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Health related quality of life in adults after burn injuries: A systematic review.

ABSTRACT: OBJECTIVES:Measurement of health-related quality of life (HRQL) is essential to qualify the subjective burden of burns in survivors. We performed a systematic review of HRQL studies in adult burn patients to evaluate study design, instruments used, methodological quality, and recovery patterns. METHODS:A systematic review was performed. Relevant databases were searched from the earliest record until October 2016. Studies examining HRQL in adults after burn injuries were included. Risk of bias was scored using the Quality in Prognostic Studies tool. RESULTS:Twenty different HRQL instruments were used among the 94 included studies. The Burn Specific Health Scale-Brief (BSHS-B) (46%), the Short Form-36 (SF-36) (42%) and the EuroQol questionnaire (EQ-5D) (9%) were most often applied. Most domains, both mentally and physically orientated, were affected shortly after burns but improved over time. The lowest scores were reported for the domains 'work' and 'heat sensitivity' (BSHS-B), 'bodily pain', 'physical role limitations' (SF-36), and 'pain/discomfort' (EQ-5D) in the short-term and for 'work' and 'heat sensitivity', 'emotional functioning' (SF-36), 'physical functioning' and 'pain/discomfort' in the long-term. Risk of bias was generally low in outcome measurement and high in study attrition. CONCLUSION:Consensus on preferred validated methodologies of HRQL measurement in burn patients would facilitate comparability across studies, resulting in improved insights in recovery patterns and better estimates of HRQL after burns. We recommend to develop a guideline on the measurement of HRQL in burns. Five domains representing a variety of topics had low scores in the long-term and require special attention in the aftermath of burns.

SUBMITTER: Spronk I

PROVIDER: S-EPMC5967732 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Health related quality of life in adults after burn injuries: A systematic review.

Spronk Inge I Legemate Catherine C Oen Irma I van Loey Nancy N Polinder Suzanne S van Baar Margriet M

PloS one 20180524 5

<h4>Objectives</h4>Measurement of health-related quality of life (HRQL) is essential to qualify the subjective burden of burns in survivors. We performed a systematic review of HRQL studies in adult burn patients to evaluate study design, instruments used, methodological quality, and recovery patterns.<h4>Methods</h4>A systematic review was performed. Relevant databases were searched from the earliest record until October 2016. Studies examining HRQL in adults after burn injuries were included. ...[more]

PMID: 29795616

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Project description:BACKGROUND:A prominent outcome measure within burn care is health related quality of life (HRQL). Until now, no model for long-term recovery of HRQL exists for adult burn patients which requires large samples with repeated measurements. Re-use and the combination of existing data is a way to achieve larger data samples that enable the estimation of long-term recovery models. The aim of this secondary data analysis was to assess the recovery of HRQL after a burn injury over time. METHODS AND FINDINGS:Data from ten European studies on generic HRQL assessed in adult burn patients (either with the EQ-5D or SF-36) from five different countries were merged into one dataset. SF-36 outcomes were transformed into EQ-5D outcomes. A 24-month recovery of HRQL (EQ-5D utility) was modeled using a linear mixed-effects model and adjusted for important patient and burn characteristics. Subgroups of patients with mild and intermediate burns (?20% total body surface area (TBSA) burned) and with major burns (>20% TBSA burned) were compared. The combined database included 1687 patients with a mean age of 43 (SD 15) years and a median %TBSA burned of 9% (IQR 4-18). There was large improvement in HRQL up to six months after burns, and HRQL remained relatively stable afterwards (studied up to 24 months post burn). However, the estimated EQ-5D utility scores remained below the norm scores of the general population. In this large sample, females, patients with a long hospital stay and patients with major burns had a delayed and worse recovery. The proportion of patients that reported problems for the EQ-5D dimensions ranged from 100% (pain/discomfort at baseline in patients with major burns) to 10% (self-care ?3 months after injury in patients with mild and intermediate burns). After 24 months, both subgroups of burn patients did not reach the level of the general population in the dimensions pain/discomfort and anxiety/depression, and patients with major burns in the dimension usual activities. A main limitation of the study includes that the variables in the model were limited to age, gender, %TBSA, LOS and time since burn as these were the only variables available in all datasets. CONCLUSIONS:The 24-month recovery model can be used in clinical practice to inform patients on expected HRQL outcomes and provide clinicians insights into the expected recovery of HRQL. In this way, a delayed recovery can be recognized in an early stage and timely interventions can be started in order to improve patient outcomes. However, external validation of the developed model is needed before implementation into clinical practice. Furthermore, our study showed the benefit of secondary data usage within the field of burns.

Project description:BackgroundObstetric brachial plexus injuries (OBPIs) are rare but can have significant implications for those affected, their caregivers and the health system. Symptoms can range from restricted movement to complete paralysis of the arm. We investigated health-related quality of life in adults with OBPIs and parents of children with permanent OBPIs, compared these with population norms, and investigated whether certain socio-demographic or clinical factors were associated with the quality of life in these cohorts.MethodsA cross-sectional study examined 50 affected adults and 78 parents. Participants completed EQ-5D-5 L and characteristics questionnaires. EQ-5D-5 L responses were mapped onto an EQ-5D-3 L value set to generate utility scores. Mean utility scores were compared with English population norms. Univariable and multivariable linear regression models were conducted to assess for associations between participant characteristics and the utility scores.ResultsThe overall mean utility scores for affected adults and parents were 0.56 (SD 0.28) and 0.80 (SD 0.19) respectively. Affected adults (95% CI (-?0.38, -?0.22), p?<?0.001) and parents of children with permanent OBPIs (95% CI (-?0.10, -?0.02), p?=?0.007) had lower mean utility scores, and therefore quality of life, compared to English population norms. For affected adults, previous OBPI surgery (95% CI (0.01, 0.25), p?=?0.040), employment in non-manual work (95% CI (0.06, 0.30), p?=?0.005) and having a partner (95% CI (0.04, 0.25), p?=?0.009) appeared to be positively associated with the utility score. Affected adults receiving disability benefits related to OBPIs appeared to have worse utility scores than those not receiving any disability benefits (95% CI (-?0.31, -?0.06), p?=?0.005). For parents, employment was associated with better utility scores (95% CI (0.02, 0.20), p?=?0.024) but the presence of one or more medical condition appeared to be associated with worse utility scores (95% CI (-?0.16, -?0.04), p?=?0.001).ConclusionsAdults with OBPIs and parents of children with permanent OBPIs reported worse utility scores, and therefore quality of life, compared to the English general population. We also identified certain characteristics as possible factors to consider when dealing with utility scores in these cohorts. The utility scores in this study can be used in future economic evaluations related to OBPIs.

Project description:Poor health-related quality-of-life (HRQOL) is a significant public health issue while the use of meditative movement therapies has been increasing. The purpose of this investigation was to carry out a systematic review of previous meta-analyses that examined the effects of meditative movement therapies (yoga, tai chi and qigong) on HRQOL in adults. Previous meta-analyses of randomized controlled trials published up through February, 2014 were included by searching nine electronic databases and cross-referencing. Dual-selection and data abstraction occurred. The Assessment of Multiple Systematic Reviews Instrument (AMSTAR) was used to assess methodological quality. Standardized mean differences that were pooled using random-effects models were included. In addition, 95% prediction intervals were calculated as well as the number needed-to-treat and percentile improvements. Of the 510 citations screened, 10 meta-analyses representing a median of 3 standardized mean differences in 82 to 528 participants (median = 270) with breast cancer, schizophrenia, low back pain, heart failure and diabetes, were included. Median methodological quality was 70%. Median length, frequency and duration of the meditative movement therapies were 12 weeks, 3 times per week, for 71 minutes per session. The majority of results (78.9%) favored statistically significant improvements (non-overlapping 95% confidence intervals) in HRQOL, with standardized mean differences ranging from 0.18 to 2.28. More than half of the results yielded statistically significant heterogeneity (Q ? 0.10) and large or very large inconsistency (I2 ? 50%). All 95% prediction intervals included zero. The number-needed-to-treat ranged from 2 to 10 while percentile improvements ranged from 9.9 to 48.9. The results of this study suggest that meditative movement therapies may improve HRQOL in adults with selected conditions. However, a need exists for a large, more inclusive meta-analysis (PROSPERO Registration #CRD42014014576).

Dataset Information

Health related quality of life in adults after burn injuries: A systematic review.

Publications

Health related quality of life in adults after burn injuries: A systematic review.

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