Recovery of health-related quality of life after burn injuries: An individual participant data meta-analysis


Autoři: Inge Spronk aff001;  Nancy E. E. Van Loey aff004;  Charlie Sewalt aff001;  Daan Nieboer aff001;  Babette Renneberg aff006;  Asgjerd Litleré Moi aff007;  Caisa Oster aff009;  Lotti Orwelius aff010;  Margriet E. van Baar aff001;  Suzanne Polinder aff001
Působiště autorů: Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, The Netherlands aff001;  Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands aff002;  Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, Netherlands aff003;  Association of Dutch Burn Centres, Department Behavioural Research, Beverwijk, the Netherlands aff004;  Utrecht University, Department Clinical Psychology, Utrecht, the Netherlands aff005;  Freie Universität Berlin, Department of Clinical Psychology and Psychotherapy, Berlin, Germany aff006;  Western Norway University of Applied Sciences, Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Bergen, Norway aff007;  National Burn Centre, Haukeland University Hospital, Department of Plastic, Hand and Reconstructive Surgery, Bergen, Norway aff008;  Uppsala University, Department of Neuroscience, Psychiatry, Sweden aff009;  Linköping University, Department of Anaesthesiology and Intensive Care, and Department of Clinical and Experimental Medicine, Linköping, Sweden aff010
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
prolekare.web.journal.doi_sk: 10.1371/journal.pone.0226653

Souhrn

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.

Klíčová slova:

Burn management – Burns – Etiology – Hospitals – Patients – Quality of life – Surgical and invasive medical procedures – Young adults


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