Abstract
Introduction
For patients with severe burns, the emphasis has shifted from survival to maximizing functional outcomes. Outcome measures are tools that help establish a baseline status and monitor progression towards meaningful tasks such as activities of daily living (ADLs) and mobility (Staley et al. 1996). The goal of this retrospective study is to describe the use of functional outcome measures in burn patients in an outpatient setting using standardized measures.
Methods
A retrospective chart review of burn patients seen in the outpatient burn clinic between February 1, 2017 and May 31, 2019 was conducted. Only patients seen for burn injury, treated as outpatients, and with functional outcome measures recorded were included in the study. Pertinent demographic and clinical data were collected as well as outcome measures. All patients had grip strength dynamometry performed. Patients with upper extremity and lower extremity burns were administered the The Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and Lower Extremity Functional Scale (LEFS). Return to work data was also collected if the patient was employed at baseline.
Results
A total of 113 out patients were included in the analysis. Mean age was 43 years (20–88 years) with a mean TBSA of 6.1% (0.1 -67%). The mean number of OT and PT visits in the clinic were both 1.4. Initial grip strength measurements were obtained in 67 patients at a mean of post burn day (PBD) 33 and an average grip strength of 21.29 kg (right) and 26.8 kg (left). Follow up grip strength measurements were obtained in 45 patients on mean PBD 43 with right hand 49.98 kg and left hand of 51.28 kg. Initial QuickDASH was administered to 89 patients on PBD 47 with a mean percent disability of 48.72 (0–100). Second QuickDASH was given to 45 patients on PBD 68 with a mean percent disability score of 37.01 (0 – 95.45) - Initial LEFS was given to 77 patients mean PBD 61 with a mean % of maximal function score of 44%. Second LEFS was given to 40 patients mean PBD 71 with a mean % maximal function score of 58%. Mean return to work for the 46 patients who were employed was 53.6 days post burn.
Conclusions
Positive improvements were shown in grip strength and lower extremity function, but a decline in function was demonstrated for upper extremity function. This decline may be the result of a nearly 50% attrition rate on follow up QuickDASH measures due to discharge of highly functional individuals, meaning the remaining upper extremity burn patients had more severe injuries and dysfunction.
Applicability of Research to Practice
Ongoing research is needed to identify the best timing of outcome measures and how to best incorporate this information into burn treatment plans.
Responsiveness of self-report and therapist-rated upper extremity structural impairment and functional outcome measures in early rheumatoid arthritis
