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Association Between Rehabilitation Frequency and Functional Outcomes After Burn Injury: A Single-Center Retrospective
Yazeed Temraz1,2, Theeb Al Salem1,2, Shaimaa Khan1,2
1Rehabilitation Department, Ministry of the National Guard-Health Affairs, Riyadh 11426, Saudi Arabia.
Objective:
To identify key predictors of clinical outcomes in burn survivors and clarify the role of mixed-depth burns and confounding by indication in observational rehabilitation research.
Design:
Retrospective cohort study using data from a burn rehabilitation registry (January 2024 to July 2025).
Setting:
Burn rehabilitation center.
Participants:
120 adult patients (age ≥ 18 years) with burns affecting ≥1% total body surface area (TBSA) and complete baseline data.
Interventions:
Not applicable.
Main Outcome Measures:
Primary outcome was functional improvement (ΔFIM). Secondary outcomes included pain reduction (ΔPain), scar severity (Vancouver Scar Scale; VSS), Activities of Daily Living (ADL) improvement, and Range of Motion (ROM) recovery. Multivariable linear and logistic regression models were used to identify predictors.
Results:
Patients achieved significant improvements in function (mean ΔFIM = 11.3 ± 8.9 points) and pain (mean ΔPain = 1.28 ± 0.81). Having a mixed-depth burn was the strongest predictor of worse scar outcomes (β = 2.52, 95% CI: 0.93 to 4.12, p = 0.002) and failure to achieve full ROM (OR = 0.089, 95% CI: 0.008 to 0.930, p = 0.043). An apparent association between inpatient ward care and better scar outcomes (β = -1.30, p = 0.020) was determined to be an artifact of confounding by indication, as the outpatient group had a higher proportion of high-risk mixed-depth burns (6.2% vs. 3.5%). Longer therapy duration was the only significant predictor of achieving ADL goals (OR = 1.014, 95% CI: 1.002 to 1.026, p = 0.025).
Conclusions:
Injury characteristics, particularly the presence of a mixed-depth burn, emerged as the dominant predictors of long-term scar and functional outcomes. This study identifies mixed-depth burns as a potentially high-risk clinical phenotype requiring targeted therapeutic strategies and demonstrates the critical importance of accounting for confounding by indication when evaluating rehabilitation outcomes in observational burn research.
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