HEALTH RELATED QUALITY OF LIFE AFTER BURNS: ARE WE REALLY TREATING BURNS?
AbstractBackground: During the last few decades management of burns has undergone positive revolutionarychange. Today, over 50% of all patients with burns involving 80% of their total body-surface area cansurvive. Although the objective assessment by attending physician can well define a patient’s degree ofhealth, the patient’s subjective perceptions and expectations that can influence burn survivors’experience of their life is much more important. Methods: Adult burn patients of both sexes admittedto burn unit with major burns either by size or site who required reconstruction for burn injury were thesubjects of this study. The health related quality of life was assessed using SF-36v2®, questionnaire.Results: The mild to moderate pain complaint by 87 (88%) of all burn survivors, badly impact rolephysical and general health with resultant decrease in physical component summary. What was moredifficult to explain was the decreased mental health which is evident soon after the incidence andpersisted throughout the period of follow-up, showing statistically insignificant improvement whencompared from basal score (p=0.008). Longitudinal decline in HRQoL had strong relationship withfemale sex, involvement of prime area, hospital admissions, hospital stay and sessions of surgery. Sex,occupation, involvement of prime area and hospital admissions, were the important predictors fordecrease in physical component summary of burn survivors. Involvement of prime area and hospitaladmissions were important determinant for decrease in mental component summary. Conclusion: Thelevel and quality of multidisciplinary rehabilitation that these victims needs is very low as compared todeveloped countries. These patients need long term professional, psychological, and social support.Keywords: Quality of Life, Burn Survivors, Health related Quality of Life, subjective health
Constitution of the World Health Organization. In: World Health
Organization, Handbook of basic documents. 5th ed. Geneva:
Palais Des Nations;1952.p.3–20.
Klein MB, Lezotte DL, Fauerbach JA, Herndon DN, Kowalske
KJ, Carrougher GJ, et al. The National Institute on Disability and
Rehabilitation Research burn model system database: a tool for
the multicenter study of the outcome of burn injury. J Burn Care
Jeffrey R Saffle. Predicting outcomes of burns. [Editorial] N Engl
J Med 1998;338:387–8.
Esselman PC, Thombs BD, Magyar-Russell G, Fauerbach, JA.
Burn rehabilitation: State of the science. Am J Physical Med
Saffle JR. Clinical research in burns: State of the science, 2006. J
Burn Care Res 2007;28:546–8.
Patrick DL, Bush JW, Chen MM. Toward an operational
definition of health. J Health Soc Behav 1973;14:6–23.
Testa MA, Simonson DC. Assessment of Quality-of-life
Outcomes. N Engl J Med 1996;334:835–40.
Guyatt GH, Feeny DH, Patrick DL. Measuring health-related
quality of life. Ann Intern Med 1993;118:622–9.
Wang R, Wu C, Zhao Y, Yan X, Ma X, Wu M, et al. Health
related quality of life measured by SF-36: a population-based
study in Shanghai, China. BMC Public Health 2008;8:292.
Rose MS, Koshman ML, Spreng S, Sheldon R. Statistical issues
encountered in the comparison of health-related quality of life in
diseased patients to published general population norms:
problems and solutions. J Clin Epidemiol 1999;52:405–12.
Streiner DL. Breaking up is hard to do: the heartbreak of
dichotomizing continuous data. Can J Psychiatry 2002;47:262–6.
Bergamasco EC, Rossi LA, da C G Amancio A, de Carvalho EC.
Body image of patients with burns sequellae: evaluation through
the critical incident technique. Burns 2002;28:47–52.
Kildal M, Andersson G, Gerdin B. Health status in Swedish burn
patients. Assessment utilizing three variants of the Burn Specific
Health Scale. Burns 2002;28:639–45.
Fayers PM, Machin D. Quality of life: The assessment, analysis
and interpretation of patient-reported outcomes, 2nd ed.
Chichester: John Wiley and Sons; 2007.
Anzarut A, Chen M, Shankowsky H, Tredget EE. Quality of life
and outcome predictors following massive burn injury. Plast
Reconstr Surg 2005;116:791–7.
Pavoni V, Gianesello L, Paparella L, Buoninsegni LT, Barboni E.
Outcome predictors and quality of life of severe burn patients
admitted to intensive care unit. Scand J Trauma Resusc Emerg
Shakespeare V. Effect of small burn injury on physical, social and
psychological health at 3–4 months after discharge. Burns
Sullivan M, Karlsson J. The Swedish SF-36 Health Survey III.
Evaluation of criterion-based validity: results from normative
population. J Clin Epidemiol 1998;51:1105–13.
Van Loey NE, Van Son MJ. Psychopathology and psychological
problems in patients with burn scars: epidemiology and
management. Am J Clin Dermatol 2003;4:245–72.
Wisely JA, Hoyle E, Tarrier N, Edwards J. Where to start?
Attempting to meet the psychological needs of burned patients.
Novelli B, Melandri D, Bertolotti G, Vidotto G. Quality of life
impact as outcome in burns patients. G Ital Med Lav Ergon
;31(1 Suppl A):A58–63.
Fauerbach JA, Heinberg L, Lawrence JW, Munster AM, Palombo
DA, Richter D, et al. Effects of early body image dissatisfaction
on subsequent psychological and physical adjustment after
disfiguring injury. Psychosom Med 2000;62:576–82.
Thombs BD, Notes LD, Lawrence JW, Magyar-Russell G,
Bresnick MG, Fauerbach JA. From survival to socialization: A
longitudinal study of body image in survivors of severe burn
injury. J Psychosom Res 2008;64:205–12.
Thombs BD, Haines JM, Bresnick MG, Magyar-Russell G,
Fauerbach JA, Spence RJ. Depression in burn reconstruction
patients: Symptom prevalence and association with body image
dissatisfaction and physical function. Gen Hosp Psychiatry
Lionelli GT, Pickus EJ, Beckum OK, Decoursey RL, Korentager
RA. A three decade analysis of factors affecting burn mortality in
the elderly. Burns 2005;31:957–63.
Fauerbach JA, Lezotte D, Hills RA, Cromes GF, Kowalske K,
deLateur BJ. Burden of burn: a norm-based inquiry into the
influence of burn size and distress on recovery of physical and
psychosocial function. J Burn Care Rehabil 2005;26:21–32.
Dyster-Aas J, Kildal M, Willebrand M. Return to work: and
health related quality of life after burn injury. J Rehabil Med
Tahir SM, Memon AR, Kumar M, Ali SA. Self inflicted burn; a
high tide. J Pak Med Assoc 2010;60:338–41.