Burns Rehabilitation

A multidisciplinary programme for burns management, treatment and prevention in low income countries.

Research question

Is the implementation of a culturally adapted multidisciplinary care quality and rehabilitation programme for burn survivors clinically effective, cost-effective, sustainable, and scalable across Pakistan?

Background

The World Health Organisation (WHO) describes the 11 million burns and 265,000 burn-related deaths annually as a forgotten global public health crises. 90% of burns occur in low-and-middle-income-countries (LMICs) where burns prevention activities, quality of care and rehabilitation services are inadequate. Over half of global burns-related deaths occur in the South Asia among adults. Lack of coordinated burns care and rehabilitation may result in reduced quality of life, anxiety, depression, post-traumatic stress disorder (PTSD), and increased mortality and social disintegration. Burns care and rehabilitation surpasses acute management extending into the social reintegration of patients thus requiring a multidisciplinary approach. To date, burns prevention, care quality and rehabilitation have not received sufficient attention in policy initiatives in Pakistan and other LMICs in the region. This calls for research to evaluate culturally adapted prevention, care quality and rehabilitation programmes for burns that can be implemented across LMICs.

Aims and Objectives

We seek to: Co-adapt (with patients, caregivers, clinicians, and service users) a culturally appropriate burns care quality and rehabilitation programme for burn survivors; Evaluate the acceptability, clinical effectiveness, and cost-effectiveness of its implementation across Pakistan and to determine its scalability and sustainability; Improve burn prevention and risk assessment and reduce stigma; Build capacity and capability in burn care, prevention and research in Pakistan.

Methods

Our proposed plan of work is organised into six work-packages (WPs):

WP1: Qualitative research to understand patient, family and provider contexts for co-adapting a culturally appropriate burn care quality and rehabilitation programme;

WP2: Develop and implement national burn registry based on the WHO global burn registry initiative;

WP3: Cluster RCT with internal pilot, economic and process evaluation to determine clinical and cost-effectiveness of the burns care and rehabilitation programme in Pakistan compared to usual care;

WP4: Mixed method evaluation of using social medial campaigns to promote burn prevention & risk assessment at communities/workplaces/industries, improve first aid support and reduce burn-related stigma;

WP5: work with policy makers, health and academia, social enterprises, government and non-government sectors, voluntary agencies and the community to better understand, prevent and manage burn-related injuries;

WP6: Develop sustainable capacity and capability in treatment and rehabilitation for burn injuries and research.

Timelines for delivery

The proposed programme of work will be conducted over 48 months. WP-1 in year-1, WP2 and WP-3 in year 2,3 and 4; WP-5 and 6 across the 4 years.

Anticipated Impact and Dissemination

A clinical and cost-effective burn care quality and rehabilitation programme has huge potential to save lives and contribute health and socio-economic benefits for patients, families, and the healthcare system in Pakistan. The nation-wide implementation and involvement of burn centres across all provinces offer an excellent opportunity to overcome the problem of burn care access experienced in LMICs. We will disseminate our findings widely, using a variety of approaches, supported by our stakeholder and patient advisory groups.