Effect of Telenursing and Face-to-Face Training Techniques on Quality of Life in Burn Patients: A Clinical Trial

Published:December 21, 2019DOI:



      To compare the effect of telenursing and face-to-face training on the quality of life (QOL) of patients with a burn injury.


      This clinical trial with pretest–posttest design on 3 groups was conducted in Kermanshah, Iran, from 2017 to 2018. Convenience sampling was used.


      A tertiary hospital in Kermanshah, west of Iran.


      A total of 90 patients with burns of grade 2 and 3 after discharge from the hospital were randomly assigned to 3 groups including telenursing (30), face-to-face training (30), and control (30).


      Each intervention group received 1-on-1 telephone training and face-to-face training in 8 sessions (2 sessions of 15 to 20min/wk). The control group received regular care.

      Main Outcome Measures

      QOL was evaluated by the Burn Specific Health Scale–Brief (BSHS-B).


      The mean BSHS-B scores before and after intervention for telenursing, face-to-face, and the control group were 71.43±21.92 and 133.06±11.97; 64.83±26.16 and 124.83±23.05; and 58.63±20.89 and 73.13±33.04, respectively. There was a statistically significant difference among the 3 groups with respect to the training methods after intervention (P<.001). In addition, post hoc test did not show a significant difference between the telenursing and face-to-face groups (P=.244).


      Educational methods in the form of telenursing and face-to-face training were effective and promoted QOL in survivors of burn injuries. Both telenursing and face-to-face training can be used to improve the QOL of survivors of burn injuries during the rehabilitation phase.


      List of abbreviations:

      BHSC-B (Burn Health Specific Scale–Brief), QOL (quality of life), TBSA (total-burn surface area)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Farrokh-Eslamlou H.R.
        • Khorasani-Zavareh D.
        • Oshnouei S.
        • Mokhtarpour S.
        Epidemiology of burns injury among women in reproductive age in the West Azerbaijan Province of Iran: a three year case-study.
        Saf Promot Inj Prev (Tehran). 2014; 2: 31-38
        • Elalem S.M.A.
        • Shehata O.S.M.
        • Shattla S.I.
        The effect of self-care nursing intervention model on self-esteem and quality of life among burn patients.
        Clin Nurs Stud. 2018; 6: 79
        • Nielson C.B.
        • Duethman N.C.
        • Howard J.M.
        • Moncure M.
        • Wood J.G.
        Burns: pathophysiology of systemic complications and current management.
        J Burn Care Res. 2017; 38: e469-e481
        • Liang C.
        • Wang H.J.
        • Yao K.
        • Pan H.
        • Wang K.
        Predictors of health-care needs in discharged burn patients.
        Burns. 2012; 38: 172-179
        • Smolle C.
        • Cambiaso-Daniel J.
        • et al.
        Recent trends in burn epidemiology worldwide: a systematic review.
        Burns. 2017; 43: 249-257
        • Lo S.F.
        • Hayter M.
        • Hsu M.
        • Lin S.E.
        • Lin S.I.
        The effectiveness of multimedia learning education programs on knowledge, anxiety and pressure garment compliance in patients undergoing burns rehabilitation in Taiwan: an experimental study.
        J Clin Nurs. 2010; 19: 129-137
        • Hashemi F.
        • Dolatabad F.R.
        • Yektatalab S.
        • Ayaz M.
        • Zare N.
        • Mansouri P.
        Effect of Orem Self-Care program on the life quality of burn patients referred to Ghotb-al-Din-e-Shirazi Burn Center, Shiraz, Iran: a randomized controlled trial.
        Int J Community Based Nurs Midwifery. 2014; 2: 40
        • Druery M.
        • Newcombe P.A.
        • Cameron C.M.
        • Lipman J.
        Factors influencing psychological, social and health outcomes after major burn injuries in adults: cohort study protocol.
        BMJ Open. 2017; 7 (e017545)
        • Abouie A.
        • Salamati P.
        • Hafezi-Nejad N.
        • et al.
        Incidence and cost of non-fatal burns in Iran: a nationwide population-based study.
        Int J Inj Contr Saf Promot. 2018; 25: 23-30
        • Gonçalves N.
        • Ciol M.A.
        • Dantas R.A.S.
        • Farina Junior J.A.
        • Rossi L.A.
        A randomized controlled trial of an educational programme with telephone reinforcement to improve perceived health status of Brazilian burn victims at 6-month post discharge.
        J Adv Nurs. 2016; 72: 2508-2523
        • Tang D.
        • Li-Tsang C.W.
        • Au R.K.
        • et al.
        Functional outcomes of burn patients with or without rehabilitation in mainland China.
        Hong Kong J Occup Ther. 2015; 26: 15-23
        • Kvannli L.
        • Finlay V.
        • Edgar D.W.
        • Wu A.
        • Wood F.M.
        Using the Burn Specific Health Scale-Brief as a measure of quality of life after a burn—what score should clinicians expect?.
        Burns. 2011; 37: 54-60
        • Falder S.
        • Browne A.
        • Edgar D.
        • et al.
        Core outcomes for adult burn survivors: a clinical overview.
        Burns. 2009; 35: 618-641
        • Pishnamazi Z.
        • Rejeh N.
        • Heravi-Karimooi M.
        • Vaismoradi M.
        Validation of the Persian version of the Burn Specific Health Scale–Brief.
        Burns. 2013; 39: 162-167
        • Wu P.
        • Wang X.
        • Jin R.
        • et al.
        A 27-year follow-up for a patient with 100% total body surface area burn.
        J Burn Care Res. 2018; 39: 302-307
        • Li-Tsang C.W.
        “Scarless world or scar-less world”: expedition on new perspectives on management of post-burn hypertrophic scar.
        Burns Trauma. 2016; 4: 22
        • Rodríguez-Gázquez Mde L.
        • Arredondo-Holguín E.
        • Herrera-Cortés R.
        Effectiveness of an educational program in nursing in the self-care of patients with heart failure: randomized controlled trial.
        Rev Lat Enfermagem. 2012; 20: 296-306
        • Rahimi-Kian F.
        • Dehghan-Nayeri N.
        • Mehran A.
        • Shirazi M.
        • Senobari M.
        Comparing the effects of face-to-face training and booklet-based education on maternal outcomes in gestational diabetes: a randomized controlled clinical trial.
        Nurs Pract Today. 2016; 3: 44-50
        • Fathani M.
        • Afzal A.M.
        • Tadayonfar M.
        Evaluation of the effect of designated educational intervention on the improvement of quality of life in caregivers of patients with chronic heart failure.
        J Babol Univ Med Sci. 2016; 18: 20-25
        • Shokraiean N.
        Comparison of the effect of face-to-face teaching and the educational booklet on the patient’s learning after urologic surgical procedures.
        J Nurs Educ. 2012; 1: 70-77
        • Higano K.
        • Shibayama T.
        • Ichikawa M.
        • et al.
        The effects of telenursing with goal attainment scaling in diabetic patients: a case report.
        Int J Nurs Clin Pract. 2015; 2: 2015
        • Kamei T.
        • Yamamoto Y.
        • Kajii F.
        • Nakayama Y.
        • Kawakami C.
        Systematic review and meta-analysis of studies involving telehome monitoring-based telenursing for patients with chronic obstructive pulmonary disease.
        Jpn J Nurs Sci. 2013; 10: 180-192
      1. Brunner LS. Brunner & Suddarth's textbook of medical-surgical nursing: Lippincott Williams & Wilkins; 2010.

        • Fard S.J.
        • Ghodsbin F.
        • Kaviani M.J.
        • Jahanbin I.
        • Bagheri Z.
        The effect of follow up (telenursing) on liver enzymes in patients with nonalcoholic fatty liver disease: a randomized controlled clinical trial.
        Int J Community Based Nurs Midwifery. 2016; 4: 239
        • Liu W.T.
        • Huang C.D.
        • Wang C.H.
        • Lee K.Y.
        • Lin S.M.
        • Kuo H.P.
        A mobile telephone-based interactive self-care system improves asthma control.
        Eur Respir J. 2011; 37: 310-317
        • McManus R.J.
        • Mant J.
        • Bray E.P.
        • et al.
        Telemonitoring and self-management in the control of hypertension (TASMINH2): a randomised controlled trial.
        Lancet. 2010; 376: 163-172
        • McCorkle R.
        • Ercolano E.
        • Lazenby M.
        • et al.
        Self-management: enabling and empowering patients living with cancer as a chronic illness.
        CA Cancer J Clin. 2011; 61: 50-62
        • Egede L.E.
        • Williams J.S.
        • Voronca D.C.
        • Gebregziabher M.
        • Lynch C.P.
        Telephone-delivered behavioral skills intervention for African American adults with type 2 diabetes: a randomized controlled Trial.
        J Gen Intern Med. 2017; 32: 775-782
        • Mavandadi S.
        • Wray L.O.
        • DiFilippo S.
        • Streim J.
        • Oslin D.
        Evaluation of a telephone-delivered, community-based collaborative care management program for caregivers of older adults with dementia.
        Am J Geriatr Psychiatry. 2017; 25: 1019-1028
        • Mohammadi N.
        • Omidi A.
        • Soleymani R.
        • Roshanaei G.
        The effect of telephone nursing follow-up on self-efficacy of females with type 2 diabetes mellitus.
        Sci J Hamadan Nurs Midwifery Fac. 2017; 25: 61-68
        • Shohani M.
        • Mozafari M.
        • Khorshidi A.
        • Lotfi S.
        Comparing the effects of face-to-face and telenursing education on the quality of family caregivers caring in patients with cancer.
        J Family Med Prim Care. 2018; 7: 1209
        • Kildal M.
        • Andersson G.
        • Fugl-Meyer A.R.
        • Lannerstam K.
        • Gerdin B.
        Development of a brief version of the burn specific health scale (BSHS-B).
        J Trauma. 2001; 51: 740-746
        • Elsherbiny O.E.E.
        • Salem M.A.
        • El-Sabbagh A.H.
        • Elhadidy M.R.
        • Eldeen S.M.A.
        Quality of life of adult patients with severe burns.
        Burns. 2011; 37: 776-789
        • Shahid F.
        • Ismail M.
        • Khan S.
        Assessment of quality of life in post burn survivors: a cross-sectional single-center first validation study from Pakistan.
        Burns Open. 2018; 2: 35-42
        • Druery M.
        • Brown T.L.H.
        • Muller M.
        Long term functional outcomes and quality of life following severe burn injury.
        Burns. 2005; 31: 692-695
        • Pandya A.A.
        • Corkill H.A.
        • Goutos I.
        Sexual function following burn injuries: literature review.
        J Burn Care Res. 2015; 36: e283-e293
        • Dowda D.J.
        • Li F.
        Major concerns and issues in burn survivors in Australia.
        Burns Trauma. 2014; 2: 84
        • Abu-Sittah G.
        • El Khatib A.
        • Dibo S.
        Thermal injury to the hand: review of the literature.
        Ann Burns Fire Disasters. 2011; 24: 175
        • Clarke A.
        A colour atlas of burn injuries.
        Chapman and Hall Medical Atlas Series, London1992
        • Al Ghriwati N.
        • Sutter M.
        • Pierce B.S.
        • Perrin P.B.
        • Wiechman S.A.
        • Schneider J.C.
        Two-year gender differences in satisfaction with appearance after burn injury and prediction of five-year depression: a latent growth curve approach.
        Arch Phys Med Rehabil. 2017; 98: 2274-2279
        • Heydarikhayat N.
        • Ashktorab T.
        • Rohani C.
        • Zayeri F.
        Effect of post-hospital discharge follow-up on health status in patients with burn injuries: a randomized clinical trial.
        Int J Community Based Nurs Midwifery. 2018; 6: 293
        • Grisbrook T.
        • Reid S.
        • Edgar D.
        • Wallman K.
        • Wood F.
        • Elliott C.
        Exercise training to improve health related quality of life in long term survivors of major burn injury: a matched controlled study.
        Burns. 2012; 38: 1165-1173
        • Brewin M.
        • Homer S.
        The lived experience and quality of life with burn scarring—the results from a large-scale online survey.
        Burns. 2018; 44: 1801-1810
        • Javanmardifard S.
        • Ghodsbin F.
        • Kaviani M.J.
        • Jahanbin I.
        The effect of telenursing on self-efficacy in patients with non-alcoholic fatty liver disease: a randomized controlled clinical trial.
        Gastroenterol Hepatol Bed Bench. 2017; 10: 263
        • Shi S.
        • Yang H.
        • Hui Y.
        • et al.
        Epidemiologic characteristics, knowledge and risk factors of unintentional burns in rural children in Zunyi, Southwest China.
        Sci Rep. 2016; 6: 35445
        • Balenton N.
        • Chiappelli F.
        Telenursing: bioinformation cornerstone in healthcare for the 21st century.
        Bioinformation. 2017; 13: 412