Factors predicting health status and recovery of hand function after hand burns in the second year after hospital discharge
Introduction
Given humans’ innate action to guard their face from injury, hands are the most commonly burnt body part [1], [2] involved in more than 50% of all burns and greater than 80% of severe burns [2], [3]. Of these, dorsal (posterior) hand burns are the most common. This area of the hand involves intricate networks of tendons, bones, and connective tissues, with minimal protective subcutaneous tissue, making them prone to deep burns and complicated sequelae [4]. Despite each hand representing less than 3% of TBSA, according to the Wallace Rule of Nines, the American Burn Association classifies hand burns as major injuries benefiting from specialized treatment [5].
The challenges that burn survivors face are far more complex than the functional limitations that they may experience. Some aspects of burns, including aesthetics and decreased control of the body and environment, can lead to people experiencing decreased self-esteem, social avoidance, and anxiety about their future [6]. A prospective longitudinal mulitcentre study of 301 patients with burns found that it is common for this population to develop psychological illnesses [7]. Additionally, a history of psychiatric illness has been associated with reduced psychological functioning at 12 months after burn [8], and poorer long-term health related quality of life (HRQoL) [9]. Males are less likely than females to experience psychological issues [10].
There remains inconsistent and limited evidence of the factors affecting recovery of adults with hand burns. Several factors, such as burn depth, TBSA, and premorbid health have been found to consistently influence patient outcomes. A recent retrospective study of 378 Eastern Chinese patients found that burn depth increased the risk of undergoing surgery [11] and another 11-year retrospective study of 572 patients from Kosovo found that burn severity was associated with complications after injury, including contracture deformities and amputations [12]. Similarly, Williams et al.’s [13] prospective, longitudinal study of 52 hand burn patients reported that burns that could be managed conservatively or with Biobrane had more rapid return to active range of motion (ROM) and daily functioning (1 month), compared to ongoing difficulties with these at 12 months for patients with more severe hand burns that underwent grafting. There is, however, conflicting evidence regarding the impact on health status in the medium to long-term. For example, Öster, Willebrand [14] found that pre-burn psychological impairment was not associated with HRQoL, which is contrary to the findings reported above. There is also a general lack of research focusing on both the physical and psychological impacts of hand burns, with numerous factors yet to be thoroughly researched, including whether damage to specific hand structures results in different impacts.
This study aimed to identify factors that predict health status and hand function of people with hand burns at 12–24 months after injury. We included factors thought to influence outcome hand burns, such as specific hand structures affected, patient co-morbidities, insurance status, time to hospitalization, types of grafting, and the timing of occupational therapy (including hand therapy) interventions.
Section snippets
Setting
This study was conducted at the Victorian Adult Burns Service (VABS), a state-wide adult burns service located at the Alfred Hospital. The VABS is a 300-bed university affiliated tertiary referral centre in Melbourne, Victoria, Australia. Victoria has a population of approximately 5.91 million people, and approximately 98% of all severely injured adult burn patients in the state are managed at the VABS.
Ethics
Approval was obtained from University and Hospital Human Research Ethics Committees.
Study design and inclusion criteria
Patients
Participant demographics, injury factors, and treatment factors
Of the 148 eligible past patients, we had no current phone or address details for 55 and another one was deceased, giving us a total possible sample of 92. Of these, 26 declined and 41 returned full datasets giving us a 44.5% response rate. Demographic and injury characteristics are presented in Table 1; treatment characteristics are in Table 2.
Outcome measure scores
The mean BSHS-B total score was 136.64(±26.01) out of a maximum possible score of 160. The lowest scoring domain was Heat Sensitivity, with an overall
Discussion
This study explored the demographic, injury and treatment variables that predict worse outcome in health status and hand function of patients with burns to one or both hands at 12–24 months after burn.
Conclusions
Our findings show that there are demographic, injury, and treatment factors that predict recovery in the second year after hand burns, and therefore, it is vital to consider all three aspects to determine the optimal treatment pathway. The major findings from this study suggest that women and those with a history of psychiatric illness are particularly vulnerable to poorer outcomes in health status and/or hand function, and are likely to benefit from greater rehabilitation support and long-term
Conflict of interest
None.
Acknowledgements
Thank you to all past patients of the Victorian Adult Burns Service for the time they donated to this study through completing the outcome measure surveys. Thank you to Miss Heather Cleland, Director of the Victorian Adult Burns Service, for her contribution to the study design. Thank you to The Alfred's consulting biostatistician, Eldho Paul, from the Monash University Department of Epidemiology and Preventive Medicine and Stuart Lee from the Monash Alfred Psychiatry Research Centre for their
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2022, BurnsCitation Excerpt :As a result, assessment of hand function recovery became priorities in both rehabilitation settings and research to know what deficits excite in the hand, detecting changes over time, identifying the pattern of hand recovery, and providing information about the effectiveness of clinical interventions, and rehabilitation programs, as well as the cost-effectiveness of the healthcare services [2,8–10]. Several published studies from industrialized countries used several outcomes measures to capture function recovery after a pediatric hand burn at a specified time point [11–15] However, there is no universal standard battery used (5). None of them compared the findings with normal healthy children, and limited researches were conducted about factors that influence this recovery [13–15].
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2020, Cooper's Fundamentals of Hand Therapy: Clinical Reasoning and Treatment Guidelines for Common Diagnoses of the Upper ExtremityFactors Affecting Employment After Burn Injury in the United States: A Burn Model System National Database Investigation
2020, Archives of Physical Medicine and RehabilitationCitation Excerpt :For every 10 days of inpatient hospitalization, individuals were 14% less likely to find employment after injury at 12 months (data from the entire group analysis). This finding corroborates other reports2,11,16,18,20,23,26,29,33 and suggests that longer hospitalization may be a surrogate for either severity of injury or a complicated psychosocial situation at hospital discharge. Women also had lower odds of being employed at 12 months after burn injury.