Elsevier

Burns

Volume 40, Issue 1, February 2014, Pages 17-29
Burns

Review
Adult burn survivors’ personal experiences of rehabilitation: An integrative review

https://doi.org/10.1016/j.burns.2013.08.003Get rights and content

Abstract

Burn rehabilitation is a lengthy process associated with physical and psychosocial problems. As a critical area in burn care, the aim was to systematically synthesise the literature focussing on personal perceptions and experiences of adult burn survivors’ rehabilitation and to identify factors that influence their rehabilitation. Studies were identified through an electronic search using the databases: PubMed, CINAHL, EMBASE, Scopus, PsycINFO and Trove of peer reviewed research published between 2002 and 2012 limited to English-language research with search terms developed to reflect burn rehabilitation. From the 378 papers identified, 14 research papers met the inclusion criteria. Across all studies, there were 184 participants conducted in eight different countries. The reported mean age was 41 years with a mean total body surface area (TBSA) burn of 34% and the length of stay ranging from one day to 68 months. Significant factors identified as influential in burn rehabilitation were the impact of support, coping and acceptance, the importance of work, physical changes and limitations. This review suggests there is a necessity for appropriate knowledge and education based programmes for burn survivors with consideration given to the timing and delivery of education to facilitate the rehabilitation journey.

Introduction

Since antiquity, the trauma of a severe burn has beset humankind with poor outcomes and survival rates. The loss of both function and independence, can be physically limiting, requiring aggressive rehabilitation to improve functionality and quality of life. Accordingly, rehabilitation is a critical element in the recovery of those who sustain severe burn injuries. Primarily, the importance of an early and rigorous focus on regaining physical and emotional independence remains critical. Consequently, identification of specific rehabilitation needs is a key priority for those with severe burns to facilitate the restoration of their independence. However, the progression to a rehabilitation facility is often delayed due to the rehabilitation facility's inability to manage burn wounds [1]. Moreover, there are increasing concerns related to complications with burn wound care requiring unplanned readmissions to burn units [2], [3]. Despite the extent of both the physical and psychological trauma endured, the growing body of literature concerning burn rehabilitation is based mainly on research relating to complications of severe burns and largely of a quantitative nature. However, there is dearth of literature that explores the personal perceptions and experiences of adults’ rehabilitation after a severe burn. Therefore this integrative review aims to illuminate the personal perceptions and experiences of rehabilitation as experienced by adult burn survivors through voice and narrative and to understand the factors that influence burn rehabilitation. The integration of burn survivors’ perspectives offers a means of reaffirming burn rehabilitation.

Section snippets

Review process

The framework guiding this integrative review is based on Whittemore and Knafl's [4] five stages: problem identification, literature search, data evaluation, data analysis and presentation (Fig. 1).

Literature search

A systematic search was conducted of PubMed, EMBASE, CINAHL, PsychINFO, Scopus and grey literature using the Trove database. Boolean connectors AND, OR and NOT were used to combine search terms as burn, rehabilitation, perception and experiences. In addition, the references of potential papers

Study characteristics

The review incorporated a broad perspective on adults’ perceptions and experiences of burn rehabilitation addressing peer support [7], [8], [9], adherence to therapy [10], the return to work [8], [11], psychosocial implications [12], quality of life [13], [14], adaption and coping [15], [16], [17] and regaining independence and the reintegration into society [9], [18], [19], [20]. Of the included 14 papers, there were 184 participants involved in studies conducted across eight different

Limitations and strength of evidence

This integrative review is limited by the small number of original papers that were identified for evaluation. Two studies used the same cohort of participants further limiting the pool of research that is incorporated into the integrative review [14], [15], [18], [13]. The incorporation of primarily qualitative studies may be viewed as a limitation. However, the importance of methodological congruence within the review requires consideration. The participants incorporated into the integrative

Conclusion

Ongoing educative support to the health professionals, burn survivors and their families remains an important element in burn rehabilitation. There is a necessity for appropriate knowledge and education based programmes for burn survivors with consideration given to the timing and delivery of education to facilitate the rehabilitation journey. Research that explores the broad understanding of burn survivors’ experiences and perceptions of both the physical and psychosocial rehabilitation

Conflict of interest

The authors declare that they have no conflicts of interest; such as employment, consultancies, stock ownership, honoraria, paid expert testimony, patent applications/registrations, grants or other funding.

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