Mathers Jonathan, Moiemen Naiem, Bamford Amy, Gardiner Fay, Tarver Joanne
Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.
The Scar Free Foundation Centre for Burns Research, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK.
Burns Trauma. 2020 Nov 1;8:tkaa030. doi: 10.1093/burnst/tkaa030. eCollection 2020.
There have been several attempts to define core outcome domains for use in research focused on adult burns. Some have been based in expert opinion, whilst others have used primary qualitative research to understand patients' perspectives on outcomes. To date there has not been a systematic review of qualitative research in burns to identify a comprehensive list of patient-centred outcome domains. We therefore conducted a systematic review of qualitative research studies in adult burns.
We searched multiple databases for English-language, peer-reviewed, qualitative research papers. We used search strategies devised using the SPIDER tool for qualitative synthesis. Our review utilized an iterative three-step approach: (1) outcome-focused coding; (2) development of descriptive accounts of outcome-relevant issues; and (3) revisiting studies and the broader theoretical literature in order to frame the review findings.
Forty-one articles were included. We categorized papers according to their primary focus. The category with the most papers was adaptation to life following burn injury (n = 13). We defined 19 outcome domains across the 41 articles: (1) sense of self; (2) emotional and psychological morbidity; (3) sensory; (4) scarring and scar characteristics; (5) impact on relationships; (6) mobility and range of joint motion; (7) work; (8) activities of daily living and self-care; (9) treatment burden; (10) engagement in activities; (11) wound healing and infection; (12) other physical manifestations; (13) financial impact; (14) impact on spouses and family members; (15) analgesia and side effects; (16) cognitive skills; (17) length of hospital stay; (18) access to healthcare; and (19) speech and communication. We suggest that sense of self is a core concern for patients that, to date, has not been clearly conceptualized in the burns outcome domain literature.
This outcome domain framework identifies domains that are not covered in previous attempts to outline core outcome domains for adult burn research. It does so with reference to existing theoretical perspectives from the sociology and psychology of medicine. We propose that this framework can be used as a basis to ensure that outcome assessment is patient-centred. Sense of self requires further consideration as a core outcome domain.
已有多项尝试来定义用于成人烧伤研究的核心结局领域。一些基于专家意见，而其他则采用质性研究来了解患者对结局的看法。迄今为止，尚未对烧伤领域的质性研究进行系统评价以确定以患者为中心的结局领域的完整清单。因此，我们对成人烧伤的质性研究进行了系统评价。
我们在多个数据库中搜索英文、同行评审的质性研究论文。我们使用了利用SPIDER工具设计的搜索策略进行质性综合。我们的评价采用了迭代的三步法：（1）以结局为重点的编码；（2）对与结局相关问题进行描述性阐述；（3）重新审视研究及更广泛的理论文献以构建评价结果。
纳入了41篇文章。我们根据其主要重点对论文进行分类。论文数量最多的类别是烧伤后对生活的适应（n = 13）。我们在这41篇文章中定义了19个结局领域：（1）自我意识；（2）情绪和心理疾病；（3）感觉；（4）瘢痕形成及瘢痕特征；（5）对人际关系的影响；（6）活动能力和关节活动范围；（7）工作；（8）日常生活活动和自我护理；（9）治疗负担；（10）参与活动；（11）伤口愈合和感染；（12）其他身体表现；（13）经济影响；（14）对配偶和家庭成员的影响；（15）镇痛及副作用；（16）认知技能；（17）住院时间；（18）获得医疗保健的机会；（19）言语和沟通。我们认为自我意识是患者的核心关注点，而迄今为止，在烧伤结局领域文献中尚未得到清晰的概念化。
这个结局领域框架确定了在先前概述成人烧伤研究核心结局领域的尝试中未涵盖的领域。它参考了医学社会学和心理学的现有理论观点。我们建议这个框架可作为确保结局评估以患者为中心的基础。自我意识作为一个核心结局领域需要进一步考虑。
