Jeffrey C. Schneider

Purpose To explore the relationship between burn survivors’ pre-injury occupation and the likelihood of successful return to employment in the post-rehab setting. Methods Participants in the Burn Model Systems database were designated as Labor or Non-labor employees based on their self-reported occupation pre-injury. The groups were compared across a variety of demographic and clinical variables using descriptive statistics. Logistic regression models were used to examine employment status at 12 months, and a Cox proportional hazards model was used to examine time to return to work. Sankey diagrams examined patterns in career change between the two groups. Results Burn survivors working in Labor occupations prior to injury differed from Non-labor counterparts across several sociodemographic and injury-related characteristics, including lower education levels, higher rates of employment-related injuries, and different insurance coverage patterns. In the a priori logistic regression model, Labor Group status was associated with lower odds of employment at 12 months (OR=0.44, 95% CI 0.22–0.90, p=0.024). However, this association was no longer statistically significant in a post hoc sensitivity analysis additionally adjusting for education and insurance status (OR=0.47, 95% CI 0.20–1.08, p=0.076). In the Cox proportional hazards model, participants in Labor occupations experienced a significantly slower return to work than those in Non-labor occupations (HR=0.51, 95% CI 0.31–0.82, p=0.005). Conclusion These findings underscore the importance of providing tailored support to burn survivors seeking to resume employment and demonstrate that the relationship between pre-injury occupation and workforce reintegration may differ depending on the employment outcome examined. While the association between Labor Group status and employment at 12 months was attenuated after accounting for education and insurance, Labor Group status remained significantly associated with a slower return to work. Pre-injury occupation, together with socioeconomic and structural factors, may therefore be important to consider when developing initiatives to support workforce reintegration following burn injury.

Introduction: While pain and pruritus are well-established sequelae of burn injury, their downstream impact on pediatric burn survivors is poorly characterized. This project addresses this gap by evaluating associations of pain and pruritus with functional and psychosocial symptoms at 12 months post-injury in pediatric burn survivors. Methods: Using a multicenter longitudinal database (injured between 2014 and 2024), this retrospective review identified pediatric burn survivors aged 8-17 years who completed a self-reported survey assessing pain and pruritus at 12-months post-injury. Patient-Reported Outcomes Measurement Information System domains included pain intensity, pruritus, physical function, anxiety, depression, and fatigue. General linear models were fitted at the 12-month follow-up to evaluate independent associations between pain and pruritus scores and demographic, functional, and psychosocial variables. Results: The study included 67 pediatric burn survivors with a mean age of 11.8 ± 2.9 years. In multivariate regression models at 12 months post-injury, demographic and burn characteristics were not significant predictors of pain or pruritus. Both higher pain and itch were significantly associated with greater anxiety (P = .0109; P < .0001), depression (P = .0021; P = .0006), and fatigue (P = .0053; P = .0096); higher itch was additionally associated with worse physical function (P = .0396). Conclusions: This review shows that even 1 year after injury, pain and pruritus remain strongly associated with psychosocial distress, with pruritus additionally linked to impaired physical function. These findings highlight that pain and itch are interrelated drivers of impaired quality of life in children.

Social participation is a long-term goal for individuals recovering from burns. However, individuals often face various challenges in this domain. The Life Impact Burn Recovery Evaluation (LIBRE) Profile is a validated patient-reported outcome measure of social participation developed specifically for adults with burn injury. Measures are typically administered during clinic visits and using paper-based questionnaires, which limit access and timely connection with resources. This study describes the design, development, and pilot testing of LIBRE GO!, a mobile application that digitizes the LIBRE Profile to assess social participation and connects survivors with community-based resources. The design and development process employed an iterative and user-centered approach involving burn survivors, clinicians, technology experts, and researchers. The developed application comprises four primary functions: “Start a new LIBRE Survey”, “My Scores”, “Resources”, and “About”. Pilot testing was conducted with eight burn survivors, who rated the Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM) and subsequently participated in focus groups to share feedback. Average scores for the AIM, IAM, and FIM were 4.13, 4.28, and 4.31 out of 5, respectively. Participants reported that the application was easy to use as a valuable tool for tracking social engagement and connecting with resources. Broad dissemination and use of LIBRE GO! will empower burn survivors and provide clinicians and researchers with an accessible and validated outcome assessment tool to support evidence-based approaches for improving social participation after burn injury.

The Preschool Life Impact Burn Recovery Evaluation Computer Adaptive Test was developed using Rasch methods and computer adaptive testing technologies to assess burn recovery among children aged 1–5 years. To enhance accessibility in settings without advanced computer technology, this study developed Short Forms. Calibration data from the Preschool Life Impact Burn Recovery Evaluation item bank were used for short-form item selection. Items were iteratively added to maximize test information function, with reliability constrained to ≥0.8. Differential item functioning was evaluated, and Cronbach’s alpha and score correlations were used to assess internal consistency and validity. Data were obtained from 500 parents of burn survivors (mean ± SD age = 3.0 ± 1.4 years; 55.2% male; mean total body surface area burned = 4.2%; mean time since burn = 1.1 years). Three 10-item short forms were developed for Communication and Language, Physical Functioning, and Emotional Well-being. Differential item functioning analyses indicated the need for age-specific Communication and Language forms (>3 years and ≤3 years). Across all short forms, ceiling effects were ≤15% and floor effects <1%. Marginal reliability ranged from 0.74 to 0.90, Cronbach’s alpha from 0.86 to 0.90, and correlations with the full item bank from 0.97 to 0.98. The short forms demonstrated strong psychometric properties and minimal measurement bias. The short forms approximate the computer adaptive test score for each scale and are a part of the Preschool Life Impact Burn Recovery Evaluation Profile, offering a practical and valid assessment of recovery outcomes in preschool-aged children with burn injuries.

Adolescence is a period of major developmental and social change, and when coupled with the challenges of burn injuries, it can significantly affect social interactions and relationships. To develop a burn-specific outcome measure for teens, the Teen-Aged Life Impact Burn Recovery Evaluation (TA-LIBRE12–19) was created. This study details the qualitative analysis of transcripts from teen burn survivors used to co-produce an item pool related to Interpersonal Interactions and Relationships. Stakeholder focus groups involving teens were conducted to identify key outcomes relevant for assessing burn recovery. Participants shared their perspectives on how burns impact their lives, with discussions continuing until thematic saturation was reached. Identified themes were assigned to pre-established domains, and new items were generated from recurring concepts not captured in existing instruments. Two focus groups were conducted with seven teen burn survivors. The median age was 13.8 years (IQR 12.1–16.3), and 71% were female. Half of the burns were fire/flame-related, with a median time since injury of 5.5 years (IQR 0.5–12.1) and a median burn size of 20% total body surface area (IQR 0.3–60). Novel concepts from teen burn survivors produced 28 new items. The final Interpersonal Interactions and Relationships subdomain is comprised of 51 items, 45.1% (n=23) from legacy instruments and 54.9% (n=28) newly developed from teen input. Including burn survivors’ voices in developing the TA-LIBRE12–19 highlights the importance of co-production. Over half of the items originated from qualitative input, ensuring the instrument reflects relevant, patient-centered outcomes for teen burn recovery.

Burn injuries are functionally limiting, and premorbid mobility impairments may further complicate recovery. Premorbid mobility impairments are associated with worse outcomes in other populations; however, their role in burn recovery remains unclear. This retrospective cohort study included adult burn survivors injured from 2014 to 2025 extracted from the Burn Model System National Burn Database. Premorbid mobility impairment was defined as self-reported preburn physical problems or impairments affecting mobility (difficulty moving the arms, legs, or body). Outcomes included length of stay, discharge disposition, and PROMIS Global Mental Health scores at 6- and 12-month follow-ups postinjury. All regression models were adjusted for age, TBSA, and inhalation injury. The model for Global Mental Health scores additionally adjusted for discharge location, Global Physical Health, preinjury Global Mental Health, and follow-up time. A total of 1372 adult burn survivors were included, with a mean age of 46.2 years. Premorbid mobility impairment was associated with longer hospital stay (incidence rate ratio 1.15; 95% CI, 1.04-1.27; P = .006) and discharge to a shelter (odds ratio 1.75; 95% CI, 1.41-2.19; P < .001). There was also a trend toward lower PROMIS Mental Health scores among survivors with premorbid mobility impairments (β = −1.92, P = .091). Premorbid mobility impairment is associated with poorer burn outcomes, including longer hospital stay and discharge to unstable settings such as shelters, and may also be linked to poorer mental health outcomes. It remains unclear whether shelter discharge reflects premorbid housing instability or a new postburn disposition.