A study funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR).
According to the American Burn Association, 1 per 10,000 people will require inpatient hospitalization at a burn center every year. Studies have shown that adults with burn injuries have lower health-related quality of life compared to the general population, although it tends to improve over time. Social participation is important for a person's quality of life, but physical and psychological symptoms resulting from burn injuries can hinder their ability to participate in social activities. These symptoms can include pain and heat intolerance, and post-traumatic stress and depression, among others. Further, positive psychological adjustment, known as post-traumatic growth (PTG), may also be a factor in social participation of people with burn injuries. However, more research is needed to understand how physical and psychological well-being, as well as PTG, contribute to social participation of people with burn injuries.
In a recent NIDILRR-funded study, researchers looked at whether early physical and psychological factors at 6 and 12 months after injury predict social participation outcomes at 24 months after burn injury.
Researchers at the Boston-Harvard and Northwest Regional Burn Injury Model System Centers analyzed data from 181 individuals enrolled in the Burn Model Systems (BMS) database who were over 18 years old, less than 24 months after burn injury, and answered social participation questions collected at 24-months. Researchers examined differences between 6 and 12 months using BMS data on predictor variables: psychological symptoms of post-traumatic stress, depression, or anxiety; physical symptoms of sleep disturbance, fatigue, pain interference, and heat intolerance; PTG; and social participation. Researchers also collected data at 24 months about how comfortable they were in social interactions and in social activities. They analyzed the 6-month factors and the 12-months factors separately to assess these two social participation outcomes.
The average age of participants included in this study was 48 years, 65% were men, and 83% were White. Researchers compared the differences in psychological symptoms, physical symptoms, and PTG between 6 and 12 months:
- There were no significant differences between 6 and 12 months after burn injury in participant scores for PTG, post-traumatic stress, depression, anxiety, fatigue, or pain interference.
- Participants’ scores for sleep disturbance decreased from 6 months to 12 months after injury.
- While more participants met the criteria for PTSD at 6-months than at 12 months after injury, there were no significant differences in participant score.
- More participants reported heat intolerance at 12 months than at 6 months.
At 24 months after injury, 57% of participants reported being mildly or moderately uncomfortable in social interactions, while 66% of participants reported being mildly or moderately uncomfortable and 2% very uncomfortable in social activities. When the researchers looked at of 6-month or 12-month factors that predicted social participation outcomes, they found that:
- Higher pain interference scores at 6 months and higher PTSD scores at both 6 month and 12 months were associated with being uncomfortable in social interactions at 24 months after injury.
- Higher pain interference and depression scores at both 6 months and 12 months were associated with being uncomfortable in social activities at 24 months after injury.
- Heat intolerance at 12 months was associated with being uncomfortable in social activities at 24 months after injury.
- PTG at 6 and 12 months did not predict either social participation outcomes.
The authors noted that post-traumatic stress and depression may lead to feeling uncomfortable in or avoiding social engagement. Pain and heat interference may negatively impact social participation due to their adverse effect on social engagement involving physically activities, especially outdoors. Finally, authors noted that PTG did not predict social participation because there were no meaningful differences in level of PTG among the data collection time points in this study. Further, it may take longer than 24 months for PTG have an impact on improving social interactions and activities.
According to the authors, the findings of this study highlight the importance of promoting both the physical and psychological well-being for people with burn injuries in the early stages of their recovery for better social participation outcomes in the future. Burn care providers may want to incorporate management of pain and other physical symptoms, as well as post-traumatic stress and depression, early in recovery to support their patients in returning to social participation in the community. Researchers may also want to further explore the role of PTG and social participation in people with burn injuries, including longer follow-up periods to better understand the relationship.
To learn more:
The Boston-Harvard Burn Injury Model System Center has resources for people with burn injuries and care providers to learn about social participation and peer support.
The Model Systems Knowledge Translation Center offers individuals and practitioners a wide range of research-based information resources on burn injury, including collections focused on social interaction, resilience, PTSD, and other relevant topics.
To learn more about this study:
Deng H., Shepler, L.J., Chacon, K.L., Tenney, D., Ni, P., Stewart, B.T., Carrougher, G.J., Kowalske, K., Wolf, S.E., Slavin, M.D., Kazis, L.E., Ryan, C.M., Schneider, J.C. (2024) Predictors at 6 and 12 months for social participation outcome at 24 months in the adult burn injury population: A burn model system national database study. Archives of Physical Medicine and Rehabilitation, 105: 235-42. This article is available from the NARIC collection under Accession Number J93894.