Recovery of Functional Independence following Major Burn Survival: a Systematic Review

Background Major burn injury, despite advancements in care and prevention, can have a profound impact on long-term morbidity, affecting quality of life and socioeconomic standing. We aim to explore factors predicting recovery of independence, the expected rate and time in majorly burned patients, and the measures of progress used. Method A systematic search of four databases (MEDLINE, EMBASE, COCHRANE, CINAHL) was conducted for studies reporting outcomes pertaining to physical ability indicative of independent function in adult (>15y) cohorts who had suffered a major burn (>20% TBSA) up to 30 years post-treatment in a developed specialised burn service. Data extracted included factors affecting, rate of, and time to achievement of function in five independence domains, as well as the outcome measures used. Results 21 eligible studies were included comprising 1298 major burns survivors with a combined mean age of 39.6y and a mean TBSA of 25.8%. The most significant recurring factors impacting recovery of independent function were older age, female gender, burn severity, prolonged ICU and hospital admission, preceding mental health conditions, and post-acute psychological issues. Exercise-based rehabilitation conferred benefits on major burn patients even over 2 years post-injury. Discharge to independent living from hospital occurred in 27% to 97% of patients, while return to work rate reports varied from 52% to 80%. Burns Specific Health Scale-Brief, Functional Independence Measure, and Physical Composite Score (SF-36) were the most widely used outcome scoring systems. Conclusion Major burn survivors have protracted recovery with potential for persistent chronic impairments, remaining consistently below baseline levels of function. Non-modifiable factors such as age and gender, and disease characteristics such as burn size with associated physical, physiological and psychosocial sequelae are contributory. Further research is required to explore achievement of specific milestones of major burn and polytrauma critical care patients, while early targeted rehabilitation addressing physical, psychological and vocational needs has promising potential benefit.