Investigating the Inter-rater Reliability of the Functional Assessment for Burns (FAB) Score in Adult Burn Inpatients

Study purpose:

Burn survivors face numerous physical challenges (e.g. reduced range of motion, upper/lower limb impairments, pain, swelling and itching) that affect activities of daily living (e.g. feeding, hygienic self-care, dressing, getting in/out of bed, walking and stair climbing). Assessment of physical function and independence, through valid and reliable instruments, is essential during inpatient rehabilitation of adult burn survivors in order to optimise their physical recovery and determine likely discharge outcomes. The FAB assessment is routinely carried out on patients at St Andrew's Burns Centre and the predictive validity of the FAB score has previously been tested in adult burn patients, however it has yet to be tested for inter-rater reliability. Therefore, the main purpose of this study is to investigate the ability of the FAB score to collect accurate data, free from measurement error, when used by multiple raters observing the same clinical episode.

Study design:

A quantitative reliability study will be carried out. All patients admitted to adult inpatients at St Andrew's Burn Centre will be screened and recruited according to inclusion/exclusion criteria by the Chief Investigator. There will be no change to patients' routine care as it is standard protocol for patients admitted to the burns ward to receive a FAB assessment within 48h of admission (FAB 1), and 48h of discharge (FAB 2), with interim assessments performed as necessary to monitor patients' progress and aid in maintaining motivation. In order to avoid any risk of potentially causing patients distress from too many assessing therapists, a maximum of three clinicians will be selected from a convenience sample of the burns inpatient therapy team (n=12). For each episode, the most clinically senior of the three raters will conduct the FAB assessment. Each rater will score the patient individually and will be blinded to the other observers' results. If a patient requires the assistance of more than one physiotherapist/occupational therapist to complete a task, the clinician is permitted to report, "I am assisting/supervising/not assisting", but not state how this would be represented as a FAB score.

Data analysis: