Effects on health-related quality of life of therapeutic exercise in burn survivors: A systematic review and meta-analyses.

Abstract

Burn injuries often result in long-term physical and psychological impairments that negatively impact health-related quality of life. Although therapeutic exercise is a key component of burn rehabilitation, its specific effects on health-related quality of life among adult burn survivors are unclear. The aim of this study was to systematically evaluate and meta-analyze the evidence on the effectiveness of therapeutic exercise in improving health-related quality of life among adult burn survivors. We performed a systematic search of the PubMed, Scopus, Web of Science, PEDro, and Cochrane Library databases from their inception until January 2025. The research question was formulated using the PICOS model, and only clinical trials or randomized controlled trials involving adults were included. Therapeutic exercise interventions followed American College of Sports Medicine (ACSM) guidelines for either aerobic or resistance training, with usual care serving as the comparator. The Cochrane Risk of Bias Tool was used to assess risk of bias. The protocol was registered in PROSPERO (CRD42024527745). Seven studies involving 340 burn patients were included, and three studies were pooled for a meta-analysis using RevMan 5. Therapeutic exercise significantly improved burn-specific health-related quality of life (Short Form-36, the Burn Specific Health Scale-Brief, WHOQOL-BREF and EuroQol-5D) particularly in simple abilities (mean difference [MD] = 0.69; 95 % confidence interval [CI] = 0.26-1.12; p = 0.002) and affective aspects (MD = 1.63; 95 % CI = 1.00-2.26; p < 0.001) of the Burn Specific Health Scale-Brief. However, no significant effect was observed in interpersonal relationships (p = 0.09). Substantial heterogeneity (I² = 83 %) was observed, requiring cautious interpretation of the results. This systematic review and meta-analysis provide evidence that therapeutic exercise interventions significantly improve health-related quality of life in adult burn survivors. The findings are consistent across most health-related quality of life domains, in particular, the results of our meta-analysis show significant improvements in affect and simple skills.