Burn Specific Health Scale-Brief Research Articles

Early predictors of health-related quality of life outcomes at 12 months post-burn: ABLE study

There remains a paucity of evidence on the early predictors of long-term Health-Related Quality of Life (HRQoL) outcomes post-burn in hospitalised adults. The overall aim of this study was to identify the factors (personal, environmental, burn injury and burn treatment factors) that may predict long-term HRQoL outcomes among adult survivors of hospitalised burn injuries at 12 months post-burn. A total of 274 participants, aged 18 years or over, admitted to a single state-wide burn centre with a burn injury were recruited. Injury and burn treatment information were collected from medical records or the hospital database and surveys collected demographic and social data. HRQoL outcome data were collected at 3-, 6- and 12-months using the 12-Item Short Form Survey (SF-12 v1) and Burns Specific Health Scale-Brief (BSHS-B). Personal, environmental, burn injury and burn treatment factors were also recorded at baseline. Analyses were performed using linear and logistic regression. Among 274 participants, 71.5 % (N=196) remained enrolled in the study at 12 months post-burn. The majority of participants reported HRQoL outcomes comparable with population norms and statistically significant improvements in generic (SF-12 v1) and condition-specific (BSHS-B) outcomes over time. However, for participants with poor HRQoL outcomes at 12-months post-burn, Univariable predictors included longer hospital length of stay, unemployment at the time of injury, a diagnosed pre-injury mental health condition, inadequate pre-burn social support, intentional injury, recreational drug use pre-injury and female gender. The early multivariable predictors of insufficient HRQoL outcomes were female gender, a previously diagnosed mental health condition, unemployment, inadequate social support, intentional injury, and prolonged hospital length of stay. These results suggest potential factors that could be used to screen and burns patients for psychosocial intervention and long-term follow up.

Effects of early exercise training following severe burn injury: a randomized controlled trial.

Despite being a stable component of burn rehabilitation at later stages of recovery, exercise training is not commonly provided during the acute phase of burns. A lack of evidence surrounding its efficacy and safety in severely burned adults has hampered its implementation in acute burn care. The aim of this study was to investigate the capacity of early exercise training to modulate parameters of postburn muscle wasting and quality of life. Adults <65years of age with burns ≥40% total burn surface area (TBSA) were randomly allocated to either receive early exercise (n = 29) in addition to standard care or standard care alone (n = 29). Early exercise involved resistance and aerobic training, which commenced as early as possible and lasted for a duration of 6 to 12 weeks, in line with burn center length of stay. Ultrasound-derived quadriceps muscle layer thickness (QMLT) and rectus femoris cross-sectional area (RF-CSA), lower limb muscle force, Eurocol Quality of Life-5 Dimensions and Burn Specific Health Scale Brief (BSHS-B) were assessed 6 and 12 weeks after baseline. Mixed models were fitted to compare between-group changes over time. A total of 58 adults [42 (95% confidence interval 40-45) years old; 40-94% TBSA range, 86% previously mechanically ventilated] participated in this study. Exercise commenced 7 days [IQR (interquartile range) 5-9] after burn center admission with an attendance rate of 93%. Allocation to the exercise group had a protective effect on the loss of muscle size from baseline to 6 weeks of follow-up (QMLT: β-coefficient: 0.05cm, p = 0.010; RF-CSA: β-coefficient: 0.05 cm2, p = 0.045), and resulted in an improved recovery from 6 to 12 weeks (QMLT: β-coefficient: 0.04cm, p = 0.01; RF-CSA: β-coefficient: 0.06 cm2, p < 0.001). Muscle force increased significantly more in the exercise group than in the control group (β-coefficient: 3.102N, p < 0.001) between 6 and 12 weeks. Besides a marginally significant effect for the BSHS-B domains 'affect' and 'interpersonal relationships' between 6 and 12 weeks, no benefits were observed in the other assessed quality-of-life measures. No serious adverse events were reported in the exercise group. The results of this study support the use of early exercise training as a feasible and efficacious therapeutic strategy to manage burn-related changes in muscle size and strength in adults with acute severe burn injury.

Quality of life and functional Outcomes among Burn Patients: A Cross Sectional Survey

Background: Burn injuries are a significant health issue leading to physical and emotional complications, impacting both social life and mental health. They necessitate a comprehensive approach for recovery, intertwining various physical and psychological aspects. The primary aim is to sustain a satisfactory level of functionality and life enjoyment, tailored to the individual's essential needs, for an extended period. Objective: The principal objective of this study was to quantitatively evaluate the quality of life and functional outcomes in burn patients. Methods: In this cross-sectional study, data was gathered from 156 burn patients from three medical facilities: Aziz Bhatti Shaheed Teaching Hospital in Gujrat, CMH Kharian, and Jinnah Hospital in Lahore. The Burn Specific Health Scale-Brief (BSHS-B) questionnaire was employed for data collection. The sample included patients aged 18-65 years with varying degrees of burn severity. Results: Data was processed using SPSS version 25. The average age of the patients was 34 years, with a gender distribution of 53.21% female and 46.79% male. Marital status was divided into 66.03% married and 33.97% unmarried individuals. Socio-economic status revealed 4.49% from upper-class, 41.67% from middle-class, and 53.85% from lower-class levels. The average Quality of Life (QoL) score was 70.42 ± 33.75, indicating a diverse range of experiences among participants. Conclusion: The findings suggest that individuals with burn injuries can achieve a satisfactory quality of life and functional independence. This underscores the importance of comprehensive care and support for burn patients to enhance their overall well-being.

Health-related quality of life after burn injury due to bioethanol-fueled fireplaces

ObjectiveCommercially available bioethanol-fueled fireplaces are a potential source of burns and are commonly used for home use. The present study aimed to evaluate the quality of life following burn injuries that were caused by bioethanol-related accidents. MethodsBurned patients who were admitted to our burn unit with burn injury due to bio-ethanol fueled fire places between January 2010 and December 2021 were contacted to ask for their willingness to participate in this study. They were asked to answer questions regarding the circumstances of the accident and three questionnaires to capture burn specific and general health related quality of life (Burn Specific Health Scale-Brief (BSHS-B), Short-Form Health Survey 36 (SF-36)) and general information about the accident. Patients were matched and compared to a group of patients suffering comparable burns from other burn mechanisms, which were also admitted to our burn unit at the same time. ResultsOf 35 patients that met the inclusion criteria, 19 answered the questionnaire and were compared to 38 patients with other burn mechanisms. There were no statistical differences regarding age (bioethanol: 37.4 ± 14.7 years vs. control: 36.2 ± 14.3 years, p = 0.777), TBSA (9.9 ± 6.8% vs. 8.9 ± 10.4, p = 0.715), and sex (42.1% females vs. 36.8% females, p = 0.882). Most patients in the bioethanol-group reported that they did not follow the manual instructions (68.4%) and that the accident happened during the refilling process (52.6%).There was no significant difference in any subscale of the BSHS-B or the SF-36. DiscussionBurns related to bioethanol-fueled fireplaces are rare compared to other typical burn mechanisms. However, as they are used for personal pleasure and interior design, psychological impairment following burn may be even more critical. Detailed education on the use of these fireplaces needs to take place in order to reduce the risk of accidents.

Patient-reported outcomes and their predictors 2 years after burn injury: A cross-sectional study.

This study aimed to describe patient-reported outcomes 2 years after burn injury and to comprehensively elucidate predictors that may influence these outcomes. This cross-sectional, prospective study included 352 patients who were admitted to the Department of Burn Surgery at a tertiary teaching hospital between January 2017 and December 2020. We collected demographic and disease-related data and instructed participants to complete the Readiness for Hospital Discharge Scale (RHDS) and the Burn Specific Health Scale-Brief (BSHS-B) questionnaire. The overall score of patient-reported outcomes 2 years after burn injury was 126.55 ± 33.32 points, and the dimensions with the lowest scores were "hand function" (13.96 ± 5.75), "heat sensitivity" (14.84 ± 4.90), "treatment regimens" (13.41 ± 6.77) and "work" (11.30 ± 4.97). Multiple linear regression analysis revealed that less postburn pruritus, better readiness for hospital discharge, less total body surface area (TBSA), better social participation, white-collar jobs, older age, better sleep quality and burns not caused by electricity were associated with better outcomes. Patients experienced poor patient-reported outcomes 2 years after burn injury. Integrated rehabilitative care is necessary to address patients' unique needs and improve long-term patient-reported outcomes.

Factors influence the dignity of burns patients: A cross-sectional study.

There is a high incidence of burns in China and the sequelae of post-burn scar growth, disfigurement, and other body image disorders can cause serious psychological distress to burns patients, and negatively affecting the patient's dignity. However, there is limited knowledge relating to the dignity of burns patients. To investigate the factors that affect dignity in burns patients. Cross-sectional study. We recruited 323 burn patients from the burn unit of a tertiary care hospital. The Patient Dignity Scale, Burn Specific Health Scale-Brief, Hospital Anxiety and Depression Scale were used to assess burn patients' dignity, quality of life, anxiety, and depression, respectively. 18 sociodemographic variables were included in the questionnaire. Before the data were collected, the study protocol was reviewed and approved by the Ethics Committee of the Guangzhou Red Cross Hospital of Jinan University (Reference: 2022-149-02) and all patients provided and signed informed consent forms. This study included 323 burns patients; of these, 26 (8%) had a mild loss of dignity, 94 (29.1%) had a moderate loss of dignity, 125 (38.7%) had a severe loss of dignity, and 78 (24.1%) had a very severe loss of dignity. The main factors that influence the loss of dignity in burns patients, including the department in which the patient was treated after their burns, gender, the clinical stage of the burn, quality-of-life, depression, resident medical insurance, the cause of the burn, and the burn site. In most cases, the loss of dignity after burn injury is serious. Clinical health care professionals can provide personalized whole-life dignity care for patients by considering the factors that affect the dignity of burns patients, developing targeted dignity management programs, and implementing individualized interventions to maintain dignity, thus helping burns injury patients return to social life and work.

Effects of exercise training on muscle wasting, muscle strength and quality of life in adults with acute burn injury

ObjectivesExercise training during the acute phase of burns is difficult to implement but offers potential benefits. This multicenter trial explored the effects of an exercise program on muscular changes and quality of life during burn center stay. MethodsFifty-seven adults with burns ranging between 10% and 70% TBSA were allocated to receive either standard of care (n = 29), or additionally exercise (n = 28), consisting of resistance and aerobic training, commenced as early as possible according to safety criteria. Muscle wasting (primary outcome), quantified by ultrasound-derived quadriceps muscle layer thickness (QMLT) and rectus femoris cross-sectional area (RF-CSA), muscle strength and quality of life (Burn Specific Health Scale-Brief (BSHS-B) and EQ-5D-5L) were assessed at baseline, four and eight weeks later, or hospital discharge. Mixed models were used to analyze between-group changes over time with covariates of interest added in stepwise forward modeling. ResultsThe addition of exercise training to standard of care induced significant improvements in QMLT, RF-CSA, muscle strength and the BSHS-B subscale hand function (ß-coefficient. 0.055 cm/week of QMLT, p = 0.005). No added benefit was observed for other quality-of-life measures. ConclusionsExercise training, administered during the acute phase of burns, reduced muscle wasting, and improved muscle strength throughout burn center stay.

Validation of the Burn Survivor Fear-Avoidance Questionnaire and Its Association With Pain Intensity, Catastrophizing, and Disability.

According to the Fear-avoidance (FA) model, FA beliefs can lead to disability due to avoidance of activities expected to result in pain or further injury. Extensive research on the relationship of FA, pain, catastrophizing, and disability has been generated with patients suffering from chronic neck and back pain, but little research has been conducted with burn survivors. To address this need, the Burn Survivor FA Questionnaire (BSFAQ) was developed (Langlois J, Vincent-Toskin, S, Duchesne, P et al. Fear-avoidance beliefs and behaviors of burn survivors: A mixed-methods approach. Burns 2021;47:175-89.) but has not been validated. Thus, the primary objective of this study was to investigate the construct validity of the BSFAQ among burn survivors. The secondary objective was to examine the relationship between FA and 1) pain intensity and 2) catastrophizing at baseline, 3 months and 6 months postburn, and 3) disability among burn survivors at 6 months postburn. A prospective mixed-methods approach was used to examine the construct validity by comparing the quantitative scores of the BSFAQ to independently performed qualitative interviews of burn survivors (n = 31) that explored their lived experiences, to determine if the BSFAQ discriminated those who had, from those who did not have FA beliefs. Data for the secondary objective, scores of burn survivors (n = 51) pain intensity (numeric rating scale), catastrophizing (pain catastrophizing scale), and disability (Burn Specific Health Scale-brief), were collected through a retrospective chart review. For the primary objective, Wilcoxon rank sum test results showed a statistically significant difference (P = .015) between the BSFAQ scores of participants who were identified from the qualitative interviews as fear avoidant compared to those who were identified as non fear avoidant, with a receiver operating characteristic curve indicating that the BSFAQ correctly predicted FA 82.4% of the time. For the secondary objective, Spearman correlation test results showed a moderate correlation between FA and 1) pain at baseline (r = .466, P = .002), 2) catastrophizing thoughts over time (r = .557, P = .000; r = .470, P = .00; r = .559, P = .002 respectively at each time point), and 3) disability at 6 months postburn (r = -.643, P = .000). These results support that the BSFAQ is able to discriminate which burn survivors are experiencing FA beliefs. It is also consistent with the FA model since burn survivors who express FA are more likely to report higher levels of pain early during their recovery that correlates with persistently elevated catastrophizing thoughts and ultimately results in higher self-reported disability. The BSFAQ demonstrates construct validity and is able to correctly predict fear-avoidant burn survivors; however, additional research is required to further examine the BSFAQ's clinimetric properties.

Prognostic Analysis of Skin Scar Loosening and Tissue-Expansive Autologous Skin Grafting in the Treatment of Skin Postburn Scars.

This study aims to observe and investigate the clinical value of scar loosening and tissue-expansive autologous skin grafting in the treatment of postburn scars and independent risk characteristics for surgery-related complications. We retrospectively analyzed 94 cases with postburn scars, and all patients were treated with scar loosening and autologous skin grafting. Overall therapeutic effects were evaluated using the standard of cure and improvement of clinical diseases. Burn Specific Health Scale-brief was used to analyze patients' quality of life. The visual analog scale scores were used to analyze esthetic satisfaction. Surgery-related complications were recorded, and logistic regression model was used to analyze independent factors affecting surgery-related complications. As for overall efficacy evaluation, 50 cases were cured, 19 cases were markedly improved, 17 cases improved, and 8 cases were detected and tested, and the overall effective rate was 91.4%. The Burn Specific Health Scale-brief and visual analog scale score showed a trend of increasing gradually. It indicated that the patients were satisfied with the operation and their quality of life was improved. The logistic regression model showed that history of skin disease (OR=1.53 (1.08-2.16), P =0.02) and skin area (OR=2.50 (1.22-4.50), P <0.01) were significantly associated with surgery-related complications. Scar loosening and autologous skin grafting is a safe and effective treatment. The history of skin disease and skin area was the independent factors for surgery-related complications.

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

ObjectivesThe 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. MethodsCross-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. ResultsAmong 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) ConclusionPICS occurred in 66 % of major burns with two or three components affected simultaneously in 60 %, i.e. more frequently than in general ICU patients.

Implementation of a nursing rehabilitation model to improve quality of life of patients with hand burns: A randomized clinical trial.

Burn is known as a life-threatening event in people's lives, causing numerous physical, psychological, and social harms and negatively affecting patients' quality of lives. This study was designed to evaluate the effectiveness of implementing a nursing rehabilitation model in improving the quality of life of people with hand burns. This was a randomized clinical trial conducted on 60 burn patients admitted to the Shahid Motahari Hospital, Burn Research Center, Iran University of Medical Sciences, Tehran, Iran in 2021. The patients were randomly allocated into two groups of intervention and control (n = 30 per group). The participants of the intervention group received a 5-week nursing rehabilitation program in two phases: at the acute phase (admission) and the recovery phase (before discharge). Data were collected using the Burns Specific Health Scale Brief (BSHS-B) questionnaire before each phase. The quality of life (Qol) - was significantly different comparing the two groups before the intervention (p = 0.042). Covariance analysis showed that after the intervention, the mean quality of life score was significantly higher in the intervention than the control group, indicating a better Qol in the recent group (p <0.001). In the control group, the mean score of Qol was not significantly different before and after the intervention; however, this difference was statistically significant in the intervention group (p = 0.001). The implementation of the nursing rehabilitation model improved the Qol of patients with hand burns. So, this model seems to be an appropriate and effective strategy to accelerate the rehabilitation of patients with hand burns and their return to society.

Validation of the Spanish version of the Burn Specific Health Scale-Brief (BSHS-B) questionnaire

BackgroundThe Burn Specific Health Scale-Brief (BSHS-B) is considered a validated questionnaire to evaluate quality of life after burn. The purpose of this study was to translate the BSHS-B into Spanish and perform its cross-cultural adaptation.MethodsFirst, BSHS-B was translated from English into Spanish. Subsequently, 84 patients answered the Spanish version of BSHS-B and SF-36 scales to assess the reliability (Cronbach’s alpha), construct validity (Spearman rank test), and stability in time (intra-class correlation coefficient).ResultsThe BSHS-B-Sp showed a good internal consistency with a global Cronbach’s alpha of 0.96. Correlations between the major domains of BSHS-B and SF-36 are reported with Spearman’s coefficient ranging from 0.29 to 0.87 in all sub-domains (p < 0.01). Stability in time was confirmed by intra-class correlation coefficient (0.91–0.99 for every sub-domain and 0.98 for global score, p < 0.001).ConclusionsThe Spanish version of the BSHS-B demonstrated an appropriated internal consistency, construct validity, and stability in time. This fact supports its applicability to evaluate the quality of life of burn patients.Level of evidence: Not gradable

T4 Validation of the Burn Survivor Fear-avoidance Questionnaire

IntroductionAccording to the Fear-Avoidance (FA) Model, FA beliefs can lead to disability due to avoidance of activities expected to result in pain or further injury. Extensive research on the relationship of FA, pain, catastrophizing, and disability has been generated with patients suffering from chronic neck and back pain, but little research has been conducted with burn survivors. To address the need for a valid evaluation of FA in burn survivors, Langlois and colleagues developed, but did not validate, the Burn Survivor Fear-Avoidance Questionnaire (BSFAQ). Thus, the primary objective of this study was to investigate the construct validity of the BSFAQ among burn survivors. The secondary objective was to examine the relationship between FA and (i) pain intensity and (ii) catastrophizing at baseline (admission to rehab), 3 months and 6 months post-burn, and (iii) disability among burn survivors at 6 months post-burn.MethodsA prospective mixed methods approach was used to examine the construct validity by comparing the quantitative scores of the BSFAQ to independently performed qualitative interviews of burn survivors (n=31) that explored their lived-experiences, to determine if the BSFAQ discriminated those who had, from those who did not have FA beliefs and behaviors. Data for the secondary objective, scores of burn survivors (n=51) pain intensity (measured by the Numeric Rating Scale), catastrophizing (measured by the Pain Catastrophizing Scale), and disability (measured by the Burn Specific Health Scale-brief), were collected through a retrospective chart review.ResultsFor the primary objective, Wilcoxon Rank Sum Test results showed a statistically significant difference (p=0.015) between the BSFAQ scores of participants who were identified from the qualitative interviews as fear-avoidant compared to those who were identified as non-fear-avoidant. For the secondary objective, the Spearman correlation test results showed a moderate correlation between FA and (i) pain at baseline (r=0.466, p=0.002), a moderate correlation with (ii) catastrophizing thoughts over time (r=0.557, p=0.000; r=0.470, p=0.00; r=0.559, p=0.002 respectively at each time point), and a moderate correlation with (iii) disability at 6 months post-burn (r=-0.639, p=0.000).ConclusionsThese results support that the BSFAQ is able to discriminate which BS are experiencing fear-avoidant beliefs and behaviours. As has been reported in other patient populations, burn survivors who express FA are more likely to report higher levels of pain early during their recovery that correlates with elevated catastrophizing thoughts, which are maintained across time and ultimately results in higher self-reported disability, which is consistent with the FA model.

Long term effects of burn injury on health-related quality of life of adult burn survivors in Iceland: a descriptive cross-sectional study and validation of the Icelandic version of the Burn Specific Health Scale-Brief (BSHS-B)

The aim of the study was to assess the long-term effects of burn injury on the health-related quality of life of adult burn survivors in Iceland and to validate the translated Icelandic version of the Burn Specific Health Scale-Brief (BSHS-B). The participants of this descriptive cross-sectional study were all burn survivors, 18 years or older, admitted to hospital for 24 hours or more because of skin burn during a 15 years period (N=196). They completed questionnaire about their health (BSHS-B), health related quality of life (EQ-5D-5) and additional questions on burn-related symptoms and their burn experience. Response rate was 34% (N=66). Men were 77%, mean age 45.7 years (sf=18.3 and range 18-82 years), mean age when burned was 34.0 (sf=20,1, range 1-75), median time from burn accident was 11.5 years (range 1-44 years) and 32% had been burned when under 18 years of age. Burn-specific health was 4.4-4.0 (median) and health on the EQ5D-5vas scale was 80 (median, range 10-100). Those who lost a body part or had skin transplantation had more negative body image and needed more selfcare than others (p<). A significant proportion of participants reported physical and psychosocial symptoms such as itch (48%), persistent pain (37%), anxiety/depression (29%) and negative self-image (37%). Majority (67%) believed they did not get enough information, follow-up, or support after discharge from hospital. The Icelandic version of the Burn Specific Health Scale-Brief (BSHS-B) was reliable, but more research is needed to establish its validity. These findings suggest that most Icelandic burn survivors report acceptable health and health-related quality of life. The study identified a subgroup of survivors that experience persistent physical and psychosocial symptoms. Team approach with holistic support after discharge, for a prolonged period of time aiming at preventing physical and psychiatric morbidity, is recommended.

Evaluation of the Psychometric Properties of the Burn Specific Health Scale-Brief: A National Institute on Disability, Independent Living, and Rehabilitation Research Burn Model System Study.

The Burn Specific Health Scale-Brief (BSHS-B) is a commonly used burn-specific health outcome measure that includes 40 items across nine subscales. The objective of this study was to use both classical and modern psychometric methods to evaluate psychometric properties of the BSHS-B. Data were collected postburn injury by a multisite federally funded project tracking long-term outcomes. We examined dimensionality, local dependence, item fit, and functioning of response categories, homogeneity, and floor and ceiling effects. Items were fit to Item Response Theory models for evaluation. A total of 653 adults with burn injury completed the BSHS-B. Factor analyses supported unidimensionality for all subscales, but not for a total score based on all 40 items. All nine of the subscales had significant ceiling effects. Six item pairs displayed local dependence suggesting redundance and 11 items did not fit the Item Response Theory models. At least 15 items have too many response options. Results identified numerous psychometric issues with the BSHS-B. A single summary score should never be used for any purpose. Psychometric properties of the scale need to be improved by removing redundant items, reducing response categories, and modifying or deleting problematic items. Additional conceptual work is needed to, at a minimum, revise the work subscale and optimally to revisit and clearly define the constructs measured by all the subscales. Additional items are needed to address ceiling effects.

The Effect of a Recreational Therapy Program on the Pain Anxiety and Quality of Life of Patients With Burn Injuries: A Randomized Clinical Trial.

Pain anxiety and dysfunction are among the most prevalent complications of burns, impacting the quality of life (QOL) of patients with burn injuries. As a nonpharmaceutical approach, recreational therapy can be effective in reducing the complications of burns. This study aimed to examine the effect of a recreational therapy program on the pain anxiety and QOL of patients with burn injuries. This controlled randomized clinical trial was conducted on 58 patients admitted to the burn center of Imam Reza Hospital in Mashhad, Iran. These patients were randomly allocated to the intervention and control group. The intervention group received a recreational therapy program three sessions a week, for 2 weeks. The control group performed routine daily activities. As the main variable of the study, the Burn Specific Pain Anxiety Scale and Burn Specific Health Scale-Brief were completed for both groups before and 2 weeks after the intervention. After controlling confounders, the pain anxiety score in the intervention group was significantly lower than in the control group (P = .002). The total QOL score was significantly higher in the intervention group than the control group (P = .001). In addition, the intervention significantly increased the scores of QOL in the physical (P < .001), emotional (P = .009), and social (P < .001) dimensions. As it reduces pain anxiety and promotes the QOL of patients with burn injuries, this recreational therapy program is recommended for promoting the mental health and QOL of these patients.

Effect of Self Care Education on Quality of Life and Body Image among Burned Patients

Abstract: Burns have a negative effect on quality of life of patients and can impair their physiological, psychological, social and spiritual well-being. Aim of the study: to evaluate the effect of self-care education on quality of life and body image among burned patients. Research design: Quasi-experimental design. Setting: The study was conducted in burn department and outpatient's burn clinic, at Assiut Burn Center, Assiut city. Sample: Sixty male and female adult patients their age (18-65) years, diagnosed with first, second and third degree of burn. Percentage of burn from 18 - 45%. Tools: three tools used in this study: Patient assessment sheet, it included (personal and medical data), Burn Specific Health Scale-Brief (BSHS-B), and self-care education booklet. Results: Less than half of sample was in the age group of 36-55 years with mean 42.08 ± 13. 415 yrs. There was a highly significant statistical difference for patients’ quality of life and body image before and after self-care education. Conclusion: Self-care education was effective on improving quality of life and body image among burned patients. Recommendations: Teaching booklet for burned patients to improve quality of life should be available in burn departments.

T2 One Year Follow up Results of the DETECT Enzymatic Debridement Multicenter RCT

Abstract Introduction Bromelain Based Debridement (BBD) of deep thermal burns has been approved for use in Europe, Argentina, Russia, South Korea, Peru, and Israel, and is an investigational product in the United States. Topline results of acute stage endpoints of the DETECT Phase 3 multicenter RCT have been reported previously. The aim of this abstract is to present the 12-month follow-up of predefined endpoints of scar quality, function and quality of life (QoL). Methods One-hundred and seventy-five adult patients with deep burns were randomized in a Phase 3 clinical trial to one of 3 treatment arms – BBD, Standard of Care (SOC), or Gel vehicle (placebo control) in a 3:3:1 ratio (75 BBD, 75 SOC, and 25 Gel). Scar quality (cosmesis) and function data were analyzed for longer-term data collected at 3, 6, 12 (and 24 - data not yet final) months. Cosmesis and function were measured using Modified Vancouver Scar Scale (MVSS) and Patient and Observer Scar Assessment Scale (POSAS) to demonstrate that BBD treatment was non-inferior to SOC treatment, as measured at 12 months from wound closure date, evaluated by assessors blinded to the treatment arm. QoL was measured by the EQ-5D (EuroQol 5 Dimensions), VAS (Visual Analog Scale) and BSHS-B (Burn Specific Health Scale – Brief) scales. Missing values were imputed in the analysis using multiple imputation, with best case-worst case imputations as sensitivity analyses. Results The 12-month follow-up mean MVSS scores were lower (better) for the BBD group (3.70±2.10) than for the SOC (5.08±3.11) and Gel groups (5.63±2.99). A regression analysis showed that BBD has a 1.36 MVSS point advantage over SOC after adjustment for all other variables in the model (p-value = 0.0027). The 95% CI for this treatment effect was -2.24 to -0.48, excluding the pre-defined non-inferiority margin of +1.9 points, thus establishing non-inferiority of BBD treatment compared with SOC. Note that the interval also excludes 0, indicating superiority of BBD over SOC. The 3- and 6-month follow-up MVSS scores are also lower for the BBD group (5.51±3.09, 4.43±2.59) than for the SOC (6.63±3.44, 5.43±3.75) and Gel (7.56±2.67, 8.89±3.37) groups. POSAS total scores followed similar trends to MVSS scores but did not reach statistical significance at 12 months. QOL was generally similar among the treatment arms. Conclusions In addition to the significant acute stage results presented previously, the long-term results of this RCT further demonstrate the safety of BBD treatment, including significantly better 12-month follow-up MVSS scores.

Activity Impairment, Work Status, and Work Productivity Loss in Adults 5-7 Years After Burn Injuries.

An important aspect of the rehabilitation of burn patients is social participation, including daily activities and work. Detailed information on long-term activity impairment and employment is scarce. Therefore, we investigated activity impairment, work status, and work productivity loss in adults 5–7 years following burn injuries, and investigated associations with burn-specific health-related quality of life (HRQL) domains. Adult participants completed the Work Productivity and Activity Impairment General Health questionnaire and the Burn Specific Health Scale-brief (BSHS-B) 5–7 years post-burn. Outcomes were compared between participants with mild/intermediate and severe burns (>20% total body surface area burned). Seventy-six (36%) of the 213 participants experienced some degree of activity impairment due to burn-related problems 5–7 years post-burn. Seventy percent of the population was employed; 12% of them experienced work productivity loss due to burn-related problems. Nineteen percent reported changes in their work situation (partly) because of the burn injury. A higher proportion of participants with severe burns had activity impairments (56% vs 29%; P = .001) and work productivity loss (26% vs 8%; P < .001) compared to participants with mild/intermediate burns. Activity impairment and work productivity loss were both associated with burn-related work problems and lower mood, measured with the BSHS-B. In conclusion, a substantial part of the study population experienced activity impairment and work productivity loss, was unemployed, and/or reported changes in their work situation due to their injury. Particularly patients with severe burns reported productivity loss and had lower employment rates. This subscribes the importance of addressing work-related functioning in the rehabilitation of burn patients.

Differences in parent-perceived and patient-reported quality of life among young adult burn patients: A prospective longitudinal study

PurposeThis study examines the differences in parent-perceived and patient-reported quality of life (QoL) among young adult burn patients three years after injury and the factors affecting these differences. MethodThe sample comprised 35 burn patients from the Formosa Fun Coast Water Park dust explosion and their parents. The study was conducted from June 2016 to August 2018. We used self-report questionnaires to collect socio-demographic data, the adapted Chinese version of the Burn Specific Health Scale-Brief, and the Impact of Events Scale for Burn. ResultsThe analysis indicated that simple abilities recovered the fastest, while body image recovered the slowest. The variation trends of these factors were similar but parents’ scores were lower than patients’ scores. Parents’ post-traumatic stress disorder (PTSD) scores were higher than that of patients, but were not statistically significant. Parents’ gender and PTSD levels and patients’ burn area affected differences in parent-perceived QoL among patients. PTSD levels were significantly higher among mothers. ConclusionsFor parents, PTSD is a common response to their children experiencing burn injuries. Parents’ observations of warning signs enable early medical intervention. Establishing a family-centered care plan, providing psychological support for both parents and patients, and forming a continuous care system with efficient communication can support patients’ return to society.