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Su YJ. PTSD and depression in adult burn patients three months postburn: The contribution of psychosocial factors. Gen Hosp Psychiatry 2023; 82:33-40. [PMID: 36933318 DOI: 10.1016/j.genhosppsych.2023.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/01/2023] [Accepted: 03/09/2023] [Indexed: 03/20/2023]
Abstract
OBJECTIVE Burn injuries can be traumatic and increase the risk of posttraumatic stress disorder (PTSD) and major depression (MDD). The current study examined the incremental contribution of established predictors of PTSD and theory-derived cognitive predictors to PTSD and depression early after burn. METHODS Participants were 118 adult burn patients consecutively admitted to the largest burn center in Taiwan who completed a baseline assessment, of which 101 (85.6%) were reassessed 3-month post-burn. RESULTS Three months after the burn, 17.8% and 17.8% of participants met probable DSM-5 PTSD and MDD, respectively. The rates rose to 24.8% and 31.7% using a cut-off of 28 on the Posttraumatic Diagnostic Scale for DSM-5 and 10 on the Patient Health Questionnaire-9, respectively. After controlling for potential confounders, the model with established predictors uniquely explained 26.0% and 16.5% of the variance of PTSD and depressive symptoms 3-month post-burn, respectively. The model with theory-derived cognitive predictors uniquely explained 17.4% and 14.4% of the variance, respectively. Posttrauma social support and thought suppression remained significant predictors of both outcomes. CONCLUSION A sizeable subset of burn patients suffer from PTSD and depression early after burn. Social and cognitive factors are implicated in the development and recovery of post-burn psychopathology.
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Affiliation(s)
- Yi-Jen Su
- Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, Taiwan, ROC; Department of Psychiatry, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC.
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2
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Mc Kittrick A, Gustafsson L, Hodson T, Di Tommaso A. Exploration of individuals perspectives of recovery following severe hand burn injuries. Burns 2023; 49:467-475. [PMID: 35570111 DOI: 10.1016/j.burns.2022.04.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/21/2022] [Accepted: 04/26/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Burns to one or both hands can impact how a person interacts with the world around them. Research regarding the specific impact of hand burn injuries and the experiences of individuals who have sustained hand burn injuries remains limited. OBJECTIVE The aim of this study was to explore the lived experiences of people with severe hand burn injuries, including their return to daily activities. METHODS This study used an interpretive description approach, incorporating 23 semi-structured interviews with people who had sustained severe hand burn injuries. RESULTS A major theme, "changes over time ", was identified and reflected the progressive nature of the experience over time. This was present in all three sub-themes: physical recovery, activities of daily living recovery, and psychosocial impact. Participants described a dual process of managing the recovery of the burn injury and burn rehabilitation interventions, whilst simultaneously learning to live with their injury and finding ways to engage in their occupations to the best of their abilities. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS The findings of the study suggest that burns recovery could be described in terms of performance rather than impairment and needs to be continuously monitored overtime.
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Affiliation(s)
- Andrea Mc Kittrick
- Department of Occupational Therapy, Royal Brisbane and Women's Hospital, Herston, 4029 QLD, Australia; Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, QLD 4111, Australia.
| | - Louise Gustafsson
- Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, QLD 4111, Australia; Honorary Associate Professor School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, 4072 QLD Australia
| | - Tenelle Hodson
- Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, QLD 4111, Australia
| | - Amelia Di Tommaso
- Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, QLD 4111, Australia
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Carel D, Pantet O, Ramelet AS, Berger MM. Post Intensive Care Syndrome (PICS) physical, cognitive, and mental health outcomes 6-months to 7 years after a major burn injury: A cross-sectional study. Burns 2023; 49:26-33. [PMID: 36424236 DOI: 10.1016/j.burns.2022.10.004] [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: 07/05/2022] [Revised: 09/16/2022] [Accepted: 10/30/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The Post Intensive Care Syndrome (PICS) has been described in intensive care (ICU) survivors, being present in 50% of patients surviving 12 months, with well-defined risk factors. Severely burned patients combine many of these risk factors, but the prevalence of PICS has not yet been documented in burns. The study aimed to answer this question and identify associations of PICS with clinical characteristics. METHODS Cross-sectional descriptive study of major burn survivors admitted to the burn ICU between 2013 and 2019. Main inclusion criteria: major burns>20 %BSA and ICU admission. The PICS components were assessed using three questionnaires: 1) Physical with Burn Specific Health Scale-Brief (BSHS-B); 2) Cognitive health with MacNair Cognitive Difficulties Self-Rating Scale (CDS); 3) Mental health with the Hospital Anxiety and Depression Scale (HADS) questionnaire. PICS was considered present if at least one component out of three was abnormal. Data as mean±SD. RESULTS Among the 288 patients admitted during the period, 132 met the inclusion criteria: 53 patients were finally enrolled. They were aged 44 ± 18 years at the time of injury and burned 24 ± 20 BSA % and stayed 25 ± 44 days in the ICU. PICS was identified in 35 patients (66 %): more than one component was altered in 21 patients (60 %). Principal risk factors were more than 3 general anesthetics, prolonged mechanical ventilation (>4 days), ICU stay (>8 days), and hospital stay (>25 days) CONCLUSION: PICS occurred in 66 % of major burns with two or three components affected simultaneously in 60 %, i.e. more frequently than in general ICU patients.
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Affiliation(s)
- Dan Carel
- Service of adult intensive care, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Olivier Pantet
- Service of adult intensive care, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Institute of Higher Education and Research in Healthcare (IFS), Faculty of Biology & Medicine, Lausanne University, and Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Anne-Sylvie Ramelet
- Service of adult intensive care, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Institute of Higher Education and Research in Healthcare (IFS), Faculty of Biology & Medicine, Lausanne University, and Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Mette M Berger
- Service of adult intensive care, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
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Bhalla A, Bamer AM, Temes C, Roaten K, Carrougher GJ, Schneider JC, Stoddard FJ, Stewart B, Gibran NS, Wiechman SA. Posttraumatic Stress Disorder Symptom Clusters as Predictors of Pain Interference in Burn Survivors: A Burn Model System National Database Study. J Burn Care Res 2023; 44:27-34. [PMID: 35866527 PMCID: PMC9990905 DOI: 10.1093/jbcr/irac088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Individuals who experience burns are at higher risk of developing posttraumatic stress disorder and chronic pain. A synergistic relationship exists between posttraumatic stress disorder and chronic pain. We sought to evaluate the role of individual posttraumatic stress disorder symptom clusters as predictors of pain interference. We hypothesized that the hyperarousal and emotional numbing symptom clusters would be predictive of pain interference, even when accounting for the other two posttraumatic stress disorder symptom clusters, pain intensity, and other covariates. Multivariate linear regression analyses were completed using data from the Burn Model System National Database. A total of 439 adult participants had complete responses on self-report measures assessing posttraumatic stress disorder symptoms, pain intensity, and pain interference at 6-month after discharge and were included in analyses. Results indicate hyperarousal (B = .10, p = .03) and emotional numbing (B = .13, p = .01) posttraumatic stress disorder symptom clusters were each significantly associated with pain interference, even when accounting for pain intensity (B = .64, p < .001). Results highlight the importance of the emotional numbing and hyperarousal posttraumatic stress disorder symptom clusters in explaining pain interference. Findings suggest that when posttraumatic stress disorder symptoms or chronic pain are present, screening for and treating either condition may be warranted to reduce pain interference. Further, psychological interventions that target emotional numbing and hyperarousal posttraumatic stress disorder symptoms may be fruitful for promoting better coping with chronic pain and reducing pain interference.
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Affiliation(s)
- Arjun Bhalla
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Alyssa M. Bamer
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Christina Temes
- Department of Psychiatry, Massachusetts General Hospital, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kimberly Roaten
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Jeffrey C. Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Spaulding Research Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Frederick J. Stoddard
- Department of Psychiatry, Massachusetts General Hospital, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Barclay Stewart
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Nicole S. Gibran
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Shelley A. Wiechman
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
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Xie C, Hu J, Cheng Y, Yao Z. Researches on cognitive sequelae of burn injury: Current status and advances. Front Neurosci 2022; 16:1026152. [PMID: 36408414 PMCID: PMC9672468 DOI: 10.3389/fnins.2022.1026152] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/20/2022] [Indexed: 09/29/2023] Open
Abstract
Burn injury is a devastating disease with high incidence of disability and mortality. The cognitive dysfunctions, such as memory defect, are the main neurological sequelae influencing the life quality of burn-injured patients. The post-burn cognitive dysfunctions are related to the primary peripheral factors and the secondary cerebral inflammation, resulting in the destruction of blood-brain barrier (BBB), as is shown on Computed Tomography (CT) and magnetic resonance imaging examinations. As part of the neurovascular unit, BBB is vital to the nutrition and homeostasis of the central nervous system (CNS) and undergoes myriad alterations after burn injury, causing post-burn cognitive defects. The diagnosis and treatment of cognitive dysfunctions as burn injury sequelae are of great importance. In this review, we address the major manifestations and interventions of post-burn cognitive defects, as well as the mechanisms involved in memory defect, including neuroinflammation, destruction of BBB, and hormone imbalance.
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Affiliation(s)
- Chenchen Xie
- Department of Neurology, Affiliated Hospital and Clinical Medical College of Chengdu University, Chengdu, China
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Hu
- Department of Neurology, First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Yong Cheng
- Department of Neurology, General Hospital of Central Theater Command of PLA, Wuhan, China
| | - Zhongxiang Yao
- Department of Physiology, Army Medical University, Chongqing, China
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O’Reilly P, Meskell P, Whelan B, Kennedy C, Ramsay B, Coffey A, Fortune DG, Walsh S, Ingen-Housz-Oro S, Bunker CB, Wilson DM, Delaunois I, Dore L, Howard S, Ryan S. Psychotherapeutic interventions for burns patients and the potential use with Stevens-Johnson syndrome and toxic epidermal necrolysis patients: A systematic integrative review. PLoS One 2022; 17:e0270424. [PMID: 35759493 PMCID: PMC9236256 DOI: 10.1371/journal.pone.0270424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 06/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background
The existing evidence demonstrates that survivors of SJS/TEN have reported long-lasting psychological effects of their condition. Burns patients experience similar psychological effects. It is important to look at ways to help allay the psychological complications of SJS/TEN. As there is an absence of evidence on SJS/TEN psychotherapeutic interventions, it was judged to be beneficial to determine the evidence underpinning psychotherapeutic interventions used with burns patients.
Aims and objectives
The aim of this systematic integrative review was to synthesize the evidence relating to psychotherapeutic interventions used with adult burns patients and patients with SJS/TEN.
Method
The systematic review was guided by Whittemore and Knafl’s integrative review process and the PRISMA guidelines. Nine databases were searched for English and French language papers published January 2008 to January 2021. The protocol for the review was registered with PROSPERO.
Results
Following a screening process, 17 studies were included in the review. Two themes were identified using content analysis, (i) Empirically supported psychotherapeutic treatments, (ii) Alternative psychotherapeutic treatments. This review revealed no evidence on specific psychotherapeutic interventions for patients with SJS/TEN. Some of the interventions used with burns patients, viz. relaxation therapy, hypnosis and cognitive behavioral therapy showed some significant benefits. However, the evidence for burns patients is mainly focused on pain and pain anxiety as outcomes.
Conclusion
Following further research, some of the interventions deployed in burns patients may be applicable to SJS/TEN patients, particularly stress reduction techniques. In addition, the caring behaviours such as compassion, respect, and getting to know the patient as a person are important components to psychological care.
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Affiliation(s)
- Pauline O’Reilly
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
- Health Implementation Science and Technology (HIST) Research Cluster, University of Limerick, Limerick, Ireland
- * E-mail:
| | - Pauline Meskell
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Barbara Whelan
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Catriona Kennedy
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
- School of Nursing, Midwifery and Paramedic Practice, Robert Gordon University, Aberdeen, Scotland
| | - Bart Ramsay
- Charles Centre for Dermatology, University Hospital Limerick, ULHG, Limerick, Ireland
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Alice Coffey
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
- Health Implementation Science and Technology (HIST) Research Cluster, University of Limerick, Limerick, Ireland
| | - Donal G. Fortune
- Health Research Institute, University of Limerick, Limerick, Ireland
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Sarah Walsh
- Dermatology Department, King’s College Hospital, London, United Kingdom
| | - Saskia Ingen-Housz-Oro
- Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Univ Paris Est Créteil EpiDermE, Créteil, France
| | - Christopher B. Bunker
- Department of Dermatology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Donna M. Wilson
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Isabelle Delaunois
- Regional Medical Library, University Hospital Limerick, Limerick, Ireland
| | - Liz Dore
- Glucksman Library, University of Limerick, Limerick, Ireland
| | - Siobhan Howard
- Health Research Institute, University of Limerick, Limerick, Ireland
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Sheila Ryan
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
- Charles Centre for Dermatology, University Hospital Limerick, ULHG, Limerick, Ireland
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7
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Scoglio AAJ, Reilly ED, Girouard C, Quigley KS, Carnes S, Kelly MM. Social Functioning in Individuals With Post-Traumatic Stress Disorder: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2022; 23:356-371. [PMID: 32812513 DOI: 10.1177/1524838020946800] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Post-traumatic stress disorder (PTSD) can lead to multiple deleterious outcomes and has negative, sometimes debilitating, impacts on general functioning of those affected. This systematic review of 26 articles evaluates the existing literature on social functioning outcomes used in PTSD research, the association between PTSD and social functioning, and the impact of interventions for PTSD on social functioning. A review of 26 articles using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines for systematic reviews showed that PTSD was associated with significant impairment in global social functioning. This review also reveals the need for both standardized definitions and better assessment methods to operationalize social functioning and improve our ability to compare findings across studies. The literature also suggests that some evidence-based treatments for PTSD improve social functioning despite not explicitly targeting social functioning in the treatment. The findings of this review suggest that there are ample opportunities for improving both research and interventions to improve global social functioning in PTSD.
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Affiliation(s)
- Arielle A J Scoglio
- Social and Community Reintegration Research Program, ENRM VA Medical Center, Bedford, MA, USA
- Institute of Health Equity and Social Justice Research, Northeastern University, Boston, MA, USA
| | - Erin D Reilly
- Social and Community Reintegration Research Program, ENRM VA Medical Center, Bedford, MA, USA
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Caitlin Girouard
- Social and Community Reintegration Research Program, ENRM VA Medical Center, Bedford, MA, USA
| | - Karen S Quigley
- Social and Community Reintegration Research Program, ENRM VA Medical Center, Bedford, MA, USA
- Center for Healthcare Organizational and Implementation Research, ENRM VA Medical Center, Bedford, MA, USA
- Department of Psychology, Northeastern University, Boston, MA, USA
| | | | - Megan M Kelly
- Social and Community Reintegration Research Program, ENRM VA Medical Center, Bedford, MA, USA
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
- VISN 1 New England Mental Illness Research, Education, and Clinical Center, ENRM VA Medical Center, Bedford, MA, USA
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Boersma-van Dam E, Engelhard IM, van de Schoot R, Van Loey NEE. Bio-Psychological Predictors of Acute and Protracted Fatigue After Burns: A Longitudinal Study. Front Psychol 2022; 12:794364. [PMID: 35140660 PMCID: PMC8818679 DOI: 10.3389/fpsyg.2021.794364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/28/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Fatigue after burns is often attributed to the hyperinflammatory and hypermetabolic response, while it may be best understood from a bio-psychological perspective, also involving the neuro-endocrine system. This longitudinal multi-center study examined the course of fatigue up to 18 months postburn. The contribution of bio-psychological factors, including burn severity, pain, and acute PTSD symptoms, to the course and persistence of fatigue was studied in a multifactorial model. Methods Participants were 247 adult burn survivors. Fatigue symptoms were assessed with the Multidimensional Fatigue Inventory during the acute phase and subsequently at 3, 6, 12, and 18 months postburn, and were compared to population norms. Age, gender, burn severity, acute PTSD symptoms and pain were assessed as potential predictors of fatigue over time in a latent growth model. Results At 18 months postburn, 46% of the burn survivors reported fatigue, including 18% with severe fatigue. In the acute phase, higher levels of fatigue were related to multiple surgeries, presence of pain, and higher levels of acute PTSD symptoms. Fatigue gradually decreased over time with minor individual differences in rate of decrease. At 18 months, pain and acute PTSD symptoms remained significant predictors of fatigue levels. Conclusions Protracted fatigue after burns was found in almost one out of five burn survivors and was associated with both pain and acute PTSD symptoms. Early detection of PTSD symptoms and early psychological interventions aimed at reducing PTSD symptoms and pain may be warranted to reduce later fatigue symptoms.
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Affiliation(s)
- Elise Boersma-van Dam
- Association of Dutch Burn Centres, Beverwijk, Netherlands
- Department of Clinical Psychology, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, Netherlands
- *Correspondence: Elise Boersma-van Dam,
| | - Iris M. Engelhard
- Department of Clinical Psychology, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, Netherlands
| | - Rens van de Schoot
- Department of Methodology and Statistics, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, Netherlands
- Optentia Research Program, Faculty of Humanities, North-West University, Vanderbijlpark, South Africa
| | - Nancy E. E. Van Loey
- Department of Clinical Psychology, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, Netherlands
- Maasstad Hospital and Association of Dutch Burn Centres, Rotterdam, Netherlands
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Solomon EA, Phelan E, Tumbaga LG, Karashchuk IP, Greenhalgh DG, Sen S, Palmieri TL, Romanowski KS. Understanding factors in burn patient follow-up. J Burn Care Res 2021; 44:501-507. [PMID: 34525203 DOI: 10.1093/jbcr/irab168] [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: 01/31/2021] [Indexed: 11/13/2022]
Abstract
Follow-up rates (FUR) are concerningly low among burn-injured patients. This study investigates the factors associated with low FUR and missed appointments (MA). We hypothesize that patients who are homeless, use illicit substances, and have psychiatric comorbidities will have lower rates of follow-up (FU) and more MAs. Data from a discharge-planning survey of 281 burn-injured patients discharged from September 2019 - July 2020 was analyzed and matched with patients' EMR records for a retrospective chart review. Data collected included general demographics, burn characteristics, hospitalization details, FU visits, MAs, homeless status, substance use, major psychiatric illness (MPI), and survey responses. Data analysis used Chi-square, Fisher's exact test, Student t-test, Wilcox Rank Sum test, and Multivariate Regression Analysis (MVR). Overall, 37% of patients had no FU in clinic and 46% had one or more MA. On MVR, homeless patients were more likely to never follow up, OR = 0.227 (95% CI = 0.106-0.489), as were patients who anticipated transportation difficulties, OR = 0.275 (95% CI = 0.151-0.501). Homeless patients were more likely to have MA, OR= 0.231 (95% CI = 0.099-0.539). On univariate analysis, patients with one or more documented MPI had lower FUR, with 50.62% having no FU (p = 0.0020). Among patients who responded to the survey that they were current drug users, 52% had no FU as compared to 28% of patients who responded that they did not use drugs (p = 0.0007). Factors associated with lower FUR and more MAs include homeless status, substance use, MPI, and transportation difficulties.
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Affiliation(s)
- Eve A Solomon
- UC Davis School of Medicine, University of California, Davis, Sacramento, CA, Stockton Blvd, Sacramento, CA
| | - Elizabeth Phelan
- Firefighters Burn Institute Regional Burn Center, University of California, Davis, Sacramento, CA. Stockton Blvd, Sacramento, CA
| | - Lilia G Tumbaga
- Firefighters Burn Institute Regional Burn Center, University of California, Davis, Sacramento, CA. Stockton Blvd, Sacramento, CA
| | - Irina P Karashchuk
- UC Davis School of Medicine, University of California, Davis, Sacramento, CA, Stockton Blvd, Sacramento, CA
| | - David G Greenhalgh
- Department of Surgery, Division of Burn Surgery, University of California, Davis, Sacramento, CA,. Stockton Blvd, Sacramento, CA
| | - Soman Sen
- Department of Surgery, Division of Burn Surgery, University of California, Davis, Sacramento, CA,. Stockton Blvd, Sacramento, CA
| | - Tina L Palmieri
- Department of Surgery, Division of Burn Surgery, University of California, Davis, Sacramento, CA,. Stockton Blvd, Sacramento, CA
| | - Kathleen S Romanowski
- Department of Surgery, Division of Burn Surgery, University of California, Davis, Sacramento, CA,. Stockton Blvd, Sacramento, CA
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10
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Nosanov LB, Prindeze NJ, Schneider DM, Clemente LE, Parrish KR, Travis TE, Shupp JW, Johnson LS. Prevalence and risk factors for acute stress disorder and posttraumatic stress disorder after burn injury. Am J Surg 2021; 223:151-156. [PMID: 34330520 DOI: 10.1016/j.amjsurg.2021.07.035] [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: 03/23/2021] [Revised: 06/10/2021] [Accepted: 07/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Psychological consequences of burn injury can be profound. Acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) are known sequelae, but routine identification is challenging. This study aims to identify patient characteristics associated with outpatient positive screens. METHODS The Primary Care Posttraumatic Stress Disorder questionnaire (PC-PTSD-4) was administered at initial outpatient Burn Center visits between 5/2018-12/2018. Demographics, injury mechanism, and total body surface area (TBSA) were recorded. Those with ≥3 affirmative answers were considered positive. Patients with positive and negative screens were compared. RESULTS Of 307 surveys collected, 292 (median TBSA 1.5 %, IQR 0.5-4.0 %) remained for analysis after exclusions. Of those, 24.0 % screened positive. Positive screens were associated with presence of a deep component of the injury, injury mechanism, upper extremity involvement, ICU admission, and prolonged hospital length of stay. CONCLUSIONS Numerous factors distinguish burn injury from other traumatic mechanisms and contribute to disproportionate rates of traumatic stress disorders. Optimization of burn-oriented ASD and PTSD screening protocols can enable earlier intervention.
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Affiliation(s)
- Lauren B Nosanov
- Department of Surgery, Weill Cornell Medicine, New York, NY, USA; Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA
| | - Nicholas J Prindeze
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA; The Burn Center, Department of Surgery, MedStar Washington Hospital Center, USA; Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA
| | - Daniel M Schneider
- The Burn Center, Department of Surgery, MedStar Washington Hospital Center, USA; Department of Psychiatry, Georgetown University School of Medicine, Washington, DC, USA
| | - Lisa E Clemente
- The Burn Center, Department of Surgery, MedStar Washington Hospital Center, USA
| | - Katherine R Parrish
- The Burn Center, Department of Surgery, MedStar Washington Hospital Center, USA; Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA
| | - Taryn E Travis
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA; The Burn Center, Department of Surgery, MedStar Washington Hospital Center, USA; Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA
| | - Jeffrey W Shupp
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA; The Burn Center, Department of Surgery, MedStar Washington Hospital Center, USA; Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA; Department of Biochemistry and Molecular and Cellular Biology, Georgetown University School of Medicine, Washington, DC, USA
| | - Laura S Johnson
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA; The Burn Center, Department of Surgery, MedStar Washington Hospital Center, USA; Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA.
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11
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de Vries V, de Jong AEE, Hofland HWC, Van Loey NE. Pain and Posttraumatic Stress Symptom Clusters: A Cross-Lagged Study. Front Psychol 2021; 12:669231. [PMID: 34135828 PMCID: PMC8201070 DOI: 10.3389/fpsyg.2021.669231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/03/2021] [Indexed: 11/13/2022] Open
Abstract
Pain and posttraumatic stress disorder (PTSD) frequently co-occur but underlying mechanisms are not clear. This study aimed to test the development and maintenance of pain and PTSD symptom clusters, i.e., intrusions, avoidance, and hyperarousal. The longitudinal study included 216 adults with burns. PTSD symptom clusters, indexed by the Impact of Event Scale-Revised (IES-R), and pain, using a graphic numerical rating scale (GNRS), were measured during hospitalization, 3 and 6 months post-burn. Cross-lagged panel analysis was used to test the relationships between pain and PTSD symptom clusters. Cross-lagged results showed that in-hospital intrusions predicted pain and avoidance 3 months post-burn. In-hospital pain predicted intrusions and avoidance 3 months post-burn and a trend was found for hyperarousal (90% CI). In the second wave, intrusions predicted pain and hyperarousal. Pain predicted hyperarousal. This study provides support for an entangled relationship between pain and PTSD symptoms, and particularly subscribes the role of intrusions in this bidirectional relationship. To a lesser extent, hyperarousal was unidirectionally related to pain. These results may subscribe the driving role of PTSD, particularly intrusions, which partly supports the Perpetual Avoidance Model.
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Affiliation(s)
- Vivian de Vries
- Department of Medical Psychology, Red Cross Hospital, Beverwijk, Netherlands
| | - Alette E E de Jong
- Burn Center, Red Cross Hospital, Beverwijk, Netherlands.,Association of Dutch Burn Centers, Department Psychological and Nursing Research, Beverwijk, Netherlands
| | - Helma W C Hofland
- Burn Center, Maasstad Hospital, Rotterdam, Netherlands.,Association of Dutch Burn Centers, Department Psychological and Nursing Research, Rotterdam, Netherlands
| | - Nancy E Van Loey
- Association of Dutch Burn Centers, Department Psychological and Nursing Research, Beverwijk, Netherlands.,Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands
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12
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The Relationship of Orofacial Pain and Dental Health Status and Oral Health Behaviours in Facial Burn Patients. Pain Res Manag 2021; 2021:5512755. [PMID: 34055118 PMCID: PMC8123994 DOI: 10.1155/2021/5512755] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/24/2021] [Accepted: 05/03/2021] [Indexed: 12/02/2022]
Abstract
This study aims to examine the association of orofacial pain and oral health status and oral health behaviours in facial burn patients. The participants in this cross-sectional study were randomly recruited from the Burn Care Center, Institute of Medical Sciences, Islamabad, Pakistan. An intraoral evaluation was carried out to record the DMFT and OHI-S. A self-administered questionnaire was used to collect information on sociodemographic status, brushing frequency, and dental visits. Orofacial pain during mandibular movement was assessed using the Visual Analogue Scale (VAS). Psychological status was assessed using the Generalized Anxiety Disorder Scale and Impact of Events Scale. ANOVA and simple and multiple linear regression tests were used to analyse the data. From the 90 facial burn patients included, the majority were below 34 years of age, female, single or divorced, and unemployed. The mean DMFT was 10.7, and 71% had poor oral hygiene. 56% of the participants had moderate-to-severe anxiety, and 68% had posttraumatic stress disorder. 53% of the participants had moderate-to-severe pain during mouth opening or moving the mandible with a mean score of 41.5. Analyses showed that orofacial pain was associated with less frequent brushing, irregular dental visits, greater DMFT score, and more plaque accumulation (OHI-S). It was also associated with employment status, the severity of a burn, anxiety, and stress. The treatment and management of dental and oral conditions in burn patients need judicious balance in controlling and accurate assessment of the pain and improving psychological problems in burn patients.
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13
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Thibaut A, Shie VL, Ryan CM, Zafonte R, Ohrtman EA, Schneider JC, Fregni F. A review of burn symptoms and potential novel neural targets for non-invasive brain stimulation for treatment of burn sequelae. Burns 2021; 47:525-537. [PMID: 33293156 PMCID: PMC8685961 DOI: 10.1016/j.burns.2020.06.005] [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: 10/16/2019] [Revised: 04/30/2020] [Accepted: 06/06/2020] [Indexed: 12/12/2022]
Abstract
Burn survivors experience myriad associated symptoms such as pain, pruritus, fatigue, impaired motor strength, post-traumatic stress, depression, anxiety, and sleep disturbance. Many of these symptoms are common and remain chronic, despite current standard of care. One potential novel intervention to target these post burn symptoms is transcranial direct current stimulation (tDCS). tDCS is a non-invasive brain stimulation (NIBS) technique that modulates neural excitability of a specific target or neural network. The aim of this work is to review the neural circuits of the aforementioned clinical sequelae associated with burn injuries and to provide a scientific rationale for specific NIBS targets that can potentially treat these conditions. We ran a systematic review, following the PRISMA statement, of tDCS effects on burn symptoms. Only three studies matched our criteria. One was a feasibility study assessing cortical plasticity in chronic neuropathic pain following burn injury, one looked at the effects of tDCS to reduce pain anxiety during burn wound care, and one assessed the effects of tDCS to manage pain and pruritus in burn survivors. Current literature on NIBS in burn remains limited, only a few trials have been conducted. Based on our review and results in other populations suffering from similar symptoms as patients with burn injuries, three main areas were selected: the prefrontal region, the parietal area and the motor cortex. Based on the importance of the prefrontal cortex in the emotional component of pain and its implication in various psychosocial symptoms, targeting this region may represent the most promising target. Our review of the neural circuitry involved in post burn symptoms and suggested targeted areas for stimulation provide a spring board for future study initiatives.
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Affiliation(s)
- Aurore Thibaut
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States; GIGA-Institute and Neurology Department, University of Liège and University Hospital of Liège, Liège, Belgium
| | - Vivian L Shie
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States
| | - Colleen M Ryan
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States; Shriners Hospitals for Children-Boston, Boston, MA, United States
| | - Ross Zafonte
- Massachusetts General Hospital and Brigham and Women's Hospital, Boston, United States
| | - Emily A Ohrtman
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States
| | - Jeffrey C Schneider
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States.
| | - Felipe Fregni
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States.
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14
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El Khatib A, Jeschke MG. Contemporary Aspects of Burn Care. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:386. [PMID: 33923571 PMCID: PMC8073568 DOI: 10.3390/medicina57040386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 02/06/2023]
Abstract
The past one hundred years have seen tremendous improvements in burn care, allowing for decreased morbidity and mortality of this pathology. The more prominent advancements occurred in the period spanning 1930-1980; notably burn resuscitation, early tangential excision, and use of topical antibiotic dressings; and are well documented in burn literature. This article explores the advancements of the past 40 years and the areas of burn management that are presently topics of active discussion and research.
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Affiliation(s)
- Arij El Khatib
- Unité des Grands Brûlés, University of Montreal Medical Centre Sanguinet, 1051, Rue Sanguinet, Montréal, QC H2X 0C1, Canada
| | - Marc G. Jeschke
- Department of Surgery, Division of Plastic Surgery, Department of Immunology, Ross Tilley Burn Centre-Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, 2075 Bayview Avenue, Rm D704, Toronto, ON M4N 3M5, Canada;
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15
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Association of symptom severity, pain and other behavioral and medical comorbidities with diverse measures of functioning among adults with post-traumatic stress disorder. J Psychiatr Res 2021; 134:113-120. [PMID: 33383494 DOI: 10.1016/j.jpsychires.2020.12.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 12/17/2020] [Accepted: 12/21/2020] [Indexed: 12/23/2022]
Abstract
Post-traumatic stress disorder (PTSD) is an often disabling mental disorder whose management typically focuses on reducing PTSD symptoms. Chronic pain and other comorbidities that commonly accompany PTSD symptoms may also be independently associated with disability. Using data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions, we examined the independent association of PTSD symptom severity, pain interference, non-PTSD psychiatric and substance use disorders (SUD), and medical illnesses with each of four domains of function: mental health-related quality of life and physical functioning assessed with the Mental Health Composite Score (MCS) and Physical Function Score (PFS) of the Short Form-12; perceived social support from the Interpersonal Support and Evaluation List-12 (ISEL-12); and self-reported past year employment. Among 1779 individuals representing 11 million U.S. adults who met the Diagnostic and Statistical Manual-5 (DSM-5) criteria for Past Year PTSD, the MCS (41.2; SD 12.5), PFS (44.8; SD 13.2) and ISEL-12 (33.6; SD 7.2) indicated substantial disability when compared to population norms, and only 63.6% were employed. Multiple regression showed the MCS had a modest negative association with PTSD symptoms, pain interference, psychiatric multimorbidity and medical comorbidity although not with SUD. PFS and employment had significant negative associations with pain interference and medical comorbidity. ISEL-12 had a weak negative association with PTSD symptoms and non-PTSD psychiatric comorbidity. Common comorbidities thus significantly influence disability associated with PTSD, often more strongly than PTSD symptoms. PTSD treatment may require integrative multimorbidity management beyond a focus on PTSD symptoms.
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16
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Katsu A, Tyack Z, Mackey M, Elliott JM, Mackenzie L. Return to employment for working-aged adults after burn injury: a scoping review protocol. BMJ Open 2021; 11:e044145. [PMID: 33408216 PMCID: PMC7789466 DOI: 10.1136/bmjopen-2020-044145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Cutaneous burns can have a catastrophic effect on people's lives and may restrict opportunities for employment due to physical impairment and psychosocial deficits. Failure or delay in return to work can result in loss of income and support for the family unit. It can also negatively affect life role and identity and present difficulties with future opportunities. Current literature indicates multiple discrete influences on return to work as a result of burn injury but an understanding of how working-aged adults resume employment after burn injury is lacking. This scoping review will provide a comprehensive overview of the current literature by mapping and consolidating knowledge in this area of burn recovery and thus provide an informative basis for developing return-to-work programmes for survivors of burn injury. METHODS AND ANALYSIS This scoping review protocol will follow the Arksey and O'Malley's (2005) methodological framework. A comprehensive search strategy has been developed with subject expert librarians. These databases were used: OvidSP: Medline, Embase, PsycINFO, PubMed and Cochrane Central Register of Controlled Trials and EBSCOhost: CINAHL and Scopus. Reference lists of selected full text will be hand searched for additional literature. To enhance consistency and rigour, all reviewers will undertake a calibration exercise before paired reviewers independently screen all records using Rayyan. Full-text articles meeting the study inclusion criteria will be retrieved and examined. Extracted data will be analysed using the International Classification of Functioning, Disability and Health. ETHICS AND DISSEMINATION Ethics approval is generally not required for scoping reviews. Findings of this scoping review will be reported in a peer-reviewed journal and presented at conferences.
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Affiliation(s)
- Akane Katsu
- Discipline of Occupational Therapy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Occupational Therapy, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Zephanie Tyack
- Centre for Children's Burns and Trauma Research, University of Queensland, South Brisbane, Queensland, Australia
| | - Martin Mackey
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - James M Elliott
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Kolling Institute, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Lynette Mackenzie
- Discipline of Occupational Therapy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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17
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Burn injury induces elevated inflammatory traffic: the role of NF-κB. Inflamm Res 2020; 70:51-65. [PMID: 33245371 DOI: 10.1007/s00011-020-01426-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 12/11/2022] Open
Abstract
A burn insult generally sustains a hypovolemic shock due to a significant loss of plasma from the vessels. The burn injury triggers the release of various mediators, such as reactive oxygen species (ROS), cytokines, and inflammatory mediators. Damage-associated molecular patterns (DAMPs) and pathogen-associated molecular patterns (PAMPs), stemming from foreign microbial discharge and damaged tissue or necrotic cells from the burn-injured site, enter the systemic circulation, activate toll-like receptors (TLRs), and trigger the excessive secretion of cytokines and inflammatory mediators. Inflammation plays a vital role in remodeling an injured tissue, detoxifying toxins, and helps in the healing process. A transcription factor, nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), contributes to a variety of physiological and pathological conditions, including immune response, cell death, cell survival, and inflammatory processes. During the pathogenesis of a burn wound, upregulation of various cytokines and growth factors lead to undesirable tissue inflammation. Thus, NF-κB, a dominant moderator of inflammation, needs to be altered to prove beneficial to the treatment of burns or other inflammation-associated diseases. This review addresses the relationship between NF-κB and elevated inflammation in a burn condition that could potentially be altered to induce an early wound-healing mechanism of burn wounds.
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18
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Pain Management in Burn Patients. CURRENT TRAUMA REPORTS 2020. [DOI: 10.1007/s40719-020-00203-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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19
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Almarghoub MA, Alotaibi AS, Alyamani A, Alfaqeeh FA, Almehaid FF, Al-Qattan MM, Kattan AE. The Epidemiology of Burn Injuries in Saudi Arabia: A Systematic Review. J Burn Care Res 2020; 41:1122-1127. [PMID: 32479634 DOI: 10.1093/jbcr/iraa084] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Burns are potentially catastrophic injuries that disproportionately affect non-Western countries. We summarize results on the epidemiology of burn injuries in Saudi Arabia of all eligible papers through 2019, specifically evaluating the age and gender of patients, the location and mechanism of injury, burn size and severity, and outcomes. Between July 5 and July 10, 2019, a comprehensive literature review was performed on MEDLINE, EMBASE, Google Scholar, and the Cochrane Library. For this search, "Saudi Arabia," coupled with the search terms "burn," "thermal burn," "flame burn," "chemical burn," "electrical burn," and "contact burn" to identify all abstracts potentially relating to the topic of interest. Eleven studies, encompassing 3308 patients, met eligibility criteria. Younger children (variably defined as ≤10-12) accounted for 52% of all burns. Males outnumbered females by an overall ratio of 1.42:1. About 83% of burns occurred at homes. Scald injuries accounted for 62.4% of injuries, followed by flame-induced burns (28.7%), electrical burns (3.3%), and chemical burns (2.8%). Pertaining to burn extent and severity, 80% to 100% of the burns were limited to <40% total body surface area, while roughly 60% were second-degree burns. Most patients remain in the hospital for 1 to 4 weeks. The overall mortality across studies including patients of all ages was 6.9%, while just 0.76% in the two studies restricted to pediatric patients. Scald injuries involving young children comprise the lion's share of burn injuries in Saudi Arabia. Increased public awareness is necessary to reduce the incidence and severity of these potentially catastrophic injuries.
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Affiliation(s)
- Mohammed A Almarghoub
- Plastic and Reconstructive Surgery Section, Department of Surgery, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Ahmed S Alotaibi
- Plastic and Reconstructive Surgery Section, Department of Surgery, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Anas Alyamani
- Plastic Plastic and Reconstructive Surgery Section, Department of Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Faisal A Alfaqeeh
- Plastic and Reconstructive Surgery Section, Department of Surgery King, Khaled University Hospital, Riyadh, Saudi Arabia
| | - Faisal F Almehaid
- Plastic and Reconstructive Surgery Section, Department of Surgery, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammad M Al-Qattan
- Plastic and Reconstructive Surgery Section, Department of Surgery, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdullah E Kattan
- Division of Plastic and Hand Surgery, King Saud University, Riyadh, Saudi Arabia
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20
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Tracy LM, Edgar DW, Schrale R, Cleland H, Gabbe BJ. Predictors of itch and pain in the 12 months following burn injury: results from the Burns Registry of Australia and New Zealand (BRANZ) Long-Term Outcomes Project. BURNS & TRAUMA 2020; 8:tkz004. [PMID: 32346541 PMCID: PMC7175773 DOI: 10.1093/burnst/tkz004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/21/2019] [Accepted: 12/02/2019] [Indexed: 11/14/2022]
Abstract
Background Itch and pain are common complaints of patients with burn injuries. This study aimed to describe the prevalence and predictors of itch and moderate to severe pain in the first 12 months following a burn injury, and determine the association between itch, moderate to severe pain, work-related outcomes, and health-related quality of life following a burn injury. Methods Burn patients aged 18 years and older were recruited from five Australian specialist burn units. Patients completed the 36-item Short Form Health Survey Version 2 (SF-36 V2), the Sickness Impact Profile (SIP) work scale, and a specially developed questionnaire relating to itch at 1, 6, and 12 months post-injury. Moderate to severe pain was defined as a score less than 40 on the bodily pain domain of the SF-36 V2. Multivariate mixed-effects regression models were used to identify patient and burn injury predictors of itch and moderate to severe pain. Results Three hundred and twenty-eight patients were included. The prevalence of itch decreased from 50% at 1 month to 27% at 12 months. Similarly, the prevalence of moderate to severe pain decreased from 23% at 1 month to 13% at 12 months. Compared to patients aged 18-34, the adjusted odds of experiencing any itch were 59% (95% CI: 0.20, 0.82) and 55% (95% CI: 0.22, 0.91) lower for patients aged between 35 and 49 and ≥ 50 years, respectively. Compared to patients aged 18-34, the adjusted odds of experiencing moderate to severe pain were 3.12 (95% CI: 1.35, 7.20) and 3.42 (95% CI: 1.47, 7.93) times higher for patients aged 35-49 and ≥ 50 years, respectively. Conclusions Less than 15% of patients reported moderate or severe pain at 12 months, while approximately one-quarter of the patients reported itch at the same period. The presence of moderate to severe pain was associated with a greater negative impact on health-related quality of life and work outcomes compared to itch. Further research is needed to improve our ability to identify patients at higher risk of persistent itch and pain who would benefit from targeted review and intervention studies.
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Affiliation(s)
- Lincoln M Tracy
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia
| | - Dale W Edgar
- State Adult Burn Unit, Fiona Stanley Hospital, 11 Warren Drive, Murdoch, Western Australia, 6150, Australia.,Burn Injury Research Node, The University of Notre Dame, 19 Mouat Street, Fremantle, Western Australia, 6959, Australia
| | - Rebecca Schrale
- Tasmanian Burns Unit, Burns & Surgical Specialties Unit 5A, Royal Hobart Hospital, GPO Box 1061, Hobart, Tasmania, 7001, Australia
| | - Heather Cleland
- Victorian Adult Burns Service, The Alfred, Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia.,Health Data Research UK, Swansea University Medical School, Swansea University, Singleton Park, Swansea, Wales SA28PP, United Kingdom
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21
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Gauffin E, Öster C. Patient perception of long-term burn-specific health and congruence with the Burn Specific Health Scale-Brief. Burns 2019; 45:1833-1840. [DOI: 10.1016/j.burns.2018.12.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 12/19/2018] [Accepted: 12/22/2018] [Indexed: 12/24/2022]
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22
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Mauck MC, Shupp JW, Williams F, Villard MA, Jones SW, Hwang J, Smith J, Karlnoski R, Smith DJ, Cairns BA, McLean SA. Hypertrophic Scar Severity at Autograft Sites Is Associated With Increased Pain and Itch After Major Thermal Burn Injury. J Burn Care Res 2019; 39:536-544. [PMID: 29596686 DOI: 10.1093/jbcr/irx012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Approximately three quarters of major thermal burn injury (MThBI) survivors suffer from hypertrophic scarring (HTS) and over half experience chronic pain or itch. In survivors of MThBI, HTS and chronic pain or itch are considered one of the greatest unmet challenges of postburn injury care and psychosocial reintegration. Although scarring, itch, and pain have been clinically associated, there are no prospective, multisite studies examining tissue autograft site pain or itch and scar outcomes. The authors collected a representative cohort (n = 56) of MThBI survivors who received autografting within 14 days of injury and evaluated graft-site pain or itch severity (0-10 Numeric Rating Scale) and HTS using a validated scar photograph assessment scale 6 months following MThBI. Given that stress is known to influence wound healing, the authors also assessed the relationship between previous trauma exposure, peritraumatic stress, preburn overall health (SF-12), scarring, and chronic pain or itch severity using Spearman's correlation. Association between HTS and chronic pain or itch was significant in a linear regression model adjusted for age, sex, and ethnicity (β = 0.2, P = .033 for pain, β = 0.2, P = .019 for itch). Results indicate that prior trauma exposure is inversely correlated (r = -.363, P = .030) with scar severity, but not pain or itch severity 6 months after MThBI. Study results suggest that preburn chronic pain or itch is associated with pathological scarring 6 months following MThBI. Results also indicate that stress may improve scarring after MThBI. Further work to understand the mechanisms that underlie both HTS and chronic pain or itch and their relationship to chronic stress is critical to the development of novel therapies to assist burn survivors recover.
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Affiliation(s)
- Matthew C Mauck
- Institute for Trauma Recovery, Chapel Hill, North Carolina.,Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina
| | - Jeffrey W Shupp
- The Burn Center, MedStar Washington Hospital Center, Washington, DC
| | - Felicia Williams
- Jaycee Burn Center, University of North Carolina Chapel Hill, North Carolina
| | - Marie Ashley Villard
- Institute for Trauma Recovery, Chapel Hill, North Carolina.,Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina
| | - Samuel W Jones
- Jaycee Burn Center, University of North Carolina Chapel Hill, North Carolina
| | - James Hwang
- Jaycee Burn Center, University of North Carolina Chapel Hill, North Carolina
| | - Jennifer Smith
- Institute for Trauma Recovery, Chapel Hill, North Carolina.,Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina
| | - Rachel Karlnoski
- Department of Surgery, University of South Florida, Tampa, Florida
| | - David J Smith
- Department of Surgery, University of South Florida, Tampa, Florida
| | - Bruce A Cairns
- Jaycee Burn Center, University of North Carolina Chapel Hill, North Carolina
| | - Samuel A McLean
- Institute for Trauma Recovery, Chapel Hill, North Carolina.,Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina.,Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina
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23
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Nelson S, Uhl K, Wright LA, Logan D. Pain is Associated With Increased Physical and Psychosocial Impairment in Youth With a History of Burn Injuries. THE JOURNAL OF PAIN 2019; 21:355-363. [PMID: 31400474 DOI: 10.1016/j.jpain.2019.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/23/2019] [Accepted: 08/02/2019] [Indexed: 10/26/2022]
Abstract
Burn injuries are significantly painful and associated with physical and psychological impairment. However, little research to-date has examined the potential role of the subjective experience of pain in either physical or psychological impairment in this population. This may be particularly important to examine, given that the pain experience can often be a significant barrier to recovery in other pediatric populations. The current study examined the cross-sectional and predictive relationships between patient-reported experience of pain (operationalized as PROMIS pain interference and self-reported pain intensity) and physical and psychosocial outcomes. Data were gathered as part of the Burn Model System National Database (1994-2018) with the data request inclusive of pediatric self-report PROMIS measures, child PTSD, and post-traumatic growth symptoms assessed at 6- and 12-month postdischarge following initial injury. A total of 65 youth between the ages of 6 and 16 years at the time of their injury were included in the dataset. Correlational and regression analyses indicated that pain interference was cross-sectionally and longitudinally associated with decreased physical functioning, depressive symptoms, and peer relationships. Pain intensity was significantly associated with and predictive of physical functioning and pain interference. Results of the current study are an important first step in understanding the pain experience and associated outcomes in youth with a history of burn injuries. Future research is needed to further examine these relationships. PERSPECTIVE: This study presents preliminary findings from a national database on pain-related outcomes both cross-sectionally and longitudinally in youth with a history of burn injury. To-date, pain-related outcomes are poorly understood in this population and the results of this study serve to inform future research and treatment-related efforts.
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Affiliation(s)
- Sarah Nelson
- Division of Pain Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
| | - Kristen Uhl
- Division of Pain Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Laura A Wright
- Division of Pain Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Deirdre Logan
- Division of Pain Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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24
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Thomas BD, Ford CG, Addicks SH, Williford DN, Manegold EM, Randall CL, Aballay AM, Hajduk GM, Duncan CL. Implementation of a Psychosocial Screener for Adults in an Outpatient Burn Clinic. J Burn Care Res 2019; 40:331-335. [PMID: 30806462 DOI: 10.1093/jbcr/irz020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/05/2019] [Accepted: 02/20/2019] [Indexed: 11/14/2022]
Affiliation(s)
- Ben D Thomas
- Department of Psychology, West Virginia University, Morgantown, West Virginia
| | - Cameron G Ford
- Department of Psychology, West Virginia University, Morgantown, West Virginia
| | - Sarah H Addicks
- Department of Family Medicine, University of Minnesota School of Medicine, Rochester, Minnesota
| | - Desireé N Williford
- Department of Psychology, West Virginia University, Morgantown, West Virginia
- West Penn Hospital Burn Center, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Ellen M Manegold
- Department of Psychology, West Virginia University, Morgantown, West Virginia
| | - Cameron L Randall
- Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle, Washington
| | - Ariel M Aballay
- West Penn Hospital Burn Center, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Gina M Hajduk
- West Penn Hospital Burn Center, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Christina L Duncan
- Department of Psychology, West Virginia University, Morgantown, West Virginia
- West Penn Hospital Burn Center, Allegheny Health Network, Pittsburgh, Pennsylvania
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Fauerbach JA, Gehrke AK, Mason ST, Gould NF, Milner SM, Caffrey J. Cognitive Behavioral Treatment for Acute Posttrauma Distress: A Randomized, Controlled Proof-of-Concept Study Among Hospitalized Adults With Burns. Arch Phys Med Rehabil 2019; 101:S16-S25. [PMID: 30776324 DOI: 10.1016/j.apmr.2018.11.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 09/14/2018] [Accepted: 11/04/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE (1) To evaluate the feasibility of conducting a randomized controlled trial (RCT) of the Safety, Meaning, Activation and Resilience Training (SMART) intervention vs nondirective supportive psychotherapy (NDSP) in an acutely hospitalized adult survivor of burn injury sample; and (2) to assess the preliminary effect of SMART on acute stress disorder (ASD), posttraumatic stress disorder (PTSD), and major depressive disorder (MDD) symptom reduction as secondary prevention. DESIGN Proof-of-concept, parallel group RCT design. SETTING Regional burn center. PARTICIPANTS Acutely injured, hospitalized adult survivors of burn injury (N=50) were randomly assigned to SMART (n=28) or nondirective supportive psychotherapy (n=22). Due to dropout and missing data, final sample size was 40, SMART (n=21) and nondirective supportive psychotherapy (n=19). INTERVENTIONS SMART is a manualized, 4-session cognitive behavioral therapy-based psychological intervention targeting ASD, PTSD, and MDD symptoms. NDSP is a manualized, 4-session protocol. MAIN OUTCOME MEASURES Davidson Trauma Scale ([DTS]; diagnostic proxy for ASD and PTSD; clinical cutoff=40, with higher score=higher severity) and the Patient Health Questionnaire-9 ([PHQ-9]; diagnostic proxy for MDD; clinical cutoff=10, with higher score=higher severity) at pretreatment, immediate posttreatment, and 1 month posttreatment. RESULTS At baseline, median DTS scores and PHQ-9 scores were above clinical cutoffs and did not differ across groups. At 1 week and 1 month posttreatment, median DTS and PHQ-9 scores were beneath clinical cutoffs in the SMART group; scores remained above clinical cutoffs in the NDSP group at these time points. CONCLUSIONS It is feasible to conduct an RCT of SMART in hospitalized adult survivors of burn injury. SMART has the potential to yield clinically significant outcomes. Additional studies are needed to replicate and extend these findings.
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Affiliation(s)
- James A Fauerbach
- Johns Hopkins Burn Center, Johns Hopkins Bayview Medical Center, Baltimore, Maryland; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Amanda K Gehrke
- Johns Hopkins Burn Center, Johns Hopkins Bayview Medical Center, Baltimore, Maryland; Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Shawn T Mason
- Johnson and Johnson Health and Wellness Solutions, New Brunswick, New Jersey
| | - Neda F Gould
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephen M Milner
- Johns Hopkins Burn Center, Johns Hopkins Bayview Medical Center, Baltimore, Maryland; Department of Surgery, Division of Plastics and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Julie Caffrey
- Johns Hopkins Burn Center, Johns Hopkins Bayview Medical Center, Baltimore, Maryland; Department of Surgery, Division of Plastics and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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26
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Ren Z, Zhang P, Wang H, Wang H. Qualitative research investigating the mental health care service gap in Chinese burn injury patients. BMC Health Serv Res 2018; 18:902. [PMID: 30486854 PMCID: PMC6263539 DOI: 10.1186/s12913-018-3724-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 11/16/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Psychological disturbances are prevalent in people with burn injuries; however, psychological services are rarely accessiblepost-burn injury in China. The objective of this qualitative study was to explore and conceptualize the obstacles to delivering mental health care in burn injury patients. METHODS The researchers used a grounded theory research approach to interview sixteen burn injury patients, five nurses, four rehabilitation therapists, five medical doctors, and eight caregivers regarding their experiences with current health care services and barriers. RESULTS An explorative model was generated from the data, and the relationships among the categories were identified. People's beliefs, knowledge, socioeconomic status, cultural understanding of mental health, and social stigma appear to play key roles in the public health approach to post-burn health promotion and post-burn psychosocial interventions. CONCLUSION The model proposed in our research highlights the need to focus on the underlying social, economic, and cultural determinants of mental health care. The underlying social determinants of the mental health care gap that is responsible for the ill-prepared health care must be addressed.
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Affiliation(s)
- Zhengjia Ren
- Department of Clinical Psychology, The First Affiliated Hospital to Army Medical University (Third Military Medical University), Chongqing, China
| | - PeiChao Zhang
- Research Center for Modern Psychology, Wuhan University, Wuhan, China
| | - HongTao Wang
- Department of Burn and Cutaneous Surgery, Burn Centre of the People Liberation Army, The First Affiliated Hospital of Air Force Medical University, Xi’an, China
| | - Hongyan Wang
- Department of Cadre Ward, Navy General Hospital, Beijing, 100048 China
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Nelson S, Conroy C, Logan D. The biopsychosocial model of pain in the context of pediatric burn injuries. Eur J Pain 2018; 23:421-434. [PMID: 30288844 DOI: 10.1002/ejp.1319] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/20/2018] [Accepted: 09/28/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Burns are a common and traumatic source of childhood injury in the United States. The treatment and recovery from burn injuries can be significantly painful and may lead to chronic or persistent pain for years following the initial incident. Further, burn injuries in youth have been found to increase the potential for significant psychosocial (e.g., anxiety, depression, PTSD) and physical (e.g., decreased mobility) impairment. Relatedly, the general experience and processing of pain in youth can also be associated with greater psychosocial (e.g., anxiety, depression) impairment and functional disability over time. However, the phenomenology and associated characteristics of the pain experience following burn injury and, in particular, the potential for combined impact on physical and psychosocial outcomes in youth with severe and/or prolonged pain and a history of burn injury is poorly understood. METHODS A review of the literature was performed in the areas of burn injuries and outcomes associated with both acute and chronic pain with youth and adult populations. RESULTS The current review highlights current gaps in the literature in important areas of function in youth with a history of burn injuries using the biopsychosocial model of pain. Future research and considerations for practice are also outlined. CONCLUSIONS Gaining a greater understanding of the relationship between pain, physical impairment, and psychosocial functioning in these youth is significantly important in order to provide greater preventative and treatment-related intervention going forward. SIGNIFICANCE Using a biopsychosocial framework, this review highlights the need for a greater understanding of pain processing and the long-term potential for persistent pain and pain-related impairment (e.g., functional disability) in youth with a history of burn injuries.
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Affiliation(s)
- Sarah Nelson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Caitlin Conroy
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.,Mayo Clinic Pediatric Pain Rehabilitation Center, Boston Children's Hospital, Boston, Massachusetts
| | - Deirdre Logan
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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Predictors of health-related quality of life after burn injuries: a systematic review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:160. [PMID: 29898757 PMCID: PMC6000969 DOI: 10.1186/s13054-018-2071-4] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 05/17/2018] [Indexed: 01/08/2023]
Abstract
Background Identifying predictors of health-related quality of life (HRQL) following burns is essential for optimization of rehabilitation for burn survivors. This study aimed to systematically review predictors of HRQL in burn patients. Methods Medline, Embase, Web of Science, Cochrane, CINAHL, and Google Scholar were reviewed from inception to October 2016 for studies that investigated at least one predictor of HRQL after burns. The Quality in Prognostic Studies tool was used to assess risk of bias of included studies. Results Thirty-two studies were included. Severity of burns, postburn depression, post-traumatic stress symptoms, avoidance coping, less emotional or social support, higher levels of neuroticism, and unemployment postburn were found to predict a poorer HRQL after burns in multivariable analyses. In addition, weaker predictors included female gender, pain, and a postburn substance use disorder. Risk of bias was generally low in outcome measurement and high in study attrition and study confounding. Conclusions HRQL after burns is affected by the severity of burns and the psychological response to the trauma. Both constructs provide unique information and knowledge that are necessary for optimized rehabilitation. Therefore, both physical and psychological problems require attention months to years after the burn trauma. Electronic supplementary material The online version of this article (10.1186/s13054-018-2071-4) contains supplementary material, which is available to authorized users.
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29
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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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Fishbain DA, Pulikal A, Lewis JE, Gao J. Chronic Pain Types Differ in Their Reported Prevalence of Post -Traumatic Stress Disorder (PTSD) and There Is Consistent Evidence That Chronic Pain Is Associated with PTSD: An Evidence-Based Structured Systematic Review. PAIN MEDICINE 2018; 18:711-735. [PMID: 27188666 DOI: 10.1093/pm/pnw065] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Objectives The hypotheses of this systematic review were the following: 1) Prevalence of post-traumatic stress disorder (PTSD) will differ between various types of chronic pain (CP), and 2) there will be consistent evidence that CP is associated with PTSD. Methods Of 477 studies, 40 fulfilled the inclusion/exclusion criteria of this review and were grouped according to the type of CP. The reported prevalence of PTSD for each grouping was determined by aggregating all the patients in all the studies in that group. Additionally all patients in all groupings were combined. Percentage of studies that had found an association between CP and PTSD was determined. The consistency of the evidence represented by the percentage of studies finding an association was rated according to the Agency for Health Care Policy and Research guidelines. Results Grouping PTSD prevalence differed ranging from a low of 0.69% for chronic low back pain to a high of 50.1% in veterans. Prevalence in the general population with CP was 9.8%. Of 19 studies, 16 had found an association between CP and PTSD (84.2%) generating an A consistency rating (consistent multiple studies). Three of the groupings had an A or B (generally consistent) rating. The veterans grouping received a C (finding inconsistent) rating. Conclusion The results of this systematic review confirmed the hypotheses of this review.
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Affiliation(s)
- David A Fishbain
- Department of Psychiatry, Miller School of Medicine at the University of Miami, Florida, USA.,Neurological Surgery, Miller School of Medicine at the University of Miami, Florida, USA,Anesthesiology, Miller School of Medicine at the University of Miami, Florida, USA.,Department of Psychiatry, Miami VA Medical Center, Miami, Florida, USA.,State Farm Insurance Bloomington, Illinois, USA
| | - Aditya Pulikal
- Department of Psychiatry, Miller School of Medicine at the University of Miami, Florida, USA
| | - John E Lewis
- Department of Psychiatry, Miller School of Medicine at the University of Miami, Florida, USA
| | - Jinrun Gao
- State Farm Insurance Bloomington, Illinois, USA
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Van Loey NE, Klein-König I, de Jong AEE, Hofland HWC, Vandermeulen E, Engelhard IM. Catastrophizing, pain and traumatic stress symptoms following burns: A prospective study. Eur J Pain 2018; 22:1151-1159. [PMID: 29436110 DOI: 10.1002/ejp.1203] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Pain and posttraumatic stress disorder (PTSD) symptoms are significant problems in the aftermath of a burn injury and they often co-occur. Catastrophizing has been linked to both phenomena. The aim of this study was to investigate the underlying role of catastrophizing in PTSD symptoms and pain following burns. METHODS This prospective study included 216 patients with burns. PTSD symptoms and pain were measured during hospitalization (T1) and 6 (T2) and 12 months (T3) postburn. The Impact of Event Scale-Revised (IES-R) indexed PTSD symptoms. Acute pain (T1) was the mean pain during the first two weeks of hospitalization measured using an 11-point graphic numeric rating scale. Chronic pain was indexed using the single item 'average' pain from the Brief Pain Inventory (BPI). Catastrophizing was measured at T1 and T2 using the Cognitive Emotion Regulation Questionnaire (CERQ). Data were analysed using structural equation modelling (SEM). RESULTS The results showed that T2 catastrophizing mediated between acute and chronic PTSD symptoms, and T3 pain. Furthermore, the study revealed significant associations between catastrophizing, PTSD symptoms and pain at the respective measurements, and significant longitudinal associations between the constructs. CONCLUSION A negative cognitive-affective response to a burn event, such as catastrophizing, mediated the relationship between acute and chronic PTSD symptoms and later chronic pain. Screening for catastrophizing and acute PTSD symptoms is recommended to identify persons at risk for chronic PTSD symptoms and pain. SIGNIFICANCE The identification of individuals who have the tendency to catastrophize may assist in finding those at risk for development of both chronic PTSD symptoms and chronic pain. Individuals may benefit from early psychological therapy focussing on catastrophizing and acute PTSD symptoms that may ameliorate both chronic PTSD symptoms and pain.
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Affiliation(s)
- N E Van Loey
- Behavioural Research, Association of Dutch Burn Centers, Beverwijk, The Netherlands.,Clinical Psychology, Utrecht University, The Netherlands
| | - I Klein-König
- OCRN Child and Youth Mental Health Care, Groningen, The Netherlands
| | - A E E de Jong
- Burn Center, Red Cross Hospital, Beverwijk, The Netherlands
| | - H W C Hofland
- Burn Center, Maasstad Hospital, Rotterdam, The Netherlands
| | - E Vandermeulen
- Burn Center, Queen Astrid Military Hospital, Brussels, Belgium
| | - I M Engelhard
- Clinical Psychology, Utrecht University, The Netherlands
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Wiechman S, Hoyt MA, Patterson DR. Using a Biopsychosocial Model to Understand Long-Term Outcomes in Persons With Burn Injuries. Arch Phys Med Rehabil 2018; 101:S55-S62. [PMID: 29501455 DOI: 10.1016/j.apmr.2018.01.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 12/10/2017] [Accepted: 01/23/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the importance of preburn adjustment, injury-related variables, and selection of coping style in various outcome measures using a biopsychosocial model. DESIGN Longitudinal study. SETTING Outpatient burn clinics. PARTICIPANTS Burn survivors (N=231) who participated in this study as part of a larger burn model system study of 645 patients with major burn injuries. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The 36-Item Short-Form Health Survey was used to assess preburn adjustment. Other outcome measures entered into the model included the Ways of Coping Checklist Revised, the Brief Symptom Inventory, the Beck Depression Inventory-II, and the Davidson Trauma Scale. RESULTS Correlational and mediational analyses revealed that preburn emotional health predicted better adjustment at year 1 and more posttraumatic stress disorder symptoms at year 2. Better preburn emotional health was also related to less use of avoidance coping strategies, which was found to be a mediator of the effect of preburn emotional health and posttraumatic stress disorder symptoms. Burn injury characteristics were not significantly associated with psychological adjustment at either year 1 or year 2. CONCLUSIONS The results indicate that there is a complex relation between premorbid mental health and the selection of coping strategies that affect long-term adjustment in persons recovering from a burn injury. This relation seems to have greater effect on long-term outcomes than does preburn emotional or physical health alone or the severity of the burn.
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Affiliation(s)
- Shelley Wiechman
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA.
| | | | - David R Patterson
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA
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Three Years After Black Saturday: Long-Term Psychosocial Adjustment of Burns Patients as a Result of a Major Bushfire. J Burn Care Res 2018; 37:e244-53. [PMID: 25501772 DOI: 10.1097/bcr.0000000000000223] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite increasing evidence that burn injuries can result in multiple psychological sequelae, little is known about the long-term psychosocial adjustment to burns sustained in a major bushfire. The aim of the present study was to assess long-term psychological distress and health-related quality of life in Australian burns patients as a result of the 2009 Black Saturday bushfires. Eight male and five female burns patients with a mean age of 53.92 (SD = 11.82) years who received treatment at a statewide burns service participated in the study. A battery of standardized questionnaires was administered to assess general psychological distress, burns-specific and generic health-related quality of life, alcohol use, and specific psychological symptoms of posttraumatic stress disorder, depression, and anxiety. The results revealed that more than 3 years after Black Saturday 33% of the burns patients still suffered "high" to "very high" levels of general distress, whereas 58% fulfilled partial or full criteria for posttraumatic stress disorder. Furthermore, participants still experienced significantly impaired physical health functioning as compared to their preinjury status including limitations in work-based activities, increased bodily pain, and lower vitality overall. The trajectory of distress varied for participants. Some individuals experienced little distress overall, whereas others displayed a decline in their stress levels over time. Notwithstanding, some patients maintained high levels of distress throughout or experienced an increase in distress at a later stage of recovery. The results point to the importance of psychosocial screening to identify distress early. Follow-up assessments are crucial to diagnose individuals with chronic or late onset of distress.
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Tang G, Zhang T, Wang X, Song Z, Liu F, Zhang Q, Huo R. Analysis of differentially expressed genes in white blood cells isolated from patients with major burn injuries. Exp Ther Med 2017; 14:2931-2936. [PMID: 28966676 PMCID: PMC5613207 DOI: 10.3892/etm.2017.4899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 07/24/2017] [Indexed: 12/14/2022] Open
Abstract
The aim of the present study was to identify differentially expressed genes (DEGs) and their related functions and pathways of major burn injuries, and to prevent the occurrence of complications. The expression profiling of E-GEOD-37069 was downloaded from ArrayExpress Archive. The DEGs of major burn injuries were identified. Gene Ontology (GO) and Kyoto Encyclopedia of Gene and Genomes (KEGG) functional enrichment analysis were then performed for the DEGs. Based on the KEGG database, a pathway relationship network was constructed, and DEGs in significant GO terms and pathways were investigated. Gene signal network and gene co-expression network of these inserted DEGs were constructed. A total of 3,328 DEGs of major burn injuries were identified, including 1,337 up- and 1,991 downregulated DEGs. These DEGs were mainly enriched into various GO terms, including transcription, DNA-dependent, signal transduction and blood coagulation. Moreover, they were also enriched into different pathways, such as hematopoietic cell lineage, metabolic pathway and chemokine signaling pathway. The pathway relationship network was constructed with 72 nodes. The MAPK signaling pathway was the hub node. Based on the same gene symbol, 702 DEGs were obtained, identified in both GO terms and pathways. Finally, the gene signaling network and gene co-expression network were constructed with 391 and 128 nodes, respectively. These identified DEGs, including GNB2, LILRA2, ARRB2 and ARHGEF2, may be potential key genes involved in the treatment of major burn injuries and prevention of complications.
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Affiliation(s)
- Gongjie Tang
- Department of Burn and Plastic Surgery, Linyi Central Hospital, Linyi, Shandong 276400, P.R. China
| | - Tao Zhang
- Department of Burn and Plastic Surgery, Linyi Central Hospital, Linyi, Shandong 276400, P.R. China
| | - Xinbo Wang
- Department of Burn and Plastic Surgery, Linyi Central Hospital, Linyi, Shandong 276400, P.R. China
| | - Zengmei Song
- Department of Burn and Plastic Surgery, Linyi Central Hospital, Linyi, Shandong 276400, P.R. China
| | - Fucun Liu
- Department of Burn and Plastic Surgery, Linyi Central Hospital, Linyi, Shandong 276400, P.R. China
| | - Qian Zhang
- Department of Burn and Plastic Surgery, Linyi Central Hospital, Linyi, Shandong 276400, P.R. China
| | - Ran Huo
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital, Jinan, Shandong 250011, P.R. China
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McLean L, Chen R, Kwiet J, Streimer J, Vandervord J, Kornhaber R. A clinical update on posttraumatic stress disorder in burn injury survivors. Australas Psychiatry 2017; 25:348-350. [PMID: 28372459 DOI: 10.1177/1039856217700285] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Burn injuries are complex traumatic events carrying high risks of acute physical and psychosocial morbidity. With greater survival, clinical and research attention has turned to psychosocial recovery outcomes and risk factors. It is timely to summarise current issues in posttraumatic disorders after burn injury for mental health and integrative care clinicians. Posttraumatic stress disorder (PTSD) is a common outcome of severe burn injury. There are difficulties in delivering current best practice treatments to many survivors especially those in rural and remote areas and those with comorbidities. Vicarious traumatization of clinicians, families and carers requires attention and internationally there are moves to psychosocial screening and outcome tracking. CONCLUSIONS The role of the multidisciplinary treatment, integrated and trauma-informed care is essential. While level 1 evidence for PTSD treatments theoretically applies, adaptations that consider comorbidities and treatment contexts are often essential with further research required.
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Affiliation(s)
- Loyola McLean
- Senior Staff Psychiatrist, Westmead Psychotherapy Program, WSLHD, Parramatta, NSW, and; A/Prof Course Coordinator, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Runsen Chen
- Psychologist and Student Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Julia Kwiet
- Senior Social Worker, Severe Burn Injury Unit, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Jeffrey Streimer
- Senior Staff Specialist Psychiatrist and Director of Consultation-Liaison Psychiatry, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - John Vandervord
- Senior Surgeon, Severe Burn Injury Unit, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Rachel Kornhaber
- Lecturer in Nursing, Rozelle Campus, University of Tasmania, Hobart, TAS, Australia
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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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Schweininger S, Forbes D, Creamer M, McFarlane AC, Silove D, Bryant RA, O'Donnell ML. The temporal relationship between mental health and disability after injury. Depress Anxiety 2015; 32:64-71. [PMID: 24995589 DOI: 10.1002/da.22288] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 04/14/2014] [Accepted: 05/31/2014] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE This longitudinal study investigated the temporal relationship patterns between disability and mental health after injury, with a focus on posttraumatic stress disorder (PTSD), depression, and anxiety. METHOD We conducted a multi-sited longitudinal cohort study with a large sample of hospital patients admitted after injury (N = 1,149, mean age = 37.9, 73.6% male). Data were collected prior to discharge from hospital, and follow-up assessments took place 3 and 12 months postinjury. A cross-lagged structural equation model (SEM) was used to assess the prospective relationship between posttraumatic stress, anxiety, and depression symptoms and disability while controlling for demographic characteristics and objective measures of injury severity. RESULTS Acute depression significantly predicted 3-month disability, and 3-month PTSD severity significantly predicted 12-month disability. Premorbid disability had a significant effect on acute anxiety, depression, and posttraumatic stress symptoms, and 3-month depression but disability after the injury did not predict 12-month psychopathology. CONCLUSIONS We did not find a reciprocal relationship between disability and psychopathology. Rather we found that depression played a role in early disability while PTSD played a role in contributing to long-term delays in the recovery process. The results of this study highlight the need for mental health screening for symptoms of PTSD and depression in the acute aftermath of trauma, combined with early intervention programs in injury populations.
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Affiliation(s)
- Stephanie Schweininger
- Australian Centre for Posttraumatic Mental Health, Carlton, Victoria, Australia; Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia
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Seehausen A, Ripper S, Germann G, Hartmann B, Wind G, Renneberg B. Efficacy of a burn-specific cognitive-behavioral group training. Burns 2014; 41:308-16. [PMID: 25300755 DOI: 10.1016/j.burns.2014.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 07/04/2014] [Accepted: 07/05/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of the present study was to evaluate the efficacy of a newly developed cognitive-behavioral group training, specifically designed for burn patients. METHOD In a multicenter-study data pre- and post treatment and at 6-month follow-up were obtained from participants of the group program (Intervention group, IG; n=86) and a control group who received treatment as usual (TAU; n=128). Outcome variables of psychological distress, resources and health-related quality of life of both groups were compared using linear mixed models. RESULTS Up to 6 months after group treatment, the IG reported a substantial decline of general symptom severity as well as posttraumatic stress, whereas the TAU group showed no significant change over time. Optimism increased in the IG after group treatment, but not in the TAU group. Regarding overall quality of life both groups showed a gradual improvement over the three assessment points. CONCLUSION The newly developed burn-specific cognitive-behavioral group intervention had positive effects on psychological well-being and resources of burn participants. As a consequence, the group intervention has been implemented as inherent part of the regular burn treatment in two rehabilitation centers in Germany.
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Affiliation(s)
- Annika Seehausen
- Department of Hand, Plastic and Reconstructive Surgery, Burn Centre, BG Trauma Centre, Berlin, Germany
| | - Sabine Ripper
- Department of Hand, Plastic and Reconstructive Surgery, Burn Centre, BG Trauma Centre, Ludwigshafen, Germany
| | - Günter Germann
- Department of Hand, Plastic and Reconstructive Surgery, Burn Centre, BG Trauma Centre, Ludwigshafen, Germany
| | - Bernd Hartmann
- Department of Hand, Plastic and Reconstructive Surgery, Burn Centre, BG Trauma Centre, Berlin, Germany
| | - Gerhard Wind
- Department of Hand, Plastic and Reconstructive Surgery, Burn Centre, BG Trauma Centre, Ludwigshafen, Germany
| | - Babette Renneberg
- Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany.
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Stergiou-Kita M, Grigorovich A, Gomez M. Development of an inter-professional clinical practice guideline for vocational evaluation following severe burn. Burns 2014; 40:1149-63. [DOI: 10.1016/j.burns.2014.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 12/31/2013] [Accepted: 01/04/2014] [Indexed: 01/09/2023]
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Ekeblad F, Gerdin B, Öster C. Impact of personality disorders on health-related quality of life one year after burn injury. Disabil Rehabil 2014; 37:534-40. [PMID: 24963942 DOI: 10.3109/09638288.2014.933898] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Personality disorders (PDs) are associated with significant distress, disability, and cause great difficulties in life. PDs have been suggested to influence adaptation after major burns, but the potential relationship has not been fully elucidated. This study aimed to describe the prevalence of PDs in 107 patients with major burn injury, and to identify the impact of PDs on perceived patient outcome assessed as health-related quality of life (HRQoL) one year after burn. METHODS One burn-specific instrument (Burn Specific Health Scale-Brief (BSHS-B)) and two generic instruments (EuroQol Five Dimensions and Short Form 36 Health Survey) were used, and Psychiatric Axis I and II disorders were assessed one year post burn. RESULTS This study identified an above normal prevalence of PDs among individuals afflicted by burn, and participants with PD had a significantly larger lifetime burden of Axis I disorders compared to participants without PD. Participants with PDs scored significantly lower than those without PD in the BSHS-B domain Skin involvement, and the effect of having a PD was related to the subscale Treatment regimens. There was no relationship between the presence of PD and generic HRQoL. CONCLUSIONS An implication of these observations is that special rehabilitation efforts including more tailored interventions must be offered to these patients to ensure that the obstacles they perceive to caring for themselves in this respect are eliminated. IMPLICATIONS FOR REHABILITATION This study identified an above normal prevalence of PDs among individuals afflicted by burn and these individuals reported poor burn-specific health-related quality of life. The identification of difficulties with compliance and endurance regarding daily skin care may cause negative consequences for optimal rehabilitation and underscore the importance of offering more tailored interventions in rehabilitation. Inflexible behavioral patterns related to the PD diagnosis imply the need for communication strategies by the rehabilitation team, which include flexibility, creativity, and diplomacy. There is a need for further research focusing on identifying the factors that facilitate the individual's own ability to take action and have control.
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Affiliation(s)
- Frida Ekeblad
- Department of Neuroscience Psychiatry, Uppsala University , Uppsala , Sweden and
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Hakkarainen TW, Burkette Ikebata N, Bulger E, Evans HL. Moving beyond survival as a measure of success: understanding the patient experience of necrotizing soft-tissue infections. J Surg Res 2014; 192:143-9. [PMID: 24923631 DOI: 10.1016/j.jss.2014.05.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 04/15/2014] [Accepted: 05/02/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Necrotizing soft tissue infections (NSTIs) represent a devastating spectrum of disease with high case mortality and resource intensive care. Treatment consists of wide surgical debridement and often prolonged periods of intensive care unit care. Major complications are common. The severity of the disease and the aggressive treatment requirements put survivors at risk for significant long-term sequelae related to the trauma of both disease and treatment. Information about the postdischarge impact of NSTIs on survivors is extremely limited. Qualitative approaches are typically used to explore new phenomena and to capture individuals' thoughts, feelings, or interpretations of meaning and process. Therefore, qualitative methods are ideally suited for hypothesis generation to guide future quantitative study and ensure measured outcomes are patient-centered. MATERIALS AND METHODS Semistructured interviews were conducted with survivors of NSTIs from a single regional referral center. Stratified purposive sampling was used to select interview candidates based on severity of illness. Descriptive thematic analysis was performed to identify major themes described by the patients. RESULTS Interviews with 18 survivors identified three primary domains of experience: (1) individual factors, (2) relational factors, and (3) societal factors. These domains were split into the following two categories: factors effecting the disease process and recovery, and factors that were outcomes of the disease process. Each category yielded between one and seven themes. Themes identified included physical, psychological, relationship, and employment aspects. CONCLUSIONS Patient's reported quality of life was significantly affected by their disease and recovery. The results demonstrate that many outcomes of importance for patients are not easily assessed by traditional measures of outcomes. This work illustrates the multidimensional nature of recovery from critical illness, and shows that it represents a massive transition period in the lives of survivors that affects the patient, their family, and the patient's ability to interact with society. Interviews with survivors ensure that the patient voice is heard before developing tools to assess long-term outcomes.
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Affiliation(s)
- Timo W Hakkarainen
- Department of Surgery, University of Washington Medical Center, Seattle, WA.
| | | | - Eileen Bulger
- Department of Surgery, University of Washington Medical Center, Seattle, WA
| | - Heather L Evans
- Department of Surgery, University of Washington Medical Center, Seattle, WA
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Dowda DJ, Li F. Major concerns and issues in burn survivors in Australia. BURNS & TRAUMA 2014; 2:84-7. [PMID: 27602366 PMCID: PMC5012066 DOI: 10.4103/2321-3868.130192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 03/18/2014] [Indexed: 12/03/2022]
Abstract
Burn injury significantly impacts the victim’s long-term quality of life, both physically and psychosocially. This prospective, observational study aimed to assess the physical and psychological health status in adult burn survivors in Sydney Australia using the Burns Specific Health Scale-Brief Version (BSHS-B) questionnaire, together with analysis of the baseline demographic data collected from medical records. A total of 24 adult acute burn victims admitted consecutively to the Burns Unit at Concord Repatriation General Hospital, Sydney, Australia between March 2007 and February 2009 fulfilled the inclusion criteria and participated in the study. The BSHS-B questionnaire (which includes nine domains or subscales) was administered to all 24 participants in person at time of discharge and by mail 6, 12, and 24 months post discharge. By 12 months, 11 participants dropped out and the final analysis was performed on the remaining 13 participants. The analyzed results showed that: 1) Perceived return to work was the only variable that continued to change with time at 12 months after discharge (P < 0.01); 2) At 12 months; return to work was significantly correlated with simple functional ability (P < 0.05), heat sensitivity (P < 0.01), and treatment regimes (P < 0.05), but no longer with affect and body image as demonstrated at 6 months. In summary, our findings have shown that the perception of returning to work changes significantly with time post discharge and this perception is affected by certain subscales of the BSHS-B. Given that return to work is one of the most important outcome concerns and issues of recovery for adult burn injury victims and families, it is essential that therapists be aware of the factors influencing return to work and address these factors through a comprehensive rehabilitation program.
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Affiliation(s)
- Deborah J Dowda
- Burns Unit, Concord Repatriation General Hospital, Sydney, Australia
| | - Frank Li
- Burns Unit, Concord Repatriation General Hospital, Sydney, Australia
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Long-term posttraumatic stress symptoms vary inversely with early opiate dosing in children recovering from serious burns. J Trauma Acute Care Surg 2014; 76:828-32. [DOI: 10.1097/ta.0b013e3182ab111c] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Stergiou-Kita M, Grigorovich A. Guidelines for vocational evaluation following burns: integrated review of relevant process and factors. JOURNAL OF OCCUPATIONAL REHABILITATION 2013; 23:476-503. [PMID: 23423804 DOI: 10.1007/s10926-013-9428-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
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.
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Affiliation(s)
- Mary Stergiou-Kita
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada,
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Renneberg B, Ripper S, Schulze J, Seehausen A, Weiler M, Wind G, Hartmann B, Germann G, Liedl A. Quality of life and predictors of long-term outcome after severe burn injury. J Behav Med 2013; 37:967-76. [DOI: 10.1007/s10865-013-9541-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 09/17/2013] [Indexed: 10/26/2022]
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48
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Mitsunaga Junior JK, Gragnani A, Ramos MLC, Ferreira LM. Rat an experimental model for burns: a systematic review. Acta Cir Bras 2013; 27:417-23. [PMID: 22666760 DOI: 10.1590/s0102-86502012000600010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 04/16/2012] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To revise and systematize scientific knowledge of the experimental model for cutaneous burns in rats. METHODS A bibliographical review from 2008 up to January 2011 in PubMed, EMBASE and LILACS was undertaken. Were used the keywords: animal models, burns and rats. 221 studies were identified, and 116 were selected. RESULTS It was found that: 54/86 (62.7%) had third degree burns; 55/73 (75.3%) studied the back; 45/78 (57.6%) used heated water and 27/78 (35.9%) incandescent instruments; 39/78 (50%) studied systemic effects; 22/71 (31%) used ketamine associated with xylazine; 61/64 (95.3%) performed depilation with appropriate equipment; 36/72 (50%) used microscopy; more than 50% did not describe analgesia or antibiotics during the postoperative period; in 42/116 (36.2%) postoperative fluid therapy was performed; and the time interval after the burn, up to the beginning of the results analysis varied from 7s up to four weeks. Legislation issues on burn experiments are discussed. CONCLUSION The hot water was the main method to induce burns those of third degree on the back, with anesthesia using ketamine and xylazine, after depilation. These were evaluated microscopically, without using analgesia or an antibiotic during the postoperative period. The studies were not very reproducible.
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Öster C, Willebrand M, Ekselius L. Burn-specific health 2 years to 7 years after burn injury. J Trauma Acute Care Surg 2013; 74:1119-24; discussion 1124. [PMID: 23511154 DOI: 10.1097/ta.0b013e318283cca0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Knowledge concerning the pattern of recovery and predictors of burn-specific health years after burn injury is limited, and these factors were therefore assessed with a disease-specific instrument, the Burn Specific Health Scale-Brief. METHODS Consecutive adult burn patients were prospectively included during hospitalization and assessed at 3, 6, and 12 months as well as at 2 years to 7 years (4.6 years on average) after burn. Data concerning injury characteristics, sociodemographic variables, psychiatric disorders, and burn-specific health were obtained. RESULTS Burn-specific health improved over time, from 6 months to the final assessment after burn. At 2 years to 7 years after burn, most problems were reported in the subscales heat sensitivity, body image, and work. The regression analyses revealed that length of stay, any preburn psychiatric disorder, major depression, and posttraumatic stress disorder 12 months after burn were predictors of long-term burn-specific health in the affect and relations domain, whereas time since injury, length of stay, and major depression 12 months after burn predicted outcome in the skin involvement domain. Predictors for the subscale work were length of stay, working at the time of injury, and posttraumatic stress disorder at 12 months. CONCLUSION This study underscores that significant improvement in postburn health can be expected even later than 2 years after injury. Furthermore, the results imply that both preburn factors and factors identified 1 year after burn have impact on burn-specific health after several years. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Caisa Öster
- Department of Neuroscience Psychiatry, Uppsala University, Uppsala, Sweden.
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50
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Assunção FFO, Dantas RAS, Ciol MA, Gonçalves N, Farina JA, Rossi LA. Reliability and validity of the body image quality of life inventory: Version for Brazilian burn victims. Res Nurs Health 2013; 36:299-310. [DOI: 10.1002/nur.21538] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2013] [Indexed: 11/09/2022]
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