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.

Fig 1. Flowchart outlining selection of studies.

Fig 2. Instruments used to measure health-related quality of life in >1 study.

BSHS-B = Burn Specific Health Scale—Brief, SF-36 = Medical Outcome Study Short Form—36 items, EQ-5D = EuroQol five dimensions questionnaire, BSHS = Burn Specific Health Scale, BSHS-A = Burn Specific Health Scale—Abbreviated, BSHS-R = Burn Specific Health Scale Revised, 15D = 15-dimensional health-related quality of life instrument, QLQ = Quality of Life Questionnaire, SF-12 = Medical Outcome Study Short Form—12 items, QOLS = Quality of Life Scale, WHOQOL-BREF = World Health Organization Quality of Life—BREF, YABOQ = Young Adult Burn Outcome Questionnaire.

Fig 3. Time points at which health-related quality of life in burn patients was assessed.

Note. Data on pre-burn HRQL is collected retrospectively.

Fig 4. Risk of bias assessed with four domains of the Quality in Prognostic Studies (QUIPS) risk of bias tool.

Fig 5

a. BSHS-B domain scores for six domains for seventeen studies. b. BSHS-B domain scores for three domains for seventeen studies.

Fig 6. SF-36 physical component summary scores and mental component summary scores for five studies.

The black line in the figures represents the US-norm score.

Fig 7

a. SF-36 domain scores for six dimensions for fourteen studies. The line in the figures represent the US-norm score. b. SF-36 domain scores for two dimensions for fourteen studies. The line in the figures represent the US-norm score.

Fig 8. EQ-5D scores the visual analogue scale, the EQ-5D index and five dimensions for three to five studies.

The line in the figures represent the composed norm score based on norm scores of the countries where the studies were conducted [111]. The y-axis represents 0–100% patients with no problems on a specific domain.