Early ambulation impacts on quality-of-life outcomes positively after lower limb burn injury: A group trajectory analysis
Publication Details
Evans, C.,
Hince, D.,
Tatlow, C.,
Pienaar, P.,
Truter, P.,
Wood, F.,
Bulsara, M.,
Berghuber, A.,
Gittings, P.,
&
Edgar, D.
(2024).
Early ambulation impacts on quality-of-life outcomes positively after lower limb burn injury: A group trajectory analysis.
Burns, Early View (Online First).
Abstract
Introduction: Despite the challenges of providing burn care throughout the 2.5MKm2 jurisdiction of Western Australia, early intervention after injury remains a key premise of the multidisciplinary model of care applied by the State Adult Burn Unit (SABU) team. In particular, contemporary guidelines support the facilitation of early ambulation after lower limb burn and skin grafting. Thus, this study aimed to evaluate the association between the timing of ambulation after burn and surgery on quality of life (QoL) outcomes.
Methods: Data from 1707 lower limb burn patients aged ≥ 18, admitted to the SABU between February 2011- December 2019, were included. Self-reported QoL longitudinal outcomes were assessed using the Short Form 36 and Burn Specific Health Scale Brief. Three recovery trajectories were defined according to their QoL outcome responses, mapped out to one year. Early ambulation was defined as occurring within 48 h of acute burn or surgery, as per SABU routine practice.
Results: Early ambulation was shown to have a positive association to the higher QoL trajectory group (> 75% of cohort), though not statistically significant for the Physical Component (PCS) and Mental health Component (MCS) summary scores of the SF36; however, ambulation pathway was associated with adjusted long-term BSHS-B QoL outcomes. The least favorable trajectory of long-term recovery of the physical aspects of QoL was seen in those with higher TBSA and complications and increasing age and comorbidities. In contrast, the mental health components of QoL were robust to all those factors, apart from pre-existing comorbidities.
Conclusion: Early ambulation after lower limb burn, and surgery, was positively associated with early and long-term QoL outcomes. Recovery trajectory is strongly indicated by where the patient journey begins after early acute care. The optimal physical QoL recovery trajectory was shared by those who were younger with reduced TBSA; complications; and, comorbidities whereas the mental health QoL trajectories were only impacted by comorbidities.
Keywords
burns, early ambulation, quality-of-life, Short Form 36 (SF36), Burns Specific Health Scale Brief (BSHS-B)
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