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
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.
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.
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