Verification Status, Rehabilitation Staffing, and Care Practices in U.S Outpatient Burn Clinics

Skilled occupational and physical therapists (OT/PT) provide essential services during outpatient (OP) burn follow-up to support comprehensive long-term recovery. Although ABA verification promotes burn therapist (OT/PT) integration in OP burn clinics, barriers related to staffing, time, and space remain, and little is known about burn therapist integration post-discharge. This study examined the relationship between both verification status and use of burn therapy services in OP burn clinics with three aspects of follow-up care: clinic structure and staffing; rehabilitation access and care delivery models; and patient access, barriers, and continuity of care. A 20-question electronic survey was distributed to 125 U.S. burn centers. Fisher's exact and chi-square tests were used for bivariate analyses, and Firth penalized logistic regression for multivariable analyses. Responses were received from 54 centers (43%). Most centers were ABA-verified (61%), and 65% reported dedicated burn therapists in the OP clinic. In multivariable analysis, therapist presence was not independently associated with verification status but was significantly associated with burn surgeon-led reconstruction programs (OR = 4.19, p = .043) and presence of garment programs (OR = 8.58, p = .043). Holding verification status constant, presence of dedicated OP burn therapy staff was significantly associated with increased outpatient rehabilitation utilization, including higher odds of clinic-based burn therapy referrals (OR = 9.20, p = .002) and post- reconstruction burn therapy follow-up (OR = 3.66, p = .042). These findings suggest that verification supports the integration of therapists, but that therapist presence itself is a critical factor driving comprehensive long-term rehabilitation.