Health-related quality of life in burn survivors from low-and middle-income countries: A systematic review and targeted comparative analysis of rehabilitation interventions.

Abstract

Burn injuries place a high burden on low- and middle-income countries (LMICs), accounting for over 90% of global fire-related deaths. As survival improves, the metric for successful care has shifted to health-related quality of life (HRQoL). Recovery in LMICs is compounded by limited rehabilitation access, poverty, and social stigma. This systematic review synthesizes evidence on HRQoL outcomes and their predictors among burn survivors in LMICs. Following PRISMA 2020 guidelines, we systematically searched PubMed/MEDLINE, Cochrane, and regional databases (2013-2025) across Asian, African, and Middle Eastern LMICs. We included quantitative studies (cross-sectional, cohorts, randomized controlled trials [RCTs]) using validated HRQoL instruments. Studies were limited to 15 days to 3 months post-injury/discharge. Due to measurement heterogeneity, a full meta-analysis was precluded, but a targeted comparative analysis using standardized mean differences was performed on four intervention comparisons. The search yielded 721 records, with 10 studies included from South Asia, Africa, and the Middle East. The review identified consistently markedly impaired HRQoL, with the most compromised domains being physical functioning and psychological well-being. Key predictors of poor HRQoL included greater burn severity (e.g., ≥20% TBSA, third-degree burns) and crucial socioeconomic factors. Limited interventional data demonstrated that targeted physical rehabilitation, self-care education, and low-cost, remote delivery models significantly improved short-term scores. The targeted comparative analysis revealed a moderate-to-large standardized effect on HRQoL scores (Cohen's d ranging from 1.51 to 3.81) favoring rehabilitation interventions. HRQoL is severely compromised among burn survivors in LMICs, driven by clinical severity and exacerbated by socioeconomic barriers. Promising, scalable, low-cost rehabilitation programs can meaningfully improve short-term outcomes. Future research must prioritize standardized core outcome sets and policies should focus on integrating essential mental health and social support into long-term care frameworks.