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Article

Association Between Rehabilitation Frequency and Functional Outcomes After Burn Injury: A Single-Center Retrospective Analysis of Confounding by Indication

by
Yazeed Temraz
1,2,*,
Theeb Al Salem
1,2,
Shaimaa Khan
1,2,
Raghad Alshehri
1,2,
Lina Alosaimi
1,2,
Mariam Hantoul
1,2,
Rahaf Alrajhi
1,2,
Rayya Alabdali
1,2,
Amal Bahumayim
1,2,
Ibtihal Al Jafin
1,2,
Fai Al Qazlan
1,2 and
Abdulmajeed Al Ehaideb
1,2
1
Rehabilitation Department, Ministry of the National Guard-Health Affairs, Riyadh 11426, Saudi Arabia
2
King Abdullah International Medical Research Center (KAIMRC), Riyadh 11426, Saudi Arabia
*
Author to whom correspondence should be addressed.
Eur. Burn J. 2026, 7(1), 6; https://doi.org/10.3390/ebj7010006
Submission received: 3 December 2025 / Revised: 7 January 2026 / Accepted: 14 January 2026 / Published: 19 January 2026
(This article belongs to the Special Issue Global Perspectives on Burn Prevention, Management, Collaboration, and Disparities)
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Abstract

Objective: To identify key predictors of clinical outcomes in burn survivors and clarify the role of mixed-depth burns and confounding by indication in observational rehabilitation research. Design: Retrospective cohort study using data from a burn rehabilitation registry (January 2024 to July 2025). Setting: Burn rehabilitation center. Participants: 120 adult patients (age ≥ 18 years) with burns affecting ≥1% total body surface area (TBSA) and complete baseline data. Interventions: Not applicable. Main Outcome Measures: Primary outcome was functional improvement (ΔFIM). Secondary outcomes included pain reduction (ΔPain), scar severity (Vancouver Scar Scale; VSS), Activities of Daily Living (ADL) improvement, and Range of Motion (ROM) recovery. Multivariable linear and logistic regression models were used to identify predictors. Results: Patients achieved significant improvements in function (mean ΔFIM = 11.3 ± 8.9 points) and pain (mean ΔPain = 1.28 ± 0.81). Having a mixed-depth burn was the strongest predictor of worse scar outcomes (β = 2.52, 95% CI: 0.93 to 4.12, p = 0.002) and failure to achieve full ROM (OR = 0.089, 95% CI: 0.008 to 0.930, p = 0.043). An apparent association between inpatient ward care and better scar outcomes (β = −1.30, p = 0.020) was determined to be an artifact of confounding by indication, as the outpatient group had a higher proportion of high-risk mixed-depth burns (6.2% vs. 3.5%). Longer therapy duration was the only significant predictor of achieving ADL goals (OR = 1.014, 95% CI: 1.002 to 1.026, p = 0.025). Conclusions: Injury characteristics, particularly the presence of a mixed-depth burn, emerged as the dominant predictors of long-term scar and functional outcomes. This study identifies mixed-depth burns as a potentially high-risk clinical phenotype requiring targeted therapeutic strategies and demonstrates the critical importance of accounting for confounding by indication when evaluating rehabilitation outcomes in observational burn research.
Keywords: burn rehabilitation; mixed-depth burns; scar outcome; confounding by indication; physical therapy; occupational therapy; Vancouver Scar Scale; functional independence measure burn rehabilitation; mixed-depth burns; scar outcome; confounding by indication; physical therapy; occupational therapy; Vancouver Scar Scale; functional independence measure
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MDPI and ACS Style

Temraz, Y.; Al Salem, T.; Khan, S.; Alshehri, R.; Alosaimi, L.; Hantoul, M.; Alrajhi, R.; Alabdali, R.; Bahumayim, A.; Al Jafin, I.; et al. Association Between Rehabilitation Frequency and Functional Outcomes After Burn Injury: A Single-Center Retrospective Analysis of Confounding by Indication. Eur. Burn J. 2026, 7, 6. https://doi.org/10.3390/ebj7010006

AMA Style

Temraz Y, Al Salem T, Khan S, Alshehri R, Alosaimi L, Hantoul M, Alrajhi R, Alabdali R, Bahumayim A, Al Jafin I, et al. Association Between Rehabilitation Frequency and Functional Outcomes After Burn Injury: A Single-Center Retrospective Analysis of Confounding by Indication. European Burn Journal. 2026; 7(1):6. https://doi.org/10.3390/ebj7010006

Chicago/Turabian Style

Temraz, Yazeed, Theeb Al Salem, Shaimaa Khan, Raghad Alshehri, Lina Alosaimi, Mariam Hantoul, Rahaf Alrajhi, Rayya Alabdali, Amal Bahumayim, Ibtihal Al Jafin, and et al. 2026. "Association Between Rehabilitation Frequency and Functional Outcomes After Burn Injury: A Single-Center Retrospective Analysis of Confounding by Indication" European Burn Journal 7, no. 1: 6. https://doi.org/10.3390/ebj7010006

APA Style

Temraz, Y., Al Salem, T., Khan, S., Alshehri, R., Alosaimi, L., Hantoul, M., Alrajhi, R., Alabdali, R., Bahumayim, A., Al Jafin, I., Al Qazlan, F., & Al Ehaideb, A. (2026). Association Between Rehabilitation Frequency and Functional Outcomes After Burn Injury: A Single-Center Retrospective Analysis of Confounding by Indication. European Burn Journal, 7(1), 6. https://doi.org/10.3390/ebj7010006

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