scholarly journals Interpreting Life Impact Burn Recovery Evaluation Profile Scores for Use by Clinicians, Burn Survivors, and Researchers

2020 ◽  
Author(s):  
Mary D Slavin ◽  
Colleen M Ryan ◽  
Jeffrey C Schneider ◽  
Amy Acton ◽  
Flor Amaya ◽  
...  
Keyword(s):  
Social Participation ◽  
Burn Injury ◽  
Sexual Relationships ◽  
Cut Points ◽  
Delphi Approach ◽  
Patient Reported ◽  
Burn Survivors ◽  
Life Impact ◽  
Four Levels ◽  
Different Levels

Abstract The Life Impact Burn Recovery Evaluation (LIBRE) Profile is a patient-reported outcome measure developed to assess social participation in adult burn survivors. This study identified numeric score cut-points that define different levels of social participation ability and described each level. An expert panel identified numeric score cut-points that distinguish different levels of social participation for the six LIBRE Profile domains. Methods employed an iterative, modified-Delphi approach, and bookmarking to review calibrated item banks. Analyses (using calibration sample data and repeated in a validation sample) examined means, SDs, and sample distributions for each level. Analyses of variance examined score differences between levels. The panel developed descriptions for each established level. Initial cut-points resulted in four levels for five domains (Social Activities, Social Interactions, Romantic Relationships, Sexual Relationships, and Work & Employment) and five levels for the sixth domain (Relationships with Family & Friends). Comparisons demonstrated significant differences between level mean scores for all domains (P < .05) except Relationships with Family & Friends. Based on follow-up surveys, Relationships with Family & Friends score cut-points were adjusted to identify four levels with significant score differences between all levels. Panelists reached consensus for level descriptions. Score cut-points and descriptions identify different levels of social participation, providing a relevant context for interpreting LIBRE Profile numeric scores. LIBRE Profile Social Participation levels will help clinicians and persons with burn injury interpret LIBRE Profile numeric scores and promote use of this important new assessment.

Social Participation of Burn Survivors and the General Population in Work and Employment: A Life Impact Burn Recovery Evaluation (LIBRE) Profile Study

2019 ◽  
Vol 40 (5) ◽  
pp. 669-677 ◽  
Author(s):  
Cayla J Saret ◽  
Pengsheng Ni ◽  
Molly Marino ◽  
Emily Dore ◽  
Colleen M Ryan ◽  
...  
Keyword(s):  
General Population ◽  
Posttraumatic Growth ◽  
Social Participation ◽  
Burn Injury ◽  
Response Shift ◽  
Sample Mean ◽  
Burn Survivors ◽  
Life Impact ◽  
Work Integration ◽  
Work And Employment

AbstractIntroductionWork integration and retention after burn injury is a key outcome. Little is known about how burn survivors reintegrate into the workplace. This article compares scores on the Life Impact Burn Recovery Evaluation (LIBRE) Profile, a burn-specific measure of social participation, between burn survivors and general population samples, focusing on the Work and Employment domain.MethodsConvenience samples of burn survivors and the U.S. population were obtained. Differences in demographic and clinical characteristics and LIBRE Profile scores were assessed. To examine work and employment, we compared family and friends, social activities, and social interactions scores among working vs nonworking burn survivors.ResultsSix hundred and one burn survivors (320 employed) and 2000 U.S. residents (1101 employed) were surveyed. The mean age (P = .06), distributions of sex (P = .35), and Hispanic ethnicity (P = .07) did not differ significantly. Distributions of race (P < .01) and education (P = .01) differed significantly. The burn survivor sample had higher scores, demonstrating higher participation, for work and employment (mean = 49.5, SD = 9.42) than the general sample (mean = 46.94, SD = 8.94; P < .0001), which persisted after adjusting for demographic characteristics. Scores on the three domains administered to all respondents were higher (P < .001) for working than nonworking burn survivors.ConclusionDistributions indicated higher social participation in the burn survivor sample than the general sample. Possible explanations include sample bias; resilience, posttraumatic growth, or response-shift of survivors; and limitations of using items in the general sample. Working burn survivors scored higher than those not working. Future work can explore factors that mediate higher scores and develop interventions.

833 The Importance of Trajectory Curves for the Implementation of Outcome Benchmarks in a Clinical Setting

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S254-S255
Author(s):  
Brian M Kelter ◽  
Audrey E Wolfe ◽  
Mary D Slavin ◽  
Lewis Kazis ◽  
Colleen M Ryan ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Literature Review ◽  
Social Participation ◽  
Burn Injury ◽  
Patient Specific ◽  
Clinical Settings ◽  
Patient Reported ◽  
Burn Survivors ◽  
Analytical Approaches ◽  
Over Time

Abstract Introduction The creation of individualized treatment plans that address social participation in burn survivors requires an understanding of the expected changes over time from the original burn injury. The Life Impact Burn Recovery Evaluation (LIBRE) Profile is a patient-reported outcome measure for social participation after burn injury. Visual representation of expected change over time of a population is achieved through the development of trajectory curves (TCs), serving as benchmarks for recovery. In order to optimize the implementation of LIBRE Profile TCs, a literature review was conducted to examine utilization of TCs in other clinical settings. Methods A review of studies published from 2014–2019, demonstrating TCs as growth or treatment models in clinical settings, was performed. Literature was identified by searching “trajectory curves,” “trajectory models,” and “clinic” or “clinical” in PubMed. Articles focusing on three areas of inquiry were included: 1) measuring individual patient growth; 2) comparing progress for similar patient cohorts to provide contextualized reference for personal growth; 3) predictive medicine/risk assessment for interventional care in various conditions. Results The initial literature review identified 141 manuscripts. A total of 107 were excluded and 34 manuscripts were reviewed and categorized based on the three areas of inquiry (Figure 1; Table 1). Positive results from TCs in all areas of inquiry were noted in 22 of the 34 the chosen studies. General trends for each area of inquiry include: an increased ability for parents and clinicians to track individual patient progress in what was primarily anthropometric studies; articles relating to comparative cohort tracking show that trajectory-driven analytical approaches offer displays of progress across similar clinical groups of recovery for given conditions. Use of TCs in predictive care or risk assessment typically relate to acute conditions such as asthma, traumatic brain injury, or degenerative conditions (neurocognitive or musculoskeletal). For the most part, these diagnoses depict a positive trend for clinicians to identify future outcomes using fitted trajectories. Conclusions These findings support the clinical use of trajectory curves to present patient-specific, cohort-relative, and predictive treatment for outcome-based results post-burn for burn survivors. Applicability of Research to Practice Future research will assess the use of LIBRE Profile recovery trajectories as benchmarks for optimization of social participation outcomes.

Development of the life impact burn recovery evaluation (LIBRE) profile: assessing burn survivors’ social participation

2017 ◽  
Vol 26 (10) ◽  
pp. 2851-2866 ◽  
Author(s):  
Lewis E. Kazis ◽  
Molly Marino ◽  
Pengsheng Ni ◽  
Marina Soley Bori ◽  
Flor Amaya ◽  
...  
Keyword(s):  
Social Participation ◽  
Burn Survivors ◽  
Life Impact

69 Defining Numerical Cutoff Values for Mild, Moderate, and Severe Pain in Adult Burn Survivors

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S48-S49
Author(s):  
Gretchen J Carrougher ◽  
Alyssa M Bamer ◽  
Claudia Baker ◽  
Stephanie A Mason ◽  
Barclay T Stewart ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Severe Pain ◽  
Burn Injury ◽  
Short Form ◽  
Information Criterion ◽  
Pain Interference ◽  
Cut Points ◽  
Burn Survivors ◽  
Average Pain ◽  
F Statistics

Abstract Introduction Pain is a common and often debilitating sequelae of a significant burn injury. Clinicians and researchers need clinically valid, reliable pain measures to guide treatment decisions and to provide evidence for study protocol development. Pain rating scores that represent mild, moderate, and severe pain in the burn survivor population have not been established. The aim of this study was to determine the numerical pain intensity rating scores that best represent mild, moderate, and severe pain in adult burn survivors. Methods Average pain intensity visual analog scale (VAS; 0–10) and customized PROMIS pain interference short form was administered to adult burn survivors (age ≥18) treated at a regional burn center at hospital discharge and at 6, 12, and 24-months postburn. To identify the optimal VAS scores for mild, moderate, and severe pain we computed F values and Bayesian Information Criterion (BIC) statistics associated with multiple ANOVA comparisons for mean pain interference scores by various VAS pain intensity cut points. Six possible cut points (CP) were compared: CP 3,6; CP 3,7; CP 4,6; CP 4,7; CP 2,5; and CP 3,5. For example, CP 3,6 refers to pain categorized as mild (0–3), moderate (4–6), and severe (7–10). Optimal cutoffs were those with the highest ANOVA F statistics. Models with similar F statistics were compared using changes in BIC. Results 178 participants (85% white, 65% male, mean age of 46 years) with pain intensity and interference scores at one or more timepoints comprised the study sample. The optimal classification for mild, moderate, and severe pain at baseline and 12-months was CP 2,5. Although CP 3,6 had the highest F value at 6-months, there was not strong evidence to support CP 3,6 over CP 2,5 (BIC difference: 2.9); similarly, CP 3,7 had the highest value at 24-months, but the BIC difference over CP 2,5 was minimal (2.2). Conclusions We recommend that visual analog pain intensity scores for adult burn survivors be categorized as mild (0–2), moderate (3–5), and severe (6–10). These findings advance our understanding regarding the meaning of pain intensity ratings following a burn injury and provide an objective definition for clinical management, quality improvement, and pain research.

Trajectory Curves for Purposes of Benchmarking and Predicting Clinical Outcomes: A Scoping Review

2022 ◽  
Author(s):  
Brian M Kelter ◽  
Audrey E Wolfe ◽  
Lewis E Kazis ◽  
Colleen M Ryan ◽  
Amy Acton ◽  
...  
Keyword(s):  
Social Participation ◽  
Scoping Review ◽  
Burn Injury ◽  
Clinical Settings ◽  
Effective Strategies ◽  
Patient Health Status ◽  
Patient Health ◽  
Life Impact ◽  
Pubmed Search ◽  
Future Outcomes

Abstract Trajectory curves are valuable tools to benchmark patient health status and predict future outcomes. A longitudinal study is underway to examine social participation after burn injury using the Life Impact Burn Recovery Evaluation (LIBRE) Profile with the goal of developing trajectory curves for specific domains that focus on social re-integration. We conducted a scoping review to inform and understand trajectory curves applied in clinical settings to compare outcomes for an individual to a matched cohort of comparable patients or predicted expected outcomes over time. This scoping review utilized a PubMed search from January 2014 to August 2019 for the following terms: “trajectory curves” or “trajectory models” and “clinic” or “clinical.” Only articles that specifically referenced longitudinal and clinical research designs were included in the scoping review. Articles were assessed using standard scoping review methods and categorized based on clinical application of trajectory curves for either benchmarking or prediction. The initial literature review identified 141 manuscripts and 34 met initial inclusion criteria. The reviewed articles support the clinical use of trajectory curves. Findings provide insight into several key determinants involved with the successful development and implementation of trajectory curves in clinical settings. These findings will inform efforts to use the LIBRE Profile to model social participation recovery and assist in developing effective strategies using trajectory curves to promote social reintegration after burn injury.

scholarly journals The Associations of Gender With Social Participation of Burn Survivors: A Life Impact Burn Recovery Evaluation Profile Study

2018 ◽  
Vol 39 (6) ◽  
pp. 915-922 ◽  
Author(s):  
Benjamin Levi ◽  
Casey T Kraft ◽  
Gabriel D Shapiro ◽  
Nhi-Ha T Trinh ◽  
Emily C Dore ◽  
...  
Keyword(s):  
Social Participation ◽  
Burn Survivors ◽  
Life Impact ◽  
Profile Study

119 Satisfaction with Life and Community Integration Outcomes up to 20 Years after Burn Injury

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S79-S80
Author(s):  
Callie Abouzeid ◽  
Audrey E Wolfe ◽  
Gretchen J Carrougher ◽  
Nicole S Gibran ◽  
Radha K Holavanahalli ◽  
...  
Keyword(s):  
Satisfaction With Life ◽  
Burn Injury ◽  
Community Integration ◽  
Satisfaction With Life Scale ◽  
National Database ◽  
Patient Reported ◽  
Burn Survivors ◽  
The Impact ◽  
Over Time

Abstract Introduction Among the many challenges burn survivors face, community integration is often difficult and might affect overall satisfaction with life long-term. The purpose of this study is to examine quality of life, based on life satisfaction and community integration, at long-term follow-ups in the burn population. Methods Data from the Burn Model System National Database (1997–2020) were analyzed. Patient-reported outcome measures were collected at discharge with a recall of preinjury status, and at 5, 10, 15, and 20 years after injury. The Satisfaction with Life Scale (SWLS) was used to measure participants’ satisfaction with life and the Community Integration Questionnaire (CIQ) measured level of community integration. A random intercept model was used to fit the data and generate a score trajectory with 95% confidence intervals to demonstrate the changes in scores over time and the impact of the demographic and clinical covariates on the model. SWLS trajectory is depicted in the Figure. Results The study population included 214 adult burn survivors with a mean age of 45.2 years. The population was mainly male (65.9%) and white (77.1%) with a mean burn size of 22.5% and average length of hospital stay of 34.7 days. This study found that SWLS scores decrease over time, but CIQ scores were relatively stable. The CIQ model with additional covariates were not statistically significant and did not improve the fit of the model. Conclusions Satisfaction with life was significantly worse over time. Community integration showed little or no change over the long term.

Comparison of PROMIS Anxiety and Depression, PHQ-8, and GAD-7 to screen for anxiety and depression among patients presenting for spine surgery

2019 ◽  
Vol 30 (4) ◽  
pp. 524-531
Author(s):  
Taylor E. Purvis ◽  
Brian J. Neuman ◽  
Lee H. Riley ◽  
Richard L. Skolasky
Keyword(s):  
Major Depression ◽  
Spine Surgery ◽  
Characteristic Curve ◽  
Depression Scale ◽  
Data Driven ◽  
Anxiety And Depression ◽  
Measurement Information ◽  
Generalized Anxiety ◽  
Cut Points ◽  
Patient Reported

OBJECTIVEIn this paper, the authors demonstrate to spine surgeons the prevalence and severity of anxiety and depression among patients presenting for surgery and explore the relationships between different legacy and Patient-Reported Outcomes Measurement Information System (PROMIS) screening measures.METHODSA total of 512 adult spine surgery patients at a single institution completed the 7-item Generalized Anxiety Disorder questionnaire (GAD-7), 8-item Patient Health Questionnaire (PHQ-8) depression scale, and PROMIS Anxiety and Depression computer-adaptive tests (CATs) preoperatively. Correlation coefficients were calculated between PROMIS scores and GAD-7 and PHQ-8 scores. Published reference tables were used to determine the presence of anxiety or depression using GAD-7 and PHQ-8. Sensitivity and specificity of published guidance on the PROMIS Anxiety and Depression CATs were compared. Guidance from 3 sources was compared: published GAD-7 and PHQ-8 crosswalk tables, American Psychiatric Association scales, and expert clinical consensus. Receiver operator characteristic curves were used to determine data-driven cut-points for PROMIS Anxiety and Depression. Significance was accepted as p < 0.05.RESULTSIn 512 spine surgery patients, anxiety and depression were prevalent preoperatively (5% with any anxiety, 24% with generalized anxiety screen-positive; and 54% with any depression, 24% with probable major depression). Correlations were moderately strong between PROMIS Anxiety and GAD-7 scores (r = 0.72; p < 0.001) and between PROMIS Depression and PHQ-8 scores (r = 0.74; p < 0.001). The observed correlation of the PROMIS Depression score was greater with the PHQ-8 cognitive/affective score (r = 0.766) than with the somatic score (r = 0.601) (p < 0.001). PROMIS Anxiety and Depression CATs were able to detect the presence of generalized anxiety screen-positive (sensitivity, 86.0%; specificity, 81.6%) and of probable major depression (sensitivity, 82.3%; specificity, 81.4%). Receiver operating characteristic curve analysis demonstrated data-driven cut-points for these groups.CONCLUSIONSPROMIS Anxiety and Depression CATs are reliable tools for identifying generalized anxiety screen-positive spine surgery patients and those with probable major depression.

T3 Are Burns a Chronic Condition: Examining Physical and Mental Functioning up to 20 Years After Injury

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S2-S3
Author(s):  
Callie Abouzeid ◽  
Audrey E Wolfe ◽  
Gretchen J Carrougher ◽  
Nicole S Gibran ◽  
Radha K Holavanahalli ◽  
...  
Keyword(s):  
Mental Health ◽  
Hospital Stay ◽  
National Database ◽  
Time Points ◽  
Patient Reported ◽  
Burn Survivors ◽  
Population Demographic ◽  
The Impact ◽  
Over Time

Abstract Introduction Burn survivors often face many long-term physical and psychological symptoms associated with their injury. To date, however, few studies have examined the impact of burn injuries on quality of life beyond 2 years post-injury. The purpose of this study is to examine the physical and mental well-being of burn survivors up to 20 years after injury. Methods Data from the Burn Model System National Database (1997–2020) were analyzed. Patient-reported outcome measures were collected at discharge with a recall of preinjury status, and then at 5, 10, 15, and 20 years after injury. Outcomes examined were the Physical Component Summary (PCS) and Mental Component Summary (MCS) of the Short Form-12. Trajectories were developed using linear mixed methods model with repeated measures of PCS and MCS scores over time and controlling for demographic and clinical variables. The model fitted score trajectory was generated with 95% confidence intervals to demonstrate score changes over time and associations with covariates. Results The study population included 420 adult burn survivors with a mean age of 42.4 years. The population was mainly male (66%) and white (76.4%) with a mean burn size of 21.5% and length of hospital stay of 31.3 days. Higher PCS scores were associated with follow-up time points closer to injury, shorter hospital stay, and younger age. Similarly, higher MCS scores were associated with earlier follow-up time points, shorter hospital stay, female gender, and non-perineal burns. MCS trajectories are demonstrated in the Figure. Conclusions Burn survivors’ physical and mental health worsened over time. Such a trend is different from previous reported results for mental health in the general population. Demographic and clinical predictors of recovery over time are identified.

scholarly journals 502 Adapting to COVID19: Can Virtual Burn Camp be as Impactful as Last Year’s In-person Camp?

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S98-S98
Author(s):  
Jessica Banks ◽  
Matt Ferdock ◽  
Jennifer Nagle
Keyword(s):  
Burn Injury ◽  
Summer Camp ◽  
Sense Of Self ◽  
Age Groups ◽  
Self Esteem ◽  
Summer Program ◽  
Critical Question ◽  
Camp Counselors ◽  
Positive Effects ◽  
Burn Survivors

Abstract Introduction Skin is not the only casualty following a burn accident. Many children suffer long term, debilitating emotional effects from their burn injury (Abdullah et al. 1994; Kornhaber et al. 2018). Armstrong-James et al. (2018) and Maslow and Lobato (2010) found that summer camps explicitly designed for burn survivor children can positively impact children’s adaptability to stares and comments and improve their sense of self-esteem. Camp Susquehanna has been a summer camp for burn survivors for the past 25+ years. When the COVID19 pandemic closed many businesses, we decided to transition our in-person camp to 100% online. Researchers demonstrated the positive effects of summer camp for burn survivors (Maslow & Lobato, 2010; Bakker et al. 2011). However, the effects of a 100% online camp are not known. Our concern was, are we able to transition and be as impactful as it is face to face at camp? What will the schedule and activities look like in this new format? How will we ensure all children participating will have access to online and the supplies necessary? Methods We opted to select a three-week format with two sessions a day divided into two age groups. We ensured every child had internet access then mailed out a “camp in the box.” It contained all the things needed for each planned activity. The critical question remained, however, will we be as impactful? The current research looks at quantitative and qualitative measures of self-esteem, happiness, and satisfaction following participation in a three-week summer program held in July 2020. We make comparisons to previous years’ results. The authors expected that self-esteem, happiness, and satisfaction levels matched or exceeded last years’ levels. Results We collected data from 42 campers and 22 volunteer camp counselors. Results show that campers were able to receive the support they needed, not only from the staff but also from their peers. Conclusions The delivery method was indeed different this year, but the positive effect on our campers remained the same.

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