Burn Specific Health Scale.

Description

The Burn Specific Health Scale (BSHS) is the only condition-specific health status instrument for use in patients with burn injuries. It was originally developed by Blades et al in 1982 and has subsequently had abbreviated (BSHS-A; Munster et al 1987), revised (BSHS-R; Blalock et al 1994) and, most recently, brief (BSHS-B; Kildal et al 2001) versions produced. It is a self-administered questionnaire and the different versions have been translated into several languages. The original version contained 114 items. The BSHS-A has 80 items across four domains (physical, mental, social, and general) and eight subscales (mobility and self-care, hand function, role activities, body image, affective, family/friends, sexual activity, and general health concerns). The BSHS-R has 31 items with two domains (physical and psychological) and seven sub-domains, and the BSHS-B has 40 items covering nine domains (heat sensitivity, affect, hand function, treatment regimens, work, sexuality, interpersonal relationships, simple abilities, and body image). The brief version is cited commonly in the literature and was developed because of perceived shortcomings with the other versions in coverage of aspects of burn-specific health and inter-correlation of domains and sub-domains (Willebrand and Kildal 2008). A recent second-order factor analysis of the BSHS-B revealed three broad domains: affect and relations, function, and skin involvement. These authors suggest that the work sub-scale be considered as an outcome domain in itself.

Instructions to the client and scoring: The BSHS-B takes 10-15 minutes to complete and 5 minutes to score. Responses are made on a 5-point scale from 0 (extreme (ly)) to 4 (none/not at all) for each of the 40 items and patients are asked to select the best answer. Mean scores are calculated for each of the domains.

Reliability and validity: Internal consistency of the BSHS-B has been shown to be good with a Cronbach's [alpha] of 0.75-0.93 (Kildal et al 2001). There is evidence of concurrent validity for the BSHS-B when compared with the abbreviated and revised versions (Kildal et al 2002). It is claimed that the BSHS-B exhibits construct validity in its association with a variety of aspects of burn-related health (Willebrand and Kildal 2008, Wikehult 2008).

The BSHS-B has been used to establish criterion validity for the QuickDASH in an Australian sample with upper limb burns and it was found that while mean scores improved over the period of the study for both measures, the effect sizes were greater for the QuickDASH (Wu et al 2007). When used in conjunction with the SF-36, the BSHS-B was found to provide more useful information regarding fear-avoidance and post-traumatic stress disorder in relation to return to work (Dyster-Aas et al 2007).

Commentary

Outcome measurement in burn care is currently under review as, until relatively recently, the principal measure of outcome was survival. With improvements in mortality rates, the emphasis has shifted to assessment of morbidity (Blades et al 1982). It is recommended that a battery of measures be used to reflect the multidimensional nature of the sequelae of burn injury. These should include condition-specific as well as generic measures of health status so that meaningful data related to the condition can be collected as well as allowing for comparison with other conditions and population norms (Dyster-Aas et al 2007, Litlere Moi et al 2006). In addition, measures of function and disability (impairment, activity limitation, and restrictions in participation) are needed and linkage to the International Classification of Functioning, Disability and Health (ICF) is desirable (van Baar et al 2006).

The BSHS is the only condition-specific measure of health status currently in use for the burn injury population and was originally developed to reflect the morbidity associated with burn injuries (Blades et al 1982). The BSHS has been used increasingly in the literature; in the most recent publications, there has been almost exclusive use of the BSHS-B with most of the research emanating from the Uppsala University Burns Research Group who were responsible for the development of this version.

The reliability of the BSHS-B has been established in one study in English but has not been replicated. Construct and criterion validity of the Korean version of the BSHS-B have been established (Son et al 2005). There has also been principal component factor analysis (Kildal et al 2001) and second order factor analysis (Willebrand and Kildal 2008).

Limitations include the lack of information on clinically important change, possible ceiling effects, and minimal comparison with other measures. There is a need for further research to investigate these clinimetric issues but the BSHS-B does represent an attractive option for the assessment of burn-specific health status in conjunction with generic measures of quality of life such as the SF-36.

Margaret McMahon

Dublin, Ireland

References

Blades et al (1982) J Trauma 22: 872-875.

Blalock SJ et al (1994) J Trauma 36: 508-515.

Dyster-Aas et al (2007) J Rehabil Med 39: 49-55.

Kildal et al (2001) J Trauma 51: 740-746.

Kildal et al (2002) Burns 28: 639-645.

Litlere Moi et al (2006) J Trauma 61: 961-969.

Munster et al (1987) J Trauma 27: 425-428.

Son et al (2005) Korean Medical Database.

Van Baar et al (2005) Burns 32: 1-9.

Wikehult (2008) http://urn.kb.se/resolve?urn=urn:nbn:se:uu:div a-9262.

Willebrand M, Kildal M (2008) J Trauma 64: 1581-1586.

Wu et al (2007) Burns 33: 843-849.