Evaluation and development of psychotherapeutic interventions after severe burn injuries for patients during hospitalisation and rehabilitation Part 2

Status:

completed 01/2010

Aims:

In the course of a three year multi-centric study sponsored by the DGUV the effects of thermal trauma were investigated.
Based on the obtained information a psycho-educative behavioural group program for severely injured burn patients were to be developed. The aim of this program was to prevent long lasting psychological impairment and to support the patient in the process of reintegration in his/her vocational and social environment.
Further on a compliance enhancing concept was elaborated to support pressure garment therapy. The objective of the ongoing project was to apply and to evaluate the above mentioned interventions. Additionally the catamnesis data were collected for a more precise long term analysis.

Activities/Methods:

Several BG-trauma centres (Ludwigshafen, Berlin, Halle/Saale) and special rehabilitation centres for severely burned patients were involved in the implementation and evaluation of the group program:
- After completion of the treatment manual training for the cooperating psychotherapist
- Comparing of a treatment group (TG), obtaining the standard treatment and participating in the psycho-educative behavioural group training, and a control group (CG)
- Evaluation of the group training, be compared before and after the program and six month later, regarding variables such as psychological impairment, quality of life and capacity to work
- Statistical analysis of an ANOVA with repeated measurement
- Continuation of the catamnesis data to generate prognostic models for risk an resilience factors for burned patients and differentiate various subgroups
- Comparing of the prevalence of psychiatric diagnoses of burn patients with the average population

Results:

In the largest prospective study of burn patients in Germany to date, data were collected at five assessment points (from the acute treatment phase up to three years post burn). Patients reported high psychological impairment, especially immediately after the accident. This psychological impairment had a strong influence on the length of time out of work and on quality of life reported by patients.
In addition to the prospective longitudinal study two interventions for the psychological support of burn patients were developed and their efficacy systematically evaluated. The first was a cognitive behavioural group therapy for burn patients to provide support for reintegration in daily routine after a burn injury and to prevent long term psychological sequels.
The intervention was effective in reducing posttraumatic stress after burn injuries. Within the treatment group (n=70) the decrease of posttraumatic symptoms was significant while the impairment of the control group (n=103) persisted. This effect remained stable six months after treatment.
The second treatment was a short intervention to improve adherence to pressure garment therapy to prepare patients for the use of the garments. The results of a first study with 44 participants showed that patients are in need of more information than is currently provided. Participants judged the intervention as very helpful and interesting. Patients who had participated in the intervention reported higher rates of adherence to pressure garment therapy.

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