| Author: | Bayuo, Jonathan |
| Title: | Effects of a nurse-led transitional rehabilitation programme (4Cs-TBuRP) for adult burn survivors : a pilot randomised controlled trial |
| Advisors: | Wong, Kam Yuet Frances (SN) |
| Degree: | Ph.D. |
| Year: | 2022 |
| Subject: | Burns and scalds -- Patients -- Rehabilitation -- China Burns and scalds -- Patients -- Medical care -- China Hong Kong Polytechnic University -- Dissertations |
| Department: | School of Nursing |
| Pages: | xxviii, 610 pages : color illustrations |
| Language: | English |
| Abstract: | Background: Rehabilitation is a key component of burn care which seeks to improve functional outcomes and optimise the post-burn recovery process. Burns rehabilitation is in a young stage in Mainland China, and it is only in recent years that it is considered a significant part of burns management. Rehabilitative support, where available, is often passive with a significant emphasis on managing only physical problems. The emergence of the Coronavirus Disease-2019 (COVID-19) heightened this gap as it led to either suspension or limited availability of outpatient services. Subsequently, post-burn recovery outcomes, including quality of life, psychological functioning, sleep pattern, and physical role functioning are adversely affected. Aim: To develop and evaluate the preliminary effects of a nurse-led transitional rehabilitation programme for adult burn survivors at the Gansu Province of the People's Republic of China. Design and methods: Guided by the Medical Research Council Framework, the development phase of the study involved in-depth review of existing literature and a qualitative phase involving adult burn survivors and burn care staff. Following the development phase, the pilot randomised trial approach was employed to ascertain the preliminary effects of the intervention at the study site. A sample of 60 adult burn survivors, aged ≥18 years were randomly allocated to either the control or treatment group with 30 participants per arm. Participants in the intervention group received an 8-week comprehensive transitional rehabilitative programme delivered by burn care nurse case managers. The transitional rehabilitation programme comprised of two phases: pre-discharge and active follow-up phase. Structured telephone and WeChat follow-ups were also conducted. Generalised Estimating Equation (GEE) was employed to ascertain group changes, within group effects (time), and group by time interaction effects. Intention-to-treat (ITT) analysis was adopted as the primary analytical approach. Per protocol (PP) analysis and the unadjusted ITT model were employed as the secondary analysis approach to ascertain the robustness of the study findings. Quality of life was the primary outcome of interest in this study. The secondary outcomes included sleep, pain, itchiness, scarring, psychological and physical role functioning. All outcomes were evaluated at three time points: T0 (baseline), T1 (immediate post-intervention at 8 weeks), and T2 (4 weeks from T1). Results: Significantly higher scores regarding quality of life assessed with the Burn Specific Health Scale-B (p = 0.015), HADS-Depression subscale (p = 0.013), HADS-Anxiety subscale (p = 0.023), total HADS (p = 0.009), and physical role functioning (p = 0.041) were observed at the immediate post-intervention phase (T1). These improvements were sustained at follow-up (T2) as follows: quality of life on the BSHS-B (p = 0.023), HADS-Depression (p = 0.040), HADS-Anxiety (p = 0.016), total HADS (p = 0.015), and physical role functioning (p = 0.013). Although pain interference was not statistically significant at T1 (p = 0.506); at T2, it was observed to be statistically significant (p = 0.013). Between group improvement was observed regarding pain intensity (p = 0.014). Within group improvement was also observed regarding pain intensity (p = 0.001), pain interference (p = 0.049), EQ-5D-5L VAS (p = 0.018), and EQ-5D-5L index value (p = 0.001) with greater improvement observed among participants in the intervention group at T1. At T2, within group improvements were observed across these parameters except for pain intensity (p = 0.484). No statistically significant improvements were observed regarding sleep, scarring, and itchiness at T1 and follow-up (T2). Sensitivity analyses using the crude/ unadjusted GEE model and PP analysis revealed that the results were comparable to the adjusted ITT results which affirms the robust findings regarding the preliminary effects of the transitional rehabilitative programme of care. Conclusion: The transitional rehabilitation programme is helpful in improving post-burn recovery outcomes which warrants its inclusion in the burn management process. The mean scores however highlight a need to extend the programme in the long-term considering the chronicity associated with the post-burn needs. The findings also underscore the potential of burn care nurses taking on advanced, expanded roles beyond inpatient care albeit with the requisite advanced training. |
| Rights: | All rights reserved |
| Access: | open access |
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