Psychosocial adjustments 5 years after burn injury

Return-to-employment for working-aged adults after burn injury: A mixed methods scoping review

BACKGROUND

This scoping review aimed to identify the barriers, facilitators and benefits of returning to work following burn injury, outcome measures used, management strategies, and models of care.

OBJECTIVE

To provide a comprehensive overview about working-aged adults returning to their preinjury employment after burn injury.

METHODS

We followed a pre-determined scoping review protocol to search MEDLINE, CINAHL, Embase, PsycINFO, PubMed, Scopus, CCRCT and CDSR databases between 2000 to December 2023. Papers reporting primary data from previously employed adults with cutaneous burn injuries were included.

RESULTS

In all, 90 articles met the review criteria. Return-to-work was both an outcome goal and process of recovery from burn injury. Physical and psychological impairments were identified barriers. Job accommodations and modifications were important for supporting the transition from hospital to workplace. Employment status and quality of life sub-scales were used to measure return-to-work.

CONCLUSIONS

Consistent definitions of work and measurements of return-to-employment after burn injury are priorities for future research. Longitudinal studies are more likely to capture the complexity of the return-to-employment process, its impact on work participation and changes in employment over time. The social context of work may assist or hinder return-to-work more than physical environmental constraints. Equitable vocational support systems would help address disparities in vocational rehabilitation services available after burn injury.

Understanding return-to-employment experiences after burns: Qualitative scoping review findings

INTRODUCTION

Participation in work and employment is a milestone of adulthood. People returning to work after burn injury may have physical, psychological, social, and environmental barriers to overcome in order to resume their pre-injury employment. The aim of this paper is to evaluate qualitative findings regarding return-to-employment after burn injury.

METHODS

A qualitative synthesis was conducted based on the qualitative findings of an earlier mixed methods review. A pre-determined scoping review protocol was used in the earlier review to search MEDLINE, CINAHL, Embase, PsycINFO, PubMed, Scopus, CCRCT, and CDSR databases between 2000 and Aug 2021. Any papers presenting qualitative data from previously employed adults with cutaneous burn injuries were included.

FINDINGS

A total of 20 papers with qualitative data on return-to-employment after burn injury were found. Only six included studies focused on return-to-employment outcomes and the remaining studies reporting on quality of life and life experiences after burn injury. Common themes included impairments that develop and change over time; occupational identity and meaning; temporal aspects of burn recovery; burn rehabilitation services and interventions; attitudes, knowledge and support of service providers; workplace environments supporting work re-engagement after burn injury; usefulness of work accommodations; family and social supports, individuals attributes that influence re-engaging in employment; and accepting and rebuilding.

CONCLUSION

Resumption of work after burn injury is regarded as a key marker of recovery for working-aged adults by burn survivors and burn care professionals. Support at transition points during the burn recovery process and peer-led programmes were important. However, limited information currently exists regarding clinical practices, service gaps, and understanding of return-to-employment outcomes after burn injury.

Use of sensory modulation approaches to improve compression garment adherence in adults after burn: An e-Delphi study

BACKGROUND

Sensory over-responsiveness, identified through self-report and quantitative sensory testing, has been associated with compression garment non-adherence in a burn-injured cohort. This study sought expert consensus on the usefulness of, and recommendations for, sensory modulation strategies to improve compression garment adherence in sensory over-responsive adults after burn.

METHOD

Experts in the field of sensory modulation were invited to participate in a mixed-methods, three-round electronic Delphi study.

RESULTS

Experts (N = 18) agreed that sensory modulation therapy may be a useful clinical tool to improve compression garment adherence. Twenty-two items reached consensus as essential to assessment, treatment, or therapist training.

CONCLUSION

With adequate therapist training and individualized assessment and treatment, sensory modulation strategies may be a useful clinical approach to improving compression garment adherence in those who are sensory over-responsive after burn. Further research is needed to gather perceptions from burns therapists, and to implement and evaluate the effectiveness in clinical practice.

Motivating patients towards better recovery after burn: The development of a booklet to reframe perspectives

INTRODUCTION

Posttraumatic growth after burn results from integrated changes in worldview. It incorporates acceptance, belief in the self, compassion, determination and planning, emotional management and family/friend support.

METHOD

The booklet was developed in two phases. In the first phase burn survivors were invited to tell their stories pertaining to their burn recovery experiences. These stories were categorised into the above framework, and presented alongside supporting information from the burn clinical psychologist in an initial draft of the booklet. In the second phase of the study, a combination of one-to-one interviews and a focus group of burn survivors discussed, suggested improvements to the final booklet and evaluated for usefulness and acceptability.

RESULTS

A booklet was developed with a blend of patient stories and professional advice to positively reframe, integrate changed perspectives and motivate patients towards better psychological recovery after burn. It was evaluated to be useful and acceptable to new burn patients.

CONCLUSION

This booklet, designed to positively reframe perspectives for better psychosocial burn recovery, was developed with patients and evaluated by patients. It was found to be useful and acceptable to new burn patients.

The psychosocial burden of visible disfigurement following traumatic injury

Hundreds of thousands of individuals experience traumatic injuries each year. Some are mild to moderate in nature and patients experience full functional recovery and little change to their physical appearance. Others result in enduring, if not permanent, changes in physical functioning and appearance. Reconstructive plastic surgical procedures are viable treatments options for many patients who have experienced the spectrum of traumatic injuries. The goal of these procedures is to restore physical functioning and reduce the psychosocial burden of living with an appearance that may be viewed negatively by the patient or by others. Even after receipt of reconstructive procedures, many patients are left with residual disfigurement. In some, disability and disfigurement may be so profound that individuals are candidates for vascularized composite allotransplantation (VCA) procedures, i.e., the transplantation of a vascularized human body part containing multiple tissue types (skin, muscle, bone, nerves, and blood vessels) as an anatomical and/or structural unit. This narrative review paper summarizes the literature on the psychosocial burden experienced by those who have visible disfigurement. While many of these individuals experience stigma and discrimination, relatively few studies have employed a stigma framework to understand the psychosocial sequelea. This paper briefly addresses this framework. Last, particular focus is given to the psychosocial issues of individuals with particularly severe injuries who are potential candidates for VCA procedures.

Laser Treatment of Hypopigmentation in Scars: A Review

BACKGROUND

Despite history of multiple treatment modalities, repigmentation of hypopigmented scars remains a difficult clinical problem.

OBJECTIVE

The purpose of this review is to evaluate the literature on laser and combination laser plus adjunct topical therapy for hypopigmented burn and traumatic scars.

MATERIALS AND METHODS

A search on PubMed and on Oxford Academic was conducted with additional relevant literature obtained from reference lists.

RESULTS

Treatment regimens that address hypopigmentation within scars were reviewed. A combination of nonablative fractional or ablative fractional laser treatment with topical prostaglandin analogue with or without topical retinoid were found to result in superior repigmentation.

CONCLUSION

Reliable improvement of hypopigmentation in scars after laser treatment is challenging. Laser can achieve success in some cases. Ultraviolet laser can achieve modest repigmentation; however, results are short-lived and require continued re-treatment. Modest improvement in pigmentation is seen with nonablative fractional laser or ablative fractional laser alone and enhanced repigmentation is demonstrated when combining fractional laser resurfacing with topical application of synthetic prostaglandin analogues and other known modulators of melanogenesis.

Trajectory Curves for Purposes of Benchmarking and Predicting Clinical Outcomes: A Scoping Review

Trajectory curves are valuable tools to benchmark patient health status and predict future outcomes. A longitudinal study is underway to examine social participation after burn injury using the Life Impact Burn Recovery Evaluation (LIBRE) Profile with the goal of developing trajectory curves for specific domains that focus on social reintegration. We conducted a scoping review to inform and understand trajectory curves applied in clinical settings to compare outcomes for an individual to a matched cohort of comparable patients or predicted expected outcomes over time. This scoping review utilized a PubMed search from January 2014 to August 2019 for the following terms: "trajectory curves" or "trajectory models" and "clinic" or "clinical." Only articles that specifically referenced longitudinal and clinical research designs were included in the scoping review. Articles were assessed using standard scoping review methods and categorized based on clinical application of trajectory curves for either benchmarking or prediction. The initial literature review identified 141 manuscripts and 34 met initial inclusion criteria. The reviewed articles support the clinical use of trajectory curves. Findings provide insight into several key determinants involved with the successful development and implementation of trajectory curves in clinical settings. These findings will inform efforts to use the LIBRE Profile to model social participation recovery and assist in developing effective strategies using trajectory curves to promote social reintegration after burn injury.

Influential Factors in the Recovery Process of Burn Survivors in a Predominately Rural State: A Qualitative Study

Navigating the recovery journey following a burn injury can be challenging. Survivor stories can help define recovery constructs that can be incorporated into support programs. We undertook this study to determine themes of recovery in a predominately rural state. Eleven purposefully selected burn survivors were interviewed using a semi-structured format. Consensus coding of verbatim transcriptions was used to determine themes of successful recovery. Four support-specific themes were identified. These included: using active coping strategies, expressing altruism through helping others, finding meaning and acceptance, and the active seeking and use of support. These themes could be incorporated into support programming and would help guide future survivors through the recovery period.

Prevalence and predictors of scar contracture-associated re-hospitalisation among burn inpatients in China

Scar contracture, a common destructive complication causing increased re-hospitalisation rate of burn survivors and aggravated burden on the medical system, may be more seriously in Chinese population because of their higher susceptibility to scar formation. This study aims to evaluate the prevalence and predictors of scar contracture-associated re-hospitalisation among Chinese burn inpatients. This cross-sectional study screened burn inpatients hospitalised during 2013 to 2018 through the Hospital Quality Monitoring System database, among whom re-hospitalised for scar contracture were identified. Variables including sex, age, occupations, burn area, burn site and surgical treatment were analysed. Potential predictors of scar contracture-associated re-hospitalisation among burn inpatients were determined by univariate regression analyses. Of the 220,642 burn inpatients, 2146 (0.97%) were re-hospitalised for scar contracture. The re-hospitalised inpatients were predominantly men and blue-collar workers, showing younger median age at the time of burns, larger burn sizes, and higher percentage of surgical treatment compared other burn inpatients. Significant univariate predictors of scar contracture-associated re-hospitalisation included male sex, age < 50 years, blue-collar work, ≥ 40% total body superficial area burned, inhalation injured, and surgical treatment. Scar contracture is an intractable complication and a significant factor to increase re-hospitalisation rate among Chinese burn inpatients.

Interpreting Life Impact Burn Recovery Evaluation Profile Scores for Use by Clinicians, Burn Survivors, and Researchers

The Life Impact Burn Recovery Evaluation (LIBRE) Profile is a patient-reported outcome measure developed to assess social participation in adult burn survivors. This study identified numeric score cut-points that define different levels of social participation ability and described each level. An expert panel identified numeric score cut-points that distinguish different levels of social participation for the six LIBRE Profile domains. Methods employed an iterative, modified-Delphi approach, and bookmarking to review calibrated item banks. Analyses (using calibration sample data and repeated in a validation sample) examined means, SDs, and sample distributions for each level. Analyses of variance examined score differences between levels. The panel developed descriptions for each established level. Initial cut-points resulted in four levels for five domains (Social Activities, Social Interactions, Romantic Relationships, Sexual Relationships, and Work & Employment) and five levels for the sixth domain (Relationships with Family & Friends). Comparisons demonstrated significant differences between level mean scores for all domains (P < .05) except Relationships with Family & Friends. Based on follow-up surveys, Relationships with Family & Friends score cut-points were adjusted to identify four levels with significant score differences between all levels. Panelists reached consensus for level descriptions. Score cut-points and descriptions identify different levels of social participation, providing a relevant context for interpreting LIBRE Profile numeric scores. LIBRE Profile Social Participation levels will help clinicians and persons with burn injury interpret LIBRE Profile numeric scores and promote use of this important new assessment.

An Examination of Follow-up Services Received by Vulnerable Burn Populations: A Burn Model System National Database Study

While disparities in healthcare outcomes and services for vulnerable populations have been documented, the extent to which vulnerable burn populations demonstrate disparities in long-term care is relatively underexplored. This study's goal was to assess for differences in long-term occupational or physical therapy (OT/PT) and psychological service use after burn injury in vulnerable populations. Data from the Burn Model System National Database (2006-2015) were analyzed. The vulnerable group included participants in one or more of these categories: 65 years of age or older, nonwhite, no insurance or Medicaid insurance, preinjury receipt of psychological therapy or counseling, preinjury alcohol and/or drug misuse, or with a preexisting disability. Primary outcomes investigated were receipt of OT/PT and psychological services. Secondary outcomes included nine OT/PT subcategories. Outcomes were examined at 6, 12, and 24 months postinjury. One thousand one hundred thirty-six burn survivors (692 vulnerable; 444 nonvulnerable) were included. The vulnerable group was mostly female, unemployed at time of injury, and with smaller burns. Both groups received similar OT/PT and psychological services at all time points. Adjusted regression analyses found that while the groups received similar amounts services, some vulnerable subgroups received significantly more services. Participants 65 years of age or older, who received psychological therapy or counseling prior to injury, and with a preexisting disability received more OT/PT and psychological or peer support services at follow-up. Overall, vulnerable and nonvulnerable groups received comparable OT/PT and psychological services. The importance of long-term care among vulnerable subgroups of the burn population is highlighted by this study. Future work is needed to determine adequate levels of follow-up services.

[A Qualitative Study on Interpersonal Relationships of Patients with Facial Burn Injuries: Phenomenological Study]

PURPOSE

The purpose of the study was to explore the experience of patients with facial burn injuries regarding their interpersonal relationships.

METHODS

The phenomenological research method was used. Participants of the study consisted of five males and three females. Data were collected through individual in-depth interviews from November, 2014 to February, 2015 and analyzed using Colaizzi's method.

RESULTS

Five theme clusters were extracted that described patients' experiences. They are "being a lonely foreigner," "closing my mind toward the world," "hiding hurt feelings," "companion of my face," and "communicating with the world".

CONCLUSION

The results of this study provide a deep understanding and insight into the experience of interpersonal relationships among facial burn patients. The development of a comprehensive program including physical, psychological, and social aspects is recommended to address the problems facial burn patients encounter in interpersonal relationships and to facilitate interaction.

Early and late-recorded predictors of health-related quality of life of burn patients on long-term follow-up

BACKGROUND

Unintentional and intentional burn injuries vary across age groups, gender, income, and global region. In high-income countries, the trend over the last several years has been a reduction in burn incidence, burn severity, length of hospital stay, and mortality rate. However, there is a lack of data on predictors of the health-related quality of life (HRQoL) of major burn survivors extending beyond a follow-up period of 10 years.

PATIENTS AND METHODS

This single-center cross-sectional study is considering 42 long-term severe burn survivors with deep partial thickness burns and an affected total body surface area (TBSA) of ≥20%. For study eligibility design a minimum follow-up of 10 years was obligatory. Entitled individuals were asked to fill in the generic Short Form 36 (SF-36) questionnaire. The physical (PCS) and mental (MCS) component scores of the SF-36 were used as the primary outcome variables. Putative predictor variables were drawn from medical records. Burn-specific functionality and scar tissue quality were assessed using the Burn Specific Health Scale-Brief (BSHS-B) questionnaire and the Patient and Observer Scar Assessment Scale (POSAS), respectively. Correlation between putative predictor variables and SF-36 norm scores were evaluated by Pearson- and Point-Biserial correlation as well as multivariate linear regression. The SF-36 norm scores were compared to the general German population.

RESULTS

Mean follow-up was 14 (±3) years with a minimum and maximum of 10 and 28 years, respectively. Mean age at the time of the incident was 37 (±17) years. The majority of individuals were male (74%). The mean burn size was 39 (±17) % (TBSA) with 76% of the individuals showing a full thickness burn. SF-36 norm scores were not statistically different from the general population. Statistically significant independent predictor variables of the physical summary score were: age at the time of the injury (-0.381), time since injury (-0.466), length of hospital stay (-0.356), limb amputation (-0.318), unemployment (-0.433), work (0.593), hand function (0.601), body image (0.518), affect (0.355), simple abilities (0.602), burns involving the hands (-0.339) and back (-0.343), POSAS patient- (-0.521) and observer scores (-0.483). In multivariate analysis, work (4.315), the POSAS Score (-2.082) and the age at the time of the incident (-0.242) were statistically significant predictors. Statistically significant independent predictor variables of the mental summary score were: duration of mechanical ventilation (-0.459), hand function (0.415), body image (0.502), sexual activity (0.625), social support (0.542), burns involving the back (-0.315) and affect (0.692). In multivariate analysis, affect (13.844) and the length of mechanical ventilation (-0.115) were statistically significant independent predictor variables.

CONCLUSION

Ten years after the burn incident, the quality of life was on average comparable to the one in the general population. Multiple variables seem to influence the physical and mental long-term outcome. Herein presented data may support in adapting and designing follow-up strategies tailored to a patient's burn-specific circumstances.

Insecure adult attachment style is associated with elevated psychological symptoms in early adjustment to severe burn: A cross-sectional study

Research into recovery and adjustment after burn injury has indicated a link between psychopathological symptoms including traumatic stress, distress, depression and anxiety, and worse psychosocial and physical outcomes. The severity of psychological symptoms does not always correlate with that of the burn injury, and symptoms can be ongoing in certain patients for extensive periods, leading to a need for early screening in burns patients for psychological vulnerabilities. One potential factor influencing recovery from the psychological impact of burn injury is adult attachment style, specifically secure and insecure attachment, as this describes how an individual organizes their stress regulation. This cross-sectional study measured: (a) attachment style (via the Relationship Questionnaire [RQ]): (b) negative psychological symptoms (via the Depression Anxiety and Stress Scale [DASS]); and, (c) post-traumatic symptoms (via the Davidson Trauma Scale [DTS]) in a cohort of burns patients (n = 104, 51 analysed) in a severe burns unit in Australia during the acute phase of their recovery. Secure attachment style was inversely related to psychopathological symptoms. Secure participants scored significantly lower scores on the DASS (M = 17.63, SD = 17.07) compared to self-rated insecure participants [(M = 42.38, SD = 34.69), p < .01] and on the DTS (M = 14.22, SD = 15.42) compared to insecure participants [(M = 40.54, SD = 35.72), p < .01]. Similar results were found in analyses controlling for covariates of gender, age and burn severity as potential confounders. This research suggests attachment style may play an important role in psychosocial recovery from severe burn injury.

Cognitive Distortions as Trauma-Specific Irrational Beliefs Among Burn Patients

Burn injuries are most certainly stressful events, particularly when permanent disfigurement is a result. This situation can lead to the onset of irrational beliefs which can in turn lead to long-term psychological problems such as depression, anxiety, shame, guilt, posttraumatic stress, etc. The objective of this study is to explore the irrational beliefs among burn patients and its correlates in an Iranian sample. This cross-sectional study included 329 patients who had experienced disfigurement, as result of burn injuries. In order to assess irrational beliefs, a Scale for Irrational Thoughts after Burning was used. To identify correlated variables with irrational beliefs, both bivariate and multivariate analysis methods were conducted. In multivariate linear regression, forward strategy was used for building the model. The results of bivariate analysis showed that the location of the burn on bodies (body parts generally exposed in social environment or parts culturally perceived as sensitive areas of body), marital status, urbanities, age group, geographical areas, etiology of burning, and intent of injury had significant relationships with irrational beliefs (P < .05). Using forward linear regression, gender, marital status, geographical areas, etiology of burning, body burn by location (body parts generally exposed in social environment or parts culturally perceived as sensitive areas of body), and intent of injury had significant correlation with irrational beliefs. The models predicted 15.5% (P < .001) of irrational beliefs. Considering to irrational beliefs and development of facilities for screening is necessary. Moreover, consultation with mental health experts after burn injuries is highly recommended.

Spiritual Transcendence and Psychological Adjustment: The Moderating Role of Personality in Burn Patients

The current study examined the moderating role of personality traits (neuroticism and extraversion) on the relationship between spiritual transcendence and positive change, and spiritual transcendence and distress in burn patients. The sample (N = 98) comprised adult burn patients (age = 25-50) admitted to three hospitals in Lahore, Pakistan. They were assessed according to a demographic information sheet, the NEO Personality Inventory (McCrae and Costa in J Personal Soc Psychol 52:81-90, 1987), the Spiritual Transcendence Index (Seidlitz et al. in J Sci Study Relig 41:439-453, 2002), the Depression, Anxiety, Stress Scales-21 (Lovibond and Lovibond in Manual for the Depression Anxiety Stress scales, Psychology Foundation, Sydney, 1995), and the Perceived Benefit Scales (McMillen and Fisher in Soc Work Res 22(3):173-186, 1998). Stepwise moderated regression analysis showed that both personality traits (neuroticism and extraversion) played a moderating role in the relationship between spiritual transcendence and positive change, and spiritual transcendence and distress in burn patients. The findings highlight the potential role spiritual transcendence may have in understanding and improving the psychological adjustment of burn patients.

Reduced Postburn Hypertrophic Scarring and Improved Physical Recovery With Yearlong Administration of Oxandrolone and Propranolol

BACKGROUND

Massive burns induce a hypermetabolic response that leads to total body wasting and impaired physical and psychosocial recovery. The administration of propranolol or oxandrolone positively affects postburn metabolism and growth. The combined administration of oxandrolone and propranolol (OxProp) for 1 year restores growth in children with large burns. Here, we investigated whether the combined administration of OxProp for 1 year would reduce scarring and improve quality of life compared with control.

STUDY DESIGN

Children with large burns (n = 480) were enrolled into this institutional review board-approved study; patients were randomized to control (n = 226) or administration of OxProp (n = 126) for 1 year postburn. Assessments were conducted at discharge and 6, 12, and 24 months postburn. Scar biopsies were obtained for histology. Physical scar assessments and patient reported outcome measures of physical and psychosocial function were obtained.

RESULTS

Reductions in cellularity, vascular structures, inflammation, and abnormal collagen (P < 0.05) occurred in OxProp-treated scars. With OxProp, scar severity was attenuated and pliability increased (both P < 0.05). Analyses of patient-reported outcomes showed improved general and emotional health within the OxProp-treated group (P < 0.05).

CONCLUSIONS

Here, we have shown improvements in objective and subjective measures of scarring and an increase in overall patient-reported physical function. The combined administration of OxProp for up to a year after burn injury should be considered for the reduction of postburn scarring and improvement of long-term psychosocial outcomes in children with massive burns.

The Effect of Pre-Discharge Training on the Quality of Life of Burn Patients

Introduction: Many physical, psychological, social and economic complications have been reported after discharge, which have a negative impact on the quality of life of burn patients. The present research examines the effect of pre-discharge training program on the life quality of patients with burns.

Methods: This is a pre and post-experimental study with control group that was conducted in 2015 in teaching hospital Sina. The control group received the typical instructions upon being discharged from hospital while the experimental group received in-person training in the form of question-answer, pamphlets and a researcher-made instruction booklet. The patients’ life quality was evaluated when they were being discharged, a month and then three months after they were discharged.

Results: The result showed that the quality of life has a significant statistical difference across the three time points. And these differences are compared using Bonferroni’s adjustment multiple comparisons indicating that pre-discharge training affects the quality of life scores and this effect continues over time.

Conclusion: The results show that the pre-discharge training has significantly improved the life quality among the burns patients. The improvement of life quality is also correlated with the quantitative variable of total body surface area percent (TBSA %). Thus, planning and designing in-discharge training programs based on the existing context, combined with training packages focusing on the patients’ needs could be a very significant step in more successful implementation of the follow-up programs on the burn patients and improving their quality of life.

Health related quality of life in adults after burn injuries: A systematic review

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.

Effects of structured home-based exercise program on depression status and quality of life in burn patients

BACKGROUND

Burns can cause life-threatening injuries and severe limitations. This study aimed to evaluate the effects of the structured home-based exercise program on depression status and quality of life in burn patients.

MATERIALS AND METHODS

This study was carried out in the Wound and Burn Treatment Department of University of Health Sciences, Dr. Lütfi Kırdar Kartal Education and Research Hospital, Istanbul. Thirty burn patients voluntarily participated in this study. Patients' demographic data such as burn area and grade, percentage, type, number of grafts, and duration of hospitalization were recorded. The quality of life was evaluated using the Short Form-36 (SF-36), and depression status was evaluated using Beck Depression Inventory (BDI). The home-based exercise program was defined by the clinical physiotherapist on the day when the patient was discharged. The home-based exercise program was applied for 3 weeks. Evaluations were performed at discharge and repeated after 3 weeks at the end of the exercise program.

RESULTS

Of the 30 patients who completed the study (age range, 21-61 years; mean, 34.9±12.99 years), 96.7% (n=29) were male and 3.3% (n=1) were female. A statistically significant difference was observed between BDI and SF-36 scores before and after the home-based exercise program (p<0.05). BDI scores decreased after the home-based exercise program, whereas SF-36 scores increased.

CONCLUSION

Our study concludes that burn patients who underwent the structured home-based exercise programs attained acceleration of their physical, social, and psychological integrity. Thus, establishing a structured home-based exercise program according to the burn type and clinical course should be continued.

Long-Term Outcomes in Patients Surviving Large Burns: The Musculoskeletal System

The authors have previously described long-term outcomes related to the skin in patients surviving large burns. The objective of this study was to describe the long-term musculoskeletal complications following major burn injury. This is a cross-sectional descriptive study that includes a one-time evaluation of 98 burn survivors (mean age = 47 years; mean TBSA = 57%; and mean time from injury = 17 years), who consented to participate in the study. A comprehensive history and physical examination was conducted by a senior and experienced Physical Medicine and Rehabilitation physician. In addition to completing a Medical Problem Checklist, subjects also completed the Burn-Specific Health Scale (Abbreviated 80 item), a self-report measure used to review the level of functional adaptation. Joint pain, joint stiffness, problems walking or running, fatigue, and weak arms and hands are conditions that continue to be reported at an average of 17 years from the time of burn injury. Seventy-three percent (68 of 93) of the study sample were found to have a limitation of motion and areas most affected were the neck (47%), hands (45%), and axilla (38%). The global (Burn-Specific Health Scale-total) score for the overall sample was 0.78. Subjects with limitation of motion had significant difficulty in areas of mobility, self-care, hand function, and role activities. This study underscores the importance of long-term follow-up care and therapeutic interventions for survivors of major burn injury, as they continue to have significant and persistent burn-related impairments even several years following injury.

A qualitative exploration of psychosocial specialists' experiences of providing support in UK burn care services

INTRODUCTION

A burn can have a significant and long-lasting psychosocial impact on a patient and their family. The National Burn Care Standards (2013) recommend psychosocial support should be available in all UK burn services; however, little is known about how it is provided. The current study aimed to explore experiences of psychosocial specialists working in UK burn care, with a focus on the challenges they experience in their role.

METHODS

Semi-structured telephone interviews with eight psychosocial specialists (two psychotherapists and six clinical psychologists) who worked within UK burn care explored their experiences of providing support to patients and their families.

RESULTS AND DISCUSSION

Thematic analysis revealed two main themes: burn service-related experiences and challenges reflected health professionals having little time and resources to support all patients; reduced patient attendance due to them living large distances from service; psychosocial appointments being prioritised below wound-related treatments; and difficulties detecting patient needs with current outcome measures. Therapy-related experiences and challenges outlined the sociocultural and familial factors affecting engagement with support, difficulties treating patients with pre-existing mental health conditions within the burn service and individual differences in the stage at which patients are amenable to support.

CONCLUSION

Findings provide an insight into the experiences of psychosocial specialists working in UK burn care and suggest a number of ways in which psychosocial provision in the NHS burn service could be developed.

Impact of Work-Related Burn Injury on Social Reintegration Outcomes: A Life Impact Burn Recovery Evaluation (LIBRE) Study

OBJECTIVE

To examine differences in long-term social reintegration outcomes for burn survivors with and without work-related injuries.

DESIGN

Cross-sectional survey.

SETTING

Community-dwelling burn survivors.

PARTICIPANTS

Burn survivors (N=601) aged ≥18 years with injuries to ≥5% total body surface area or burns to critical areas (hands, feet, face, or genitals).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The Life Impact Burn Recovery Evaluation Profile was used to examine the following previously validated 6 scale scores of social participation: Family and Friends, Social Interactions, Social Activities, Work and Employment, Romantic Relationships, and Sexual Relationships.

RESULTS

Older participants, those who were married, and men were more likely to be burned at work (P<.01). Burn survivors who were injured at work scored significantly lower on the Work and Employment scale score after adjusting for demographic and clinical characteristics (P=.01). All other domain scale scores demonstrated no significant differences between groups. Individuals with work-related injuries scored significantly worse on 6 of the 19 items within the Work and Employment scale (P<.05). These individuals were more likely to report that they were afraid to go to work and felt limited in their ability to perform at work.

CONCLUSIONS

Burn survivors with work-related injuries report worse work reintegration outcomes than those without work-related injuries. Identification of those at higher risk for work reintegration challenges after burn injury may enable survivors, providers, employers, and insurers to better use appropriate resources to promote and target optimal employment outcomes.

Social challenges of visible scarring after severe burn: A qualitative analysis

INTRODUCTION

Visible scarring after burn causes social challenges which impact on interpersonal connection. These have health impacts which may worsen outcomes for burn patients and reduce the potential for posttraumatic growth (PTG).

AIM

The aim of the study was to investigate adult burn survivors' experiences of interpersonal relationships as potential barriers to posttraumatic recovery following hand or face burns.

METHOD

This qualitative study explored patient experiences of interpersonal situations. A purposive sample (n=16) who had visible burn scarring were interviewed more than two years after their burn.

RESULTS

Emotional barriers included the fear of rejection, feelings of self-consciousness, embarrassment and humiliation. Situational barriers included inquisitive questions, comments and behaviours of others. Responses depended on the relationship with the person, how they were asked and the social situation. Active coping strategies included positive reframing, humour, changing the self, and pre-empting questions. Avoidant coping strategies included avoidance of eye contact, closed body language, hiding scars, and learning to shut down conversations.

CONCLUSION

Emotional and situational barriers reduced social connection and avoidant coping strategies reduced the interaction of people with burns with others. Active coping strategies need to be taught to assist with social reintegration. This highlights the need for peer support, family support and education, and social skills training.

Combination of medical needling and non-cultured autologous skin cell transplantation (ReNovaCell) for repigmentation of hypopigmented burn scars

Burn scars remain a serious physical and psychological problem for the affected people. Clinical studies as well as basic scientific research have shown that medical needling can significantly increase the quality of burn scars with comparatively low risk and stress for the patient with regards to skin elasticity, moisture, erythema and transepidermal water loss. However, medical needling has no influence on repigmentation of large hypopigmented scars. The goal of this study is to evaluate whether two established methods - needling (for improvement of scar quality) and non-cultured autologous skin cell suspension (for repigmentation) - can be successfully combined. Twenty subjects with mean age of 33 years (6-60 years) with scars from deep second and third degree burns have been treated. The average treated surface area was 94cm² (15-250cm²) and was focused on prominent areas such as the face, neck, chest and arm. Percutaneous collagen induction or "medical needling" was performed using a roller covered with 3mm long needles. The roller is vertically, horizontally and diagonally rolled over the scar, inducing microtrauma. Then, non-cultured autologous skin cell suspension (NCASCS) was produced and applied using the ReNovaCell Autologous Cell Harvesting Device (Avita Medical), according to the manufacturer's instructions. The patients were followed 12 months postoperatively. Pigmentation changes were measured objectively, as well as with patient and observer ratings. Patient satisfaction/preference was also obtained. Taken together, the pigmentation ratings and objective measures indicate individual improvement in 17 of the study participants. The melanin increases seen 12 months after NCASCS treatment are statistically significant. Medical needling in combination with NCASCS shows promise for repigmentation of burn cars.

Guidelines for burn rehabilitation in China

Quality of life and functional recovery after burn injury is the final goal of burn care, especially as most of burn patients survive the injury due to advanced medical science. However, dysfunction, disfigurement, contractures, psychological problems and other discomforts due to burns and the consequent scars are common, and physical therapy and occupational therapy provide alternative treatments for these problems of burn patients. This guideline, organized by the Chinese Burn Association and Chinese Association of Burn Surgeons aims to emphasize the importance of team work in burn care and provide a brief introduction of the outlines of physical and occupational therapies during burn treatment, which is suitable for the current medical circumstances of China. It can be used as the start of the tools for burn rehabilitation.

The patient-body relationship and the "lived experience" of a facial burn injury: a phenomenological inquiry of early psychosocial adjustment

Background

Throughout development and into adulthood, a person’s face is the central focus for interpersonal communication, providing an important insight into one’s identity, age, sociocultural background, and emotional state. The face facilitates important social, including nonverbal, communication. Therefore, sustaining a severe burn, and in particular a facial burn, is a devastating and traumatizing injury. Burn survivors may encounter unique psychosocial problems and experience higher rates of psychosocial maladjustment, although there may be a number of potentially mediating factors.

Objectives

The purpose of this phenomenological study was to examine the early recovery experience of patients with a facial burn. In particular, this study focused on how the injury impacted on the participants’ relationship with their own body and the challenges of early psychosocial adjustment within the first 4 months of sustaining the injury.

Methods

In 2011, six adult participants encompassing two females and four males ranging from 29 to 55 years of age with superficial to deep dermal facial burns (with background burns of 0.8%–55% total body surface area) were recruited from a severe burn injury unit in Australia for participation in a Burns Modified Adult Attachment Interview. Narrative data were analyzed thematically and informed by Colaizzi’s method of data analysis.

Results

Three overarching themes emerged: relationship to self/other, coping, and meaning-making. Themes identified related to how the experience affected the participants’ sense of relationship with their own bodies and with others, as well as other challenges of early psychosocial adjustment. All participants indicated that they had experienced some early changes in their relationship with their body following their burn injury.

Conclusion

These findings highlight the struggle burn survivors experienced with postburn adjustment, but expressed altruism and optimism around their recovery. Past trauma was observed to be a significant finding in this sample. Understanding the “lived experience” supports the way clinical and family systems can foster positive adjustment and coping. Consequently, multidisciplinary burn teams and health care professionals need to understand the principles of trauma-informed care and translate these into practice in the treatment of this group of patients.

Validation of the Brazilian version of the Burn Specific Health Scale-Brief (BSHS-B-Br)

INTRODUCTION

Progressive increases in survival rates from burn trauma have shifted attention to patient rehabilitation and posttraumatic quality of life. The assessment of quality of life is strongly dependent on reliable instruments for its measurement. A literature review has revealed that the Burn Specific Health Scale-Brief (BSHS-B) questionnaire is the most commonly used instrument worldwide.

OBJECTIVES

The aim of this study was to translate the BSHS-B into the Portuguese language, adapt it culturally to the Brazilian population, and test its psychometric properties.

METHODS

The questionnaire was translated into Portuguese; culturally adapted; and tested for reproducibility, face validity, content validity, and construct validity. The translated version was tested on 92 patients with burns. Internal consistency was tested by means of Cronbach's alpha. Construct validity was performed by correlating the BSHS-B questionnaire with the Burn Specific Health Scale-Revised (BSHS-R), BurnSexQ-Escola Paulista de Medicina (EPM)/Universidade Federal De São Paulo (UNIFESP), the Rosenberg Self-Esteem Scale (RSES), and the Beck Depression Inventory (BDI).

RESULTS

Cronbach's alpha was 0.85. The Pearson correlation coefficients were significant at three time points of the reliability analysis. A significant correlation was observed between BSHS-B domains and BSHS-R, and between RSES and BDI domains. A significant correlation was also observed between BSHS-B and the BurnSexQ-EPM/UNIFESP social comfort and body image domains.

CONCLUSION

The BSHS-B questionnaire was translated into Portuguese. It is a reliable tool in this language, showing face, content, and construct validity. The modified instrument has been named BSHS-B-Br.

Comparison of long-term quality of life of pediatric burn survivors with and without inhalation injury

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.

Making meaning in a burn peer support group: qualitative analysis of attendee interviews

There is a paucity of literature on the personal experiences of burn support group members, the members' perceived benefits of group participation, and the meaning the survivors make of the support they receive. In order to provide effective psychosocial rehabilitation services and to meet the needs of burn survivors, it is important to understand the influence a support group has on its members as well as the personal experiences of those individuals who attend these groups. The purpose of this study was to explore the experiences of burn survivors in a burn survivor support group. Six self-identified burn survivors were interviewed by using a guided in-depth interview technique to explore their experiences in the support group. Key informant interviews and group observations served to triangulate the findings from the individual interviews. The experiences of the group members coalesced around four main themes: acceptance of self, perspective change, value of community, and reciprocity. The findings demonstrated the overall perceived positive impact the support group had on psychosocial recovery. For these members, the group aided the process of adjustment through the encouragement of adaptive coping strategies and the facilitation of community and relationships. Their experiences mirrored much of the literature on psychological growth from adversity. Burn survivors reported unique opportunities that allowed them to integrate their injury into their identity within an encouraging and safe environment. Using these accounts, the authors generated clinical suggestions that may encourage similar growth in other support group settings.

Burn Survivors' Experience of Core Outcomes during Return to Life: a Qualitative Study

INTRODUCTION

Burn is one of the main and common health problems that face the victims with significant challenges in their lives. The main purpose of caring and rehabilitating these people is returning them to their previous life situation. Thus, the present study was conducted with the purpose of determining the experience of burn survivors with regard to returning to life in order to be able to obtain new concepts of acceptable implications in the present cultural and religious context.

METHODS

The present study is a qualitative study that was conducted using qualitative content analysis and in-depth unstructured interviews with 15 burn survivors in 2012 and 2013 in Tabriz.

RESULTS

During the process of qualitative analysis, the content of the category "balance", as the core essence of the experience of participants, was extracted according to three sub-categories: a- the physical integration (physiological stability, saving the affected limb), b-connecting to the life stream (self-care, getting accustomed, normalization), and c- return to the existence (sense of inner satisfaction and excellence).

CONCLUSION

The results of this study confirmed the physical, psychological and social scales introduced by other studies. Also proposed the concept "return to the existence", that can be measured by the emergence of a sense of inner satisfaction and excellence in the individual, as one of the key and determinant scales in returning the victims of burn to life.

Structural equation modeling on life-world integration in people with severe burns

PURPOSE

The aim of this study was to construct and test a structural equation modeling on life-world integration in people with severe burns.

METHODS

A survey design was used. Data were collected in 2008 from 376 people who had experienced severe burns using questionnaires. The data were analyzed using structural equation modeling.

RESULTS

The fitness parameters of the modified model (χ(2)/df = 3.15, goodness of fit: .91, normal fit index: .93, Tucker Lewis Index: .93, root mean square error of approximation: .07, root mean square residual: .04, and comparative fit index: .95) indicated its suitability as the research model. Physical function directly influenced burn factor, and family support indirectly influenced life-world integration.

CONCLUSION

Physical function should be directly improved to adjust to life-world integration. A comprehensive integration approach is also necessary to help people with severe burns successfully return to society.

Polish adaptation and validation of burn specific health scale - brief

BACKGROUND

The Burn Specific Health Scale - Brief is a well-described, specific tool to assess health condition (quality of life) of burnt patients. This project was aimed at creating a Polish adaptation and validation of the Burn Specific Health Scale - Brief.

METHOD

Adaptation of the tool was performed in two stages. The first stage involved translation, back translation, evaluation by a panel of judges and a pre-test of the tool. The second stage consisted of surveying 202 burned patients. Those data were used to conduct a psychometric analysis. Reliability was checked by determining the Cronbach's α internal consistency coefficient and conducting the test-retest procedure (ICC). Content validity was evaluated by a panel of judges. Criterion validity was determined using SF-36. Construct validity was determined using known-groups validation.

RESULTS

Reliability of the tool, determined using the internal consistency coefficient (Cronbach's α=0.94) and the test-retest procedure (ICC=0.89), proved to be high. Criterion validity, determined using the relationship of results of comparable BSHS-B and SF-36 subscales, obtained a satisfactory level with a correlation of r=0.55-0.89 (p<0.01). Analysis of inter-group differences showed that patients who stayed at a hospital for more than 10 days (p=0.002), patients after surgical intervention (p=0.018), patients with a burn larger than 19% of the TBSA (p=0.01) and patients with 3rd degree burns (p=0.001) have much poorer results than the rest of the subjects.

DISCUSSION

The Polish version of BSHS-B is a reliable and valid tool for assessing quality of life of burned patients. It may be used to plan the burn treatment process and evaluate its outcomes.

Sexuality in burn victims: an integrative literature review

AIMS

To analyze and synthesize knowledge concerning sexuality in adult burn victims through an integrative literature review.

METHOD

Two researchers independently searched six electronic databases (PUBMED, LILACS, ISI Web of Science, PSYCINFO, CINAHL and EMBASE) and also performed a hand search using the following descriptors, in different combinations: burn, sexuality, gender identity, sexual behavior and sexual factors, in order to identify the articles published in English, Portuguese or Spanish, in the last 20 years. A total of 1781 articles were found and 22 were selected based on the inclusion and exclusion criteria.

RESULTS

The findings were organized into two categories that influence sexuality: (1) studies where the main purpose was to assess sexuality in burn victims; (2) studies that indirectly assess sexuality.

CONCLUSION

The synthesis of the knowledge concerning sexuality in burn victims showed that sexual dysfunction can be related to the younger ages, TBSA > 20%, burns on the genitalia and on exposed areas, prolonged length of hospital stay, avoidance coping, and mental disorders. The multidisciplinary team should be prepared to integrate sexuality as an important variable in the continuing treatment of burn patients.

Guidelines for vocational evaluation following burns: integrated review of relevant process and factors

PURPOSE

A systematic literature review was undertaken to gather evidence to develop a guideline for vocational evaluation following burn injuries (BI). This review aimed to identify the key processes evaluators should follow and the key factors they should consider when completing such evaluations.

METHODS

Steps outlined in Cochrane Handbook of Systematic Review were followed including: development of review question; search strategies and selection criteria; quality appraisal; data extraction; analysis & synthesis; drawing conclusions. Four databases (Pubmed, Medline, CINHAL, PsycINFO) and 14 websites were searched for relevant articles and studies (quantitative, qualitative), reviews and guidelines. Two reviewers independently completed reviews, performed quality assessments and extracted data into evidence tables. Using the ICF model and directed content analysis, key processes and factors were analyzed and synthesized across the evidence.

RESULTS

A total of 138 articles were identified using the key words (e.g. burns, work). Studies, reviews and guidelines were retrieved if they focused on adults and discussed the processes relevant to vocational evaluation and/or factors associated with successful return to work (RTW) following a BI. Items were excluded if they did not address adults who had suffered a burn, the process of work or RTW, or challenges related to work after a BI. Using the above criteria 76 items were retrieved for full review. Fifty-six items remained after the quality appraisal. Results were integrated to develop the Evidence-based Framework for Vocational Evaluation Following Burn Injury.

CONCLUSIONS

This framework outlines 7 key processes relevant to vocational evaluation following burn injuries.

Experiencing occupations with chronic hand disability: narratives of hand-injured adults

Introduction

Hand injuries commonly account for a fifth of all emergencies presenting to emergencydepartments of most hospitals in Europe. One-third of these injuries lead to chronic hand disability thatentails economical, psychological, physical and social implications on the wellbeing of hand-injured adultswith longterm consequences. However, knowledge about the impact of chronic hand disability onoccupations in the long term is limited.

Methods

The purpose of this narrative study was to understand how adults after a hand injury experience theimpact of chronic hand disability on their occupations over time. Participants were selected through purposive sampling. Two narrative interviews were conducted with each participant and analysed usingnarrative and structural analysis.

Results

All participants experienced the challenge of occupational disruption. They faced occupationallimitations with the consequence of changed occupational patterns, and later strived for normality. In the end, all participants still needed to get accustomed to occupational changes.

Conclusion

The findings indicate that this process of occupational adaptation continues on for at least one year after the hand injury. They further highlight the importance to support the clients through engagement in occupation during the therapy process.