Burn Specific Health Scale-Brief Research Articles

Machine learning classification of first-onset drug-naïve MDD using structural MRI

Hands are the most commonly burnt body part given humans’ innate response to guard their face from injury, and are known to have detrimental functional and psychological consequences. Conflicting evidence exists regarding the impact of hand burns on long-term health status and global functioning. The objective of this study was to identify patient and clinical characteristics that predict health status and hand function of people at 12–24 months after hand burn.The Burns Specific Health Scale-Brief (BSHS-B) and the Brief Michigan Hand Outcome Questionnaire (Brief MHQ) were administered to community-dwelling adults who were between one and two years after admission to a statewide burns service for burns including one or both hands. Demographic, injury, and treatment data were collected to identify which factors predict health status and hand function in the second year after admission. Linear regression analyses adjusted for total burn surface area and burn depth were conducted to identify important predictors or outcomes.The sample (n = 41) was 80.5% male, with a mean age of 44.5 years and total body surface area (TBSA) of 8.4%. Psychiatric illness (regression coefficient −56.6, confidence interval (95% CI) −76.70, −36.49) and female gender (−20.3; 95% CI −0.77, −40.29) were key predictors of poorer global health status on the BSHS-B. Females also scored worse on body image (−5.35; 95% CI −1.83, −8.87) and work (−4.13; 95% CI −0.64, −7.62) domains of BSHS-B. The need for reconstructive or secondary surgery (−38.84; 95% CI −58.04, −19.65) and female gender (−16.30; 95% CI −4.03, −28.57) were important predictors of poorer hand function.Women and those with a history of psychiatric illness are particularly vulnerable to poorer outcomes in health status and/or hand function after burns, and may benefit from more intensive rehabilitation support and long-term follow-up.

Impacts of low-energy extracorporeal shockwave therapy on pain, pruritus, and health-related quality of life in patients with burn: A randomized placebo-controlled study

BackgroundThe management of post-burn pain and pruritus remain a potent challenge because of their bad effects on health-related quality of life (HRQOL). The main purpose of this study was to evaluate the impacts of low-energy extracorporeal shockwave therapy (low-energy ESWT) in the management of pain, pruritus, and HRQOL in patients with burn. MethodsForty-five adult patients with burn, their age ranged from 18 to 55 years, were included in the study, they randomly assigned into 22 patients in the study group (low-energy ESWT) and 23 patients in the placebo group. The study group received low-energy ESWT (0.05–0.20mJ/mm2, a frequency of 4Hz with total shocks from 1000 to 2000 shocks) once per week for 4 successive weeks, while the placebo group received ESWT without energy. Both groups received traditional physical therapy program of selective different exercises (respiratory, range of motion, endurance, strengthening, balance, mobilization, stretching, and gait training) 3days per week for 4 weeks. Numerical Rating Scale (NRS) for pain and for pruritus, Pressure Pain Threshold (PPT), 12-Item Pruritus Severity Scale (12-PSS), and Burn Specific Health Scale-Brief (BSHS-B) were measured before and after treatment procedures in both groups. ResultsNRS were decreased significantly in the study group than in the placebo group (P<0.05). PPT, 12-PSS, and BSHS-B scores were improved more significantly in the study group than in the placebo group (P<0.05) while body image and burn associated issues were improved at the same level in both groups (P>0.05). ConclusionThe findings suggest that low-energy ESWT with traditional regular physical therapy may relive post-burn pain and pruritus, and improve HRQOL, particularly in adult patients with burn.

Trends 10 years after burn injury: A Burn Model System National Database study

BackgroundThe Burn Specific Health Scale-Brief (BSHS-B) evaluates 9 aspects of health and has been validated globally. Existing reports typically focus on outcomes shortly after injury. The purpose of this study is to determine whether quality of life remains a concern for burn survivors ten years after-injury. MethodsCross sectional data of survivors admitted from 1994 to 2006 to four US burn centers were collected in the Burn Model System National Database 10 years after injury. Responses to the items in the nine BSHS-B domains range from 0 to 4. Lower scores indicating poorer quality of life. Median scores are reported and differences were compared using Wilcoxon–Mann–Whitney test. ResultsTen-year survivor injury characteristics suggest a moderate severity of injury. Survivors scored lower in heat sensitivity, affect, body image, and work (median=3.2, 3.6, 2.8, and 3.6, respectively). Affect, body image, and interpersonal scores were significantly lower for females (median=3.1, 2.8, 3.8, respectively) than males [median=3.6, 3.3, 4, respectively (p=0.008, 0.004, 0.022, respectively)]. ConclusionsOur results suggest certain domains of burn specific health benefit from support at 10 years after injury, and select populations such as females may necessitate additional treatment to restore burn-specific health. These results support that burn injuries represent a chronic condition and long-term medical and psychosocial support may benefit burn survivor recovery.

Effect of Post-Hospital Discharge Follow-up on Health Status in Patients with Burn Injuries: A Randomized Clinical Trial.

Patients with burn injuries still face various burn-related challenges after being discharged from the hospital. Hence, a follow-up program for such patients is essential. The present study aimed to evaluate the health status of burn victims after 1.5 months follow-up. The present randomized clinical trial was of a pretest-posttest design, carried out in Kermanshah (Iran) from July 2016 to September 2017. A total of 117 participants were recruited out of which 86 were included in the analysis. The participants were randomly assigned into two groups, namely the intervention group (N=42) and the control group (N=44). All participants were evaluated both at the time of hospital discharge and at 1.5 months post-discharge. The follow-up plan for the intervention group included home visits, telenursing, and referral to specialists or health education centers. To evaluate the physical and psychological status of the participants, five different instruments were used; namely the Burn Specific Health Scale-Brief (BSHS-B), the General Health Questionnaire-28 (GHQ-28), the Brief Pain Inventory (BPI), the Vancouver Scar Scale (VSS), and the Visual Analogue Scale (VAS). All statistical analyses were performed using the SPSS software (version 17.0). Data were analyzed using the Chi-square test, independent t-test, and paired t-test. P<0.05 was considered statistically significant. The mean score of the BSHS-B questionnaire at both the time of discharge and 1.5 months post-discharge follow-up for the control and intervention groups was 61.22±19.07, 57.14±18.92; 83.70±24.73 and 105.16±29.17, respectively. There was a significant difference between the groups at 1.5 months post-discharge follow-up (P<0.001). At 1.5 months, the VSS score was 5.16±1.68 and 6.77±3.46 for the intervention and control groups, respectively. The GHQ-28 score was 28.69±12.39 and 40.79±16.20 for the intervention and control groups, respectively. The VAS and BPI scores of the control group were 5.56±3.11 and 21.93±29.25, respectively. For the intervention group, these scores were 4.85±3.49 and 15.61±27.47, respectively. There was a significant difference between the groups as to the GHQ and VSS scores (P<0.05). However, no significant difference was noted in the BPI and VAS scores (P<0.05). Health status, psychological status, and scar management were improved due to post-discharge follow-up. However, burn patients required continued care for pain, psychological health, and itching problems. Trial Registration Number: IRCT2016110630712N.

Assessment of quality-of-life in patients with face-and-neck burns: The Burn-Specific Health Scale for Face and Neck (BSHS-FN)

IntroductionBurns to the cephalic extremities are particularly implicated in problems of self-image and alterations to personal social relations. The aim of this study was to objectively assess the quality-of-life (QoL) of patients suffering from face-and-neck burns through our newly created scale: The Burn-Specific Health Scale for Face and Neck (BSHS-FN). MethodsAfter constructing the BSHS-FN, we compared QoL of patients with or without face-and-neck burns. SF-36, the French version of the BSHS-B (Burn Specific Health Scale-Brief), and the BSHS-FN were administrated to 53 patients divided into two groups: GB group (general burns, 26 patients) and FN group (face-neck burns, 27 patients). ResultsQoL evaluated using the SF-36 had a higher average total score in GB patients compared to FN patients, but there were no significant difference between the two groups (54.3±18.5 vs. 47.0±17.3, respectively, p=0.11). In contrast, in BSHS-B the total score was significantly different between the two groups with a higher score recorded for the GB group (71.9±13.4 [median: 72.8] in the GB group vs. 62.2±14.4 [median: 64.4] in the FN group). In percentage terms, total score of BSHS-FN for GB group was 79.1±10.1, while total score for FN group was 53.6±13.1 (p<0.001), with the highest score for the Face and Neck domain in GB group (99.7±1.1, p<0.001) ConclusionThe BSHS-FN seemed to be more appropriate to assess QoL for FN burn patients. This study supports its application in routine clinical practice and in international studies.

The Relationship between Quality of Life and Sexual Satisfaction in Women with Severe Burns.

Burn, especially in women, can affect the quality of life and it due to a change in sexual life. This study was designed to investigate the relationship between the quality of life and sexual satisfaction in women with burns. This was a descriptive-analytical cross-sectional study conducted on 101 women with severe burns who were referred to Imam Khomeini Hospital in Urmia, Iran, in 2016. The data gathering scales were demographic questionnaire, burn specific health scale-brief (BSHS-B) and Index of Sexual Satisfaction (ISS). The mean scores of the quality of life and sexual satisfaction were 102.94 ± 20.88 and 57.03 ± 25.91, respectively. Also, there was a significant relationship between quality of life and its subscales with sexual satisfaction and some demographic variables (p <0.05). Interventional efforts for improving sexual satisfaction and thus, quality of life in these patients are important. The findings of this study appear to be effective in planning for women with a history of burns.

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

ObjectivesMeasurement 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.MethodsA 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.ResultsTwenty 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.ConclusionConsensus 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.

Effect of burn rehabilitation program on improving quality of life (QoL) for hand burns patients: a randomized controlled study

Burn injuries, including hands are one of the most devastating injuries. Hand burns do not often play a major role in the mortality. But, they represent a huge problem that may eventually lead to chronic disabilities, lifelong impairment, and significant functional and occupational limitations. These comorbidities can negatively affect a patient’s quality of life (QoL) besides, making re-integration into society is difficult. This study aims to investigate the effect of our designated burn rehabilitation program on improving quality of life of hand burns patients. A randomized controlled study was conducted for 12 months at Mansoura University Burn Center. It included 60 adult patients with hand burns who were randomly divided and assigned to a study and control groups. Both groups underwent basic rehabilitation. A newly designed program was implemented for the study group. Data were collected using three tools; bio-socio demographic characteristics, the Burn Health Knowledge Questionnaire, and the Burn Specific Health Scale-Brief (BSHS-B). The quality of life of patients with hand burns was evaluated three times. One month and three months after implementing the burn rehabilitation program, the total mean scores for the QoL of patients in the study group improved from 31.1 ± 11.3 to 118.5 ± 21.3 and 135.4 ± 24.3, respectively (P < 0.001). In addition, the changes in QoL of the patients in the control group significantly improved from 24.8 ± 12.1 to 57.6 ± 19.1 and 87.5 ± 23.8, respectively (P < 0.001). Despite this steady improvement in the control group, the mean scores on the QoL sub-scales and total mean scores remained lower than those in the study group. Based on the results obtained in the current study, the design and implemention of a burn rehabilitation programme based on clinical knowledge improves the quality of life of patients with burns. Therefore, this program is recommended for use early as a part of the treatment process for patients with burns. Level of Evidence: Level I, risk/prognostic study.

Burn Specific Health Scale-Brief in Pregnant Burned Women: Translation and Psychometric Evaluation of the Persian Version

Background The aim of this study was to investigate the validity and reliability of the Persian version of Burn Specific Health Scale-Brief (BSHS-B) in pregnant women suffering from burns. Materials and Methods This cross-cultural psychometrics study was done in 2015 to 2016 and included 410 pregnant burned patients. Participants completed BSHS-B. The face, content and construct validity of the scale were ascertained. Reliability was also assessed using internal consistency, construct reliability and intra-class correlation coefficient (ICC). Results Construct validity determined nine factors with an eigenvalue greater than 1. The model had a good fit [(c2(68) = 412.038, p < .05, c2/df= 4.612, GFI = .893, CFI = .912, NFI = .902, IFI = .931, RMSEA (90% C.I.) = .091 (.088 - .112)] with all factors loadings greater than 0.5 and statistically significant. The internal consistency, construct reliability and ICC were greater than 0.70. Conclusion Findings revealed that the Persian version of the BSHS-B is valid and reliable, and may be used to assess and evaluate quality of life in Iranian pregnant burned patients.

Pas de différence fonctionnelle après la chirurgie ou la rééducation des personnes atteintes d’une lésion méniscale symptomatique associée à une gonarthrose

Hands are the most commonly burnt body part given humans’ innate response to guard their face from injury, and are known to have detrimental functional and psychological consequences. Conflicting evidence exists regarding the impact of hand burns on long-term health status and global functioning. The objective of this study was to identify patient and clinical characteristics that predict health status and hand function of people at 12–24 months after hand burn.The Burns Specific Health Scale-Brief (BSHS-B) and the Brief Michigan Hand Outcome Questionnaire (Brief MHQ) were administered to community-dwelling adults who were between one and two years after admission to a statewide burns service for burns including one or both hands. Demographic, injury, and treatment data were collected to identify which factors predict health status and hand function in the second year after admission. Linear regression analyses adjusted for total burn surface area and burn depth were conducted to identify important predictors or outcomes.The sample (n = 41) was 80.5% male, with a mean age of 44.5 years and total body surface area (TBSA) of 8.4%. Psychiatric illness (regression coefficient −56.6, confidence interval (95% CI) −76.70, −36.49) and female gender (−20.3; 95% CI −0.77, −40.29) were key predictors of poorer global health status on the BSHS-B. Females also scored worse on body image (−5.35; 95% CI −1.83, −8.87) and work (−4.13; 95% CI −0.64, −7.62) domains of BSHS-B. The need for reconstructive or secondary surgery (−38.84; 95% CI −58.04, −19.65) and female gender (−16.30; 95% CI −4.03, −28.57) were important predictors of poorer hand function.Women and those with a history of psychiatric illness are particularly vulnerable to poorer outcomes in health status and/or hand function after burns, and may benefit from more intensive rehabilitation support and long-term follow-up.

Validation of the Ludwigshafen German Version of the Burn Specific Health Scale-Brief.

The Burn Specific Health Scale-Brief (BSHS-B) is one of the most commonly used instruments to measure quality of life after burns. Our aim was to establish and to provide a German version of the BSHS-B for all German-speaking burn facilities. Translation and cross-cultural adaptation of the original English version into the German language was conducted. In a pilot study, 20 burn patients qualitatively validated the translated version concerning comprehensibility and content validity. The final version was then quantitatively validated by 364 patients who were treated in our burn center between 2011 and 2015. Internal consistency and test-retest reliability were assessed. Criterion validity was determined by correlating the subscales with relevant instruments (Short-Form Health Survey 36, Hospital Anxiety and Depression Scale, and Disabilities of the Arm, Shoulder and Hand Outcome Measure). The structure of the German version was investigated by principal component analysis. Confirmatory factor analysis was used to compare the structure with the original 9-factor structure and the second-order 3-factor structure. Qualitative testing revealed adequate comprehension and content validity. Cronbach's alphas ranged from α = 0.80 to α = 0.92. The test-retest reliability ranged from r = 0.72 to r = 0.97. The subscales correlated significantly with the measures of criterion validity (r = 0.30 to r = -0.77). The principal component analysis results showed a satisfactory overlap with the original data structure, except for the Affect and Sexuality domains, which were merged into 1 factor. The confirmatory factor analyses revealed the best model fit for the second-order 3-factor structure, excluding the Work domain. The Ludwigshafen German version of the BSHS-B shows good psychometric properties. It is well suited for clinical use, further research, and international comparison.

Modified Vancouver Scar Scale score is linked with quality of life after burn

IntroductionThis study aimed to determine if a scar quality is associated with quality of life (QoL) at six months post-burn and beyond. MethodsQuantile regression models adjusted for covariates were used to demonstrate the relationship of modified Vancouver Scar Scale (mVSS) total (with and without pigmentation) and the mVSS components, to the Burn Specific Health Scale-Brief (BSHS-B) scores (full scale, Affect and Relations domain, Skin Sensitivity domain). ResultsThe sample (n=341) comprised 67% males, 83% with skin grafts with a median age 38 years, total body surface area (TBSA) 4%, length of stay seven days, mVSS total score of five and BSHS-B total score of 153. Between six and 12 months of injury, mVSS total, TBSA and female gender were significantly associated with the BSHS-B, a situation that was not affected by the presence or absence of pigmentation scores. The mVSS components did not individually influence QoL. DiscussionmVSS total score, gender and burn size data may be a useful adjunct to experienced clinical judgment for identifying at risk patients and directing appropriate, timely resource allocation.

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

IntroductionThe Burn Specific Health Scale-Brief questionnaire is a widely validated tool for estimating the health related quality of life and for assessing the best multidisciplinary management of burn patients. The aim of this study was to translate the BSHS-B into French and to investigate its reliability and validity. MethodsAccording to the procedure proposed by the Scientific Advisory Committee of the Medical Outcomes Trust, the Burn Specific Health Scale-Brief (BSHS-B) was translated from the English version into French. In order to test the reliability of the French version of the BSHS-B, 53 burn patients French speakers completed the BSHS-B and SF-36 questionnaires from two to four years after burn. Ten of them have been re-tested at 6 months after the first evaluation. To evaluate clinical utility of the BSHS-F, internal consistency, construct validity (using SF-36) and stability in time were assessed using Cronbach's alpha statistic, Spearman rank test, and intra-class correlation coefficient respectively. ResultsThe French version of the BSHS-B Cronbach's alpha coefficient was 0.93 and was >0.80 for all the sub-domains. French version of the BSHS-B and the SF-36 were positively correlated, all the associations were statistically significant (p<0.01). Intra-class correlation coefficients for test–retest ranged between 0.95 and 0.99 for the sub-domains. The intra-class correlation coefficient (ICC) for the total score was 0.98. ConclusionThe French version of the BSHS-B shows a robust rate of internal consistency, construct validity and stability in time, supporting its application in routine clinical practice as well as in international studies.

Factors predicting health status and recovery of hand function after hand burns in the second year after hospital discharge

IntroductionHands are the most commonly burnt body part given humans’ innate response to guard their face from injury, and are known to have detrimental functional and psychological consequences. Conflicting evidence exists regarding the impact of hand burns on long-term health status and global functioning. The objective of this study was to identify patient and clinical characteristics that predict health status and hand function of people at 12–24 months after hand burn. MethodsThe Burns Specific Health Scale-Brief (BSHS-B) and the Brief Michigan Hand Outcome Questionnaire (Brief MHQ) were administered to community-dwelling adults who were between one and two years after admission to a statewide burns service for burns including one or both hands. Demographic, injury, and treatment data were collected to identify which factors predict health status and hand function in the second year after admission. Linear regression analyses adjusted for total burn surface area and burn depth were conducted to identify important predictors or outcomes. ResultsThe sample (n=41) was 80.5% male, with a mean age of 44.5 years and total body surface area (TBSA) of 8.4%. Psychiatric illness (regression coefficient −56.6, confidence interval (95% CI) −76.70, −36.49) and female gender (−20.3; 95% CI −0.77, −40.29) were key predictors of poorer global health status on the BSHS-B. Females also scored worse on body image (−5.35; 95% CI −1.83, −8.87) and work (−4.13; 95% CI −0.64, −7.62) domains of BSHS-B. The need for reconstructive or secondary surgery (−38.84; 95% CI −58.04, −19.65) and female gender (−16.30; 95% CI −4.03, −28.57) were important predictors of poorer hand function. ConclusionWomen and those with a history of psychiatric illness are particularly vulnerable to poorer outcomes in health status and/or hand function after burns, and may benefit from more intensive rehabilitation support and long-term follow-up.

Convergent and discriminant validity of quality of life measures used in burn populations

IntroductionThe primary goal of this study was to investigate convergent validity, i.e. overlapping constructs, of the Burn Specific Health Scale-Brief (BSHS-B), the Short Form-36 items Health Survey (SF-36) and the European Quality Of Life Five Dimensions (EQ-5D) within the International Classification of Functioning Disability and Health (ICF) framework. A secondary goal was to examine the discriminant validity of the questionnaires according to burn severity (no surgery versus 1 or more surgeries). MethodsA prospective multi-centre study in adult patients with burns was conducted. At the 9 months assessment, two generic questionnaires, i.e. the SF-36 and EQ-5D, and the BSHS-B were completed. Pearson correlations were used to evaluate convergent validity. Linear discriminant analysis was used to evaluate discriminant validity. ResultsAt 9 months post-burn data from 184 persons were available of which 131 (71%) were male, mean TBSA burned was 11.8% (SD=10.2). Sixty five (34%) patients did not need surgery, 128 (66%) patients required one or more surgeries. Higher convergence was shown between the generic SF-36 and the condition specific BSHS-B whereas the EQ-5D showed lower convergence with the BSHS-B especially in the domain Activity. The generic scales discriminated across all scales whereas not all BSHS-B scales were able to differentiate problem levels across burn severity groups. ConclusionThis study demonstrates that the ICF is useful to classify scales in order to identify overlapping areas as well as to uncover gaps in relation to patient reported outcomes. Both the SF-36 and EQ-5D showed the ability to distinguish levels of functioning across burn severity groups. As the BSHS-B performed less well and relevant domains of functioning were not addressed, there is room for improvement and modification of this condition specific questionnaire to better capture burn patients’ functioning.

Female patients display poorer burn-specific quality of life 12 months after a burn injury

IntroductionAlthough gender differences in morbidity and mortality have been measured in patients with moderate to severe burn injury, little attention has been directed at gender effects on health-related quality of life (HRQoL) following burn injury. The current study was therefore conducted to prospectively measure changes in HRQoL for males and females in a sample of burn patients. MethodsA total of 114 adults who received treatment at a statewide burns service for a sustained burns injury participated in this study. Instruments measuring generic health status (Short Form 36 Medical Outcomes Survey version 2), burn-specific HRQoL (Burns Specific Health Scale-Brief), psychological distress (Kessler Psychological Distress Scale) and alcohol use (Alcohol Use Disorders Identification Tool) were prospectively measured at 3, 6 and 12 months post-burn. ResultsIn the 12 months post-injury, female patients showed overall poorer physical (p=0.01) and mental health status (p<0.001), greater psychological distress (p<0.001), and greater difficulty with aspects of burn-specific HRQoL: body image (p<0.001), affect (p<0.001), interpersonal functioning (p=0.005), heat sensitivity (p=0.01) and treatment regime (p=0.01). While significant interaction effects suggested that female patients had more improvement in difficulties with treatment regime (p=0.007), female patients continued to report greater difficulty with multiple aspects of physical and psychosocial health status 12 months post-injury. ConclusionEven though demographic variables, injury characteristics and burn care interventions were similar across genders, following burn injury female patients reported greater impairments in generic and burn-specific HRQoL along with psychological morbidity, when compared to male patients. Urgent clinical and research attention utilising an evidence-based research framework, which incorporates the use of larger sample sizes, the use of validated instruments to measure appropriate outcomes, and a commitment to monitoring long-term care, can only improve burn-care.

Assessment of quality of life (QoL) of burn patients in India using BSHS-RBA scale

IntroductionThe Burn Specific Health Scale-Brief (BSHS-B) is a popular instrument to measure quality of life (QoL) in burn patients. The current study aims at identifying the prognostic variables for our burn population using the BSHS-RBA (revised, brief and adapted) scale. Materials and methodsThe study was conducted on 60 post-burn patients using the BSHS-RBA scale. The questionnaire was administered by an interview as majority of patients were illiterate. The socio-demographic and clinical variables were analyzed against domain scores and total scores of the scale, using Mann-Whitney test and Kruskal Wallis test. ResultsThe median age of the sample was 28 years, of which 60% were females. Their median TBSA burn was 30%. The median time since burn at the time of interview was 10 months. Higher scores were noted in the domains of simple abilities and mobility, hand function and interpersonal relationship, while poorer scores were recorded in domains of skin sensitivity and body image. DiscussionThe mean score in our study was 2.36, which is quite less as compared to reports from high income countries (range: 2.58–3.36). This study provides an insight on an aspect of burn care outcome, which can be reasonably expected in low income countries with the available standard of care. Being a female, presence of hand and face burn, requirement of corrective surgeries and inability to resume work were factors associated with poor QoL. ConclusionStrategies to improve QoL of burn patients should target psychological aspects, work rehabilitation (early release of contractures) and skin hypersensitivity (including itching) to derive maximum benefit.

Validation of a Taiwanese Version of the Burn-Specific Health Scale-Brief.

The purposes of this study were to translate the brief version of the Burn-Specific Health Scale (BSHS-B) into traditional Chinese (Taiwanese) and to evaluate its psychometric properties to measure quality of life of burn patients in Taiwan. The BSHS-B-Taiwanese was translated and reviewed by an expert committee. Patients were invited to participate in this study while they visited the outpatient burn clinic. One hundred and eight burn patients participated in this study by filling out the BSHS-B-Taiwanese and SF-36 Taiwanese version. Forty-one of 108 patients completed a retest on the BSHS-B-Taiwanese. A ceiling effect was found for psychosocial functioning and all domains of the BSHS-B-Taiwanese. Internal consistency shown by Cronbach's alpha was all above 0.70 except for the interpersonal relationships domain. Of these, Cronbach's alpha ≥0.9 was found in the work, heat sensitivity, and body image domains. Test-retest reliabilities ranged from 0.74 to 0.93 except for the simple activity domain. As for the criterion validity, most of the BSHS-B-Taiwanese version was shown to have fair to moderate correlations with the SF-36-Taiwanese in corresponding domains. The discriminant validity of the BSHS-B-Taiwanese was demonstrated by significant score differences in several domains between subgroups of different severity regarding length of hospital stay and TBSA. Our finding suggests that the BSHS-Taiwanese is generally reliable and valid. A shorter version of BSHS-B-Taiwanese together with a generic instrument, such as SF-36, can be used to measure the quality of life of burn patients in Taiwan.

Towards more efficient burn care: Identifying factors associated with good quality of life post-burn

BackgroundAs minor burn patients constitute the vast majority of a developed nation case-mix, streamlining care for this group can promote efficiency from a service-wide perspective. This study tested the hypothesis that a predictive nomogram model that estimates likelihood of good long-term quality of life (QoL) post-burn is a valid way to optimise patient selection and risk management when applying a streamlined model of care. MethodA sample of 224 burn patients managed by the Burn Service of Western Australia who provided both short and long-term outcomes was used to estimate the probability of achieving a good QoL defined as 150 out of a possible 160 points on the Burn Specific Health Scale-Brief (BSHS-B) at least six months from injury. A multivariate logistic regression analysis produced a predictive model provisioned as a nomogram for clinical application. A second, independent cohort of consecutive patients (n=106) was used to validate the predictive merit of the nomogram. Results and discussionMale gender (p=0.02), conservative management (p=0.03), upper limb burn (p=0.04) and high BSHS-B score within one month of burn (p<0.001) were significant predictors of good outcome at six months and beyond. A Receiver Operating Curve (ROC) analysis demonstrated excellent (90%) accuracy overall. At 80% probability of good outcome, the false positive risk was 14%.The nomogram was validated by running a second ROC analysis of the model in an independent cohort. The analysis confirmed high (86%) overall accuracy of the model, the risk of false positive was reduced to 10% at a lower (70%) probability. This affirms the stability of the nomogram model in different patient groups over time.An investigation of the effect of missing data on sample selection determined that a greater proportion of younger patients with smaller TBSA burns were excluded due to loss to follow up. ConclusionFor clinicians managing comparable burn populations, the BSWA burns nomogram is an effective tool to assist the selection of patients to a streamlined care pathway with the aim of improving efficiency of service delivery.

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

IntroductionProgressive increases in survival rates from burn trauma have shifted attention to patient rehabilitation and posttraumatic quality of life. The assessment of quality of life is strongly dependent on reliable instruments for its measurement. A literature review has revealed that the Burn Specific Health Scale-Brief (BSHS-B) questionnaire is the most commonly used instrument worldwide. ObjectivesThe aim of this study was to translate the BSHS-B into the Portuguese language, adapt it culturally to the Brazilian population, and test its psychometric properties. MethodsThe questionnaire was translated into Portuguese; culturally adapted; and tested for reproducibility, face validity, content validity, and construct validity. The translated version was tested on 92 patients with burns. Internal consistency was tested by means of Cronbach's alpha. Construct validity was performed by correlating the BSHS-B questionnaire with the Burn Specific Health Scale-Revised (BSHS-R), BurnSexQ-Escola Paulista de Medicina (EPM)/Universidade Federal De São Paulo (UNIFESP), the Rosenberg Self-Esteem Scale (RSES), and the Beck Depression Inventory (BDI). ResultsCronbach's alpha was 0.85. The Pearson correlation coefficients were significant at three time points of the reliability analysis. A significant correlation was observed between BSHS-B domains and BSHS-R, and between RSES and BDI domains. A significant correlation was also observed between BSHS-B and the BurnSexQ-EPM/UNIFESP social comfort and body image domains. ConclusionThe BSHS-B questionnaire was translated into Portuguese. It is a reliable tool in this language, showing face, content, and construct validity. The modified instrument has been named BSHS-B-Br.