Functional Outcome after Burn Injury

Autor: Yu-FangHwang, 黃于芳
Rok vydání: 2014
Druh dokumentu: 學位論文 ; thesis
Popis: 102
This dissertation concerns the functional outcome after burn injury. The main contents can be divided into four parts: (1) the investigation on the effectiveness of web space pressure inserts for post-burn dorsal slant, (2) the study on the factors related to return to work and work modification in patients with hand burns, (3) the validation of a Taiwanese version of the Burn Specific Health Scale-Brief, and (4) the quality of life after burn injury. Web space scar formation not only faces burn patients with cosmetic issues, but it also may result in hand dysfunction. The web space pressure insert has been one of the treatment modalities for post-burn dorsal slant. To investigate the effectiveness of the modality, an individualized custom-made web space pressure insert was fitted into each web space. Inserts were worn underneath the pressure glove to create additional pressure on each web space and to inhibit distal migration of the scar to avoid the increase in the angle of the dorsal slant of the web space. Twenty-four survivors with 36 burned hands, who had been treated in the burn clinic of National Cheng Kung University Hospital, were recruited for this study. When skin wounds were closed, the participants received custom-made web space pressure inserts. The dorsal slant of each web space was measured by a conventional goniometer every time the participants visited the burn clinic. The initial and final measurements were used to compare the change in the angle of the dorsal slant of the web space. Paired t-tests were computed to determine the effectiveness of pressure inserts. The final dorsal slant angle of each web space was also compared with the unburned value by independent t-test. After 234.6  177.0 days of intervention, the mean dorsal slants of 36 dorsal burn hands’ four web spaces were all significantly reduced (P 〈 0.001). The most important finding was that the angle of the first dorsal slant could be improved to normal. A custom-made web space pressure insert could be used to improve postburn dorsal slant. Return to work is an important functional outcome for patients suffering from hand burn injury. To study the factors related to return to work and work modification in patients with hand burns, we collected demographic and burn-related data from patient charts and analyzed it to determine the work status of former patients with burned hands and what influenced their returning to work. From 284 former patients with burns, we screened 159 with burned hands, 108 of whom were interviewed through the telephone about their work status. We used logistic regression analysis to analyze factors for having work, returning to work, the length of time required to return to work, and job modifications. We found that (1) having preburn employment increased the likelihood of having postburn employment; (2) being the primary wage earner in a family increased the likelihood of having work and of a return to work postburn; (3) a longer stay in the hospital, and burn injuries on both hands and trunk increased the time required to return to work; and (4) being older and having a smaller percentage of total body burn area decreased the likelihood of returning to a job modified because of a burn injury. Returning to work was affected not only by burn-related factors but also by general demographic and employment factors. We urge occupational therapy departments to include a return-to-work program in their routine services to improve the chances of patients with hand burns to return to work. We strongly recommend that a multicenter prospective study of hand-burn injuries should be performed. Quality of life (QoL) has been regarded as a subjective measure of functional outcome for burn survivors. The Burn Specific Health Scale (BSHS) was designed to determine QoL among burn survivors. For the validation of a Taiwanese version of the Burn Specific Health Scale-Brief (BSHS-B-Taiwanese), we translated the brief version of the Burn Specific Health Scale (BSHS-B) into traditional Chinese (Taiwanese) and to evaluate its psychometric properties in order to measure quality of life of burn patients in Taiwan. The BSHS-B-Taiwanese was translated and reviewed by an expert committee. Patients were invited to participate in this study while they visited the outpatient burn clinic. Another one hundred and eight burn patients participated in this study by filling out the BSHS-B-Taiwanese and SF-36 Taiwanese version. Forty-one of 108 patients completed a retest on the BSHS-B-Taiwanese. A ceiling effect was found for psychosocial functioning and all domains of the BSHS-B-Taiwanese. Internal consistency shown by Cronbach’s alpha was all above 0.70 except for the interpersonal relationships domain. Of these, Cronbach’s alpha  0.9 was found in the work, heat sensitivity and body image domains. Test-retest reliabilities ranged from 0.74 to 0.93 except for the simple activity domain. As for the criterion validity, most of the BSHS-B-Taiwanese version was shown to have fair to moderate correlations with the SF-36-Taiwanese in corresponding domains. The discriminant validity of the BSHS-B-Taiwanese was demonstrated by significant score differences in several domains between subgroups of different severity regarding length of hospital stay and TBSA. Our finding suggests that the BSHS-B-Taiwanese is generally reliable and valid. A shorter version of BSHS-B-Taiwanese together with a generic instrument, such as SF-36, can be used to measure the QoL of burn patients in Taiwan. Although the BSHS-B-Taiwanese is intended to reflect the impact of burn injury on the QoL, the results derived from this instrument cannot be generalized for comparison with the general population or other conditions. The SF-36 is a generic outcome measure designed for a board range of population and allows comparison to be made. To capture the full pictures of the QoL post-burn, we report data from the use of the BSHS-B-Taiwanese and the SF-36-Taiwanese.Also, a comparison with norm was made by SF-36. The findings showed that our patients adapted well after their burn injury in most of domains of the BSHS-B-Taiwanese. However, burn-related and work domains were found to be lower than 0.8. There were 3 domains in Physical Composite Scale (PCS), and 1 domain in Mental Composite Scale (MCS) lower than SF-36-Taiwanese norm. This indicated the physical function was still affected to some extent by burn injury, even many years post burn. The process of recovery post-burn has involved a complex interaction among psychological, social and physical factors. Understanding the factors does help burn professionals to identify priorities and goal of burn care. The BSHS-B-Taiwanese has been constructed to describe l quality of life after burn injury Future study will attempt to identify which factors predict quality of life after burn injury measured by BSHS-B-Taiwanese.
Databáze: Networked Digital Library of Theses & Dissertations
Externí odkaz: