review ARTICLE

Burn Therapist Contributions to the American Burn Association and the Journal of Burn Care and Research: A 45th Anniversary Review Reginald Richard, MS, PT

The year 2013 marked the 45th anniversary of American Burn Association (ABA) annual meetings. At this significant juncture, a review of contributions of its members is appropriate to celebrate this milestone. Since the first ABA annual meeting and the initiation of the Journal of Burn Care and Research (JBCR), burn therapists, including both occupational and physical therapists, have grown to become integral members of the ABA, and their contributions among all members are highlighted. A systematic manual review of both ABA annual meeting proceedings and the JBCR was performed. The contributions of burn therapists to the ABA as a whole were classified, cataloged, and hand counted. Areas included: 1) quantifying ABA abstract and JBCR articles on authorship and subject matter, 2) representation on ABA committees; 3) participation in special activities; and 4) other recognitions. Burn therapists comprise 9.7% of ABA members overall. During the course of the first 44 ABA meetings, 8381 abstracts have been presented. Of this number, 634 (7.6%) have been delivered by burn therapists as lead authors. Through the end of 2011, no less than 3207 publications by all disciplines have appeared in JBCR. The vast majority of articles have been written by physicians, followed by doctorate-trained professionals. One hundredforty therapists have 249 publications (7.8%) to their credit. For both abstracts and articles, the top three subject matter topics have been: scarring, splints and casts, and outcomes. Numerous burn therapists have served as faculty and moderators at ABA annual meetings and on ABA committees including JBCR. Burn therapists have made significant contributions to the JBCR and in support of the ABA and its annual meetings over the past 45 years from the clinical, scientific, and Association perspectives. (J Burn Care Res 2014;35:465–469)

The year 2013 marked the 45th anniversary of American Burn Association (ABA) annual meetings. In recognition of this ninth quinquennial event, a review of the ABA’s accomplishments related to the contributions of its members was performed in celebration of this milestone. Since the first ABA annual meeting in 1969 held in Atlanta, Georgia, as well as the initiation of the current Journal of Burn Care From the U.S. Army Institute of Surgical Research Burn Center, Fort Sam Houston, Texas. The opinions or assertions contained herein are the private views of the author and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense. Address correspondence to Reg Richard, MS, PT, Clinical Research Coordinator Burn Rehabilitation, U.S. Army Institute of Surgical Research, 3698 Chambers Pass, Bldg 3611, Fort Sam Houston, Texas 78234. Copyright © 2014 by the American Burn Association 1559-047X/2014 DOI: 10.1097/BCR.0000000000000023

and Research (née Rehabilitation; JBCR) in 1980, burn therapists, including both occupation therapists (OTs) and physical therapists (PTs), have grown to become integral members in support of the ABA. In this review, the contributions of burn therapists relative to all ABA members are specifically highlighted. The intent of the current endeavor is to expand the historical record of burn therapist contributions to the ABA and JBCR as an updated supplement to previously recorded information.1

METHODS A systematic manual review of both the ABA annual meeting proceedings from inception through 20132 and the JBCR3,4 since its inauguration through the end of 2012 was performed. Contributions of members to the ABA in general, and burn therapists in particular, were hand-counted, classified, and 465

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cataloged. Areas of interest included: 1) quantifying ABA abstracts and JBCR articles based on authorship, discipline, and subject matter; 2) burn therapist representation on various ABA committees; 3) burn therapist participation in ABA programmatic activities; and 4) other notable burn therapist recognitions and contributions. Literature citations attributed to burn therapists were counted as individual entries for both ABA abstracts and JBCR articles only when an occupational or physical therapist or assistant was the lead author. The tallies did not include therapist presence as a coauthor. Authorship of ABA abstracts was singularly counted for burn therapists only without reference to other disciplines. Authorship in JBCR was separated out into disciplines. In both ABA proceedings and JBCR publications, burn therapists were classified according to their professional credentials as opposed to their academic degrees. Disciplines, other than therapists, were classified based on their listed professional designation relative to JBCR contributions. Where individuals of other disciples were dually credentialed, their contributions were cataloged based on the nature of the subject matter, that is, clinical or nonclinical. Subject matter was cataloged and tabulated based on the prevailing key words or topic in the title.

RESULTS As of July 16, 2012, 204 burn therapists were listed as active members of the ABA (personal communication).5 The burn therapist contingent represented 9.7% of the overall ABA membership (N = 2101) at the time. During the course of the first 45 ABA meetings, all disciplines combined have presented a

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total of 8649 abstracts. Of this number, 652 (7.5%) have been delivered by 326 different burn therapists as lead authors of podium, poster or video presentations (Figure 1). Approximately one third (N = 109) of these same burn therapists have presented two or more abstracts over the years. The three most frequent subject matter topics for burn therapist abstracts have related to the categories of: 1) scarring (14.2%); 2) splints (13.6%); and patient outcomes or outcome measures (10.1%). The remaining majority of abstracts covered a wide and varying range of subjects. The first issue of the JBCR appeared in the fall of 1980 under the title of the Journal of Burn Care & Rehabilitation with Charles R. Baxter, MD, as editor. With its first issue in 1996, the Journal changed its title by substituting “Research” for “Rehabilitation” under the newly appointed and current editor, Richard L. Gamelli, MD. Through the end of 2012, there had been 33 volumes and 194 issues of the JBCR. Since its inaugural issue, no less than 3207 publications across all disciplines have appeared in the JBCR excluding Editorials (n = 524), Letters to the Editor (n = 145), and Errata (n = 32). The vast majority of articles (n = 1835) have been written by physicians (57.2%), followed by doctorate trained professionals (n = 372–11.6%). To their credit, 142 burn therapists, as primary authors in the JBCR have contributed 254 submissions (7.8%). This contribution rate equates to approximately eight articles per year or slightly more than one contribution per issue (Figure 2). Similar to abstracts, the three most common topics included: 1) splinting/casting (15.7%); 2) scar management (14.5%); and 3) patient outcomes (12.1%). Including 2012 appointments to ABA committees, 179 burn therapists have been members of 21

Figure 1.  Plot of the number of American Burn Association abstracts presented by an occupational or physical therapist as lead author at annual meetings.

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Figure 2.  Plot of the number of articles authored by an occupational or physical therapist as lead author in the Journal of Burn Care and Research.

ABA committees (Table 1). Additionally, eight therapists have resided on the Board of Trustees and nine have served the JBCR as a Section Editor and/or on the Editorial Advisory Board. In the past, a burn therapist has served as an instructor of an ABA postgraduate course 35 times Table 1. Burn therapist representation on various committees of the American Burn Association (1974–2013) Committee Aftercare reintegration Archives Audit Awards Burn prevention By-Laws Committee Education Committee on Technology (ad hoc) Ethics International outreach Local arrangements Membership Advisory Committee (formerly Advisory Committee to the At-Large Membership) Membership Nominating Committee Organization and delivery of burn care Program Rehabilitation Research Sister Burn Center Program (ad hoc)—Chair Verification Strategic Budgeting Committee (Ad hoc) Other appointments  Board of Trustees  JBCR Editorial Board JBCR, Journal of Burn Care and Research.

Number 3 2 3 6 4 1 17 1 3 3 13 23

2 1 13 9 63 7 1 3 1 8 9

and 28 times a therapist has been on the faculty at ABA-sponsored educational symposia (Table 2). Eight burn therapists have been requested to participate as speakers at six plenary sessions. Burn therapists also have presided as moderators of 149 ABA scientific correlative sessions or sunrise/luncheon symposia beginning in 1972. Additionally, 36 different burn therapists have volunteered to assume the leadership role of Chair over the OT/PT Special Interest Group, which had its origin in 1982. Therapists have been recognized for their high level of achievements as well within the ABA (Table 3). Two burn therapists in the past have merited receipt of the Clinical Research Award for best clinical presentation at the ABA,6,7 and six have either been awarded first place (n = 3) or placed in the top three of the Burn Prevention Poster Contest at the annual meeting.8 Seven burn therapists have been honored with the Curtis P. Artz Distinguished Service Award since 1982.

DISCUSSION The ABA, founded in 1967, was organized on a multidisciplinary platform headed by burn surgeons but inclusive of all healthcare-related disciplines Table 2. Burn therapist participation in activities of the American Burn Association (1972–2013) Activity Postgraduate course instructors (total) Education Symposium faculty (total) Plenary Session speakers (individual) Sunrise Symposia moderators (total) Scientific Session moderators (total) Special Interest Group Chairs (individual)

Number 35 28 8 110 39 36

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Table 3. Burn therapist award recipients (1982–2013) Category Clinical Research Award Burn Prevention Poster Contest Curtis P. Artz Distinguished Service Award

Number 2 6 7

interested in the care and treatment of burn injuries, including both OTs and PTs.9 Available ABA membership records are sketchy in terms of breakout by disciplines. But, during the most recent 3 years, burn therapist membership in the ABA has remained fairly constant, averaging 216 members. In comparing the breakdown of today’s ABA membership, there are roughly three-and-a-half times more physician (N = 712) and nurse (N = 693) members than therapist members, with each of the first two disciplines equally representing approximately one third of the ABA membership overall. At the first ABA meeting, two abstracts were presented by verifiable burn therapists from the U. S. Army Burn Center.10,11 The greatest number of abstracts (N = 32) presented by therapists as lead authors peaked in 2001, with the abstracts divided into 11 podium and 21 poster presentations. The greatest number of podium presentation abstracts (N = 13) was delivered in 1980, which predated the opportunity to present information at the ABA annual meeting in either a poster or video format. From a historical point of view, it is interesting to note the increased trend for therapist abstract presentations beginning in 1989. Before this date, only medical doctors and academically prepared doctors of philosophy held the status of “active” membership in the ABA while all other members were designated as “associate” members. After this date, all members of the ABA were given equal status as active members as is currently the case. It could be speculated that the by-law change to grant equivalent status gave therapists, as well as other members, more “opportunities” in the ABA, including an expanded program for more allied health and nurse participation. In the 20 years before this ­ by-law change, burn therapists presented 136 abstracts, averaging roughly seven per year. After this date inclusive of 2013, 516 abstracts have been presented by therapists over the succeeding 25 years, averaging approximately 21 abstracts per year. This tripling effect of burn therapist abstracts most likely was a combination of factors, including a program change dedicated to more abstract space and an expansion of poster presentations. In 1980, the JBCR launched its inaugural volume. The first article by a therapist appeared in the second

issue.12 Therapists have had an article appear in JBCR each year except in 1982, most likely because of a lack of article submissions. In 1984, there was a steep rise in articles published by burn therapists, presumably with the initiation of the newly established PT/OT Forum.13 The PT/OT Forum, edited by Carole Johnson, PT, who was a prominent burn therapist in the ABA at the time, was the first of such forums with several more following, beginning in 1987 with the Burn Prevention Forum.14 As seen in Figure 2, the most published articles by burn therapists (N = 18) appeared in 1988. Since that time, there seems to be a tapering off of articles by burn therapists appearing in JBCR. This trend seems to reflect a similar but latent decrease in abstracts presented by therapists at ABA meetings. Hopefully, current burn therapists realize the opportunity they have in both of these avenues to make their work public and the trend reverses in the future. Therapists have actively contributed their talents and interests to most of all ABA committees available to them, beginning with the education committee in 1974. Understandably, most burn therapists (N = 63) have resided on the Rehabilitation Committee. But interestingly, the second most popular committee on which burn therapists have had the opportunity to participate in is the Membership Advisory Committee, which represents the interests and activities of the ABA membership as a whole. Although burn therapists comprise less than 10% of the total ABA membership, the visibility of the OT and PT disciplines on the burn team is logically the reason that they are represented frequently on the Membership Advisory Committee. During the years, some committees have dissolved from ABA activities because of the changing structure of the ABA. For instance, the Local Arrangements Committee, on which 13 burn therapists assisted in the mechanics of the annual meetings, disbanded after the establishment of the ABA Central Office, as the latter assumed responsibility for annual meeting oversight. In years previous to that juncture, the Program Chair worked closely with burn team members from the facility where the annual meeting was being held, customarily in the hometown or desired location of the reigning ABA president. Additionally, some committee participation is available only by serving on the Board of Trustees such as the Audit, Awards and Nominating Committees. Throughout the years that the ABA has been in existence, eight burn therapists have helped to govern the ABA by their presence on the Board of Trustees. In a similar manner for the JBCR, nine burn therapists have worked as either editor of the

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original PT/OT Forum, now Section Editor, and/ or have been on the Editorial Advisory Board. Burn therapists have contributed to the ABA in academic ways as well. As seen in Table 2, 71 burn therapists have been educators at ABA-sponsored annual meeting postgraduate courses and education symposia, and as speakers at plenary sessions. In addition, numerous burn therapists have been relied upon for their depth and breadth of knowledge on various rehabilitation topics as having moderated both early morning Sunrises Symposia (formerly called Breakfast Sessions) beginning in 1972 or Scientific Correlative Sessions starting in 1977 as part of the ABA annual meeting. As a tribute to their ABA contributions, several burn therapists have been duly recognized for their efforts as well (Table 3). In 1982, Barbara Willis Galstaun, an OT from Galveston, Texas, was the first to receive the Curtis P. Artz Distinguished Service Award. These accolades are a testament to the quality contributions that burn therapists have made to the ABA; but the awards also reflect the ABA’s support of its component members.

CONCLUSION Burn therapists have made substantial contributions in support of the ABA and the JBCR in proportion to their membership size during the past 45 years at its annual meetings; in administrative and programmatic capacities; and to the JBCR from a clinical, scientific, and association perspective. In the years ahead, it will be most important for burn therapists to not only continue but to raise their level of vitality and visibility within the ABA. This exhortation is made in order to not only keep the interest of therapy at the forefront, but moreover, so that the

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ABA continues to grow and develop as a diversified association for its membership.

ACKNOWLEDGMENTS I thank Basil A. Pruitt, Jr., MD, for his assistance in providing early American Burn Association (ABA) abstract information and for abstract counts for ABA proceedings during 1975–1979 and to Rita Postilion, Membership Coordinator at the ABA Central Office, for membership information. REFERENCES 1. Richard R, Staley M. A silver anniversary tribute to therapists of the American Burn Association. J Burn Care Rehabil 1993;14(2 Pt 2):257–66. 2. Proceedings of the American Burn Association 1969–2013. 3. J Burn Care Rehabil 1980–2005. 4. J Burn Care Res 2006–2012. 5. Personal communication with ABA Central Office, 2012. 6. Hedman TL, Chapman TT, Dewey WS, Quick CD, Wolf SE, Holcomb JB. Two simple leg net devices designed to protect lower-extremity skin grafts and donor sites and prevent decubitus ulcer. J Burn Care Res 2007;28:115–9. 7. Yohannan SK, Tufaro PA, Hunter H, et al. The utilization of Nintendo® Wii™ during burn rehabilitation: a pilot study. J Burn Care Res 2012;33:36–45. 8. Available at; accessed August 2012. 9. Artz CP. History of burns. In: Artz CP, Moncrief JA, Pruitt Jr. BA, editors. Burns: a team approach. Philadelphia, PA: WB Saunders; 1979. p. 3–16. 10. Dobbs ER. Analysis of results of physical therapy in over 600 burn patients. Proceedings of the American Burn Association 1969, p. 16. 11. Von Prince K. Splinting of elbows in burn patients. Proceedings of the American Burn Association 1969. p 16. 12. Johnson C, Engrav LH, Heimbach DM, et al. Evaluating functional hand results after deep dermal burns with total active motion measurements. J Burn Care Rehabil 1980;1:19–21. 13. Johnson CL. PT/OT Forum. J Burn Care Rehabil 1984;5:113–5. 14. Achauter B. Burn Prevention Forum. J Burn Care Rehabil 1987;8:61.

Burn therapist contributions to the American Burn Association and the Journal of Burn Care and Research: a 45th anniversary review.

The year 2013 marked the 45th anniversary of American Burn Association (ABA) annual meetings. At this significant juncture, a review of contributions ...
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