Hand Burn Injuries and Occupational Impairment: A Study on the Impact of Burn Injuries on Return-to-Work Outcomes from the Burn Model System research program.

Abstract

Return to work (RTW) after burn injury is dependent on many variables, including type and location of burn injury, access to care, and pre-injury mental and physical health. Noting that prior studies were limited by small sample sizes, we aimed to use a large database to explore the associations between hand burn severity, functional hand outcomes, and RTW post-injury. Data from a multicenter longitudinal study were analyzed. Adults with burn injuries were classified into 6 groups ranking in severity of hand injury: (0) no hand burns, (1) single hand burn no grafting, (2) bilateral hand burn no grafting, (3) single hand burn requiring grafting, (4) bilateral hand burn requiring unilateral graft, (5) bilateral hand burn requiring bilateral grafts. Grafting was used as a proxy for burn severity. Self-reported employment status, Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity (UE) scores and reported request for work accommodations were collected at discharge, 6-, 12-, and 24-months post-injury. Descriptive statistics and analysis of variance (ANOVA) with post-hoc Tukey Test were completed to examine differences in outcomes by hand injury severity. A total of 4,621 participants met inclusion criteria. Group 5, those with most severe burns, had significantly longer RTW times than Groups 0-3 (p< 0.005). Group 5's (bilateral burn/unilateral graft) average RTW was greater, however not significantly, compared to group 4. At 6 months, the mean PROMIS UE scores for grafted groups (Group 3, 40.6; Group 5, 35.4) were significantly worse than non-grafted groups (Group 1, 46.8; Group 2, 45.0; (p< 0.0001). At 12 and 24 months, mean PROMIS UE scores were worse for grafted groups, though differences were no longer significant compared to non-grafted groups. At every time point, the majority of respondents did not request accommodations for their injuries from their employers, regardless of severity. Burn severity plays a significant role in both RTW and hand function for participants with hand burns. Additionally, the lack of correlation between burn severity and request for work accommodations hints at the baseline vulnerability of these populations. These findings suggest a need for systematic improvements in the way these patients are cared for and re-integrated into the workforce.