Evaluation of an ICF-based rehabilitation-concept thermal injuries

Status:

completed 06/2022

Aims:

Severe burn injuries can have devastating effects on all aspects of everyday life. Rehabilitation treatment aims to minimize the impact of the injury and to improve patients possibilities of participation in everyday life. Despite the high significance of rehabilitation treatment referred to by clinicians as well as researchers up to date there is a lack of reports of comprehensive evaluation studies in this field. Therefore aim of the present study is to evaluate the effectiveness and efficiency of the ICF based rehabilitation concepts for thermal injuries at two rehabilitation centers. Afterwards an evaluated and standardized treatment program after thermal injuries should be available for other clinics.

Activities/Methods:

The study was a clinical prospective cohort trial, which was undertaken at two rehabilitation centers. Only patients after thermal injuries who are insured by workers compensation were included. Of the n=103 included patients only four are female. Patients are on average 44 Years old (IQR 35-56) with a mean total body surface area of 14.55% (IQR 5.75-25). Outcome measures were chosen along the International Classification of Functioning, Disability and Health (ICF) concept. For the domain Body Function and Structure the physical functioning scale of the Short Form Health Survey SF-36 was chosen as primary outcome beside secondary outcome measures such as fitness, range of motion, grip strength etc. For the domain Participation the mental functioning scale of the SF-36 was used as primary outcome beside other secondary measures such as return to work. For Contextual factors the subscale Affect and Relations of the Burn Specific Health Scale (BSHS-B) was chosen as primary outcome measurement beside secondary outcome measurements such as scales measuring social support (Freiburg Social Support Questionnaire FsozU), global (Symptom Checklist-9 SCL-9) and posttraumatic psychological distress (Impact of Event Scale-Revised IES-R). Measurements took place at admission and discharge and at follow up 3 and 12 months after discharge. Analyzing the data included pre-post comparison of the outcome measures as well as a non-inferiority testing between the two rehabilitation centers. Further the rehabilitation process was analyzed regarding patients rehabilitation goals, goal attainment, number of goal changes and patients contentment with rehabilitation treatment.

Results:

In both rehabilitation centers patients’ outcomes are considerably improved directly after rehabilitation treatment as well as in the long term follow up. Regarding the ICF domain Body Functions and Structure patients’ ratings of the physical functioning scale of the SF-36 are significantly increased (p<.000), furthermore objective measurements such as grip strength, muscular strength, range of motion are improved as well. Ratings of mental functioning (SF-36) were also slightly improved after rehabilitation treatment. However this did not last until the follow-up visits (p = 0.204). Regarding the ICF domain Participation patients are after rehabilitation treatment improved on the subscale Affect and Relations of the BSHS-B (0.013). Furthermore, after one year 73.6% of the sample are able to work again and another 10.3% are proceeding stepwise to return to work. Patients were highly satisfied with the rehabilitation treatment and patient ratings regarding goal attainment are demonstrating a satisfying outcome. Most patient goals are applying to the ICF domain Body Function and Structure (66.8%), followed by the domain Participation (33.8%). At both rehabilitation centers patients profit well from the treatment, showing improved quality of life and body functions after rehabilitation treatment. Thus, proving the effectivity of the ICF based rehabilitation program. The present study scientifically proves the positive and sustainable effect of the investigated specific rehabilitation concept for burn victims, which can also be applied at other rehabilitation centers.

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