Return to work in adults after burn injury in Australia: Western Australian outcomes, 2006-2024.

Abstract

After a burn, return to work (RTW) is a key goal to restore social integration and quality of life. Burn survivors face multidimensional obstacles as they attempt to RTW, including physical limitations, mental health impacts, and social stigma. This study aimed to investigate the RTW rate over time and identify patient-reported factors associated with no return to work within 12 months of a burn in an Australian context. This retrospective population registry study included all eligible adult burn patients injured between 2006 - 2024 in Western Australia (WA). Outcomes included: Sickness Impact Profile (SIP, work scale) and Burn-Specific Health Scale-Brief (BSHS-B, work domain). Data analyses involved mixed-effects adjusted regression models analyzing RTW rate, work impairment, and BSHS-B work domain over time. A sample of 953 patients (16.5 % of WA burn population) were included in the study cohort, with 84.6 % of these engaged prior to their injury in work outside managing their home. Most were male (70 %), with median age 36 years (IQR: 26.0-50.0) and 84 % had surgery. The median %TBSA was 2.4 % (IQR: 0.8-6.7 %), 15 % (n = 138) of the sample suffering major (≥10 %) burns. Work-related injury was reported by 22 %. Significant predictors of reduced RTW within one year, included contact burn (p = 0.021); electrical injury (p = 0.012); male sex (p = 0.045); multiple admissions (p = 0.003); prolonged wound healing (p < 0.001); work-related injury (p = 0.008); and, more psychology sessions in the first month after burn (p < 0.001). By 6 weeks post-burn, 38 % had RTW, increasing to 92 % of the sample by 12 months. The mean time to return was 40 days (SD 50 days). At one month, 79 % reported work impairment (SIP), declining to 61 % at 6 weeks and 50 % at 12 months. Receiving more occupational therapy 1-3 months post burn was associated with reduced reported work impairment (p < 0.001). While this study, which focussed on patient-reported outcome measures, confirmed that common, non-modifiable factors were barriers to return to work, timely multidisciplinary team input was shown to facilitate the high rate of return and early occupational therapy was associated with less reported work impairment, within one year after burn.