A Coordinated Rehabilitation Program May Help Workers with Burn Injuries Get Back to Work

A study funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR).

About half a million Americans are treated for burn injuries each year, and many of these burn injuries occur in the workplace. A burn injury may result from a fire or contact with hot liquids, electricity, or chemicals. People may experience physical limitations after a burn injury that may make it difficult to return to work. Studies have shown that up to one in four burn survivors become unemployed and do not return to work after their injury. Several factors may present barriers to returning to work, including the size and location of the burn injury, the amount of time spent in the hospital, lack of an individualized rehabilitation plan, and limited psychological support. In a recent NIDILRR-funded study, researchers looked at a suite of outpatient rehabilitation services designed to help people who experience burns on the job secure the support and workplace accommodations that would enable them to return to work within 90 days of their Washington State Labor and Industries (L&I) insurance claim. The researchers wanted to find out how many participants successfully returned to their pre-injury jobs after their injury. They also looked at factors that made it more difficult for some participants to return to work.

Researchers at the Northwest Burn Injury Model System Center looked at medical and employment records of 338 adults between the ages of 17 and 76 who received burn injury care at the University of Washington’s Regional Burn Center between 2010 and 2015. The participants all had experienced their injury at work and were receiving financial support and services through the state-funded Workers’ Compensation program. About two-thirds worked in either the service or construction sectors, where burn injuries may be common. The majority of participants had relatively small burns involving less than 5% of their body surface area.

After receiving inpatient care in the hospital, the participants began outpatient care at the burn clinic. At that time, they began receiving services designed to encourage recovery and help them return to work. These services included patient and family education, employer education, and medical assessments to determine potential workplace accommodations. Participants had individualized meetings with their burn care team, including a vocational rehabilitation (VR) counselor, who provided patient and family education about following through with treatment, building their stamina while recovering, preparing to return to work, keeping track of their insurance or compensation claims. The VR counselor facilitated contact with employers and workers’ compensation case managers to discuss the participant’s plans for returning to work, and encouraged the participants to keep in touch with their employers about returning to work. Finally, each participant received an individualized Activity Prescription Form (APF), which detailed the participant’s physical limitations and any accommodations that might be needed on the job. The APF was often revised as the participant’s physical status improved. APF’s were shared between the participant, burn doctor, employer, and the workers’ compensation case manager to coordinate services.

To find out how successful the suite of services was, the researchers looked at the percentage of participants who returned to work after their injury and how long it took between the date of their workers’ compensation claim and their return to partial or full duties at work. They also compared the groups of participants who did and did not return to work in order to find out what factors might contribute to returning or not returning to work.

The researchers found that almost all of the participants (93.5%) returned to work. On average, it took them 24 days to return to work performing at least some of their original duties, and 30 days to return to full duty. Nearly all of the participants who returned to work did so well within 90 days of their L&I insurance claim, the time period preferred by the state Worker’s Compensation program. About a third of these participants received workplace accommodations, such as lighter physical duties or modified work schedules, when they first returned to work.

When the researchers looked at the participants who did not return to work, they found that many of these participants tended to have larger burns that may have required more complicated surgical treatment and longer hospital stays compared with the participants who did return to work. The researchers also found that the participants who worked in construction were less likely to return to their jobs. People surviving larger burn injuries, and those in heavy industries like construction, may require different supports to return to their original jobs, or training in new, less physically-demanding jobs.

Based on these results, the authors noted that a coordinated return-to-work program can be beneficial in helping people with burn injuries return to their jobs relatively soon after injury. Past research has shown that people who return to work during the first 90 days after injury are more likely to regain full employment, and most participants in this program met that goal. Coordination between the injury survivor, the burn care team, VR counselor, and employer can streamline the return-to-work process and offer support and encouragement to the survivor. Even with these supports, however, people working in construction and those with more complex burn injuries may have difficulties returning to work. Researchers may want to look at additional supports to assist these burn survivor groups.

To Learn More

The Northwest Burn Model System’s employment resource package helps burn injury survivors think about, get ready for, and return to or find a work situation that is comfortable for them. http://burnrehab.washington.edu/work (also available in Spanish: http://burnrehab.washington.edu/es/reincorporacion-al-trabajo-inicio)

The Model Systems Knowledge Translation Center offers a Hot Topic module on Employment After Burn Injury, including video interviews with burn injury survivors and health professionals, factsheets, and slideshows. http://www.msktc.org/burn/Hot-Topics/Employment

The Job Accommodation Network (JAN) offers resources and support to individuals with disabilities and their employers to ensure an inclusive work environment. View their collection of Accommodation Ideas for Burn Injury at http://askjan.org/media/burn.htm

To Learn More About this Study

Carrougher, G.J., Brych, S.B., Pham, T.N., Mandell, S.P., and Gibran, N.S. (2017) An intervention bundle to facilitate return to work for burn-injured workers: Report from a Burn Model System investigation. Journal of Burn Care and Research, 38(1), e70-e78. This article is available from the NARIC collection under Accession Number J75430.

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