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Title: [Occupational activity disorders of extremely severe mass burn patients in recovery period after injury: a cross-sectional survey].
Author: Shi JJ, Shen AM, Sun Y, Li YJ, Wang SN, Pan SS, Li Z, Jiao L.
Journal: Zhonghua Shao Shang Za Zhi; 2018 Sep 20; 34(9):624-628. PubMed ID: 30293366.
Abstract:
Objective: To observe the distribution of occupational activity disorders of extremely severe mass burn patients in recovery period after injury. Methods: From December 2014 to December 2015, 65 extremely severe burn patients conforming to the inclusion criteria involved in August 2 Kunshan factory aluminum dust explosion accident were admitted to Kunshan Rehabilitation Hospital. They received comprehensive rehabilitation treatment after burns, including wearing pressure clothes, ultrasound treatment, semiconductor laser and red light irradiation, motor function training, and so on. Over 2 years after injury, a cross-sectional survey was conducted on the patients' occupational activity disorders. Modified Barthel index (MBI) was used to assess the degree of activities of daily living (ADL) disorder of patients and to grade the independent level of completing each item of MBI, and then the independent level of patients completing self-care MBI items (bathing, dressing, grooming, eating, going to the toilet, urine control, and stool control) was compared with that of mobility items (going up and down stairs, bed and chair transfer, and walking). The Canadian Occupational Performance Measure (COPM) was used to assess the distribution of occupational activity disorders of patients. The distribution of the five most serious occupational activity disorders was counted, then the frequency and probability of which with frequency greater than or equal to 16 times were calculated. Data were processed with Pearson Chi-square test. Results: Over 2 years after injury, the MBI score of patients was (76±22) points, and the ADL of 83.08% (54/65) patients reached completely self-care or light ADL disorder level. The MBI items arranged according to the completing independent level of patients from high to low were urine control/stool control, walking, bed and chair transfer, going up and down stairs, going to the toilet, eating, grooming, dressing, and bathing. The independent level of patients completing self-care MBI items was lower than that of mobility items (χ(2)=62.298, P<0.001). Over 2 years after injury, the five most serious occupational activity disorders in COPM dimension were mainly concentrated in the self-care dimension, accounting for 55.38% (180/325), followed by 22.46% (73/325) of production activities and 22.15% (72/325) of recreational activities, and the centrally distributed item was the personal self-care item under self-care dimension, accounting for 42.46% (138/325). Over 2 years after injury, the five most serious occupational activity disorders with frequency greater than or equal to 16 times were dressing and undressing, bathing, perineal cleaning, wearing pressure clothes, caring for children, visiting relatives and friends, 31, 25, 16, 17, 18, and 22 times respectively, with a probability of 47.69%, 38.46%, 24.62%, 26.15%, 27.69%, and 33.85% respectively. Conclusions: Over 2 years after injury, most of the patients with extremely severe burns caused by the aluminum dust explosion were completely or basically self-care in their daily life. The disorder of self-care ADL was more serious than that of mobility, and the disorder of individual self-care activity was still the most serious occupational activity disorder of patients in this stage. Clinical trial registration: Chinese clinical trial registry, ChiCTR-OOC-16009188. 目的： 了解群体特重度烧伤患者在伤后恢复期间的作业活动障碍分布情况。 方法： 2014年12月—2015年12月，昆山市康复医院接收符合入选标准的65例"八二"昆山工厂铝粉尘爆炸事故特重度烧伤患者，对其行穿着压力衣、超声波治疗、半导体激光与红光照射及运动功能训练等烧伤后综合康复治疗。伤后2年余，对患者的作业活动障碍情况进行横断面调查，采用改良Barthel指数(MBI)评估患者日常生活活动(ADL)障碍程度并对其完成MBI各项目的独立水平进行分级，对患者完成MBI自理性项目洗澡、穿衣、修饰、进食、如厕、小便控制、大便控制与移动性项目上下楼梯、床椅转移、行走的独立水平进行对比；采用加拿大作业表现测量表(COPM)评测患者的作业活动障碍分布，统计最严重的5项作业活动障碍分布情况以及出现次数≥16次的最严重的5项作业活动障碍出现次数和概率。对数据行Pearson χ(2)检验。 结果： 伤后2年余，患者MBI得分为(76±22)分，83.08%(54/65)的患者达到日常生活完全自理或ADL轻度障碍水平；MBI各项目按患者完成的独立水平排列从高到低依次为小便控制/大便控制、行走、床椅转移、上下楼梯、如厕、进食、修饰、穿衣、洗澡；患者完成MBI自理性项目的独立水平明显低于移动性项目(χ(2)＝62.298，P<0.001)。伤后2年余，患者最严重的5项作业活动障碍在COPM中的维度分布主要集中在自我照顾维度，占55.38%(180/325)，其次为生产活动的22.46%(73/325)和娱乐活动的22.15%(72/325)；条目分布主要集中在自我照顾维度下的个人自理条目，占42.46%(138/325)。伤后2年余，本组患者出现次数≥16次的最严重的5项作业活动障碍包括穿脱衣服、洗澡、会阴部清洁、压力衣穿戴、照料子女、探亲访友，分别出现31、25、16、17、18、22次，概率分别为47.69%、38.46%、24.62%、26.15%、27.69%、33.85%。 结论： 伤后2年余，多数本批次铝粉尘爆炸致特重度烧伤患者日常生活完全自理或基本自理，自理性的ADL障碍较移动性的严重，并且个人自理活动障碍依然是该阶段患者最严重的作业活动障碍。 临床试验注册： 中国临床试验注册中心，ChiCTR－OOC－16009188。.

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