health, Massachusetts
| | - J Lomelin-Gascon
- Department of Health, Law, Policy and Management, Boston University School of Public Health, Massachusetts
| | - Pengsheng Ni
- Department of Health, Law, Policy and Management, Boston University School of Public Health, Massachusetts
| | - Amy Acton
- Phoenix Society for Burn Survivors, Grand Rapids, Michigan
| | - Molly Marino
- Department of Health, Law, Policy and Management, Boston University School of Public Health, Massachusetts
| | - Lewis E Kazis
- Department of Health, Law, Policy and Management, Boston University School of Public Health, Massachusetts
| | - Colleen M Ryan
- Massachusetts General Hospital, Shriners Hospitals for Children, Harvard Medical School, Boston
| | - Jeffrey C Schneider
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
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Romero SA, Moralez G, Jaffery MF, Huang M, Cramer MN, Romain N, Kouda K, Haller RG, Crandall CG. Progressive exercise training improves maximal aerobic capacity in individuals with well-healed burn injuries. Am J Physiol Regul Integr Comp Physiol 2019; 317:R563-R570. [PMID: 31433672 DOI: 10.1152/ajpregu.00201.2019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Long-term rehabilitative strategies are important for individuals with well-healed burn injuries. Such information is particularly critical because patients are routinely surviving severe burn injuries given medical advances in the acute care setting. The purpose of this study was to test the hypothesis that a 6-mo community-based exercise training program will increase maximal aerobic capacity (V̇o2max) in subjects with prior burn injuries, with the extent of that increase influenced by the severity of the burn injury (i.e., percent body surface area burned). Maximal aerobic capacity (indirect calorimetry) and skeletal muscle oxidative enzyme activity (biopsy of the vastus lateralis muscle) were measured pre- and postexercise training in noninjured control subjects (n = 11) and in individuals with well-healed burn injuries (n = 13, moderate body surface area burned; n = 20, high body surface area burned). Exercise training increased V̇o2max in all groups (control: 15 ± 5%; moderate body surface area: 11 ± 3%; high body surface area: 11 ± 2%; P < 0.05), though the magnitude of this improvement did not differ between groups (P = 0.7). Exercise training also increased the activity of the skeletal muscle oxidative enzymes citrate synthase (P < 0.05) and cytochrome c oxidase (P < 0.05), an effect that did not differ between groups (P = 0.2). These data suggest that 6 mo of progressive exercise training improves V̇o2max in individuals with burn injuries and that the magnitude of body surface area burned does not lessen this adaptive response.
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Affiliation(s)
- Steven A Romero
- University of Texas Southwestern Medical Center and Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas.,University of North Texas Health Science Center, Fort Worth, Texas
| | - Gilbert Moralez
- University of Texas Southwestern Medical Center and Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas
| | - Manall F Jaffery
- University of Texas Southwestern Medical Center and Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas
| | - Mu Huang
- University of Texas Southwestern Medical Center and Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas
| | - Matthew N Cramer
- University of Texas Southwestern Medical Center and Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas
| | - Nadine Romain
- University of Texas Southwestern Medical Center and Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas
| | - Ken Kouda
- University of Texas Southwestern Medical Center and Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas.,Wakayama Medical University, Wakayama, Japan
| | - Ronald G Haller
- University of Texas Southwestern Medical Center and Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas
| | - Craig G Crandall
- University of Texas Southwestern Medical Center and Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas
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Cartwright S, Saret C, Shapiro GD, Ni P, Sheridan RL, Lee AF, Marino M, Acton A, Kazis LE, Schneider JC, Ryan CM. Burn survivors injured as children exhibit resilience in long-term community integration outcomes: A life impact burn recovery evaluation (LIBRE) study. Burns 2019; 45:1031-1040. [DOI: 10.1016/j.burns.2019.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 01/31/2019] [Accepted: 02/07/2019] [Indexed: 12/20/2022]
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12
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Ohrtman EA, Zaninotto AL, Carvalho S, Shie VL, Leite J, Ianni CR, Kazis LE, Zafonte R, Ryan CM, Schneider JC, Fregni F. Longitudinal Clinical Trial Recruitment and Retention Challenges in the Burn Population: Lessons Learned From a Trial Examining a Novel Intervention for Chronic Neuropathic Symptoms. J Burn Care Res 2019; 40:792-795. [DOI: 10.1093/jbcr/irz084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Abstract
Long-term trials are key to understanding chronic symptoms such as pain and itch. However, challenges such as high attrition rates and poor recruitment are common when conducting research. The aim of this work was to explore these issues within a long-term randomized control trial using transcranial direct current stimulation to treat pain and itch. This parallel double blinded, placebo-controlled randomized trial was comprised of 15 transcranial direct current stimulation visits and 7 follow-up visits. Participants were over the age of 18, had a burn injury that occurred at least 3 weeks before enrollment, and reported having pain and/or itch that was moderate to severe in intensity. A total of 31 subjects were randomized into either an active or sham transcranial direct current stimulation groups. There were no significant differences between the groups in terms of age, race, education, baseline depression, or anxiety. The median dropout time was at visit 19 (visit 16 [SE = 1.98] for the sham group and visit 19 [SE = 1.98] for the active group). Analysis showed no differences in the dropout rate between groups [χ2(1) = 0.003, P = .954]. The dropout rate was 46.7% for the sham group and 43.8% for the active group. Overall, 45.2% of the subjects dropped out of the trial. Long-term clinical trials are an essential part of evaluating interventions for symptoms such as chronic pain and itch. However, as seen in this trial, long-term studies in the burn population often face recruitment and adherence challenges.
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Affiliation(s)
- Emily A Ohrtman
- Department of Physical Medicine and Rehabilitation, Boston-Harvard Burn Injury Model System, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ana Luiza Zaninotto
- Department of Physical Medicine and Rehabilitation, Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sandra Carvalho
- Neurotherapeutics and Experimental Psychopathology (NEP) Group, Psychological Neuroscience Lab, CiPsi, School of Psychology, University of Minho, Campus de Gualtar, Braga, Portugal
| | - Vivian L Shie
- Department of Physical Medicine and Rehabilitation, Boston-Harvard Burn Injury Model System, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jorge Leite
- Universidade Portucalense, Portucalense Institute for Human Development – INPP, Oporto, Portugal
| | - Corinne Rose Ianni
- Department of Physical Medicine and Rehabilitation, Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lewis E Kazis
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Ross Zafonte
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Colleen M Ryan
- Massachusetts General Hospital, Shriners Hospitals for Children, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
- Neurotherapeutics and Experimental Psychopathology (NEP) Group, Psychological Neuroscience Lab, CiPsi, School of Psychology, University of Minho, Campus de Gualtar, Braga, Portugal
| | - Felipe Fregni
- Department of Physical Medicine and Rehabilitation, Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
- Neurotherapeutics and Experimental Psychopathology (NEP) Group, Psychological Neuroscience Lab, CiPsi, School of Psychology, University of Minho, Campus de Gualtar, Braga, Portugal
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Romero SA, Moralez G, Jaffery MF, Huang M, Crandall CG. Vasodilator function is impaired in burn injury survivors. Am J Physiol Regul Integr Comp Physiol 2018; 315:R1054-R1060. [PMID: 30256680 DOI: 10.1152/ajpregu.00188.2018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The effect of severe burn injury on vascular health is unknown. We tested the hypothesis that, compared with nonburn control subjects, vasodilator function would be reduced and that pulse-wave velocity (a measure of arterial stiffness) would be increased in individuals with prior burn injuries, the extent of which would be associated with the magnitude of body surface area having sustained a severe burn. Pulse-wave velocity and macrovascular (flow-mediated dilation) and microvascular (reactive hyperemia) dilator functions were assessed in 14 nonburned control subjects and 32 age-matched subjects with well-healed burn injuries. Fifteen subjects with burn injuries covering 17-40% of body surface area were assigned to a moderate burn injury group, and 17 subjects with burn injuries covering >40% of body surface area were assigned to a high burn injury group. Pulse-wave velocity [ P = 0.3 (central) and P = 0.3 (peripheral)] did not differ between the three groups. Macrovascular dilator function was reduced in the moderate ( P = 0.07) and high ( P < 0.05) burn injury groups compared with the control group. Likewise, peak vascular conductance during postocclusive reactive hyperemia differed from the moderate burn injury group ( P = 0.08 vs. control) and the high burn injury group ( P < 0.05 vs. control). These data suggest that vasodilator function is impaired in well-healed burn injury survivors, with the extent of impairment not dependent on the magnitude of body surface area having sustained a severe burn injury.
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Affiliation(s)
- Steven A Romero
- University of Texas Southwestern Medical Center and Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital , Dallas, Texas.,University of North Texas Health Science Center, Ft. Worth, Texas
| | - Gilbert Moralez
- University of Texas Southwestern Medical Center and Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital , Dallas, Texas
| | - Manall F Jaffery
- University of Texas Southwestern Medical Center and Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital , Dallas, Texas
| | - Mu Huang
- University of Texas Southwestern Medical Center and Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital , Dallas, Texas
| | - Craig G Crandall
- University of Texas Southwestern Medical Center and Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital , Dallas, Texas
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Spronk I, Legemate C, Oen I, van Loey N, Polinder S, van Baar M. Health related quality of life in adults after burn injuries: A systematic review. PLoS One 2018; 13:e0197507. [PMID: 29795616 PMCID: PMC5967732 DOI: 10.1371/journal.pone.0197507] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 05/03/2018] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES Measurement of health-related quality of life (HRQL) is essential to qualify the subjective burden of burns in survivors. We performed a systematic review of HRQL studies in adult burn patients to evaluate study design, instruments used, methodological quality, and recovery patterns. METHODS A systematic review was performed. Relevant databases were searched from the earliest record until October 2016. Studies examining HRQL in adults after burn injuries were included. Risk of bias was scored using the Quality in Prognostic Studies tool. RESULTS Twenty different HRQL instruments were used among the 94 included studies. The Burn Specific Health Scale-Brief (BSHS-B) (46%), the Short Form-36 (SF-36) (42%) and the EuroQol questionnaire (EQ-5D) (9%) were most often applied. Most domains, both mentally and physically orientated, were affected shortly after burns but improved over time. The lowest scores were reported for the domains 'work' and 'heat sensitivity' (BSHS-B), 'bodily pain', 'physical role limitations' (SF-36), and 'pain/discomfort' (EQ-5D) in the short-term and for 'work' and 'heat sensitivity', 'emotional functioning' (SF-36), 'physical functioning' and 'pain/discomfort' in the long-term. Risk of bias was generally low in outcome measurement and high in study attrition. CONCLUSION Consensus on preferred validated methodologies of HRQL measurement in burn patients would facilitate comparability across studies, resulting in improved insights in recovery patterns and better estimates of HRQL after burns. We recommend to develop a guideline on the measurement of HRQL in burns. Five domains representing a variety of topics had low scores in the long-term and require special attention in the aftermath of burns.
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Affiliation(s)
- Inge Spronk
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
- Department of Public Health, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Catherine Legemate
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, VU University Medical Centre, Amsterdam, the Netherlands
| | - Irma Oen
- Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands
| | - Nancy van Loey
- Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, the Netherlands
- Utrecht University, Department of Clinical Psychology, Utrecht, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Margriet van Baar
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
- Department of Public Health, Erasmus Medical Centre, Rotterdam, the Netherlands
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15
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A Systematic Review of Patient-Reported Outcome Measures Used in Adult Burn Research. J Burn Care Res 2017; 38:e521-e545. [DOI: 10.1097/bcr.0000000000000474] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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16
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Lower-Limb Muscular Strength, Balance, and Mobility Levels in Adults Following Severe Thermal Burn Injuries. J Burn Care Res 2017; 38:327-333. [DOI: 10.1097/bcr.0000000000000495] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Brink Y, Brooker H, Carstens E, Gissing CA, Langtree C. Effectiveness of resistance strength training in children and adolescents with ≥30% total body surface area: A systematic review. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2016; 72:303. [PMID: 30135886 PMCID: PMC6093134 DOI: 10.4102/sajp.v72i1.303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 04/17/2016] [Indexed: 11/23/2022] Open
Abstract
Purpose Children and adolescents with burn injuries are at risk of living with social, educational, physical and psychological impairments. The systematic review aimed to ascertain the effectiveness of resistance strength training on muscle strength and lean body mass (LBM) in children and adolescents with burn injuries. Method Five databases were searched. Randomised controlled trials with an intervention defined as a supervised, individualised resistance exercise programme were sought. The outcomes included muscle strength and/or LBM. The PEDro scale was used to describe the methodological quality. Comparable data were combined using RevMan©. Results Seven papers were included in the review with an average methodological appraisal score of 5.7/11. Comparable data were combined for muscle strength and LBM. The meta-analysis revealed no significant clinical difference between the exercise and standard care groups after 3 months of strength training for both muscle strength (p = 0.43) and LBM (p = 0.60). Conclusions There is no conclusive evidence to support the benefit of strength training for children and adolescents with burns injuries in terms of muscle strength and LBM. However, it appears that isokinetic training might benefit children and adolescents with burns, but more studies investigating the effect of isokinetic training are required.
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Affiliation(s)
- Yolandi Brink
- Department of Interdisciplinary Health Sciences, Stellenbosch University, South Africa
| | - Heather Brooker
- Department of Interdisciplinary Health Sciences, Stellenbosch University, South Africa
| | - Emmari Carstens
- Department of Interdisciplinary Health Sciences, Stellenbosch University, South Africa
| | - Cary A Gissing
- Department of Interdisciplinary Health Sciences, Stellenbosch University, South Africa
| | - Candice Langtree
- Department of Interdisciplinary Health Sciences, Stellenbosch University, South Africa
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Egberts MR, van de Schoot R, Boekelaar A, Hendrickx H, Geenen R, Van Loey NEE. Child and adolescent internalizing and externalizing problems 12 months postburn: the potential role of preburn functioning, parental posttraumatic stress, and informant bias. Eur Child Adolesc Psychiatry 2016; 25:791-803. [PMID: 26608402 PMCID: PMC4932136 DOI: 10.1007/s00787-015-0788-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 10/22/2015] [Indexed: 11/28/2022]
Abstract
Adjustment after pediatric burn injury may be a challenge for children as well as their parents. This prospective study examined associations of internalizing and externalizing problems in children and adolescents 12 months postburn with preburn functioning, and parental acute and chronic posttraumatic stress symptoms (PTSS) from different perspectives. Child, mother, and father reports of 90 children (9-18 years), collected within the first month and 12 months postburn, were analyzed. Results indicated that overall, child and parental appraisals of pre- and postburn behavioral problems were not significantly different from reference data. Rates of (sub)clinical postburn behavioral problems ranged from 6 to 17 %, depending on the informant. Pre- and postburn behavioral problems were significantly related, but only from the parents' perspective. Path models showed an association between parental PTSS 12 months postburn and parental reports of child internalizing problems, as well as a significant indirect relationship from parental acute stress symptoms via PTSS 12 months postburn. Notably, no associations between parental PTSS and child reports of postburn behavioral problems were found. In conclusion, parental observations of child externalizing problems appear to be influenced by their perspectives on the child's preburn functioning, while parental observations of internalizing problems are also related to long-term parental PTSS. However, these factors seem of no great value in predicting behavioral problems from the child's perspective, suggesting substantial informant deviations. To optimize adjustment, clinical burn practice is recommended to adopt a family perspective including parent perception of preburn functioning and parental PTSS in assessment and intervention.
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Affiliation(s)
- Marthe R. Egberts
- />Association of Dutch Burn Centres, P. O. Box 1015, 1940 EA Beverwijk, The Netherlands , />Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands
| | - Rens van de Schoot
- />Department of Methodology and Statistics, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands , />Optentia Research Program, Faculty of Humanities, North-West University, Vanderbijlpark, South Africa
| | - Anita Boekelaar
- />Burn Centre Red Cross Hospital, Beverwijk, The Netherlands
| | | | - Rinie Geenen
- />Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands
| | - Nancy E. E. Van Loey
- />Association of Dutch Burn Centres, P. O. Box 1015, 1940 EA Beverwijk, The Netherlands , />Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands
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19
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Tang D, Li-Tsang CW, Au RK, Li KC, Yi XF, Liao LR, Cao HY, Feng YN, Liu CS. Functional Outcomes of Burn Patients with or without Rehabilitation in Mainland China. Hong Kong J Occup Ther 2015. [DOI: 10.1016/j.hkjot.2015.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background/Objective To evaluate the functional outcomes of moderate to severe burn patients with and without rehabilitation in terms of self-care performance and quality of life (QOL). Methods Fifty-five patients with total burn surface area of 30% or more were divided into two groups: rehabilitation and conventional care groups. The rehabilitation group underwent comprehensive rehabilitation interventions (e.g., occupational therapy, physiotherapy, and patient and family education) in addition to standard clinical interventions received by the conventional care group. The outcomes included self-care performance (Modified Barthel Index [MBI]), QOL (World Health Organization Quality of Life-BREF), pain and itchiness (Visual Analogue Scale [VAS]), quality of sleep, and mental health (Self-Rating Depression Scale [SDS] and Self-Rating Anxiety Scale) measured before and 3 months after the intervention. Results After the intervention, significant improvements were found in MBI, all dimensions of QOL, pain, and SDS in the rehabilitation group (all p < .05). In the conventional care group, significant improvements were found only in MBI (p < .001), the physical health dimension of QOL (p < .01), and pain (p < .001). Group comparisons showed that the rehabilitation group achieved significantly better outcomes after the intervention in MBI (p < .001), VAS score of itching (p = .009), and the physical health (p = .002), psychological health (p = .021), and social relationships dimensions of QOL (p < .001). Conclusion Patients with moderate to severe burn injuries can benefit from rehabilitation interventions in terms of physical health, mental health, performance of daily living, and QOL.
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Affiliation(s)
- Dan Tang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
- Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou, China
| | - Cecilia W.P. Li-Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Ricky K.C. Au
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Kui-cheng Li
- Department of Occupational Therapy, Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou, China
| | - Xian-feng Yi
- Department of Burn Surgery and Burn Rehabilitation, Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou, China
| | - Lin-rong Liao
- Department of Physiotherapy, Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou, China
| | - Hai-yan Cao
- Department of Occupational Therapy, Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou, China
| | - Ya-nan Feng
- Department of Occupational Therapy, Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou, China
| | - Chuan-shun Liu
- Department of Occupational Therapy, Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou, China
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20
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Disseldorp LM, Mouton LJ, Van der Woude LH, Van Brussel M, Nieuwenhuis MK. Anthropometry, muscular strength and aerobic capacity up to 5 years after pediatric burns. Burns 2015; 41:1839-1846. [DOI: 10.1016/j.burns.2015.08.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 08/13/2015] [Accepted: 08/14/2015] [Indexed: 11/30/2022]
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21
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Ganio MS, Pearson J, Schlader ZJ, Brothers RM, Lucas RAI, Rivas E, Kowalske KJ, Crandall CG. Aerobic Fitness Is Disproportionately Low in Adult Burn Survivors Years After Injury. J Burn Care Res 2015; 36:513-9. [PMID: 24043241 PMCID: PMC3954961 DOI: 10.1097/bcr.0b013e3182a22915] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A maximal aerobic capacity below the 20th percentile is associated with an increased risk of all-cause mortality (Blair 1995). Adult Adult burn survivors have a lower aerobic capacity compared with nonburned adults when evaluated 38 ± 23 days postinjury (deLateur 2007). However, it is unknown whether burn survivors with well-healed skin grafts (ie, multiple years postinjury) also have low aerobic capacity. This project tested the hypothesis that aerobic fitness, as measured by maximal aerobic capacity (VO2max), is reduced in well-healed adult burn survivors when compared with normative values from nonburned individuals. Twenty-five burn survivors (36 ± 12 years old; 13 females) with well-healed split-thickness grafts (median, 16 years postinjury; range, 1-51 years) covering at least 17% of their BSA (mean, 40 ± 16%; range, 17-75%) performed a graded cycle ergometry exercise to test volitional fatigue. Expired gases and minute ventilation were measured via a metabolic cart for the determination of VO2max. Each subject's VO2max was compared with sex- and age-matched normative values from population data published by the American College of Sports Medicine, the American Heart Association, and recent epidemiological data (Aspenes 2011). Subjects had a VO2max of 29.4 ± 10.1 ml O2/kg body mass/min (median, 27.5; range, 15.9-53.3). The use of American College of Sports Medicine normative values showed that mean VO2max of the subjects was in the lower 24th percentile (median, 10th percentile). A total of 88% of the subjects had a VO2max below American Heart Association age-adjusted normative values. Similarly, 20 of the 25 subjects had a VO2max in the lower 25% percentile of recent epidemiological data. Relative to nongrafted subjects, 80 to 88% of the evaluated skin-graft subjects had a very low aerobic capacity. On the basis of these findings, adult burn survivors are disproportionally unfit relative to the general U.S. population, and this puts them at an increased risk of all-cause mortality (Blair 1995).
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Affiliation(s)
- Matthew S. Ganio
- University of Texas Southwestern Medical Center at Dallas and Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Fayetteville, AR
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR
| | - James Pearson
- University of Texas Southwestern Medical Center at Dallas and Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Fayetteville, AR
- School of Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Zachary J. Schlader
- University of Texas Southwestern Medical Center at Dallas and Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Fayetteville, AR
| | - R. Matthew Brothers
- University of Texas Southwestern Medical Center at Dallas and Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Fayetteville, AR
- Department of Kinesiology and Health Education, University of Texas, Austin, TX
| | - Rebekah A. I. Lucas
- University of Texas Southwestern Medical Center at Dallas and Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Fayetteville, AR
- Centre for Global Health Research, Umea University, Umea, Sweden
| | - Eric Rivas
- University of Texas Southwestern Medical Center at Dallas and Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Fayetteville, AR
| | - Karen J. Kowalske
- University of Texas Southwestern Medical Center at Dallas and Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Fayetteville, AR
| | - Craig G. Crandall
- University of Texas Southwestern Medical Center at Dallas and Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Fayetteville, AR
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22
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Rosenberg M, Ramirez M, Epperson K, Richardson L, Holzer C, Andersen CR, Herndon DN, Meyer W, Suman OE, Mlcak R. Comparison of long-term quality of life of pediatric burn survivors with and without inhalation injury. Burns 2015; 41:721-6. [PMID: 25670250 PMCID: PMC4417043 DOI: 10.1016/j.burns.2015.01.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 01/12/2015] [Accepted: 01/19/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the long-term quality of life of pediatric burn survivors with and without inhalation injuries. We hypothesized that patients with inhalation injury would report more disability and lower quality of life. METHODS We examined 51 patients with inhalation injury and 72 without inhalation injury who had burns of ≥10% total body surface area, were age ≥16 years at time of the interview, and were greater than 5 years from injury. Subjects completed the World Health Organization Disability Assessment Scale II (WHODAS II) and the Burn Specific Health Scale-Brief (BSHS-B). Multiple regression analyses were used to measure the effects of inhalation injury while controlling for age at burn and TBSA. RESULTS The mean age of burn of participants with inhalation injury was 11.7±3.6 years, mean TBSA 55%±18, and mean ventilator days 8.4±9. The mean age of burn of participants without inhalation injury was 10.3±34.1 years, mean TBSA 45%±20, and mean ventilator days 1.3±5.2. Inhalation injury did not appear to significantly impact participants' scores on the majority of the domains. The WHODAS II domain of household activities showed a significant relation with TBSA (p=0.01). Increased size of burn was associated with difficulty completing tasks for both groups. The BSHS-B domain of treatment regimen showed a relation with age at burn (p=0.02). Increased age was associated difficulty in this area for both groups. CONCLUSIONS Overall the groups were comparable in their reports of disability and quality of life. Inhalation injury did not affect long-term quality of life.
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Affiliation(s)
- Marta Rosenberg
- Shriners Hospitals for Children, Galveston, TX 77550, United States; University of Texas Medical Branch, Galveston, TX 77555, United States.
| | - Maribel Ramirez
- Shriners Hospitals for Children, Galveston, TX 77550, United States; University of Texas Medical Branch, Galveston, TX 77555, United States
| | - Kathy Epperson
- Shriners Hospitals for Children, Galveston, TX 77550, United States; University of Texas Medical Branch, Galveston, TX 77555, United States
| | - Lisa Richardson
- Shriners Hospitals for Children, Galveston, TX 77550, United States; University of Texas Medical Branch, Galveston, TX 77555, United States
| | - Charles Holzer
- Shriners Hospitals for Children, Galveston, TX 77550, United States; University of Texas Medical Branch, Galveston, TX 77555, United States
| | - Clark R Andersen
- Shriners Hospitals for Children, Galveston, TX 77550, United States; University of Texas Medical Branch, Galveston, TX 77555, United States
| | - David N Herndon
- Shriners Hospitals for Children, Galveston, TX 77550, United States; University of Texas Medical Branch, Galveston, TX 77555, United States
| | - Walter Meyer
- Shriners Hospitals for Children, Galveston, TX 77550, United States; University of Texas Medical Branch, Galveston, TX 77555, United States
| | - Oscar E Suman
- Shriners Hospitals for Children, Galveston, TX 77550, United States; University of Texas Medical Branch, Galveston, TX 77555, United States
| | - Ronald Mlcak
- Shriners Hospitals for Children, Galveston, TX 77550, United States; University of Texas Medical Branch, Galveston, TX 77555, United States
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Kowalske K, Helm P. Visionary leadership in burn rehabilitation over 50 years: major accomplishments, but mission unfulfilled. PM R 2014; 6:769-73. [PMID: 25107490 DOI: 10.1016/j.pmrj.2014.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 08/01/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Karen Kowalske
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center Dallas, Dallas, TX(∗).
| | - Phala Helm
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center Dallas, Dallas, TX(†)
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24
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Meirte J, van Loey NEE, Maertens K, Moortgat P, Hubens G, Van Daele U. Classification of quality of life subscales within the ICF framework in burn research: identifying overlaps and gaps. Burns 2014; 40:1353-9. [PMID: 24685352 DOI: 10.1016/j.burns.2014.01.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 12/20/2013] [Accepted: 01/19/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Quality of life (QOL) is one of the leading outcomes in burn care research. This study classifies subscales of common QOL measures within the International Classification of Functioning disability and health (ICF) framework to determine to which extent the measures are complementary or overlapping and to investigate whether the instruments are able to describe the full spectrum of patients' functioning. METHODS A literature search was performed to determine the most frequently used questionnaires in burn research. The subscales of the three mostly used questionnaires were classified within the ICF framework. RESULTS Two generic measures, the Short Form-36 items (SF-36) and the European Quality of Life 5 Dimensions (EQ-5D), and a disease specific measure, the Burn Specific Health Scale-Brief (BSHS-B), were analyzed. The BSHS-B covered most domains and was the only scale that included personal factors. The SF-36 included only one domain in the activity limitations and similar to the EQ-5D no contextual factors were included. Environmental factors were not addressed in the questionnaires, even though these may have an impact on the quality of life in patients with burns. CONCLUSION To capture the full spectrum of dysfunctioning a combination of the BSHS-B with a generic questionnaire seems obligatory. However still some domains of functioning remain uncovered.
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Affiliation(s)
- J Meirte
- Oscare, Organisation for Burns, Scar After-care and Research, Antwerp, Belgium; University of Antwerp, Department of Rehabilitation Sciences and Physiotherapy, Antwerp, Belgium.
| | - N E E van Loey
- Association of Dutch Burn Centres, Department of Behavioural Research, Beverwijk, the Netherlands; Utrecht University, Department of Clinical and Health Psychology, Utrecht, the Netherlands
| | - K Maertens
- Oscare, Organisation for Burns, Scar After-care and Research, Antwerp, Belgium; Vrije Universiteit Brussel, Department of Clinical and Lifespan Psychology, Brussels, Belgium
| | - P Moortgat
- Oscare, Organisation for Burns, Scar After-care and Research, Antwerp, Belgium
| | - G Hubens
- University of Antwerp, Department of Antwerp Surgical Training Anatomy and Research Centre, Antwerp, Belgium
| | - U Van Daele
- University of Antwerp, Department of Rehabilitation Sciences and Physiotherapy, Antwerp, Belgium
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Abstract
The transition of pediatric burn survivors into adulthood is accompanied by a reformulation of their self-concept. To anticipate the need for and guide development of appropriate psychosocial interventions, this study examines how young adults who were burned as children perceive themselves and how this perception might affect their self-esteem. Eighty-two young adult burn survivors (45 male, 37 female) were assessed using the Tennessee Self-Concept Scale, 2nd edition (TSCS2) to determine how the participants perceive themselves and their interaction with society. To gain insight into the possible effects of these self-concept scores, relationships were analyzed between self-concept, a behavioral assessment (Young Adult Self-Report [YASR]), and a psychiatric symptom assessment (Structured Clinical Interview for DSM-IV Axis I Disorders [SCID I]). This group of burn survivors scored significantly lower in self-concepts, reflected in TSCS2 subscale scores of physical function, appearance, and sexuality, moral conduct, personal values, academics and work, and identity, than did the reference population. Pearson correlation coefficients showed that as moral, personal, family, and social aspects of self-concept decreased, clinical problems endorsed on the YASR subscales increased, including anxiety, somatic, attention, intrusive, and aggressive. Persons with lower self-concept scores on the TSCS2 personal, family, and social scales were more withdrawn on the YASR. Similarly, those with lower TSCS2 scores on the personal and family scales endorsed significantly more thought problems on the YASR. TSCS2 total self-concept, personal, and all of the supplementary scale scores were significantly lower for the group with an affective disorder. Those whose SCID I scores were consistent with a current anxiety disorder had significantly lower scores for the TSCS2 total self-concept and personal. Lower self-concept was associated with endorsement of SCID symptoms. In summary, the significantly lower self-concept scores on the TSCS2 physical scale are consistent with the physical disfigurement and handicaps common with major burn injuries, and a strong indication of this group's perception of the first impression made when interacting with others. The survivors seem to feel worthwhile within the contexts of family and friends. Although the major limitation of this study using the TSCS2 is the lack of a matched reference population to compare the burn survivors, the TSCS2 does help in gaining insight into the self-esteem issues of the burn survivor population.
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Ravindran V, Rempel GR, Ogilvie L. Embracing survival: A grounded theory study of parenting children who have sustained burns. Burns 2013; 39:589-98. [DOI: 10.1016/j.burns.2012.12.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 12/09/2012] [Accepted: 12/18/2012] [Indexed: 10/27/2022]
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Psychological consequences of pediatric burns from a child and family perspective: A review of the empirical literature. Clin Psychol Rev 2013; 33:361-71. [DOI: 10.1016/j.cpr.2012.12.006] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 12/28/2012] [Accepted: 12/31/2012] [Indexed: 10/27/2022]
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Lin SY, Chang JK, Chen PC, Mao HF. Hand function measures for burn patients: a literature review. Burns 2012; 39:16-23. [PMID: 22985975 DOI: 10.1016/j.burns.2012.08.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 06/12/2012] [Accepted: 08/21/2012] [Indexed: 10/27/2022]
Abstract
Hand function is one of the most important goals of burn rehabilitation and is a consensually important functional outcome. The purpose of this article is to review the available hand function measures commonly used for burn patients and to summarize their psychometric properties and clinical utilities to serve as guidelines for clinical practice and research. An online-database search of PubMed, MEDLINE, CINAHL and PsychInfo was performed. One hundred and seventeen articles were found and 23 of them met the inclusion and exclusion criteria. The eight identified measurement instruments were then classified into three categories: traditional component measures, performance measures and patient-reported outcome measures. Each type of hand function measure has its unique characteristics and limitations. Traditional component measures only reflect hand impairments, and may not represent hand function status. Performance measures have not been validated in the burn population and do not correlate well with patient-reported outcomes. Patient-reported outcome measures have not been rigorously validated in the burn population. A discussion of how clinicians choose these measures reflecting the purposes of their measurements and goals of intervention is provided. Moreover, future studies are suggested to develop burn-specific hand function measures.
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Affiliation(s)
- Szu-Yen Lin
- School of Occupational Therapy, National Taiwan University, Taipei, Taiwan
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Effects of a hospital based Wellness and Exercise program on quality of life of children with severe burns. Burns 2012; 39:599-609. [PMID: 22985974 DOI: 10.1016/j.burns.2012.08.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 08/13/2012] [Accepted: 08/21/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To examine the effect of a 12-week Wellness and Exercise (W&E) program on the quality of life of pediatric burn survivors with burns of ≥40% total body surface area. We hypothesized this comprehensive regimen would improve physical and psychosocial outcomes. METHODS Children were recruited for participation upon their discharge from the ICU. They were not taking anabolic/cardiovascular agents. Seventeen children participated in the W&E group and 14 children in the Standard of Care (SOC) group. Quality of life was assessed with the Child Health Questionnaire (CHQ) at discharge and 3 months. Children completed the CHQ-CF 87 and caregivers completed the CHQ-PF 28. RESULTS The mean age of children in the W&E group was 14.07±3.5 years and mean TBSA was 58±11.8%. The mean age of children in the SOC group was 13.9±3.1 years and mean TBSA was 49±7.8%. ANOVA did not reveal statistically significant differences between the groups. Matched paired t-tests revealed that parents with children in the W&E group reported significant improvements with their children's physical functioning, role/social physical functioning, mental health, overall physical and psychosocial functioning after exercise. CONCLUSIONS These results are clinically relevant in that a comprehensive W&E program may be beneficial in promoting physical and psychosocial outcomes.
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The effects of facial burns on health outcomes in children aged 5 to 18 years. J Trauma Acute Care Surg 2012; 73:S189-96. [DOI: 10.1097/ta.0b013e318265c7df] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Survivors of septic shock caused by Neisseria meningitidis in childhood: psychosocial outcomes in young adulthood. Pediatr Crit Care Med 2011; 12:e302-9. [PMID: 21499180 DOI: 10.1097/pcc.0b013e3182192d7f] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate long-term psychosocial outcomes in young adults who survived septic shock caused by Neisseria meningitidis (meningococcal septic shock) during childhood. DESIGN A cross-sectional study. SETTING The psychological investigation took place in the department of Child and Adolescent Psychiatry of the Erasmus MC-Sophia Children's Hospital. PATIENTS All consecutive surviving patients with meningococcal septic shock requiring intensive care treatment at the pediatric intensive care unit between 1988 and 2001. INTERVENTION To explore biographical characteristics (such as living conditions, educational, occupational, and marital status) and illness-related physical or social consequences a structured interview was used. To assess intellectual functioning the Groninger Intelligence Test 2 was used and to assess behavioral/emotional problems, the Adult Self-Report was used. MEASUREMENTS AND MAIN RESULTS Fifty-eight of 83 eligible septic shock survivors were evaluated (response rate: 70%). The patients were 16-31 yrs old at time of follow-up (median age: 21 yrs old). These patients had had meningococcal septic shock before 18 yrs of age. Median follow-up interval was 13 yrs, with a range of 4 to 16 yrs. For the vast majority of meningococcal septic shock patients, outcomes on biographical characteristics, intellectual functioning, and levels of behavioral/emotional problems were comparable to those of reference groups. A minority (5% to 20%) still report illness-related physical or social consequences, behavioral and emotional problems, and lower intellectual functioning. CONCLUSIONS Despite favorable outcomes for the majority of meningococcal septic shock patients in the long term, an important minority (5% to 20%) still struggles with ongoing problems as to behavioral/emotional problems, intellectual functioning, biographical characteristics, and illness-related physical or social consequences.
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Disseldorp LM, Nieuwenhuis MK, Van Baar ME, Mouton LJ. Physical Fitness in People After Burn Injury: A Systematic Review. Arch Phys Med Rehabil 2011; 92:1501-10. [DOI: 10.1016/j.apmr.2011.03.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Revised: 02/25/2011] [Accepted: 03/02/2011] [Indexed: 10/17/2022]
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Hanson MD, Zuker RM, Shaul RZ. Pediatric facial burns: Is facial transplantation the new reconstructive psychosurgery? THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2011; 16:205-10. [PMID: 19949498 DOI: 10.1177/229255030801600407] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Current pediatric burn care has resulted in survival being the expectation for most children. Composite tissue allotransplantation in the form of face or hand transplantation may present opportunities for reconstructive surgery of patients with burns. The present paper addresses the question "Could facial transplantation be of therapeutic benefit in the treatment of pediatric burns associated with facial disfigurement?" METHODS Therapeutic benefit of facial transplantation was defined in terms of psychiatric adjustment and quality of life (QOL). To ascertain therapeutic benefit, studies of pediatric burn injury and associated psychiatric adjustment and QOL in children, adolescents and adults with pediatric burns, were reviewed. RESULTS Pediatric burn injury is associated with anxiety disorders, including post-traumatic stress disorder and depressive disorders. Many patients with pediatric burns do not routinely access psychiatric care for these disorders, including those for psychiatric assessment of suicidal risk. A range of QOL outcomes were reported; four were predominantly satisfactory and one was predominantly unsatisfactory. DISCUSSION Facial transplantation may reduce the risk of depressive and anxiety disorders other than post-traumatic stress disorder. Facial transplantation promises to be the new reconstructive psychosurgery, because it may be a surgical intervention with the potential to reduce the psychiatric suffering associated with pediatric burns. Furthermore, patients with pediatric burns may experience the stigma of disfigurement and psychiatric conditions. The potential for improved appearance with facial transplantation may reduce this 'dual stigmata'. Studies combining surgical and psychiatric research are warranted.
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Employment outcomes after burn injury: a comparison of those burned at work and those burned outside of work. J Burn Care Res 2011; 32:294-301. [PMID: 21228711 DOI: 10.1097/bcr.0b013e31820aaf56] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study compares employment rates and barriers to return to work in subjects burned at work with those burned outside of work. Further, this study examines the influence of electrical etiology on return to work outcomes. The electronic records of burn survivors treated at a Regional Burn Center outpatient clinic from 2001 to 2007 were retrospectively reviewed. Inclusion criteria included employment at the time of burn injury and age of 18 years or older. Demographic and medical data were collected. Documentation of barriers to return to work was reviewed and classified into eight categories. Return to employment was grouped into four time intervals: 0 to 3, 3 to 6, 6 to 12, and greater than 12 months after injury. Logistic regression analysis was used to determine predictors of unemployment at greater than 1 year for subjects burned at work, outside of work, and those burned at work without electric injury. The authors identified 197 patients for inclusion in the study. Their age was 37 ± 0.8 years (mean ± SEM), and TBSA burned was 16 ± 1%. Fifty percent of subjects were burned at work. Electric etiology was seen only in those burned at work (n = 24). Forty-four percent (n = 43) of subjects injured at work remained unemployed at 1 year compared with 22% (n = 22) of subjects injured outside of work. The most frequent employment barriers included pain (72%), neurologic problems (62%), and psychiatric problems (53%) for those burned at work; and pain (63%), neurologic problems (59%), and impaired mobility (54%) for those burned outside of work. Significant predictors of unemployment at greater than 12 months included burn at work, pain, impaired mobility, other medical problems, and inpatient rehabilitation (P < .05). When the electrical injury subjects are removed from the analysis, significant predictors of unemployment at 12 months include burn at work, pain, inpatient rehabilitation, and length of stay (P < .05). Burn survivors experience multiple complex barriers in returning to work. Burn at work is a significant predictor of unemployment at 1 year even after controlling for electric etiology. Further study is required to better understand the influence of work setting on employment outcomes.
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Abstract
Burn rehabilitation is an essential component of successful patient care. In May 2008, a group of burn rehabilitation clinicians met to discuss the status and future needs of burn rehabilitation. Fifteen topic areas pertinent to clinical burn rehabilitation were addressed. Consensus positions and suggested future research directions regarding the physical aspects of burn rehabilitation are shared.
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Abstract
BACKGROUND Many advances have been made in the understanding and management of burn injury, dramatically increasing pharmacological decision options for burn care professionals. Since burn injury is so multi-faceted, these advances cross many injury processes, both acute and chronic. OBJECTIVE The purpose of this review was to highlight the advances and decision options across the entire scope of the burn injury process. The burn-related processes with the most significant pharmacological options of approved products are highlighted. METHODS The scope of the current research is the most pertinent literature, which has been summarized with the addition of a personal perspective. RESULTS/CONCLUSIONS Many advances over the past decade in multiple fields have made pharmacological options plentiful in burn care. That said, there are many problems for the burn patient which persist, making burn injury still the most severe form of trauma. These issues range from management of a catabolic state with involuntary weight loss in the critical burn to severe itching in the rehabilitating patient. There are also many more treatment options available today. Two key reasons stand out as the most prominent. One reason is the fact that burn care has become much more proactive, by searching out new approaches to solve old problems. Now the treatment approach is altering its focus on manipulating the course of a burn. Examples include the use of temporary skin substitutes in partial thickness or second degree burns, decreasing pain and increasing the healing rate. Another is the use of slow release silver dressing as the topical burn wound antimicrobial of choice, markedly reducing discomfort, the need for dressing changes and an overall decrease in infection. In larger, deeper burns, the approach has changed from the chronic management of an open burn wound to rapid excision and wound closure, eliminating the burn as a source of complications. In addition, there has been a very aggressive approach to controlling the profound hypermetabolic, catabolic response to burns, rather than simply treating the outcome of this predictable post-burn complication. Approaching psychosocial stress again by prevention rather than treatment of established problems is another example. The second reason for increased options and differences in management involves the mindset of those individuals taking care of burns. Tremendous differences in experience are involved in decision-making. Different opinions are based on the expertise and also the personal preferences of those managing the burn.
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Affiliation(s)
- Robert H Demling
- Brigham and Women's Hospital, Harvard Medical School, The Burn and Trauma Center, Boston, MA 02120, USA.
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Baker CP, Rosenberg M, Mossberg KA, Holzer C, Blakeney P, Robert R, Thomas C, Meyer W. Relationships between the Quality of Life Questionnaire (QLQ) and the SF-36 among young adults burned as children. Burns 2008; 34:1163-8. [PMID: 18672333 DOI: 10.1016/j.burns.2008.05.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2007] [Accepted: 05/11/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine the relationship between two measures that can be used to examine quality life among pediatric burn survivors. DESIGN Prospective, correlational study. SETTING Acute and rehabilitation pediatric burn care facility. PARTICIPANTS Eighty young adult survivors of pediatric burns, who were 18-28 years of age, with burns of 30% or greater, and were at least 2 years after burn. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The SF-36 and the Quality of Life Questionnaire (QLQ) were used to assess participant's self-reported general health and long-term adjustment. RESULTS Significant correlations (p< or =0.001) were found between the total quality of life score of the QLQ and the mental component scale of the SF-36. However, no significant correlations were found between the total quality of life score of the QLQ and the SF-36 physical component scale. CONCLUSIONS Approximately 100,000 children are treated for burns annually, with a high percentage surviving, creating a challenge for health care professionals who need to prepare burn survivors with their psychosocial and physical well-being as adults. This study found that the SF-36 and QLQ are measuring somewhat different aspects of psychosocial and physical adjustment. It is recommended that both tools could be useful to the burn practitioner in assessing quality of life.
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Affiliation(s)
- Christine P Baker
- School of Allied Health Sciences, University of Texas Medical Branch, Galveston, TX, United States; Shriners Hospitals for Children, Shriners Burns Hospital, Galveston, TX 77555-1144, USA.
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Patterson DR. The NIDRR Burn Injury Rehabilitation Model System Program: Selected Findings. Arch Phys Med Rehabil 2007; 88:S1-2. [DOI: 10.1016/j.apmr.2007.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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