Quality of Life Outcomes for Burn Patients: The Aggregate Does Not Tell The Complete Story

Thursday, 16 July 2009: 4:25 PM

Linda H. Yoder, RN, MBA, PhD, AOCN, FAAN
Nursing Aministration and Healthcare Systems Management, University of Texas at Austin School of Nursing, Austin, TX
Kathryn M. Gaylord, PhD, APRN, BC
Nursing, United States Institute of Surgical Research Fort Sam Houston, TX, Fort Sam Houston, TX

Learning Objective 1: describe quality of life (QOL) issues faced by burn survivors.

Learning Objective 2: discuss the importance of examining similarities and differences of civilian and military burn survivors.

Purpose: To examine quality of life (QOL) outcomes in burn survivors post-hospitalization.
Methods: A prospective, repeated measures study examined QOL outcomes in 137 burn victims (88 civilian; 49 military).  Subjects completed the Abbreviated Burn Specific Health Scale (BSHS-A) and the Satisfaction with Life Scale (SWLS) at burn unit discharge, 3, 6, 12, and 18 months post-discharge. General linear modeling with a Greenhouse-Geisser correction was used to examine scale and subscale elements over time (p≤ .05=sig).
Results: 88 cases consisted of complete data over the 5 time periods. Most subjects were men who were married and employed at the time of their burn injury, and possessed a high school education or some college. The mean age of the civilians was 41 years, while the mean military age was 31 years. The primary burn injury cause was thermal and the mean TBSA was 17.5%. When data were analyzed in the aggregate, participants improved over time on all domains of the BSHS-A (F=48.5, p≤.0001) and SWLS scores (F=3.09, p=.02).   Both civilian and military subjects reported significantly improved QOL within groups over time on the BSHS-A (civilian F=35.73, p=.000; military F=15.47, p=.000), no significant changes were reported using the SWLS. Military subjects began with higher BSHS-A and SWLS scores than the civilians, but between 6 and 12 months military participants demonstrated a plateau or even decline in perceived QOL, while civilians continued to show improvement.
Conclusion: Discharge from the burn unit marks the beginning of a lengthy adjustment process for victims with burn injuries. Military versus civilian patients may have different expectations about their ability to rehabilitate, especially if military patients desire to remain in the military. Clearly, military patients seem to undergo some type of re-evaluation of their quality of life between 6 and 12 months. This period needs to be better understood to develop appropriate QOL interventions.