Burn Specific Health Scale

The Burn Specific Health Scale (BSHS) is the only condition-specific health status instrument for use in patients with burn injuries. It was originally developed by Blades et al in 1982 and has subsequently had abbreviated (BSHS-A; Munster et al 1987), revised (BSHS-R; Blalock et at t994) and, most recently, brief (BSHS-B; Kildal et at 2001) versions produced. It is a self-administered questionnaire and the different versions have been translated into several languages. The original version contained 114 items. The BSHS-A has 80 items across four domains (physical, mental, social, and general) and eight subscales (mobility and self-care, hand function, role activities, body image, affective, family/friends, sexual activity, and general health concerns). The BSHS-R has 31 items with two domains (physical and psychological) and seven sub-domains, and the BSHS-B has 40 items covering nine domains (heat sensitivity, affect, hand function, treatment regimens, work, sexuality, interpersonal relationships, simple abilities, and body image). The brief version is cited commonly in the literature and was developed because of perceived shortcomings with the other versions in coverage of aspects of burn-specific health and inter-correlation of domains and sub-domains (Willebrand and Kildal 2008). A recent second-order factor analysis of the BSHS-B revealed three broad domains: affect and relations, function, and skin involvement. These authors suggest that the work sub-scale be considered as an outcome domain in itself. Instructions to the client and scoring: The BSHS-B takes 10-15 minutes to complete and 5 minutes to score. Responses are made on a 5-point scale from 0 (extreme (ly)) to 4 (none/not at all) for each of the 40 items and patients are asked to select the best answer. Mean scores are calculated for each of the domains. Reliability and validity: Internal consistency of the BSHS-B has been shown to be good with a Cronbach's a of 0.75-0.93 (Kildal et al 2001). There is evidence of concurrent validity for the BSHS-B when compared with the abbreviated and revised versions (Kildal et al 2002). It is claimed that the BSHS-B exhibits construct validity in its association with a variety of aspects of burn-related health (Willebrand and Kildal 2008, Wikehult 2008). The BSHS-B has been used to establish criterion validity for the QuickDASH in an Australian sample with upper limb burns and it was found that while mean scores improved over the period of the study for both measures, the effect sizes were greater for the QuickDASH (Wu et al 2007). When used in conjunction with the SF-36, the BSHS-B was found to provide more useful information regarding fear-avoidance and post-traumatic stress disorder in relation to return to work (Dyster-Aas et a] 2007).