Health-related quality of life outcomes and recovery trajectories following burn injury

Abstract

Background: Assessing generic health-related quality of life in patients with burn injuries is increasingly common, yet previous studies have focused on specific timepoints in isolation rather than looking at the recovery trajectory for patients over time. This study aimed to: (i) describe the health status of burn patients over a one-year follow-up period, (ii) identify factors associated with recovery trajectories, and (iii) establish whether health-related recovery trajectories differ by key patient and injury characteristics.

Methods: We followed 441 patients who sustained a burn injury between January and December 2021. Follow-up data were obtained through telephone interview and/or online self-completion at three, six, and 12 months postinjury. The 5-Level EuroQoL 5 Dimensions Questionnaire (EQ-5D-5L) was collected as a measure of health-related quality of life, and multinomial logistic regression modelling was used to identify characteristics associated with recovery trajectories in each of the EQ-5D-5L dimensions.

Results: Three hundred and forty-four patients (88 %) completed at least two follow-ups. The proportion of patients reporting no problems in each of the EQ-5D-5L items increased over time, and the majority of patients presented as "problem-free" (ranging from 43.9 % for the pain or discomfort item to 77.0 % for the usual care item). Having a deep dermal or full-thickness burn or a pre-existing mental health, alcohol, or other drug condition were most commonly associated with a patient belonging to a sub-optimal recovery trajectory. For example, this study confirmed patients with deep dermal or full-thickness burns had a greater risk of having persistent problems compared to patients with superficial or mid-dermal burns for each EQ-5D-5L domain: mobility (adjusted relative risk ratio [95 % confidence interval] 4.91 [2.16-11.15]), self-care (4.14 [1.40-12.27]), usual activities (4.76 [2.04-11.07]), pain or discomfort (3.75 [1.87-7.52]), and anxiety or depression (2.76 [1.34-5.69]).

Conclusions: The current findings highlight that regardless of burn severity, survivors can still experience challenges with their recovery throughout the first 12 months following injury. These findings may help healthcare practitioners identify patients at risk of poorer outcomes, allowing for personalised recovery and rehabilitation plans to be designed and implemented to optimise care and return to function.

Keywords: Burns; Follow-up; Mental health; Mobility; Pain; Quality of life; Recovery.