Recovery of physical functioning after burns

The ultimate goal of burn care is to assist patients in returning to their
pre-injury level of functioning, while maximizing their emotional and cosmetic
outcomes. Achieving adequate, if not pre-injury, levels of functioning is of
course important on the short term. Additionally, there is a growing
understanding of the importance of maintaining certain levels of physical
fitness and physical activity throughout life to prevent disability, morbidity
later on in life. Various studies confirm the clinical and burn survivors*
experiences that the level of functioning prior to the injury is not always
achieved again. Knowledge concerning the recovery of physical fitness and
interventions to improve it is predominantly based on studies involving
children with severe burns. Knowledge concerning adults with less extensive
burns is lacking.
Achieving adequate physical fitness may be a goal in itself in view of proven
health benefits. However, for the vast majority of patients and for society in
general its relevance is found in its - expected- contribution to being able to
be active, participate in life, and health related quality of life (HRQoL).
There is scarce evidence concerning the relationship between recovery of
physical fitness and activity, participation and quality of life. Besides
fitness other factors will also play a role. In patients with burns one of
these factors may be fatigue, which is an often-heard complaint.

To identify potential rehabilitation needs of adult patients with burns we aim
to:

1) investigate the course of physical fitness, physical activity and fatigue
after discharge.
2) identify factors that can predict the recovery, or lack thereof, at an early
stage.
3) investigate how the recovery of physical fitness, physical activity,
fatigue, participation and HRQoL are related.

Prospective observational study with a 12 month follow-up

The risks and inconvenience of participation are kept as low as possible.
To minimally burden the participants with additional travel time, the physical
fitness assessments will, wherever possible, be scheduled in combination with
routine follow-up appointments. Completing the questionnaires will take time,
but can be done online, or on paper if preferred, and throughout a full week at
the participants* convenience. Wherever possible, assessments and their timing
have been chosen to coincide with those that are part of care as usual at the
burn centre. The exericse test (Steep Ramp Test) only takes 2 to 3 minutes,
hence the burden and risk is low. Additionally, before testing, participants
are screened for any contra-indiciations for maximal exerise testing. The other
physical fitness assessments i,e. muscular strength, body composition, and
flexibility, are also safe and non-invasive. Physical activity monitoring with
an accelerometer is without risk and the inconvenience of wearing the
accelerometer is low, as it is a very small and low-weight device, worn as a
waistband on the hip.