Content » Vol 50, Issue 5

Original report

Burn survivors’ pulmonary and muscular impairment, exercise tolerance and return-to-work following medical-vocational rehabilitation: A long-term follow-up

Viveca Björnhagen, Kristina Schüldt Ekholm, Flemming Larsen, Jan Ekholm
Kliniken för rekonstruktiv plastkirurgi, Karolinska Universitetssjukhuset, Solna, Sweden

DOI: 10.2340/16501977-2337


Objective: To follow up the long-term outcome in return-to-work (RTW) rate in burn-injury patients, and to determine the degree of impairment in pulmonary and muscular function and exercise tolerance.
Design: A prospective, longitudinal follow-up study without a control group.
Patients: Twenty-five burn-injury patients referred for medical-vocational rehabilitation.
Methods: Return-to-work rate was followed after completed medical-vocational rehabilitation. Pulmonary function was evaluated with spirometry, diffusing capacity and radio spirometry. Exercise capacity was determined using a bicycle ergometer. Muscle functions evaluated in the arms and legs were: isokinetic torque, isometric strength, endurance and muscular strength utilization.
Results: Return-to-work rate was 87%. During bicycle exercise tests the patients, on average, reached their expected workloads. The dominating lung func-tion abnormality observed on lung scintigraphy was delayed wash-out time of inhaled radioactive xenon gas, suggesting airway obstruction. All tests of shoulder-flexor and knee-extensor muscle function showed large minimum–maximum differences. Mean isometric endurance of shoulder flexors was lower than mean of references, and isokinetic knee extensor torques were slightly lower.
Conclusion: High return-to-work rates can be achieved after burn injury requiring hospital-ward care. Despite measurable impairments in muscle strength/endurance and pulmonary function in a substantial proportion of these patients, overall normal bicycle exercise capacity was observed except for a few cases.

Lay Abstract

For jobs involving physical load, functions related to respiratory and cardiovascular capacity are important. Burn-injury patients have often been exposed to smoke inhalation and/or treated with respirator for long periods, hence pulmonary functions and exercise capacity was investigated post-burn. Mobility is another important activity related to job demands, and since extremities are often injured, measurements of muscle power and endurance were taken in all extremities. Twenty-five consecutive former serious burn-injury patients referred for medical-vocational rehabilitation were studied. Pronounced variations occurred in muscular strength and endurance of extremities – from weak to powerful – where arm endurance was most affected. Pulmonary function in general was restored. Bicycle exercise performance was on average within the normal range except for a few cases. A high return-to-work rate can be achieved in a cohort of seriously compromised thermal injury patients following team-based, individualized, medical-vocational rehabilitation.


Do you want to comment on this paper? The comments will show up here and if appropriate the comments will also separately be forwarded to the authors. You need to login/create an account to comment on articles. Click here to login/create an account.