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Return to Work and Health-related Quality of Life after Severe Burn
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience. (psykiatri)
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

A major burn is one of the most severe traumas a person can experience, and recovery can be a protracted process. The principal aim was to increase the knowledge base regarding factors related to return to work and health-related quality of life (HRQoL) after burns. Patients treated at the Uppsala Burn Center between 2000 and 2007 were included on a consecutive basis. Assessments were made at hospitalization, and thereafter and included a home visit 2 to 7 years after injury.

The psychometric properties of the generic HRQoL instrument EQ-5D were investigated. The results support the use of EQ-5D as an adjunct to burn-specific assessments of HRQoL. Most former patients exhibited a good HRQoL at 2 to 7 years postburn. Not working at the time of injury and having PTSD at 12 months, as well as having low scores on the EQ VAS at 12 months, were related to a worse EQ VAS score at 2 to 7 years after injury.

The majority of former patients had returned to work 2 to 7 years postburn. Time to return to work was predicted by length of hospital stay and a personality disorder diagnosis. Predictors for not returning to work were length of stay and having any anxiety or substance use disorder prior to injury. Those who were not back at work reported lower generic and burn-specific health, and exhibited more psychiatric morbidity at follow-up than those who were working. The latter group exhibited HRQoL that was comparable to that of the general population. Participants emphasized their own psychological resources and capabilities as facilitators in the process of returning to active work.

The findings suggest that an early and systematic approach for assessing recognized risk factors enhances the possibility of discovering patients at risk of developing problems during postburn adaptation.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2010. , p. 62
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 614
Keywords [en]
Burn, Return to work, Health-related quality of life, Outcome assessment, Rehabilitation, Injuries, Psychiatric Disorders, Personality Disorder
National Category
Psychiatry
Research subject
Psychiatry
Identifiers
URN: urn:nbn:se:uu:diva-132454ISBN: 978-91-554-7929-9 (print)OAI: oai:DiVA.org:uu-132454DiVA, id: diva2:359119
Public defence
2010-12-10, Enghoffsalen, Entrance 50, Akademiska sjukhuset, Uppsala, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2010-11-15 Created: 2010-10-20 Last updated: 2011-01-13
List of papers
1. Validation of the EQ-5D questionnaire in burn injured adults
Open this publication in new window or tab >>Validation of the EQ-5D questionnaire in burn injured adults
Show others...
2009 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 35, no 5, p. 723-732Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Health-related quality of life (HRQoL) is an important aspect of adaptation after burn. The EQ-5D is a standardized generic instrument for assessing HRQoL. Its psychometric properties in a group of burn injured individuals are, however, not known.

METHODS: Seventy-eight consecutive patients admitted to a burn unit were included in a prospective longitudinal study. The participants completed the EQ-5D during acute care, and at 3, 6, and 12 months after the burn. At 6 and 12 months after the burn they also completed the Short-Form 36 Health Survey (SF-36) and the Burn Specific Health Scale-Brief (BSHS-B).

RESULTS: High feasibility of the EQ-5D was demonstrated through a high response rate and a low proportion of missing or invalid answers. The floor and ceiling effects were small. Construct validity was demonstrated through good differentiation between health states and good discrimination of health states over time. The EQ-5D was associated with burn severity and discriminated between clinical subgroups in an expected manner. Criterion validity was demonstrated through significant correlations between the EQ-5D and subscales of the SF-36 and the BSHS-B.

CONCLUSIONS: The EQ-5D has good psychometric properties, it is short and easy to administer and thus useful in assessment of HRQoL after burn.

Keywords
Psychometrics, EQ-5D, Health-related quality of life, Burn injury, Outcome assessment
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-122802 (URN)10.1016/j.burns.2008.11.007 (DOI)000268065200016 ()19297100 (PubMedID)
Available from: 2010-04-20 Created: 2010-04-20 Last updated: 2017-12-12Bibliographically approved
2. Health-related quality of life 2 years to 7 years after a severe burn
Open this publication in new window or tab >>Health-related quality of life 2 years to 7 years after a severe burn
2011 (English)In: Journal of Trauma, ISSN 0022-5282, E-ISSN 1529-8809, Vol. 71, no 5, p. 1435-1441Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Knowledge concerning the trajectory andpredictors of health-related quality of life (HRQoL) years after burninjury is fragmentary and these factors were therefore assessed usingthe EQ-5D questionnaire.

METHODS:

Consecutive adult burnpatients were included during hospitalization and assessed at 3 months, 6months, and 12 months. In addition, an interview was performed at 2years to 7 years postburn. Data concerning injury characteristics,sociodemographic variables, psychiatric disorders, and HRQoL wereobtained.

RESULTS:

The EQ-5D dimension Mobility improvedbetween hospitalization and 3 months, while Anxiety/Depression improvedbetween 12 months and 2 years to 7 years. Other dimensions improvedgradually. At 2 years to 7 years, only the dimensions Pain/Discomfortand Usual activities were lower than in the general population. Inaddition, overall HRQoL was lower than in the general population whenmeasured by EQ VAS but not by EQ-5D index. EQ-5D index at 2 years to 7years was predicted by EQ-5D index at 12 months and concurrent workstatus and pain. EQ VAS at 2 years to 7 years was predicted by previousassessments of work status, posttraumatic stress disorder and EQ VAS,and concurrent work status and substance abuse. Total amount ofexplained variance ranged between 17% and 57%.

CONCLUSIONS:

HRQoLafter burn is conveniently screened by EQ VAS. Impairment after 2 yearsto 7 years is mainly reflected in the EQ dimensions Pain/Discomfort andUsual activities and can be predicted in part by information availablebefore or at 12 months.

Keywords
Return to work, Burn injury, Health-Related Quality of Life, EQ-5D
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-132450 (URN)10.1097/TA.0b013e318208fc74 (DOI)000297118600066 ()21399545 (PubMedID)
Available from: 2010-10-20 Created: 2010-10-20 Last updated: 2017-12-12
3. Return to work after burn: a prospective study
Open this publication in new window or tab >>Return to work after burn: a prospective study
2011 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 37, no 7, p. 1117-1124Article in journal (Refereed) Published
Abstract [en]

Return to work (RTW) is one of the most important objectives to strive for in burn rehabilitation. Most individuals do return to work after burn but there is a subgroup that does not. Prospective long-time follow-up studies focusing on RTW after burn are scarce. Consecutive adult burn patients employed before injury (n = 58) were included in the present study during hospitalization and subsequently followed up for 12 months. In addition, a structured interview was performed at 2-7 years after burn. At that time; mean 4.5 years (SD 2.0) after burn; 67% of the participants had returned to their work. Predictive variables for time to RTW were length of stay (LOS) at the burn center and fulfilling criteria for Any personality disorder. No RTW was predicted by LOS and having Any anxiety disorder or Any substance use disorder prior to the burn. The non-working group reported lower generic (EQ-5D) and burn-specific (BSHS-B) HRQoL than the working group at every time point. Identification of risk factors associated with difficulties in RTW is required in order to execute individualized vocational rehabilitation.

Keywords
Return to work, vocational rehabilitation, Burn injury, EQ-5D, BSHS-B, HRQoL
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-132452 (URN)10.1016/j.burns.2011.05.019 (DOI)000296075600004 ()
Available from: 2010-10-20 Created: 2010-10-20 Last updated: 2017-12-12Bibliographically approved
4. Return to Work After Burn Injury: Burn-Injured Individuals' Perception of Barriers and Facilitators
Open this publication in new window or tab >>Return to Work After Burn Injury: Burn-Injured Individuals' Perception of Barriers and Facilitators
2010 (English)In: Journal of burn care & research : official publication of the American Burn Association, ISSN 1559-0488, Vol. 31, no 4, p. 540-550Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to explore burn-injured individuals' perception of factors seen as facilitators or barriers in the process of returning to work after a severe burn injury. Semistructured interviews were prospectively conducted with 39 former burn injury patients, admitted to the Uppsala Burn Center between March 2000 and March 2007. The participants were employed or studying at the time of injury and were interviewed on average 4.6 years after the burn. The interview data were analyzed with qualitative content analysis. Factors acknowledged by the participants as facilitators and barriers to return to work (RTW) were identified and sorted into five categories: the Individual, Social Life, Health Care and Rehabilitation, the Workplace, and Social Welfare Agencies. Facilitators were perceived to a great extent as individual characteristics, such as own ability to take action, setting up goals in rehabilitation, having willpower, being persistent, and learning to live with impairments. The possibility of getting modified work tasks or a change of workplace, when having physical or psychological impairments, was also seen as facilitating factors. Some barriers experienced as delaying RTW were difficulties when ceasing pain medication, limited knowledge of wound care at primary health care facilities, lack of individualized rehabilitation plans, and lack of psychological support during rehabilitation. Former burn injury patients emphasized psychological resources and capabilities as facilitators in the RTW process. The need in rehabilitation for a coordinator and for assessment of work capacity, and not solely a focus on impairments, is discussed.

Keywords
Return to work, burn injury, content analysis
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-132449 (URN)10.1097/BCR.0b013e3181e4d692 (DOI)000279638400004 ()20616648 (PubMedID)
Available from: 2010-10-20 Created: 2010-10-20 Last updated: 2011-11-08Bibliographically approved

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