Barriers to Return to Work After Burn Injuries

doi:10.1016/j.apmr.2007.09.009

Archives of Physical Medicine and Rehabilitation

Volume 88, Issue 12, Supplement 2, December 2007, Pages S50-S56

Presented in part to the American Burn Association, April 7, 2006, Las Vegas, NV.

https://doi.org/10.1016/j.apmr.2007.09.009 Get rights and content

Abstract

Esselman PC, Wiechman Askay S, Carrougher GJ, Lezotte DC, Holavanahalli RK, Magyar-Russell G, Fauerbach JA, Engrav LH. Barriers to return to work after burn injuries.

Objective

To identify barriers to return to work after burn injury as identified by the patient.

Design

A cohort study with telephone interview up to 1 year.

Setting

Hospital-based burn centers at 3 national sites.

Participants

Hospitalized patients (N=154) meeting the American Burn Association criteria for major burn injury, employed at least 20 hours a week at the time of injury, and with access to a telephone after discharge.

Intervention

Patients were contacted via telephone every 2 weeks up to 4 months, then monthly up to 1 year after discharge.

Main Outcome Measures

A return to work survey was used to identify barriers that prevented patients from returning to work. A graphic rating scale determined the impact of each barrier.

Results

By 1 year, 79.7% of patients returned to work. Physical and wound issues were barriers early after discharge. Although physical abilities continued to be a significant barrier up to 1 year, working conditions (temperature, humidity, safety) and psychosocial factors (nightmares, flashbacks, appearance concerns) became important issues in those with long-term disability.

Conclusions

The majority of patients return to work after a burn injury. Although physical and work conditions are important barriers, psychosocial issues need to be evaluated and treated to optimize return to work.

Section snippets

Participants

This study is a prospective study of 154 patients from 3 burn centers that participated in a federally funded, multisite data collection project (University of Washington, University of Texas Southwestern Medical Center, Johns Hopkins University). Patients were included if they met ABA criteria for major burn injury² and if they were employed at least 20 hours a week at the time of the injury. Patients were excluded if they were not working at the time of the injury, did not have access to a

Results

A total of 154 patients were entered into the study, for whom baseline data were collected. One patient with baseline data was excluded because this person did not provide any follow-up data and it was not known if this person ever returned to work. Although the maximum number of section 2 assessments for people could range from 0 to 16, the actual number depended on when the person returned to work, and rarely did anyone complete all their possible evaluations. The number of assessments per

Discussion

For people who were employed at the time of a severe burn injury, return to work is often the most important and challenging treatment goal. As seen in a previous study,⁵ most of the patients in this study were successful in returning to work by 1 year after discharge, but over 20% of the patients did not return to work because of burn-related disability. The patients in this study had stable work situations, with an average preinjury time at their jobs of 8.3 years and good job satisfaction.

Conclusions

This study shows the barriers to return to work over time as perceived by people with burn injuries. Although there is a group of people who return to work within a few months of hospital discharge and report problems primarily with physical and wound issues, over 30% of subjects with burn injuries have longer-term disabilities. In these subjects, vocational rehabilitation counseling is recommended to assist with the assessment of the workplace, identification of appropriate workplace

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The impact of discharge contracture on return to work after burn injury: A Burn Model System investigation
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Despite many advances in burn care, the development of extremity contracture remains a common and vexing problem. Extremity contractures have been documented in up to one third of severely burned patients at discharge. However, little is known about the long-term impact of these contractures. The purpose of this study was to examine the association of extremity contractures with employment after burn injury.
We obtained data from the Burn Model System database from 1994 to 2003. We included in the study cohort all adult patients who were working prior to injury and identified those discharged with and without a contracture in one of the major extremity joints (shoulder, elbow, wrist, hip, knee and ankle). We classified contracture severity according to mild, moderate and severe categories. We performed descriptive analyses and predictive modeling to identify injury and patient factors associated with return to work (RTW) at 6, 12, and 24 months.
A total of 1,203 participant records met criteria for study inclusion. Of these, 415 (35%) had developed a contracture at discharge; 9% mild, 12% moderate, and 14% severe. Among 801 (67%) participants who had complete data at 6 months after discharge, 70% of patients without contracture had returned to work compared to 45% of patients with contractures (p < 0.001). RTW increased at each subsequent follow-up time point for the contracture group, however, it remained significantly lower than in no-contracture group (both p < 0.01). In multivariable analyses, female sex, non-Caucasian ethnicity, larger burn size, alcohol abuse, number of in-hospital operations, amputation, and in-hospital complications were associated with a lower likelihood of employment. In adjusted analyses, discharge contracture was associated with a lower probability of RTW at all 3 time points, although its impact significantly diminished at 24 months.
This study indicates an association between discharge contracture and reduced employment 6, 12 and 24 months after burn injury. Among many other identified patient, injury, and hospitalization related factors that are barriers to RTW, the presence of a contracture at discharge adds a significant reintegration burden for working-age burn patients.
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: Supported by the National Institute on Disability and Rehabilitation Research, Office of Special Education and Rehabilitative Services, U.S. Department of Education (grant no. H133A020402).

: No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

: Reprints are not available from the author.

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Original articleBarriers to Return to Work After Burn Injuries

Abstract

Objective

Design

Setting

Participants

Intervention

Main Outcome Measures

Results

Conclusions

Section snippets

Participants

Results

Discussion

Conclusions

Burns

Burns

Burns

Burns

Burns

Burns

Burn rehabilitation state of the science review

Am J Phys Med Rehabil

Guidelines for the operation of burn unitsResources for optimal care of the injured patient

Barriers to employment among working-aged patients with major burn injury

J Burn Care Rehabil

Community integration after burn injuries

J Burn Care Rehabil

Time off work and return to work rates after burns: systematic review of the literature and a large two-center series

J Burn Care Rehabil

Return to work after burn injury

J Burn Care Rehabil

Factors relating to return to work after burn injury

J Burn Care Rehabil

Work status and attrition from longitudinal studies are influenced by psychiatric disorder

J Burn Care Rehabil

The Work Experience Survey: a reasonable accommodation/career development strategy

J Appl Rehabil Couns

Original article
Barriers to Return to Work After Burn Injuries