Elsevier

Burns

Volume 40, Issue 5, August 2014, Pages 788-796
Burns

Review
Health Related Quality of Life in burn patients – A review of the literature

https://doi.org/10.1016/j.burns.2013.11.014Get rights and content

Abstract

The burn trauma is multifactorial and involves pathophysiologic processes of all of the body's systems. The impact it could have on a person's life includes impairments on their esthetic appearance, interpersonal relationships, psychological, social and physical functioning. Previously, the outcomes of burn care were confined in the context of mortality and length of hospital stay. Currently, a shift is afoot from defining good health care as merely the reduction of morbidity and mortality to a more holistic approach that involves aspects of Health Related Quality of Life. In this article we aim to present a concise review of the relevant literature and relevant topics pertaining Health Related Quality of Life and burn.

Introduction

A burn is one of the most devastating injuries and conditions a person can experience in their life [1]. It is a type of injury to flesh provoked by several possible agents (thermal, mechanical, chemical, electrical or radiation). Usually it involves different skin layers but in some cases it can reach deeper tissues such as muscle and bone or even cause thermal injury to the airway and the lungs. Initial assessment of the clinical situation is based on the percentage of the Total Body Surface Area (TBSA) that has been burned (for second or third degree burn) and depth of the burn.

However, depending on the location affected, the TBSA and degree of the burn, the trauma patient can experience a number of potentially fatal complications such as shock, infection, respiratory distress and multiple organ failure. These complications happen during the acute phase of the trauma following which the difficult task of rehabilitation and integration back to the society may also have upsetting psychological effects on the burn survivor as well as on other family members [2], [3]. Moreover, the financial resources needed to cope with the burn are substantially high and extend from the patient's personal expenses to resources allocated from the health care system as well as other social costs such as property damage. Furthermore even after an optimal treatment a scar cannot be avoided completely, body appendages may be permanently damaged and the patient's appearance and function will probably be impaired [3]. Eventually the burden of rehabilitation will fall on the patient and on family members for many years after surgery [3] affecting the Quality of Life (QoL] in general, and the Health Related Quality of Life (HRQoL] of the patient in specific. [4], [5].

In this article we aim to present a concise review of the relevant literature and relevant topics pertaining HRQoL and burn.

Section snippets

Search strategy

A literature search was conducted using PubMed, Cochrane Library and Ovid using the search terms “burns”, “burn care”, “quality of life”, “health related quality of life”, “burn specific health scale”, “clinimetrics” alone or in various combinations using Boolean Operators (“and”, “or”, “not”). Relevant clinical trials and systematic reviews were studied and citations within the obtained papers were scrutinized to identify additional studies. The search was limited to publications with

Outcomes in burn care

In order to cope with the demands of burn care and evaluate health policies, it is necessary to measure the outcomes after the treatment has been provided. Existing evidence [8], [9] suggests that in doing so, a high standard of care could be maintained by interpreting research and audit findings, comparing services internationally and constantly improving the quality and cost effectiveness of the provided health services.

An outcome is the result or consequence of an action or non-action in a

Definitions of Quality of Life and Heath Related Quality of Life

The concept of QoL is broad and multidimensional to include factors such as gender, age, ethnicity, and religious beliefs [28]. When QoL is measured in healthcare, the definitions become more specific and are related to the health of a person [29]. However, the concept of health is also complex and difficult to define. The World Health Organization defines health as a state of complete physical, mental, and social well-being and not only the absence of disease or sickness [30]. This definition

Measurement of HRQoL

Previously investigators have used psychometric measures and interviews to evaluate the psychosocial adjustment of burn survivors [57]. However, overall the methods lacked standardization of the measures and results compatible with the requisites of evidence based medicine that could allow statistical processing of the data. Therefore, the emergence of HRQoL assessment tools, usually in the form of self-reported questionnaires, that meet the prerequisites of reliability, validity and

Conclusion

The results of all the studies mentioned in the literature reviewed in this article support the suggestion that burn affects the HRQoL of burn survivors in many ways. However the results, such as HRQoL scores or gender influence, are not always consistent and differ among health-care facilities and patient cultures. For example some authors report satisfactory HRQoL scores for burn survivors [4], [50] while others postulate that severe impairments of HRQoL exist even after a long period [87].

Conflict of interest statement

All authors do not have any financial and personal relationships with other people or organizations that could inappropriately influence (bias) their work.

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