ReviewFunctional outcome after burns: A review
Introduction
Because of major improvements in burn care in the 20th century, mortality from burns has substantially decreased. Nowadays, even patients sustaining massive burns have high survival rates [1]. This has resulted in a shift in attention from mortality towards the functional outcome of burns.
Survivors of major burns often experience considerable problems, affecting a broad range of functional dimensions. This includes physical problems, mental problems and social problems [1]. Moreover, small burns can also have significant consequences for a person's functioning, especially when the functional body areas such as the hands are affected [2].
Because burns occur especially in young ages and many victims suffer from the permanent consequences of their injuries from childhood to adolescence, burns might have a major impact on population health. It has become common practice to quantify the impact of diseases and injuries on population health with the help of composite health outcome measures, such as quality-adjusted life years (QALYs) and disability-adjusted life years (DALYs) [3]. These measures capture years of life lost due to premature mortality and years lived with disability of known severity in a single metric [4].
However, to make valid estimates of the years lived with disability due to burns in the population, sound epidemiological data on the incidence, severity and duration of the functional consequences of burns should be available.
This implies that data are needed:
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Include information on all dimensions of functioning relevant to burns (comprehensiveness).
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Represent all burn patients in the population. A study sample must necessarily comprise deaths due to burns and survivors of all ages, with burns of all levels of severity (representation).
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Describe recovery profiles of burn patients over time. A longitudinal prospective study design is required with a retrospective assessment of the pre-burn situation and regular follow-up measurements in survivors. A study with this design will provide insight into the course over time regarding longer-term functional consequences of burns.
In addition, the epidemiological data on burns should preferably be comparable with data collected for other diseases. This can be achieved by using generic measures, which can be applied across different patient populations [5]. These instruments usually measure several health domains, for instance, pain, physical functioning and social functioning. Frequently applied measures are the Medical Outcomes Study 36-item Short Form Health Survey (SF-36) [6], [7] and Sickness Impact Profile (SIP) [8]. These measures enable comparison of the burden of burns to the burden of other diseases and to the total burden of disease. However, a combination of burn-specific and generic measures is to be preferred. Burn-specific measures can provide detailed information on specific consequences of burns and are necessary for the interpretation of generic data. A frequently applied burn-specific measure is the Burns-Specific Health Scale [9], [10], [11], [12].
Information on functional outcome after burns is scattered throughout the literature. In 2001, a literature review was published, focusing on the consequences of burns on work status [13]. A clear summary of the existing data on all dimensions of functional outcome after burns is lacking. We have, therefore, conducted a narrative review of the available epidemiological data on functional outcome after burns.
We used the International Classification of Functioning, disabilities and health (ICF), as released by the World Health Organization [14], as a framework to describe functional consequences of burns. The ICF includes all aspects of health and thus can be used to classify the consequences of burns. The ICF gives a framework for comparison with other injuries and diseases and it can be used as a basis for the estimation of the burden due to burns in the population.
We will answer the following questions: (1) which dimensions of the ICF have been included in studies on the functional outcome after burns? (2) Which study populations and designs were used? (3) What is the current state of knowledge on the functional outcome of burns by dimensions of the ICF?
Section snippets
Literature search
We conducted a computerised literature search in Medline (1966–11/2003), using the following combinations of keywords and free textwords: (1) burns/rehabilitation and activities of daily life, health status indicators, recovery of function; (2) burns and specific measurement instruments in the field of quality-of-life (n = 15) and (instrumental) activities of daily living (n = 8); (3) burns and scalds, pain, contractures, pruritis; (4) burns and outcome assessment, follow-up, functional outcome,
Selection of studies
Fifty publications ultimately met our criteria for inclusion and exclusion. Sixteen publications focused on the functional consequences of burns in children and adolescents [1], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], 28 on adults [2], [9], [10], [11], [12], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49], [50], [51], [52], [53], [54], three on elderly patients [55], [56], [57] and
Discussion
In this review, we have summarised the published empiric data available on functional outcome after burns. We examined the included dimensions of functional outcome in terms of the ICF, assessed study designs and summarised the results of 50 publications.
The content of the available empirical data on functional outcome after burns was analysed within the framework of the ICF [14]. The majority of the selected publications reported a wide spectrum of functional dimensions. The main focus was on
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