Special Issue "Innovation in Burn Scar Prevention and Management"

A special issue of European Burn Journal (ISSN 2673-1991).

Deadline for manuscript submissions: closed (14 February 2022) | Viewed by 9003

Special Issue Editors

Dr. Zephanie F. Tyack
E-Mail Website
Guest Editor
1. Australian Centre for Health Services Innovation (AusHSI), Queensland University of Technology, Brisbane City QLD 4000, Australia
2. Centre for Children’s Burns and Trauma Research, Child Health Research Centre, The University of Queensland, St Lucia QLD 4072, Australia
Interests: burn scarring; patient-reported outcome measures (PROMs); adherence; patient engagement; health-related quality of life; low value care; paediatrics; implementation science; rehabilitation
Dr. Jill Meirte
E-Mail Website
Guest Editor
1. Department of Rehabilitation Sciences and Physiotherapy (REVAKI-MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
2. Oscare, Organisation for Burns, Scar After-Care and Research, Antwerp, Belgium
Interests: Scars; scar prevention and non-invasive treatments; burn injuries, patient reported outcome measures (PROMs); quality of life; disability (ICF); digital care pathways; rehabilitation & education

Special Issue Information

Dear Colleagues,

The prevention and management of burn scarring is of utmost importance to patients and treating multidisciplinary teams, yet the evidence base for burn scar interventions has gaps and limitations that urgently need to be addressed. There is a lack of robust evidence on the effectiveness of some of the most commonly applied scar interventions in burn care. Further, the study designs commonly used to test these interventions are limited in their ability to evaluate the complexity of scar prevention and management approaches. It is also noteworthy that few studies have tested how evidence actually translates into practice. Although evidence regarding the effectiveness of minimally invasive interventions, including ablative fractional CO2 laser and medical needling, is beginning to emerge, further investigation is required.

More attention also needs to be focused on patients with scars as strong and active players in the multidisciplinary team and in their own care. We need to better understand how patients with scars may benefit from new models of scar care that facilitate communication and shared decision making, for example, using information from patient-reported outcome measures and patient-reported experience measures in clinical practice. Although care and care pathways can be digitalised, this digitalisation needs careful development and quality checks to facilitate patient-centred scar care. In this Special Issue, we are interested in studies that apply innovative methodological approaches (for example, adaptive trials, single case designs, hybrid effectiveness–implementation studies), evidence to address gaps and limitations in the evidence, and qualitative and mixed methods research. Experimental papers, up-to-date review articles, and commentaries are all welcome. Topics are not limited to the examples provided.

Dr. Zephanie F. Tyack
Dr. Jill Meirte
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. European Burn Journal is an international peer-reviewed open access quarterly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 971 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Burn injuries
  • Scars
  • Digitalisation
  • Patient-reported outcome measures
  • Scar prevention
  • Scar management
  • Rehabilitation
  • Implementation science

Published Papers (8 papers)

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Editorial

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Editorial
Is Post-Burn Scarring a Research Priority?
Eur. Burn J. 2022, 3(2), 355-361; https://doi.org/10.3390/ebj3020030 - 03 May 2022
Viewed by 723
Abstract
National and international research budgets are insufficient to approve all requests for funding, even if a methodology is of high quality and the outputs are likely to have an impact on improving patient outcomes [...] Full article
(This article belongs to the Special Issue Innovation in Burn Scar Prevention and Management)
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Research

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Article
Aspects of Clinical Utility of the Distress Thermometer and Problem List after Burns
Eur. Burn J. 2022, 3(2), 320-327; https://doi.org/10.3390/ebj3020027 - 08 Apr 2022
Viewed by 934
Abstract
Burn survivors may benefit from screening for a broad area of problems to improve communication and inform referral needs. Therefore, the aim of this study was to investigate clinical utility aspects such as appropriateness and acceptability to clinicians and completers of an existing, [...] Read more.
Burn survivors may benefit from screening for a broad area of problems to improve communication and inform referral needs. Therefore, the aim of this study was to investigate clinical utility aspects such as appropriateness and acceptability to clinicians and completers of an existing, frequently used screening instrument in oncological populations, the Distress Thermometer and Problem List (DT and PL). Methods: Paediatric and adult patients visiting the outpatient clinic after admission to the burn centre were invited to complete the instrument. The DT and (problem domains of) the PL were related and compared to the need to discuss the reported problems. Results: A total of 160 patients were invited to complete the DT and PL, of which 139 agreed. The study shows evidence for appropriateness and high acceptability to clinicians and completers, although the effectiveness of the PL may be lower compared to the DT and needs adaptation to better meet the burn survivors’ situation. Discussion: The use of a screening instrument in the outpatient clinic environment has shown to be appropriate and acceptable and informs clinical practice to identify supportive needs in patients with burns. However, the PL needs to be adapted to the situation of the burn survivors. Full article
(This article belongs to the Special Issue Innovation in Burn Scar Prevention and Management)
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Article
Electronic Patient-Reported Outcome Measures in Burn Scar Rehabilitation: A Guide to Implementation and Evaluation
Eur. Burn J. 2022, 3(2), 290-308; https://doi.org/10.3390/ebj3020025 - 05 Apr 2022
Viewed by 1056
Abstract
In burn scar rehabilitation, electronic patient-reported outcome measures (ePROMs) are increasingly being used in research and clinical settings as part of patient- and family-centred care. These measures can identify patients’ needs and monitor the therapeutic progress of both adults and children. The feedback [...] Read more.
In burn scar rehabilitation, electronic patient-reported outcome measures (ePROMs) are increasingly being used in research and clinical settings as part of patient- and family-centred care. These measures can identify patients’ needs and monitor the therapeutic progress of both adults and children. The feedback of information from ePROMs to clinicians treating patients with scarring and psychosocial issues may have therapeutic benefits. However, testing the effectiveness of ePROMs used in the routine clinical care of patients with burn scarring is in its infancy, and one of the greatest challenges remains the implementation of ePROMs in real-world clinical settings. The aim of this paper is to provide a guide for clinicians and researchers involved in burn scar rehabilitation to assist in implementing ePROMs in clinical settings. The guide outlines strategies, processes, and considerations for ePROM implementation and the accompanying resources. Two real-world case studies of ePROM implementation are presented in burn scar clinics in Belgium and Australia. Additionally, ten recommendations for the implementation of ePROMs are provided based on research evidence and the lessons learned by the authors. The information provided should pave the way forward for using and testing these ePROMs in research and practice. Full article
(This article belongs to the Special Issue Innovation in Burn Scar Prevention and Management)
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Article
The CARe Burn Scale—Adult Form: Identifying the Responsiveness and Minimal Important Difference (MID) Values of a Patient Reported Outcome Measure (PROM) to Assess Quality of Life for Adults with a Burn Injury
Eur. Burn J. 2022, 3(1), 211-233; https://doi.org/10.3390/ebj3010019 - 10 Mar 2022
Viewed by 1168
Abstract
The CARe Burn Scales are a suite of burn-specific PROMs for adults, children, young people, and parents affected by burns. This study aimed to determine the responsiveness and minimal important difference (MID) values of the Adult Form for use in adult burn care [...] Read more.
The CARe Burn Scales are a suite of burn-specific PROMs for adults, children, young people, and parents affected by burns. This study aimed to determine the responsiveness and minimal important difference (MID) values of the Adult Form for use in adult burn care and research. Participants were recruited by 11 UK Burn Services. They completed online or paper versions of the CARe Burn Scale –Adult Form and a set of appropriate comparison validated measures and anchor questions at baseline (T1, up to 4 weeks post-burn), 3 months (T2), and 6 months post-burn (T3). A total of 269 participants took part at baseline and 226 (84%) were retained at the 6-month follow-up. Spearman’s correlation analysis and effect sizes based on Cohen’s d thresholds were reported and MID values calculated. MID values were created for all subscales and ranged from 4–15. The CARe Burn Scale–Adult Form is responsive to change over time and can therefore be used to reliably inform the management of adults’ burn injury treatment and recovery. It is freely available for clinical and research use. Full article
(This article belongs to the Special Issue Innovation in Burn Scar Prevention and Management)
Article
Pre-Burn Health-Related Quality of Life: Patient and Partner Perspectives
Eur. Burn J. 2022, 3(1), 135-144; https://doi.org/10.3390/ebj3010011 - 11 Feb 2022
Viewed by 1137
Abstract
A proxy-assessment of health-related quality of life (HRQL) may be an alternative for burn patients who are medically unable to self-report shortly after being admitted to the hospital. This study examined the patient–partner agreement on the recalled pre-injury HRQL of burn patients. In [...] Read more.
A proxy-assessment of health-related quality of life (HRQL) may be an alternative for burn patients who are medically unable to self-report shortly after being admitted to the hospital. This study examined the patient–partner agreement on the recalled pre-injury HRQL of burn patients. In a multi-centre study of 117 patient–partner pairs, the recalled pre-burn HRQL was assessed with the EQ-5D-3L + Cognition during the acute phase following the burns. Agreement was evaluated with Kappa and ICC statistics. Burn severity and PTSD symptoms were assessed as potential predictors of disagreement. The results showed that pre-burn EQ-Index scores were similar to population norms, whereas the EQ Visual Analog Scale (EQ-VAS) scores of patients were significantly higher. Agreement varied across EQ-5D domains and, after adjusting for prevalence, was substantial to almost perfect. Average agreement on the EQ-Index and EQ-VAS was, respectively, substantial and moderate, but differences between partners were larger at lower levels of HRQL, and specifically in the pain/discomfort domain. Patient–partner differences could not be explained by the patient’s age or gender, number of surgeries, partner’s presence at the burn event, or post-traumatic stress disorder (PTSD) symptoms of either the patient or partner. In conclusion, patient–partner agreement is substantial and partner–proxy reports of pre-burn EQ-5D domains and EQ-Index scores may be used to complement or serve as a substitute for the patient’s assessment. Given the moderate agreement on the EQ-VAS, it may be less suited for proxy assessment. Full article
(This article belongs to the Special Issue Innovation in Burn Scar Prevention and Management)
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Other

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Commentary
Matching Qualitative Inquiry Design and Practice to Contemporary Burns Research Questions: Are We Getting It Right?
Eur. Burn J. 2022, 3(2), 256-263; https://doi.org/10.3390/ebj3020022 - 28 Mar 2022
Viewed by 841
Abstract
Qualitative methodology has continued to develop through scholarly inquiry, with its application to burn scar research progressed substantially since early use. Concerns were raised in 2015 that qualitative inquiry in burn care and rehabilitation used a limited range of qualitative research approaches. The [...] Read more.
Qualitative methodology has continued to develop through scholarly inquiry, with its application to burn scar research progressed substantially since early use. Concerns were raised in 2015 that qualitative inquiry in burn care and rehabilitation used a limited range of qualitative research approaches. The aim of this commentary paper is to consider how broadly the suite of methodologies available within the qualitative research paradigm have been applied to burn scar research since that call. Observations from a scan of qualitative burn scar papers published since 2015 to March 2022 (n = 36) are presented. Less commonly used qualitative methodologies (such as interpretive design, interpretive phenomenological analysis, narrative inquiry, grounded theory, explanatory case study) and their contribution to burn scar research is discussed. Examples are presented to consider how the application of qualitative methodological approaches (including post-qualitative research methodologies) can be ultimately used to inform meaningful outcomes. Full article
(This article belongs to the Special Issue Innovation in Burn Scar Prevention and Management)
Perspective
Mechanomodulation: Physical Treatment Modalities Employ Mechanotransduction to Improve Scarring
Eur. Burn J. 2022, 3(2), 241-255; https://doi.org/10.3390/ebj3020021 - 26 Mar 2022
Cited by 2 | Viewed by 1366
Abstract
Every year, surgical interventions, traumatic wounds, and burn injuries lead to over 80 million scars. These scars often lead to compromised skin function and can result in devastating disfigurement, permanent functional loss, psychosocial problems, and growth retardation. Today, a wide variety of nonsurgical [...] Read more.
Every year, surgical interventions, traumatic wounds, and burn injuries lead to over 80 million scars. These scars often lead to compromised skin function and can result in devastating disfigurement, permanent functional loss, psychosocial problems, and growth retardation. Today, a wide variety of nonsurgical scar management options exist, with only few of them being substantiated by evidence. The working mechanisms of physical anti-scarring modalities remained unclear for many years. Recent evidence underpinned the important role of mechanical forces in scar remodeling, especially the balance between matrix stiffness and cytoskeleton pre-stress. This perspective article aims to translate research findings at the cellular and molecular levels into working mechanisms of physical anti-scarring interventions. Mechanomodulation of scars applied with the right amplitude, frequency, and duration induces ECM remodeling and restores the ‘tensile’ homeostasis. Depending on the scar characteristics, specific (combinations of) non-invasive physical scar treatments are possible. Future studies should be aimed at investigating the dose-dependent effects of physical scar management to define proper guidelines for these interventions. Full article
(This article belongs to the Special Issue Innovation in Burn Scar Prevention and Management)
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Commentary
Towards the Holistic Assessment of Scar Management Interventions
Eur. Burn J. 2022, 3(1), 207-210; https://doi.org/10.3390/ebj3010018 - 08 Mar 2022
Viewed by 997
Abstract
Presently, research assessments of burn scar management interventions focus on measures of scarring and scar features. However, qualitative research demonstrates that patients experience scarring and scar management therapies holistically. Patient-centred assessment should reflect this. An agreement is required regarding what to assess, which [...] Read more.
Presently, research assessments of burn scar management interventions focus on measures of scarring and scar features. However, qualitative research demonstrates that patients experience scarring and scar management therapies holistically. Patient-centred assessment should reflect this. An agreement is required regarding what to assess, which tools and measures to use and at what time points. Key issues include (1) whether and how burn- or scar-related quality-of-life measures could be included in the assessment of scar management interventions and how these are weighed against scar measures; (2) routine inclusion of the assessment of treatment burden (or treatment experience) in comparative research and (3) generating further understanding of the relationship between scar management and psychosocial adaptation, along with an assessment of this. A debate concerning a holistic and standardized evaluation of scar management interventions is needed to ensure that future evidence-based decisions are made in a patient-centred manner. Full article
(This article belongs to the Special Issue Innovation in Burn Scar Prevention and Management)
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