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Watzinger N, Hecker A, Petschnig D, Tran J, Glantschnig C, Moshammer M, Pignet AL, Ellersdorfer AM, Kamolz LP. Long-Term Functional Outcomes after Hand Burns: A Monocentric Controlled Cohort Study. J Clin Med 2024; 13:3509. [PMID: 38930038 PMCID: PMC11204761 DOI: 10.3390/jcm13123509] [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: 05/22/2024] [Revised: 06/06/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Hand burns are involved in 80-90% of severe burn injuries. Even though hands correspond to a small total burn surface area (TBSA) of less than 5%, the loss of their functionality has a significant impact on the patient's life. Studies that provide long-term results regarding hand functionality after hand burns are scarce. Therefore, this study aimed to investigate functional long-term results in a patient-centric approach regarding burn depth, unilateral and bilateral hand involvement, and (non-)isolated hand burns as potential influencing factors in patients with hand burns. Methods: We conducted a controlled cohort study of patients with burned hands treated at our department between 2005 and 2022. Healthy age-, sex-, and handedness-matched participants were used as controls. Data on the demographics, burn-related injuries, and treatments were collected. For a patient-centric approach, we used the Disabilities of the Arm, Shoulder, and Hand Questionnaire (Quick-DASH) and the Michigan Hand Questionnaire (MHQ) as patient-reported outcome measures for functional long-term evaluation, and the Patient and Observer Scar Assessment Scale (patient scale) for assessing long-term scar quality. Results: We enrolled 61 patients with 88 affected hands and 63 matched control participants. Up to 77.1% of the participants were male, with a mean age of 50.7 (±15.5) years and a follow-up of 8.1 (±4.7) years. The mean TBSA was 13.9% (±15.8), with 72.4% of the hands presenting with deep partial-thickness and full-thickness burns and most of the patients had only one hand affected (55.7%). The hand burn patients perceived significantly worse long-term functional scores in every domain of the MHQ as well as in the "overall function" and "work" of the Quick-DASH. Superficial hand burns negatively affected the two-handed activities of daily living (p = 0.013) and aesthetic appearance (p = 0.005) when both hands were involved. Isolated hand burns were associated with more difficulties in work performance (p = 0.03), whereas patients with bilateral hand involvement perceived more pain (p = 0.025). Conclusions: The patients with hand burns can achieve satisfactory long-term functional outcomes over time, but they do not reach the same long-term hand functionality as the healthy matched control group. Our study revealed that factors such as burn depth, unilateral or bilateral hand involvement, and (non-)isolated hand burns indeed have an impact on certain aspects of perceived long-term hand functionality.
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Affiliation(s)
- Nikolaus Watzinger
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria (L.-P.K.)
- COREMED—Centre for Regenerative Medicine and Precision Medicine, Joanneum Research Forschungsgesellschaft mbH, Neue Stiftingtalstraße 2, 8010 Graz, Austria
| | - Andrzej Hecker
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria (L.-P.K.)
- COREMED—Centre for Regenerative Medicine and Precision Medicine, Joanneum Research Forschungsgesellschaft mbH, Neue Stiftingtalstraße 2, 8010 Graz, Austria
| | - David Petschnig
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria (L.-P.K.)
| | - Jana Tran
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria (L.-P.K.)
| | - Caroline Glantschnig
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria (L.-P.K.)
| | - Maximilian Moshammer
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria (L.-P.K.)
- COREMED—Centre for Regenerative Medicine and Precision Medicine, Joanneum Research Forschungsgesellschaft mbH, Neue Stiftingtalstraße 2, 8010 Graz, Austria
| | - Anna-Lisa Pignet
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria (L.-P.K.)
- COREMED—Centre for Regenerative Medicine and Precision Medicine, Joanneum Research Forschungsgesellschaft mbH, Neue Stiftingtalstraße 2, 8010 Graz, Austria
| | - Anna-Maria Ellersdorfer
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria (L.-P.K.)
| | - Lars-Peter Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria (L.-P.K.)
- COREMED—Centre for Regenerative Medicine and Precision Medicine, Joanneum Research Forschungsgesellschaft mbH, Neue Stiftingtalstraße 2, 8010 Graz, Austria
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Daher RP, Piccolo MS, Baeninger M, Gragnani A. Burnt hand outcomes tool: Translation, adaptation and validation into Brazilian Portuguese. Burns 2024; 50:1030-1038. [PMID: 38402116 DOI: 10.1016/j.burns.2024.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/24/2023] [Accepted: 01/30/2024] [Indexed: 02/26/2024]
Abstract
INTRODUCTION In burn trauma, hands are often injured due to defensive action or proximity to the causative agent, leading to significant morbidity during a patients work and social rehabilitation process. In this context, the use of patient-reported outcome measures is a first step in measuring and improving these outcomes. The Burned Hand Outcome Tool (BHOT) is a specific questionnaire for adults with burned hands aimed at quantifying outcomes related to this trauma. OBJECTIVE To translate, culturally adapt, and validate the BHOT into Brazilian Portuguese. METHODS Following established standards in the literature, the original English questionnaire was translated, back translated, and analyzed by a panel of experts in the field. Cultural adaptation of the translation was carried out with a sample of target patients. The questionnaire was validated concurrently with the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire translated into Portuguese, at three time points (0 h, 2 h, 48 h), with two different evaluators. RESULTS The cultural adaptation was conducted on a sample of 30 adult patients with hand burns without the need for reassessment of the translated items. The questionnaire validation was carried out on a sample of 100 adult patients with hand burns. The Cronbach's Alpha found at the first time point was 0.936. The correlations between the questionnaires varied from 0.656 to 0.915. CONCLUSION The Burned Hand Outcome Tool has been translated, culturally adapted, and validated for a target population in Brazilian Portuguese.
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Affiliation(s)
- R P Daher
- Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), Rua Botucatu, 740, 04023900, São Paulo, SP, Brazil
| | - M S Piccolo
- Orthopedics Department, Traumatology, Plastic Surgery and Physiotherapy, Medicine College, Universidade Federal de Goiás (UFG), Rua 4, 172, Setor Oeste, Goiânia, GO, Brazil
| | - M Baeninger
- Graduate Program in Translational Surgery, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), Rua Botucatu, 740, 04023900 São Paulo, SP, Brazil
| | - A Gragnani
- Plastic Surgery Division, Coordinator of Graduate Translational Surgery Program, UNIFESP/EPM, Rua Botucatu, 740, 04023900 São Paulo, SP, Brazil.
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Li C, Solish M, Rogers AD. Evaluation of patient-reported outcome measures in burn-specific tools: A systematic review. Burns 2024; 50:1-12. [PMID: 38040617 DOI: 10.1016/j.burns.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/15/2023] [Accepted: 10/17/2023] [Indexed: 12/03/2023]
Abstract
INTRODUCTION Patient-reported outcome measures (PROMs) are now well-established tools to evaluate the quality of patient-centred care. Due to the multi-faceted and multi-disciplinary nature of the practice of burn care, as well as the range of significant potential sequelae, PROM's should form a fundamental component of burn quality improvement programs. We aim to 1. Explore biological, psychological, and social considerations that are currently listed in burn-specific PROM tools, as well as their efficacy, 2. Evaluate biological, psychological, and social factors that are considered in new burn-specific PROM tools or those under development, and 3. Identify any opportunities with respect to burn-specific PROM tools, in order to inform future investigation in this area. METHODS A search was performed of MEDLINE (Ovid), EMBASE, CINAHL, and the Cochrane Library databases. Two independent reviewers screened article titles/abstracts and then the full texts using Covidence. All studies were graded independently according to the Quality Rating Scheme for Studies and Other Evidences. RESULTS The initial search yielded 552 references. Based on ab initio inclusion and exclusion criteria, 133 full-text studies were assessed for eligibility, and 21 articles were ultimately included in the systematic review. Due to study heterogeneity, a qualitative synthesis was conducted. Existing burn-specific PROMs covered a range of biological, psychological, and social factors affecting adult and paediatric patients with burn injury, but several studies required additional PROMs for a thorough evaluation. Burn-specific PROM tools under development are poised to fill this deficit. CONCLUSION Major burn injuries are a unique form of trauma, requiring coordinated management that considers numerous factors not relevant to other patient populations. Further research is necessary to validate existing burn-specific PROM tools and to develop more comprehensive burn-specific PROM measures that more comprehensively incorporate the bio-psycho-social model of health.
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Affiliation(s)
- Calandra Li
- Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Max Solish
- Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Alan D Rogers
- Temerty Faculty of Medicine, University of Toronto, Ontario, Canada; Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Ontario, Canada; Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, University of Toronto, Ontario, Canada.
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Sizoo SJ, van Baar ME, Jelsma N, van Zuijlen PP, Nieuwenhuis MK. Outcome measures to evaluate the function of the hand after burns; a clinical initiative. BURNS OPEN 2021. [DOI: 10.1016/j.burnso.2021.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Mc Kittrick A, Gustafsson L. A Cross-sectional Survey of Health Professionals Across Australia and New Zealand to Determine What Outcome Measures Are Important From a Clinical Perspective Post Hand Burn Injury. J Burn Care Res 2021; 43:77-84. [PMID: 34226927 DOI: 10.1093/jbcr/irab086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Outcome measures are used in healthcare to evaluate clinical practice, measure efficiencies and to determine the quality of health care provided. The Burns Trauma Rehabilitation: Allied Health Practice Guidelines advocates for the collection of outcome measures post burn injuries across different time points. These guidelines recommend multiple tools which can be utilized when measuring outcomes post burn injuries. The aim of this study was to gather information from specialist clinicians regarding their clinical practice and the outcome measurement tools used post hand burn injuries. This cross-sectional study used a survey design to collect data at one given point in time across a sample population. A total of 43 clinical specialists allied health professionals responded to the survey. Respondents indicated that their patients considered hand dexterity was the most important outcome. Three months post burn injury was the most common timepoint for measurement (n = 31, 72.1%) followed by six months (n = 27, 62.8%). Patient report of hand function (n = 42, 97.7%) and observation (n = 41, 95.3%) were the most frequently reported assessment methods. The Jamar Dynamometer (n = 40, 93%), goniometer (n = 39, 90.7%) and pinch gauge (n = 36, 83.7) were the most frequency cited assessment tools. The findings of this study suggest that clinical specialist allied health collect some outcome measures in their routine practice. Based on the respondent's perceptions of barriers when using outcome measures and lack of reliable/validated tools to measure hand burn outcomes, there is a need for further studies in this area.
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Affiliation(s)
- Andrea Mc Kittrick
- Department of Occupational Therapy, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Louise Gustafsson
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia.,Discipline of Occupational Therapy, School of Allied Health Sciences, Griffith University, Nathan, QLD, Australia
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Itakussu EY, Morita AA, Kakitsuka EE, Pitta F, Cavalheri V, Hernandes NA. Instruments to assess function or functionality in adults after a burn injury: A systematic review. Burns 2021; 47:999-1011. [PMID: 33896659 DOI: 10.1016/j.burns.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 02/22/2021] [Accepted: 04/06/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Assessment of functionality or function, through valid and reliable instruments, is essential during rehabilitation of adults after a burn injury. Currently, there is no consensus in the literature regarding the most appropriate tool that should be used to assess function or functionality; there is also no synthesis of the current studies published in this area. OBJECTIVES To investigate and report the instruments used to assess function or functionality in adults after a burn injury; to identify the characteristics and evidence on their measurement properties; and to evaluate their clinical utility. METHODS We systematically searched the literature via six electronic databases and via screening reference lists of relevant studies. The review was registered in PROSPERO (CRD42016048065) and reported according to the PRISMA statement. Studies in which function or functionality of upper and/or lower limbs of adults after a burn injury was assessed were included. Exclusion criteria comprised studies in pediatric populations and conference abstracts. RESULTS Thirty-four studies were included. Twelve questionnaires and seven objective tests for function or functionality were identified. Three specific tools were found; four generic instruments have been validated in burns. Nine studies evaluated the instruments' measurement properties, presenting at least one property classified as 'fair' quality. Finally, 18 instruments demonstrated clinical utility. CONCLUSION This systematic review demonstrated that most instruments used to assess function or functionality in adults with a burn injury have not been specifically developed for this population and had their measurement properties poorly studied. Conversely, almost all instruments had clinical utility.
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Affiliation(s)
- Edna Yukimi Itakussu
- Stricto Sensu Graduate Program in Rehabilitation Sciences, State University of Londrina (UEL) and University Pitágoras Unopar (UNOPAR), Londrina, Brazil; Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil; Burn Treatment Center, University Hospital of State University of Londrina (HU-UEL), Londrina, Brazil.
| | - Andrea Akemi Morita
- Stricto Sensu Graduate Program in Rehabilitation Sciences, State University of Londrina (UEL) and University Pitágoras Unopar (UNOPAR), Londrina, Brazil; Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil.
| | - Emely Emi Kakitsuka
- Stricto Sensu Graduate Program in Rehabilitation Sciences, State University of Londrina (UEL) and University Pitágoras Unopar (UNOPAR), Londrina, Brazil; Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil.
| | - Fabio Pitta
- Stricto Sensu Graduate Program in Rehabilitation Sciences, State University of Londrina (UEL) and University Pitágoras Unopar (UNOPAR), Londrina, Brazil; Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil.
| | - Vinicius Cavalheri
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Australia; Allied Health, South Metropolitan Health Service, Perth, Australia.
| | - Nidia Aparecida Hernandes
- Stricto Sensu Graduate Program in Rehabilitation Sciences, State University of Londrina (UEL) and University Pitágoras Unopar (UNOPAR), Londrina, Brazil; Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil.
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Robillard AS, Gane C, Royea C, Lacasse L, Calva V, de Oliveira A, Nedelec B. Cross-cultural translation, adaptation and validation of the Burnt Hand Outcome Tool (BHOT) from English to French Canadian. Burns 2021; 47:1429-1441. [PMID: 33526263 DOI: 10.1016/j.burns.2020.12.019] [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: 10/20/2020] [Accepted: 12/14/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Burnt Hand Outcome Tool (BHOT) is a comprehensive tool assessing the multiple impacts of hand burn injuries which makes it essential to burn care practice, but is currently only available in English. OBJECTIVES To create a French-Canadian cross-cultural adaptation of the BHOT and to assess its content and construct convergent validity. METHODS The BHOT was translated and culturally adapted according to evidence-based principles for patient-reported outcome measures. The steps included translation to French (BHOT-F), backward translation, expert committee review, and cognitive debriefing with 5 adult participants. A pre-final version of the BHOT-F was then administered to 39 adult participants with hand burn injuries to assess construct convergent validity using the shortened Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH). Content validity was evaluated based on comments from the expert committee and participant burn survivors. RESULTS The BHOT-F was modified during the adaption process to ensure its clarity. The Cronbach's alpha value of 0.935 demonstrates the excellent internal consistency of the BHOT-F. The BHOT-F and the QuickDASH were strongly correlated (p < 0.01). Content validity was deemed satisfactory and recommendations are reported for future research. CONCLUSIONS The BHOT-F demonstrates adequate clinimetric properties to be used in clinical practice.
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Affiliation(s)
| | - Claire Gane
- School of Physical and Occupational Therapy, McGill University
| | - Claudia Royea
- School of Physical and Occupational Therapy, McGill University
| | | | - Valérie Calva
- Hôpital de réadaptation Villa Medica, Montréal, Québec, Canada
| | - Ana de Oliveira
- Center de recherche, Center hospitalier de l'Université de Montréal (CRCHUM)
| | - Bernadette Nedelec
- School of Physical and Occupational Therapy, McGill University; Hôpital de réadaptation Villa Medica, Montréal, Québec, Canada; Center de recherche, Center hospitalier de l'Université de Montréal (CRCHUM).
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Dargan D, Adjei B, Shokrollahi K. A Rule of Thumb for Hand Burns: Categorization and Mapping of Proportional Surface Area Involvement. J Burn Care Res 2020; 41:1092-1096. [DOI: 10.1093/jbcr/iraa054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Hand burns are common and often complex injuries, requiring referral to specialist centers. The patient’s thumbprint is a rapid means of accurately assessing hand burn surface area. This study aimed to establish categories and evaluate sites of hand burn surface area in order to facilitate comparison of hand burns. Sixteen burns involving the hand and wrist among 14 patients referred to a burns center were retrospectively categorized by burn mechanism, burn thickness, and hand burn surface area. The burn surface area in the clinical record was compared with that calculated by the thumbprint method and the rule of thumb diagram. Burn surface area in the clinical record was either “1%” or “<1%” in 9 of 16 cases. In contrast, the surface area was <1 thumbprint (T) in six burns, two were between 1 and 5T, three were 5 to 10T, two were 10 to 20T, two were 20 to 50T, and one was greater than 50T. The median thumbprint burn surface area was 1.5T (range 0.20–80T), which corresponds to 0.05% TBSA. The hand areas with the highest burn frequency per unit area were the dorsum of the hand and dorsum of the index finger, with relative sparing of the palm and palmar surface of the digits. Hand burns surface area varies widely, and thumbprint evaluation with categories and mapping allows finer distinction between the surface area proportions and specific sites involved, even in a small series of hand burns.
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Affiliation(s)
- Dallan Dargan
- Mersey Regional Burns and Plastic Surgery Centre and St. Helens and Knowsley Teaching Hospitals NHS Trust, Whiston Hospital, Prescot, Merseyside, UK
| | - Bismark Adjei
- Mersey Regional Burns and Plastic Surgery Centre and St. Helens and Knowsley Teaching Hospitals NHS Trust, Whiston Hospital, Prescot, Merseyside, UK
| | - Kayvan Shokrollahi
- Mersey Regional Burns and Plastic Surgery Centre and St. Helens and Knowsley Teaching Hospitals NHS Trust, Whiston Hospital, Prescot, Merseyside, UK
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