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Life Impact Burn Recovery Evaluation Profile (LIBRE)

Attempting to return to everyday life after a burn injury can be difficult, stressful and emotionally challenging. While traditional rehabilitation strategies for burn survivors focus on physical recovery, the Life Impact Burn Recovery Evaluation (LIBRE) Project focuses on the impact burn injuries have on patients’ social life. The LIBRE Profile is a self-reported outcome measure of social participation for adults (18 years or older) with burn injury. It is available as a regular survey (otherwise known as a “Short Form,”) or as a mobile app that modifies the questions based on initial responses (otherwise known as a “Computer Adaptive Test.”)

The LIBRE Profile may be used by:

  1. Burn survivors and their loved ones for self-assessment and tracking.
  2. Clinicians for assessing patients and identifying individuals who may benefit from additional resources, or for clinical quality improvement.
  3. Community organizers for community needs assessments.
  4. Researchers for quantifying social participation in a wide range of studies. Examples include intervention effectiveness studies or longitudinal outcome studies that compare same-domain scores across different time points.

International Translations of the LIBRE Profile

The International Consortium for translations of the LIBRE Profile is working toward making the LIBRE Profile available in countries around the world. Learn more >

  • Video: The LIBRE Profile: Assessing Burn Survivors' Social Participation

    The LIBRE Profile

    Assessing Burn Survivors' Social Participation

Availability

View and download the LIBRE profile for free with signed Terms of Use Agreement.

Resources for Burn Survivors

If you are looking for resources for a burn survivor, you are encouraged to consider the Phoenix Society for Burn Survivors.

Target Population

Adults 18 years of age or older with burn injury ≥ 5% total body surface area or to critical area(s) (e.g., hands, feet, face, genitals).

Studies are underway to develop a questionnaire to assess the impact of burn injury on child health in preschool and school-aged children. Actively enrolling; learn more here.

Administration Instructions

Download the LIBRE profile >

The LIBRE profile measures different aspects of an individual's ability to engage in everyday social situations across six social participation domains (areas) identified as important to people with burn injury (see below.) Each of the domains can be completed by themselves or in combination.

The LIBRE Profile can be completed one of three ways:

  1. With paper and pencil
  2. Via a mobile app
  3. Researchers can build electronic systems to capture responses using tools such as REDCap

Item responses are then summed to obtain raw scores for each domain, which can then be converted to a standardized score using a score transformation table.

Frequently Asked Questions

What if the burn survivor lacks the cognitive ability or language skills needed to answer the LIBRE Profile items?

If the burn survivor cannot read or answer the items due to cognitive impairments, intellectual disabilities, impaired language abilities, or other reasons, the LIBRE Profile should not be used.

What if the burn survivor has visual or motor impairments and cannot complete the assessment independently?

A “recorder” (e.g., clinician, family member) can help to record responses. The recorder should not influence or answer items for the burn survivor.

What if the burn survivor skips an item or several items?

Survivors are encouraged to answer all relevant questions to obtain the most accurate score; however, if the burn survivor is not able to, or does not want to answer a question, they may leave it blank.

Scoring

The Standardized Score (T-Score) places the burn survivor’s score on a common metric based on a calibration study of 601 adult burn survivors. Keep in mind that scores for each domain or area uses a unique metric, so scores from different domains are not comparable to each other.

The T-Score has a mean of 50 with a standard deviation of 10. T-Scores can be interpreted as follows:

  • LIBRE Profile-SF scale score of 50 à The burn survivor’s level of social participation is similar to the average level of social participation of the adult burn survivors included in the calibration sample.
  • LIBRE Profile-SF scale score of 40 à The burn survivor’s level of social participation is 1 standard deviation below the level of social participation of the adults included in the calibration sample.
  • LIBRE Profile-SF scale score of 60 à The burn survivor’s level of social participation is 1 standard deviation above the level of social participation of the adults included in the calibration sample.

Standard deviation image

Level

Score Range

Description

Relationships with Family and Friends involve spending time together, close relationships, and getting along.

1

<30

I am very uncomfortable in my relationships with family and friends. I get very little or no support.

2

31-44

I am somewhat uncomfortable in my relationships with family and friends. I get some support.

3

45-60

I am somewhat comfortable in my relationships with family and friends. I get quite a bit of support.

4

>61

I am very comfortable in my relationships with family and friends. I get a lot of support.

Social Activities involve outdoor activities, going to community events, and doing things with family and friends.

1

≤28

I am very uncomfortable and almost always avoid participating in social activities.

2

29-45

I am moderately uncomfortable and often avoid participating in social activities.

3

46-58

I am moderately uncomfortable and often avoid participating in social activities.

4

>59

I am comfortable and hardly ever avoid participating in social activities.

Social Interactions involve meeting strangers, going out with friends, and being in public.

1

<22

I am very uncomfortable and almost always avoid social interactions. I am very much troubled by my appearance and how others react to me.

2

23-35

I am moderately uncomfortable and often avoid social interactions. I am quite a bit troubled by my appearance and how others react to me.

3

36-54

I am mildly uncomfortable and sometimes avoid social interactions. I am somewhat troubled by my appearance and how others react to me.

4

>55

I am comfortable and hardly ever avoid social interactions. I am a little bit or not at all troubled by my appearance and how others react to me.
 

1

<30

I am very uncomfortable in my romantic relationship(s).

2

31-42

I am somewhat uncomfortable in my romantic relationship(s).

3

43-54

I am somewhat comfortable in my romantic relationship(s).

4

>55

I am very comfortable in my romantic relationship(s).

Sexual Relationships involve interest in sex, ability to have an orgasm, emotional closeness, and being able to do sexual activities.

1

≤27

I am very uncomfortable in my sexual relationship(s). My sexual relationship(s) is (are) not satisfying.

2

28-44

I am somewhat uncomfortable in my sexual relationship(s). My sexual relationship(s) is (are) somewhat satisfying.

3

45-61

I am somewhat comfortable in my sexual relationship(s). My sexual relationship(s) is (are) satisfying.

4

>62

I am very comfortable in my sexual relationship(s). My sexual relationship(s) is (are) very satisfying.

Work and Employment involve going to my job, keeping up with my work responsibilities, learning new things, and relationships with people at work.

1

≤30

I am very unsatisfied and uncomfortable at my job. I have many difficulties doing my work.

2

31-40

I am somewhat unsatisfied and uncomfortable at my job. I have some difficulty doing my work.

3

41-50

I am somewhat satisfied and comfortable at my job. I have few difficulties doing my work.

4

>51

I am very satisfied and comfortable at my job. I have hardly any difficulty doing my work.

 

Profile Domains

  • Relationships with Family & Friends

    Items ask how the burn injury may impact family relationships and socializing with the family. Perceptions include how a burn survivor’s appearance may affect the individuals’ ability to interact with family members. Included are both the comfort level and activities one participates in with family and friends, in addition to level of family support.

    Number of Items: 24

  • Social Interaction

    Items ask about the ability of burn survivors to interact with people and situations that are familiar; commonly reported problems for burn survivors are difficulty and anxiety in social situations.

    Number of Items: 25

  • Social Activities

    Items ask about the burn survivors’ perceptions of accomplishing daily activities and their ability to participate with others in these activities. These activities range from involvement in organized social events in the community (such as sporting events), informal gatherings with friends and associates, to parties with peers from work or other friends.

    Number of Items: 15

  • Work & Employment

    Items ask about relationship with coworkers, satisfaction with one’s work and the relationship with one’s peers on the job. In addition, the domain includes content related to the performance of work, work responsibilities, energy on the job and work absences due to health problems related to the burn injury.

    Number of Items: 19

  • Romantic Relationships

    Items ask about communication, the sharing of problems with a romantic partner, emotional closeness and comfort talking about problems, and enjoyment of the partner. The scale also identifies the conduct of social activities that can be both intimate and emotional.

    Number of Items: 28

  • Sexual Relationships

    Items are specific to sexual functioning and the physical act of sex and how that might impact a relationship for the burn survivor.

    Number of Items: 15

Authors

In alphabetical order:

Publications

Adult LIBRE Publications

Pediatric LIBRE Publications

LIBRE International Publications

Kazis LE, Sager A, Bailey HM, Vasudevan A, Garrity B, Tompkins RG. Physical Rehabilitation and Mental Health Care After Burn Injury: A Multinational Study [published correction appears in J Burn Care Res. 2022 May 17;43(3):758. doi: 10.1093/jbcr/irac004]. J Burn Care Res. 2022;43(4):868-879. doi:10.1093/jbcr/irab214

Vasudevan A, Bailey HM, Sager A, Kazis LE. Impact of the Early COVID-19 Pandemic on Burn Care: A Multi-National Study. J Burn Care Res. 2023;44(3):580-589. doi:10.1093/jbcr/irac076

Kazis LE, Marino M, Ni P, Soley Bori M, Amaya F, et al. Development of the life impact burn recovery evaluation (LIBRE) profile: assessing burn survivors' social participation. Qual Life Res. 2017 May 10; PubMed PMID: 28493205.

Dore EC, Marino M, Ni P, Lomelin-Gascon J, Sonis L, Amaya F, Ryan CM, Schneider JC, Jette AM, Kazis LE. Reliability & validity of the LIBRE Profile. Burns. 2018 Nov; 44(7):1750-1758. PMID: 30075970.

Marino M, Soley-Bori M, Jette AM, Slavin MD, Ryan CM, Schneider JC, Resnik L, Acton A, Amaya F, Rossi M, Soria-Saucedo R. Development of a Conceptual Framework to Measure the Social Impact of Burns. J Burn Care Res. 2016

Slavin MD, Ryan CM, Schneider JC, Acton A, Amaya F, Saret C, Ohrtman E, Wolfe A, Ni P, Kazis LE. Interpreting Life Impact Burn Recovery Evaluation Profile Scores for Use by Clinicians, Burn Survivors, and Researchers. J Burn Care Res. 2021 02 03; 42(1):23-31. PMID: 32556266

The LIBRE Profile was developed in collaboration with Boston University School of Public Health, the Boston-Harvard Burn Injury Model System, Mass General Brigham and the Phoenix Society for Burn Survivors, with funding by the National Institute on Disability, Independent Living and Rehabilitation Research, Award Number 90DP0055. The LIBRE Profile uses the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) as a conceptual framework. The LIBRE Profile was developed specifically to measure social participation in persons with a burn injury.