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Kondo T, Tsuboi H, Nishiyama K, Takahashi G, Nishimura Y. Effects of rehabilitation treatments jointly considered by physiatrists and rehabilitation therapists in patients with severe burn injury. Burns 2024; 50:1621-1631. [PMID: 38604823 DOI: 10.1016/j.burns.2024.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 03/21/2024] [Accepted: 03/31/2024] [Indexed: 04/13/2024]
Abstract
Rehabilitation treatments for patients with severe burn injury (SBI) are difficult owing to the lack of knowledge, skills, and experience among clinicians and physical and occupational therapists, resulting in serious patient disability. This study retrospectively evaluated the effectiveness of rehabilitation treatments jointly considered by physiatrists and rehabilitation therapists (Physiatrist and Registered therapist Operating rehabilitation: PROr) for patients with SBI admitted to our hospital's burn intensive care unit (BICU). Eligible patients were classified into the PROr and standard rehabilitation (SR) groups. Contents of the rehabilitation program in the BICU, the functional ambulation categories (FAC), and the Barthel index at the first rehabilitation, BICU discharge, and hospital discharge were collected. Of the 184 patients with severe burns admitted to the BICU, 29 (PROr group, n = 16; SR group, n = 13) met the eligibility criteria. The PROr group received more types of exercise interventions for a longer time than the SR group. No significant differences in the FAC and Barthel index scores at the first time of rehabilitation were found between the two groups; however, the scores of FAC and Barthel index at BICU and hospital discharges were higher in the PROr group than in the SR group. The PROr program may help in the functional improvement of patients with SBI.
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Affiliation(s)
- Takahito Kondo
- Department of Rehabilitation Medicine, Iwate Medical University, Japan; Rehabilitation Division, Iwate Medical University Hospital, Japan
| | - Hiroyuki Tsuboi
- Rehabilitation Division, Iwate Medical University Hospital, Japan
| | | | - Gaku Takahashi
- Department of Disaster and Emergency Medicine, Iwate Medical University, Japan
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Suzuki DRR, Santana LA, Ávila JEHG, Amorim FF, Modesto GP, Gottems LBD, Maldaner V. Quality indicators for hospital burn care: a scoping review. BMC Health Serv Res 2024; 24:486. [PMID: 38641612 PMCID: PMC11031897 DOI: 10.1186/s12913-024-10980-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 04/10/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Burn treatments are complex, and for this reason, a specialised multidisciplinary approach is recommended. Evaluating the quality of care provided to acute burn patients through quality indicators makes it possible to develop and implement measures aiming at better results. There is a lack of information on which indicators to evaluate care in burn patients. The purpose of this scoping review was to identify a list of quality indicators used to evaluate the quality of hospital care provided to acute burn patients and indicate possible aspects of care that do not have specific indicators in the literature. METHOD A comprehensive scoping review (PRISMA-ScR) was conducted in four databases (PubMed, Cochrane Library, Embase, and Lilacs/VHL) between July 25 and 30, 2022 and redone on October 6, 2022. Potentially relevant articles were evaluated for eligibility. General data and the identified quality indicators were collected for each included article. Each indicator was classified as a structure, process, or outcome indicator. RESULTS A total of 1548 studies were identified, 82 were included, and their reference lists were searched, adding 19 more publications. Thus, data were collected from 101 studies. This review identified eight structure quality indicators, 72 process indicators, and 19 outcome indicators listed and subdivided according to their objectives. CONCLUSION This study obtained a list of quality indicators already used to monitor and evaluate the hospital care of acute burn patients. These indicators may be useful for further research or implementation in quality improvement programs. TRIAL REGISTRATION Protocol was registered on the Open Science Framework platform on June 27, 2022 ( https://doi.org/10.17605/OSF.IO/NAW85 ).
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Affiliation(s)
- Denise R Rabelo Suzuki
- Programa de Pós-Graduação em Ciências para a Saúde, Escola Superior de Ciências da Saúde (ESCS/FEPECS), SMNH Quadra 3 Conjunto A Bloco 01 Edifício Fepecs, Asa Norte, Brasília, Distrito Federal, Brazil.
- Secretaria de Saúde do Distrito Federal (SES-DF), Setor de Rádio e TV Norte (SRTVN) 701, Via W5 Norte, lote D, Brasília, Distrito Federal, Brazil.
- Unidade de Queimados, Hospital Regional da Asa Norte (HRAN), 3° andar. Setor Médico Hospitalar Norte Q 2, Brasília, Distrito Federal, 70710-100, Brazil.
| | - Levy Aniceto Santana
- Programa de Pós-Graduação em Ciências para a Saúde, Escola Superior de Ciências da Saúde (ESCS/FEPECS), SMNH Quadra 3 Conjunto A Bloco 01 Edifício Fepecs, Asa Norte, Brasília, Distrito Federal, Brazil
- Secretaria de Saúde do Distrito Federal (SES-DF), Setor de Rádio e TV Norte (SRTVN) 701, Via W5 Norte, lote D, Brasília, Distrito Federal, Brazil
| | - Juliana Elvira H Guerra Ávila
- Secretaria de Saúde do Distrito Federal (SES-DF), Setor de Rádio e TV Norte (SRTVN) 701, Via W5 Norte, lote D, Brasília, Distrito Federal, Brazil
- Programa de Pós-Graduação em Ciências da Saúde, Universidade de Brasília (UnB), Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, Distrito Federal, Brazil
- Unidade de Queimados, Hospital Regional da Asa Norte (HRAN), 3° andar. Setor Médico Hospitalar Norte Q 2, Brasília, Distrito Federal, 70710-100, Brazil
| | - Fábio Ferreira Amorim
- Programa de Pós-Graduação em Ciências da Saúde, Universidade de Brasília (UnB), Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, Distrito Federal, Brazil
| | - Guilherme Pacheco Modesto
- Programa de Pós Graduação em Ciências do Movimento Humano e Reabilitação, Universidade Evangélica de Goiás, Cidade Universitária, Avenida Universitária, Anápolis, Goiás, Brazil
| | - Leila Bernarda Donato Gottems
- Programa de Pós-Graduação em Ciências para a Saúde, Escola Superior de Ciências da Saúde (ESCS/FEPECS), SMNH Quadra 3 Conjunto A Bloco 01 Edifício Fepecs, Asa Norte, Brasília, Distrito Federal, Brazil
- Secretaria de Saúde do Distrito Federal (SES-DF), Setor de Rádio e TV Norte (SRTVN) 701, Via W5 Norte, lote D, Brasília, Distrito Federal, Brazil
| | - Vinicius Maldaner
- Programa de Pós Graduação em Ciências do Movimento Humano e Reabilitação, Universidade Evangélica de Goiás, Cidade Universitária, Avenida Universitária, Anápolis, Goiás, Brazil
- Universidade de Brasília (UnB), Ceilândia Sul Campus Universitário, Centro Metropolitano, Ceilândia, Distrito Federal, Brazil
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Fanstone R, Price P. Global perspectives on risk factors for major joint burn contractures: A literature review. Burns 2024; 50:537-549. [PMID: 37977897 DOI: 10.1016/j.burns.2023.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/31/2023] [Accepted: 09/22/2023] [Indexed: 11/19/2023]
Abstract
Contractures are a frequent consequence of burn injuries, yet our knowledge of associated risk factors is limited. This paper provides an extensive review of relevant literature from both High-Income Countries (HICs) and Low-Middle Income Countries (LMICs). Ninety-four papers (up to June 2019) and eight subsequent publications (up to March 2022) were included, 76% of which were from HICs. The majority of publications were either descriptive studies (4 from HICs, 9 from LMICs) or papers citing putative risk factors (37 from HICs, 10 from LMICs). Seventeen publications (all from HICs) reported on the effects of individual non-surgical therapeutic interventions, often with conflicting results. Two published systematic reviews emphasised the poor quality of evidence available. Only fifteen studies (3 from LMICs) examined potential contracture risk factors with statistical comparisons of outcomes; significant findings from these included demographic, burn, comorbidities, and treatment risk factors. LMIC papers included socioeconomic and healthcare system factors as potential risks for contracture; these were rarely considered in HIC publications. Methodological issues identified from this review of literature included differences in contracture definitions, populations studied, standards of care, joints included and the timing and nature of contracture assessments.This review is the first to collate existing knowledge on risk factors for burn contractures from both HIC and LMIC settings, revealing a surprising lack of robust evidence for many accepted risk factors. In LMICs, where burns are particularly common, universal health provision is lacking and specialist burn care is both scarce and difficult to access; consequently, socioeconomic factors may have more immediate impact on contracture outcomes than specific burn treatments or therapies. Much more work is indicated to fully understand the relative impacts of risk factors in different settings so that context-appropriate contracture prevention strategies can be developed.
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Affiliation(s)
- RuthAnn Fanstone
- Centre for Global Burn Injury Policy and Research, Swansea University, UK.
| | - Patricia Price
- Centre for Global Burn Injury Policy and Research, Swansea University, UK
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Navarro Y, Huang E, Johnson C, Clark F, Coppola S, Modi S, Warren GL, Call JA. The Influence of COVID-19 on Patient Mobilization and Injury Attributes in the ICU: A Retrospective Analysis of a Level II Trauma Center. TRAUMA CARE 2024; 4:44-59. [PMID: 38606188 PMCID: PMC11007754 DOI: 10.3390/traumacare4010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
Abstract
The objectives of this study were to determine the effect of COVID-19 on physical therapy (PT) mobilization of trauma patients and to determine if mobilization affected patient course in the ICU. This retrospective study included patients who were admitted to the ICU of a level II trauma center. The patients were divided into two groups, i.e., those admitted before (n = 378) and after (n = 499) 1 April 2020 when Georgia's COVID-19 shelter-in-place order was mandated. The two groups were contrasted on nominal and ratio variables using Chi-square and Student's t-tests. A secondary analysis focused specifically on the after-COVID patients examined the extent to which mobilization (n = 328) or lack of mobilization (n = 171) influenced ICU outcomes (e.g., mortality, readmission). The two groups were contrasted on nominal and ratio variables using Chi-square and Student's t-tests. The after-COVID patients had higher injury severity as a greater proportion was classified as severely injured (i.e., >15 on Injury Severity Score) compared to the before-COVID patients. After-COVID patients also had a greater cumulative number of comorbidities and experienced greater complications in the ICU. Despite this, there was no difference between patients in receiving a PT consultation or days to mobilization. Within the after-COVID cohort, those who were mobilized were older, had greater Glasgow Coma Scale scores, had longer total hospital days, and had a lesser mortality rate, and a higher proportion were female. Despite shifting patient injury attributes post-COVID-19, a communicable disease, mobilization care remained consistent and effective.
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Affiliation(s)
- Yelissa Navarro
- Medical College of Georgia, AU/UGA Medical Partnership, Athens, GA 30602, USA
| | - Elizabeth Huang
- Medical College of Georgia, AU/UGA Medical Partnership, Athens, GA 30602, USA
| | - Chandler Johnson
- Medical College of Georgia, AU/UGA Medical Partnership, Athens, GA 30602, USA
| | - Forrest Clark
- Medical College of Georgia, AU/UGA Medical Partnership, Athens, GA 30602, USA
| | - Samuel Coppola
- Medical College of Georgia, AU/UGA Medical Partnership, Athens, GA 30602, USA
| | - Suraj Modi
- Medical College of Georgia, AU/UGA Medical Partnership, Athens, GA 30602, USA
| | - Gordon L. Warren
- Department of Physical Therapy, Georgia State University, Atlanta, GA 30302, USA
| | - Jarrod A. Call
- Department of Physiology & Pharmacology, University of Georgia, Athens, GA 30602, USA
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Schieffelers DR, Dombrecht D, Lafaire C, De Cuyper L, Rose T, Vandewal M, Meirte J, Gebruers N, van Breda E, Van Daele U. Effects of exercise training on muscle wasting, muscle strength and quality of life in adults with acute burn injury. Burns 2023; 49:1602-1613. [PMID: 37188565 DOI: 10.1016/j.burns.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/23/2023] [Accepted: 04/15/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVES Exercise training during the acute phase of burns is difficult to implement but offers potential benefits. This multicenter trial explored the effects of an exercise program on muscular changes and quality of life during burn center stay. METHODS Fifty-seven adults with burns ranging between 10% and 70% TBSA were allocated to receive either standard of care (n = 29), or additionally exercise (n = 28), consisting of resistance and aerobic training, commenced as early as possible according to safety criteria. Muscle wasting (primary outcome), quantified by ultrasound-derived quadriceps muscle layer thickness (QMLT) and rectus femoris cross-sectional area (RF-CSA), muscle strength and quality of life (Burn Specific Health Scale-Brief (BSHS-B) and EQ-5D-5L) were assessed at baseline, four and eight weeks later, or hospital discharge. Mixed models were used to analyze between-group changes over time with covariates of interest added in stepwise forward modeling. RESULTS The addition of exercise training to standard of care induced significant improvements in QMLT, RF-CSA, muscle strength and the BSHS-B subscale hand function (ß-coefficient. 0.055 cm/week of QMLT, p = 0.005). No added benefit was observed for other quality-of-life measures. CONCLUSIONS Exercise training, administered during the acute phase of burns, reduced muscle wasting, and improved muscle strength throughout burn center stay.
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Affiliation(s)
- David R Schieffelers
- Multidisciplinary Metabolic Research Unit (M2RUN), MOVANT Research Group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
| | - Dorien Dombrecht
- Multidisciplinary Metabolic Research Unit (M2RUN), MOVANT Research Group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Cynthia Lafaire
- Burn Unit, ZNA Stuivenberg, Lange Beeldekensstraat 267, 2060 Antwerp, Belgium; OSCARE, Organization for Burns, Scar After-care and Research, Van Roiestraat 18, 2170 Antwerp, Belgium
| | - Lieve De Cuyper
- Burn Unit, ZNA Stuivenberg, Lange Beeldekensstraat 267, 2060 Antwerp, Belgium; OSCARE, Organization for Burns, Scar After-care and Research, Van Roiestraat 18, 2170 Antwerp, Belgium
| | - Thomas Rose
- Burn Unit, Military Hospital Queen Astrid, Rue Bruyn 1, 1120 Brussels, Belgium
| | - Martijn Vandewal
- Burn Unit, ZNA Stuivenberg, Lange Beeldekensstraat 267, 2060 Antwerp, Belgium
| | - Jill Meirte
- Multidisciplinary Metabolic Research Unit (M2RUN), MOVANT Research Group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; OSCARE, Organization for Burns, Scar After-care and Research, Van Roiestraat 18, 2170 Antwerp, Belgium
| | - Nick Gebruers
- Multidisciplinary Metabolic Research Unit (M2RUN), MOVANT Research Group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; Multidisciplinary Edema Clinic, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Eric van Breda
- Multidisciplinary Metabolic Research Unit (M2RUN), MOVANT Research Group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
| | - Ulrike Van Daele
- Multidisciplinary Metabolic Research Unit (M2RUN), MOVANT Research Group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; OSCARE, Organization for Burns, Scar After-care and Research, Van Roiestraat 18, 2170 Antwerp, Belgium.
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Lim WC, Hill AM, Edgar DW, Elliott M, van der Lee LM. Multidisciplinary staff perceived barriers and enablers to early mobilization of patients with burns in the ICU. Burns 2023; 49:1688-1697. [PMID: 36878735 DOI: 10.1016/j.burns.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 01/17/2023] [Accepted: 02/19/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Complex challenges face clinicians managing critically ill patients with burns, particularly in the context of enhancing outcomes after a stay in ICU. Compounding this, a dearth of research explores the specific and modifiable factors that impact early mobilization in the ICU environment. AIM To explore the barriers and enablers of early functional mobilization for patients with burns in the ICU from a multidisciplinary perspective. DESIGN A qualitative phenomenological study. METHODS Semi-structured interviews supplemented by online questionnaires conducted with 12 multidisciplinary clinicians (four doctors, three nurses and five physical therapists) who previously managed burn patients at a quaternary level ICU. Data were thematically analysed. RESULTS Four main themes: patient, ICU clinicians, the workplace and the physical therapist were identified as impacting on early mobilization. Subthemes identified barriers or enablers to mobilization but all were strongly influenced by overarching theme of the clinician's "emotional filter." Barriers included high levels of pain, heavy sedation and low levels of clinician exposure to treating patients with burns. Enablers included higher levels of clinician's experience and knowledge about burn management and benefits of early mobilization; increased coordinated staff resources when undertaking mobilization; and, open communication and positive culture towards early mobilization across the multidisciplinary team. CONCLUSION Patient, clinician and workplace barriers and enablers were identified to influencing the likelihood of achieving early mobilization of patients with burns in the ICU. Emotional support for staff through multidisciplinary collaboration and development of structured burns training program were key recommendations to address barriers and strengthen enablers to early mobilization of patients with burns in the ICU.
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Affiliation(s)
- W C Lim
- School of Allied Health, Curtin University, Bentley, Western Australia, Australia
| | - A-M Hill
- School of Allied Health, WA Centre for Health & Ageing, The University of Western Australia, Crawley, Western Australia, Australia
| | - D W Edgar
- Department of Physiotherapy, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, Western Australia, Australia; Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia; Burn Injury Research Unit, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia; Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - M Elliott
- Department of Physiotherapy, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, Western Australia, Australia
| | - L M van der Lee
- School of Allied Health, Curtin University, Bentley, Western Australia, Australia; Department of Physiotherapy, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, Western Australia, Australia.
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Liu C, Xie H, Wei P, Gong T, Wu G, Xu Z, Chen S. Clinical study of early rehabilitation training combined with negative pressure wound therapy for the treatment of deep partial-thickness hand burns. Front Surg 2023; 10:1040407. [PMID: 36843993 PMCID: PMC9952234 DOI: 10.3389/fsurg.2023.1040407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/04/2023] [Indexed: 02/10/2023] Open
Abstract
Objective This study aims to explore the clinical effect of early rehabilitation training combined with negative pressure wound therapy (NPWT) for treating deep partial-thickness hand burns. Methods Twenty patients with deep partial-thickness hand burns were randomly divided into an experimental group (n = 10) and a control group (n = 10). In the experimental group, early rehabilitation training combined with NPWT was performed, including the proper sealing of the negative pressure device, intraoperative plastic brace, early postoperative exercise therapy during negative pressure treatment, and intraoperative and postoperative body positioning. Routine NPWT was conducted in the control group. Both groups received 4 weeks of rehabilitation after wounds healed by NPWT with or without skin grafts. Hand function was evaluated after wound healing and 4 weeks after rehabilitation, including hand joint total active motion (TAM) and the brief Michigan Hand Questionnaire (bMHQ). Results Twenty patients were involved in this study, including 16 men and 4 women, aged 18-70 years, and the hand burn area ranged from 0.5% to 2% of the total body surface area (TBSA). There was no significant difference in TAM and bMHQ scores between the two groups after negative pressure removal. After 4 weeks of rehabilitation training, the TAM scores and bMHQ scores were significantly improved in both groups (p < 0.05); among them, those of the experimental group were both significantly better than those of the control group (p < 0.05). Conclusion The application of early rehabilitation training combined with NPWT to treat deep partial-thickness hand burns can effectively improve hand function.
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Affiliation(s)
- Canbin Liu
- Burn & Wound Repair Department, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Institute, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Medical Center, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Provincial Key Laboratory of Burn and Trauma, Fujian Medical University Union Hospital, Fuzhou, China
| | - Hongteng Xie
- Burn & Wound Repair Department, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Institute, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Medical Center, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Provincial Key Laboratory of Burn and Trauma, Fujian Medical University Union Hospital, Fuzhou, China
| | - Pei Wei
- Burn & Wound Repair Department, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Institute, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Medical Center, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Provincial Key Laboratory of Burn and Trauma, Fujian Medical University Union Hospital, Fuzhou, China
| | - Teng Gong
- Burn & Wound Repair Department, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Institute, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Medical Center, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Provincial Key Laboratory of Burn and Trauma, Fujian Medical University Union Hospital, Fuzhou, China
| | - Guohua Wu
- Burn & Wound Repair Department, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Institute, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Medical Center, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Provincial Key Laboratory of Burn and Trauma, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zhaorong Xu
- Burn & Wound Repair Department, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Institute, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Medical Center, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Provincial Key Laboratory of Burn and Trauma, Fujian Medical University Union Hospital, Fuzhou, China,Correspondence: Shun Chen Zhaorong Xu
| | - Shun Chen
- Burn & Wound Repair Department, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Institute, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Medical Center, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Provincial Key Laboratory of Burn and Trauma, Fujian Medical University Union Hospital, Fuzhou, China,Correspondence: Shun Chen Zhaorong Xu
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Cartotto R, Johnson L, Rood JM, Lorello D, Matherly A, Parry I, Romanowski K, Wiechman S, Bettencourt A, Carson JS, Lam HT, Nedelec B. Clinical Practice Guideline: Early Mobilization and Rehabilitation of Critically Ill Burn Patients. J Burn Care Res 2023; 44:1-15. [PMID: 35639543 DOI: 10.1093/jbcr/irac008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
This Clinical Practice Guideline addresses early mobilization and rehabilitation (EMR) of critically ill adult burn patients in an intensive care unit (ICU) setting. We defined EMR as any systematic or protocolized intervention that could include muscle activation, active exercises in bed, active resistance exercises, active side-to-side turning, or mobilization to sitting at the bedside, standing, or walking, including mobilization using assistance with hoists or tilt tables, which was initiated within at least 14 days of injury, while the patient was still in an ICU setting. After developing relevant PICO (Population, Intervention, Comparator, Outcomes) questions, a comprehensive literature search was conducted with the help of a professional medical librarian. Available literature was reviewed and systematically evaluated. Recommendations were formulated through the consensus of a multidisciplinary committee, which included burn nurses, physicians, and rehabilitation therapists, based on the available scientific evidence. No recommendation could be formed on the use of EMR to reduce the duration of mechanical ventilation in the burn ICU, but we conditionally recommend the use of EMR to reduce ICU-acquired weakness in critically ill burn patients. No recommendation could be made regarding EMR's effects on the development of hospital-acquired pressure injuries or disruption or damage to the skin grafts and skin substitutes. We conditionally recommend the use of EMR to reduce delirium in critically ill burn patients in the ICU.
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Affiliation(s)
- Robert Cartotto
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Laura Johnson
- Burns and Trauma, MedStar Washington Hospital Center, Georgetown University, Washington, DC, USA
| | - Jody M Rood
- Regions Hospital Burn Center, St. Paul, Minneapolis, USA
| | | | - Annette Matherly
- University of Utah Health Burn Center, Salt Lake City, Utah, USA
| | - Ingrid Parry
- Shriners Hospital for Children, Northern California, University of California at Davis, Sacramento, California, USA
| | - Kathleen Romanowski
- Firefighters Burn Institute Regional Burn Center, University of California at Davis, Sacramento, California, USA
| | - Shelley Wiechman
- Regional Burn Center at Harborview, University of Washington, Seattle, Washington, USA
| | | | | | - Henry T Lam
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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9
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Yen HC, Han YY, Hsiao WL, Hsu PM, Pan GS, Li MH, Chen WS, Chuang HJ. Functional mobility effects of progressive early mobilization protocol on people with moderate-to-severe traumatic brain injury: A pre-post intervention study. NeuroRehabilitation 2022; 51:303-313. [DOI: 10.3233/nre-220023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Brain plasticity evoked by environmental enrichment through early mobilization may improve sensorimotor functions of patients with moderate-to-severe traumatic brain injury (TBI). Increasing evidence also suggests that early mobilization increases verticalization, which is beneficial to TBI patients in critical care. However, there are limited data on early mobilization interventions provided to patients with moderate-to-severe TBI. OBJECTIVE: We investigated the possible enhancing effects of revised progressive early mobilization on functional mobility and the rate of out-of-bed mobility attained by patients with moderate-to-severe TBI. METHODS: This is a quantitative study with a retrospective and prospective pre–post intervention design. We implemented a revised progressive early mobilization protocol for patients with moderate-to-severe TBI admitted to the trauma intensive care unit (ICU) within the previous seven days. The outcome parameters were the rate of patients attaining early mobilization (sitting on the edge of the bed) and the Perme ICU Mobility Score at discharge from the ICU. The outcome parameters in the intervention cohort were compared with those from a historical control cohort who received standard medical care a year previously. Differences in the Perme ICU Mobility Score between the two cohorts were assessed using univariate analysis of covariance. RESULTS: Forty-two patients were included in the progressive early mobilization program and were compared with 44 patients who underwent standard medical care. In the intervention cohort, 100% and 57.2% of the patients completed early rehabilitation and early mobilization, respectively, compared to 0% in the control cohort. The intervention cohort at ICU discharge showed significantly improved the Perme ICU Mobility Scores. CONCLUSIONS: The implementation of the revised progressive early mobilization program for patients with moderate-to-severe TBI resulted in significantly improved mobility at ICU discharge; however, the length of overall stay in the ICU may be not affected.
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Affiliation(s)
- Hsiao-Ching Yen
- Department of Physical Medicine and Rehabilitation, Division of Physical Therapy, National Taiwan University Hospital, Taipei, Taiwan
| | - Yin-Yi Han
- Department of Traumatology, Trauma ICU, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Ling Hsiao
- School of Nursing, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Min Hsu
- Department of Physical Medicine and Rehabilitation, Division of Physical Therapy, National Taiwan University Hospital, Taipei, Taiwan
| | - Guan-Shuo Pan
- Department of Physical Medicine and Rehabilitation, Division of Physical Therapy, National Taiwan University Hospital, Taipei, Taiwan
| | - Min-Hao Li
- Department of Physical Medicine and Rehabilitation, Division of Physical Therapy, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Shiang Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Hung-Jui Chuang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
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10
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da Silva MMM, Travensolo CDF, Probst VS, Felcar JM. Quantification of changes in functional capacity and muscle strength in patients: a burn intensive care unit cohort study. Burns 2022; 48:833-840. [PMID: 35221156 DOI: 10.1016/j.burns.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/08/2022] [Accepted: 01/16/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Regular functional status and muscle strength assessments should be performed with burn victims. OBJECTIVE To evaluate the functionality and peripheral muscle strength of burn patients admitted to the hospital. METHODS A longitudinal and prospective study was conducted from March to November 2019, including adult burn victims who were admitted to the ICU and discharged from the hospital. Patients were assessed on admission, every 10 days, at discharge from the ICU and from the hospital. Functionality was assessed using the Chelsea Critical Care Physical Assessment (CPAx) and the Functional Independence Measure (FIM). Muscle strength was assessed using the Medical Research Council (MRC) scale and handgrip dynamometry. RESULTS 41 patients were included, 27 men and 14 women, with a median age of 41 (IQR [28-56]) years, mean TBSA of 19 (SD ± 12) percent, mean Abbreviated Burn Severity Index (ABSI) of 6 (SD ± 2) and the mean ICU time was 29 (SD ± 9) days. The CPAx, FIM and MRC evaluations improved (P < 0.0001) when compared to admission to the ICU and at hospital discharge, while the dynamometry showed no statistical difference. The ABSI only showed an association with the length of stay. CONCLUSION The CPAX scale was sensitive to changes in functionality throughout the hospital stay in severely burned patients, in the present study. The assessment of global muscle strength was more sensitive than handgrip strength and the ABSI was associated with length of stay in this population.
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Affiliation(s)
| | | | - Vanessa Suziane Probst
- Postgraduation Program in Rehabilitation Sciences UEL-UNOPAR, State University of Londrina (UEL), Londrina, PR, Brazil.
| | - Josiane Marques Felcar
- Postgraduation Program in Rehabilitation Sciences UEL-UNOPAR, State University of Londrina (UEL), Londrina, PR, Brazil.
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11
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Sasaki J, Matsushima A, Ikeda H, Inoue Y, Katahira J, Kishibe M, Kimura C, Sato Y, Takuma K, Tanaka K, Hayashi M, Matsumura H, Yasuda H, Yoshimura Y, Aoki H, Ishizaki Y, Isono N, Ueda T, Umezawa K, Osuka A, Ogura T, Kaita Y, Kawai K, Kawamoto K, Kimura M, Kubo T, Kurihara T, Kurokawa M, Kobayashi S, Saitoh D, Shichinohe R, Shibusawa T, Suzuki Y, Soejima K, Hashimoto I, Fujiwara O, Matsuura H, Miida K, Miyazaki M, Murao N, Morikawa W, Yamada S. Japanese Society for Burn Injuries (JSBI) Clinical Practice Guidelines for Management of Burn Care (3rd Edition). Acute Med Surg 2022; 9:e739. [PMID: 35493773 PMCID: PMC9045063 DOI: 10.1002/ams2.739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/29/2022] [Accepted: 02/03/2022] [Indexed: 01/28/2023] Open
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dos Reis NF, Figueiredo FCXS, Biscaro RRM, Lunardelli EB, Maurici R. Psychometric Properties of the Barthel Index Used at Intensive Care Unit Discharge. Am J Crit Care 2022; 31:65-72. [PMID: 34972844 DOI: 10.4037/ajcc2022732] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The Barthel Index, originally developed and validated to assess activities of daily living in patients with neuromuscular disorders, is commonly used in research and clinical practice involving critically ill patients. OBJECTIVES To evaluate the internal consistency, reliability, measurement error, and construct validity of the Barthel Index used at intensive care unit discharge. METHODS In this observational study, 2 physiotherapists measured the physical functioning of 122 patients at intensive care unit discharge, using the Barthel Index and other measurement instruments. RESULTS The patients had a median (IQR) age of 56 (47-66) years, and 62 patients (51%) were male. The primary reason for intensive care unit admission was sepsis (28 patients [23%]), and 83 patients (68%) were receiving mechanical ventilation. The Cronbach α value indicating internal consistency was 0.81. For interrater reliability, the intraclass correlation coefficient for the total score was 0.98 (95% CI, 0.97-0.98; P < .001) and the κ statistic for the individual items was 0.54 to 0.94. The standard error of measurement was 7.22, the smallest detectable change was 20.01, and the 95% limits of agreement were -10.3 and 11.8. The Barthel Index showed moderate to high correlations with the other physical functioning measurement instruments (ρ = 0.57 to 0.88; P < .001 for all). CONCLUSION The Barthel Index is a reliable and valid instrument for assessing physical functioning at intensive care unit discharge.
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Affiliation(s)
- Nair Fritzen dos Reis
- Nair Fritzen dos Reis is a physiotherapist and doctoral student in medical sciences at Santa Catarina Federal University, Florianopolis, Brazil
| | | | - Roberta Rodolfo Mazzali Biscaro
- Roberta Rodolfo Mazzali Biscaro is a physiotherapist and doctoral student in medical sciences at Santa Catarina Federal University
| | - Elizabeth Buss Lunardelli
- Elizabeth Buss Lunardelli is a physician and a doctoral student in medical sciences at Santa Catarina Federal University
| | - Rosemeri Maurici
- Rosemeri Maurici is a physician and professor in the postgraduate program in medical sciences at Santa Catarina Federal University
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13
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Bright L, Van Der Lee L, Hince D, Wood FM, Edgar DW. Quantification of the negative impact of sedation and inotropic support on achieving early mobility in burn patients in ICU: A single center observational study. Burns 2021; 47:1756-1765. [PMID: 34629185 DOI: 10.1016/j.burns.2021.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 08/28/2021] [Accepted: 09/16/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Early rehabilitation for burns survivors in the intensive care unit (ICU) is arguably more challenging than the general population. Early achievement of functional verticality milestones (FVMs) has the potential to ameliorate the detrimental effects of bed rest and immobility observed in ICU patients and reduce healthcare costs. However, the time to achieving FVMs after burn injury is influenced by factors such as sedation practices, cardiovascular stability, mechanical ventilation, acute skin reconstruction and length of stay (LOS) during the acute intensive care period. OBJECTIVES/AIMS The aims of this study were to identify the association between early achievement of FVMs and factors influencing cessation of bedrest in adult patients with burns receiving ICU care, and to explore barriers to achievement of FVMs as recorded by clinicians. METHODS A 5-year retrospective observational cohort study was conducted. The digital medical records were reviewed for each case to explore episodes of FVMs and patient factors which may contribute to persistent bed rest, such as use of infused sedative and/or inotropic medication, mechanical ventilation, burn surgery, total body surface area (TBSA), ICU length of stay and pre-ICU practices. Logistic regression was used to examine the association between FVM achievement and treatment and injury factors in ICU survivors. RESULTS The total sample available for analysis included 64 patients. When sedation/agitation score was within recommended limits, odds of achieving FVMs was 21 times greater than periods outside those limits. When deep sedatives were infused, the odds of achieving FVMs decreased by 87% compared to periods when there was no infusion of these medications. In addition, the odds of achieving FVMs was reduced by 13% for each increase of 1 mL/h in the daily maximum noradrenaline dose. DISCUSSION AND CONCLUSION Maintaining sedation and agitation scores within the optimal range, and minimising sedative infusion and inotropic support enhances the likelihood of early and frequent mobilization in patients with burns admitted to ICU. Additional barriers identified were mechanical ventilation, burns surgery, pre-ICU practices and ICU length of stay. The challenge for clinicians moving forward is to determine how these factors may be modified to increase early mobilization of burn patients in ICU.
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Affiliation(s)
- Lauren Bright
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia; Department of Physiotherapy, Calvary Public Hospital Bruce, Bruce, Australian Capital Territory, Australia
| | - Lisa Van Der Lee
- Department of Physiotherapy, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, Western Australia, Australia
| | - Dana Hince
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Fiona M Wood
- Burn Injury Research Unit, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia; Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Dale W Edgar
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia; Department of Physiotherapy, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, Western Australia, Australia; Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia; Burn Injury Research Unit, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia; Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.
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14
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Froutan R, Saberi A, Ahmadabadi A, Mazlom SR. The Effect of a Recreational Therapy Program on the Pain Anxiety and Quality of Life of Patients with Burn Injuries: A Randomized Clinical Trial. J Burn Care Res 2021; 43:381-388. [PMID: 34329456 DOI: 10.1093/jbcr/irab153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Pain anxiety and dysfunction are among the most prevalent complications of burns, impacting the quality of life of patients with burn injuries. As a non-pharmaceutical approach, recreational therapy can be effective in reducing the complications of burns. This study aimed to examine the effect of a recreational therapy program on the pain anxiety and quality of life of patients with burn injuries. This controlled randomized clinical trial was conducted on 58 patients admitted to the burn center of XXX. These patients were randomly allocated to the intervention and control group. The intervention group received a recreational therapy program three sessions a week, for two weeks. The control group performed routine daily activities. As the main variable of the study, the Burn Specific Pain Anxiety Scale and Burn Specific Health Scale-Brief were completed for both groups before and two weeks after the intervention. After controlling confounders, the pain anxiety score in the intervention group was significantly lower than in the control group (p = 0.002). The total quality of life score was significantly higher in the intervention group than the control group (p = 0.001). In addition, the intervention significantly increased the scores of quality of life in the physical (p< 0.001), emotional (p = 0.009), and social (p< 0.001) dimensions. As it reduces pain anxiety and promotes the quality of life of patients with burn injuries, this recreational therapy program is recommended for promoting the mental health and quality of life of these patients.
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Affiliation(s)
- Razieh Froutan
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran / Department of Medical Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abolfazl Saberi
- Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Ahmadabadi
- Surgical Oncology Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Reza Mazlom
- Instructor of Nursing, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
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15
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Schieffelers DR, van Breda E, Gebruers N, Meirte J, Van Daele U. Status of adult inpatient burn rehabilitation in Europe: Are we neglecting metabolic outcomes? BURNS & TRAUMA 2021; 9:tkaa039. [PMID: 33709001 PMCID: PMC7935379 DOI: 10.1093/burnst/tkaa039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/10/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hypermetabolism, muscle wasting and insulin resistance are challenging yet important rehabilitation targets in the management of burns. In the absence of concrete practice guidelines, however, it remains unclear how these metabolic targets are currently managed. This study aimed to describe the current practice of inpatient rehabilitation across Europe. METHODS An electronic survey was distributed by the European Burn Association to burn centres throughout Europe, comprising generic and profession-specific questions directed at therapists, medical doctors and dieticians. Questions concerned exercise prescription, metabolic management and treatment priorities, motivation and knowledge of burn-induced metabolic sequelae. Odds ratios were computed to analyse associations between data derived from the responses of treatment priorities and knowledge of burn-induced metabolic sequelae. RESULTS Fifty-nine clinicians with 12.3 ± 9 years of professional experience in burns, representing 18 out of 91 burn centres (response rate, 19.8%) across eight European countries responded. Resistance and aerobic exercises were only provided by 42% and 38% of therapists to intubated patients, 87% and 65% once out-of-bed mobility was possible and 97% and 83% once patients were able to leave their hospital room, respectively. The assessment of resting energy expenditure by indirect calorimetry, muscle wasting and insulin resistance was carried out by only 40.7%, 15.3% and 7.4% respondents, respectively, with large variability in employed frequency and methods. Not all clinicians changed their care in cases of hypermetabolism (59.3%), muscle wasting (70.4%) or insulin resistance (44.4%), and large variations in management strategies were reported. Significant interdisciplinary variation was present in treatment goal importance ratings, motivation and knowledge of burn-induced metabolic sequelae. The prevention of metabolic sequelae was regarded as the least important treatment goal, while the restoration of functional status was rated as the most important. Knowledge of burn-induced metabolic sequelae was linked to higher importance ratings of metabolic sequelae as a therapy goal (odds ratio, 4.63; 95% CI, 1.50-14.25; p < 0.01). CONCLUSION This survey reveals considerable non-uniformity around multiple aspects of inpatient rehabilitation across European burn care, including, most notably, a potential neglect of metabolic outcomes. The results contribute to the necessary groundwork to formulate practice guidelines for inpatient burn rehabilitation.
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Affiliation(s)
- David R Schieffelers
- Multidisciplinary Metabolic Research Unit (M2RUN), MOVANT Research Group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Antwerp, Belgium
| | - Eric van Breda
- Multidisciplinary Metabolic Research Unit (M2RUN), MOVANT Research Group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Antwerp, Belgium
| | - Nick Gebruers
- Multidisciplinary Metabolic Research Unit (M2RUN), MOVANT Research Group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Antwerp, Belgium
- Multidisciplinary Edema Clinic, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium
| | - Jill Meirte
- Multidisciplinary Metabolic Research Unit (M2RUN), MOVANT Research Group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Antwerp, Belgium
- OSCARE, Organisation for burns, scar after-care and research, Van Roiestraat 18, 2170 Merksem, Antwerp, Belgium
| | - Ulrike Van Daele
- Multidisciplinary Metabolic Research Unit (M2RUN), MOVANT Research Group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Antwerp, Belgium
- OSCARE, Organisation for burns, scar after-care and research, Van Roiestraat 18, 2170 Merksem, Antwerp, Belgium
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16
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Lotfi M, Mirza Aghazadeh A, Davami B, Khajehgoodari M, Aziz karkan H, Khalilzad MA. Development of nursing care guideline for burned hands. Nurs Open 2020; 7:907-927. [PMID: 32587709 PMCID: PMC7308693 DOI: 10.1002/nop2.475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 11/24/2019] [Accepted: 12/09/2019] [Indexed: 11/26/2022] Open
Abstract
Aim To develop an evidence-based guideline to care for hand-burned patients. Design An integrative review. Method The search was conducted of EMBASE, PubMed, Web of Science, SCOPUS, Clinical Key, Iranmedex, Magiran, Scientific Information Database (SID), Cochran, CINAHL and Google Scholar databases from January 2000-August 2019. Following the formation of the research team, two researchers independently selected the eligible studies. The initial search resulted in 2,230 records; ultimately, 40 articles were identified to be the review after screening the records based on the study's inclusion and exclusion criteria. Quality of selected studies was evaluated with the MMAT method. Results Data syntheses of selected studies, coded by highlighting the relevant parts of the text, and assigning code words to these areas were done. Following this, a constant comparison was used to develop categories by combining codes. Finally, hand burns nursing care guideline was developed by categorizing descriptive themes in two main phases. Conclusion This review results have shown that evidence-based guidelines present high-quality recommendations for the healthcare team, which improves the quality of clinical care. Due to a lack of established guidelines in our context, it seems to be helpful to use evidence-based guidelines in managing burned hands.
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Affiliation(s)
- Mojgan Lotfi
- Department of Medical Surgical NursingFaculty of Nursing and MidwiferySina HospitalTabriz University of Medical SciencesTabrizIran
| | - Ahmad Mirza Aghazadeh
- Department of Basic sciencesParamedical FacultyTabriz University of Medical SciencesTabrizIran
| | - Babak Davami
- Faculty of MedicineSina HospitalTabriz University of Medical SciencesTabrizIran
| | - Mohammad Khajehgoodari
- Department of Medical Surgical NursingFaculty of Nursing and MidwiferyTabriz University of Medical SciencesTabrizIran
| | - Hanieh Aziz karkan
- Department of Medical Surgical NursingFaculty of Nursing and MidwiferyTabriz University of Medical SciencesTabrizIran
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Parry I, Sen S, Palmieri T, Greenhalgh D. Current Trends in Practice for Early Mobility with the Burn Population. J Burn Care Res 2020; 40:29-33. [PMID: 30351404 DOI: 10.1093/jbcr/iry049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
There is a clinical trend toward "early mobilization" of patients with burn injury, however mobility is not well defined in burn care. Burn injuries result in various extents of injury, body areas affected, and types of skin graft surgeries needed-all of which may influence the type, timing, safety, and outcome of mobilization activities. This study surveyed burn clinicians to determine current mobility practices and the influence of skin graft surgery on clinical decisions to mobilize patients. A 32-question survey was electronically distributed to burn clinicians and included questions about postoperative range of motion (ROM) and out of bed (OOB) mobility practices for various skin graft types and locations. For all types of grafts on all body locations, the average time after skin graft surgery that patients resumed ROM activities was postoperative day (POD) 3.87 (±2.04) while OOB mobility resumed on POD 2.54 (±1.38). There was significantly greater variability for OOB mobility compared to ROM (coefficient of variation [CV] 0.71 ± 0.8 vs 0.5 ± 0.05). Time to postoperative ROM was significantly different depending on the type of skin graft placed with sheet skin grafts resuming ROM the earliest. Time to OOB mobility after surgery was significantly different for different body locations with grafts placed above the waist resuming OOB mobility earliest. This study provides a summary of current mobility practices and serves as a foundation for future studies investigating the optimal timing and practical application of mobility protocols that may influence safety and outcome of burn survivors.
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Affiliation(s)
- Ingrid Parry
- Shriners Hospital for Children, Northern California, Sacramento
| | - Soman Sen
- Shriners Hospital for Children, Northern California, Sacramento
| | - Tina Palmieri
- Shriners Hospital for Children, Northern California, Sacramento
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Cambiaso-Daniel J, Parry I, Rivas E, Kemp-Offenberg J, Sen S, Rizzo JA, Serghiou MA, Kowalske K, Wolf SE, Herndon DN, Suman OE. Strength and Cardiorespiratory Exercise Rehabilitation for Severely Burned Patients During Intensive Care Units: A Survey of Practice. J Burn Care Res 2020; 39:897-901. [PMID: 29579311 DOI: 10.1093/jbcr/iry002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Minimizing the deconditioning of burn injury through early rehabilitation programs (RP) in the intensive care unit (ICU) is of importance for improving the recovery time. The aim of this study was to assess current standard of care (SOC) for early ICU exercise programs in major burn centers. We designed a survey investigating exercise RP on the ICU for burn patients with >30% total burned surface area. The survey was composed of 23 questions and submitted electronically via SurveyMonkey® to six major (pediatric and adult) burn centers in Texas and California. All centers responded and reported exercise as part of their RP on the ICU. The characteristics of exercises implemented were not uniform. All centers reported to perform resistive and aerobic exercises but only 83% reported isotonic and isometric exercises. Determination of intensity of exercise varied with 50% of centers using patient tolerance and 17% using vital signs. Frequency of isotonic, isometric, aerobic, and resistive exercise was reported as daily by 80%, 80%, 83%, and 50% of centers, respectively. Duration for all types of exercises was extremely variable. Mobilization was used as a form of exercise by 100% of burn centers. Our results demonstrate that although early RP seem to be integral during burn survivor's ICU stay, no SOC exists. Moreover, early RP are inconsistently administered and large variations exist in frequency, intensity, duration, and type of exercise. Thus, future prospective studies investigating the various components of exercise interventions are needed to establish a SOC and determine how and if early exercise benefits the burn survivor.
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Affiliation(s)
- Janos Cambiaso-Daniel
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, Texas.,Department of Surgery, Division of Plastic, Aesthetic and Reconstructive Surgery, Medical University of Graz, Austria
| | - Ingrid Parry
- Shriners Hospitals for Children, Northern California, Sacramento, California
| | - Eric Rivas
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, Texas.,Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas
| | - Jennifer Kemp-Offenberg
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, Texas
| | - Soman Sen
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas.,Department of Surgery, Division for Burn Surgery, University of California, Davis, California
| | - Julie A Rizzo
- The United States Army Institute of Surgical Research, San Antonio, Texas.,Uniformed Services University of Health Sciences, Bethesda MD
| | | | - Karen Kowalske
- University of Texas Southwest Medical Center, Dallas, Texas
| | - Steven E Wolf
- University of Texas Southwest Medical Center, Dallas, Texas
| | - David N Herndon
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, Texas
| | - Oscar E Suman
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, Texas
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Higgins SD, Erdogan M, Coles SJ, Green RS. Early mobilization of trauma patients admitted to intensive care units: A systematic review and meta-analyses. Injury 2019; 50:1809-1815. [PMID: 31526602 DOI: 10.1016/j.injury.2019.09.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 09/04/2019] [Accepted: 09/06/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the effect of early mobilization (EM) in trauma patients admitted to the ICU. Outcomes of interest included mortality, hospital and ICU length of stay (LOS), and duration of mechanical ventilation. METHODS We performed a systematic review of 4 electronic databases (Ovid MEDLINE, Embase, CINAHL, Cochrane Library) and the grey literature. Eligible study designs included randomized control trials, prospective cohorts, or retrospective cohorts. Studies must have compared EM to usual care (i.e., delayed or no mobilization) in trauma patients admitted to ICU. Overall, there were 2982 articles screened and 9 were included in the analysis. Two authors independently performed data extraction using a standardized form. Pertinent study design and population characteristics were recorded, as were prespecified outcome measures. Meta-analyses were performed using random effects models. Study quality was assessed using the Newcastle-Ottawa Scale. RESULTS Study cohorts ranged from 15 to 1132 patients (median 63) and varied in their inclusion criteria. Most studies utilized a progressive mobility protocol as their intervention. Mortality was reported in 5 studies, of which 3 observed a lower rate with EM; however, meta-analysis showed no difference in mortality between patients mobilized early and those receiving usual care. Eight studies reported on LOS (in-hospital and ICU); although all 8 studies found EM reduced LOS, the difference in LOS was not significant on meta-analysis. Finally, 3 studies reported on ventilator days, all of which observed a reduction in the EM group. On meta-analysis, duration of mechanical ventilation was significantly lower with EM (mean difference -1.18 days, 95% CI, -2.17 - -0.19). CONCLUSIONS Few studies have investigated the effects of EM in trauma ICU patients. The available evidence suggests that patients who receive EM require fewer days of mechanical ventilation, but have similar mortality and LOS compared to those receiving usual care.
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Affiliation(s)
- Sean D Higgins
- Faculty of Medicine, Dalhousie University, Halifax, NS, B3H 4R2, Canada; Trauma Nova Scotia, Nova Scotia Department of Health and Wellness, Room 1-026B Centennial Building, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada
| | - Mete Erdogan
- Trauma Nova Scotia, Nova Scotia Department of Health and Wellness, Room 1-026B Centennial Building, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada
| | - Sherry J Coles
- Faculty of Medicine, Dalhousie University, Halifax, NS, B3H 4R2, Canada; Trauma Nova Scotia, Nova Scotia Department of Health and Wellness, Room 1-026B Centennial Building, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada
| | - Robert S Green
- Trauma Nova Scotia, Nova Scotia Department of Health and Wellness, Room 1-026B Centennial Building, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada; Departments of Emergency Medicine and Critical Care, Dalhousie University, Halifax, NS, B3H 4R2, Canada.
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20
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de Figueiredo TB, Utsunomiya KF, de Oliveira AMRR, Pires-Neto RC, Tanaka C. Mobilization practices for patients with burn injury in critical care. Burns 2019; 46:314-321. [PMID: 31466922 DOI: 10.1016/j.burns.2019.07.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 06/10/2019] [Accepted: 07/27/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE Patients with burn usually undergo prolonged hospitalization due partially to the treatment of wounds and scars. Although the benefits of early mobilization are well-known in critical care patients, there are a lack of studies reporting mobilization practices and functional status for patients with burn. MATERIALS Clinical and physiotherapy data were daily collected, including ICU mobility scale (IMS) and reported barriers to mobilization therapy during a one-year period. At hospital discharge, the 6-min walking test (6MWT), Medical Research Council scale (MRCS) and handgrip strength test were applied to evaluate the patients' functionality. RESULTS Of the 74 patients admitted, 66% were placed on mechanical ventilation (MV). Mobilization therapy was administered in 67.2% of physiotherapy sessions, with passive mobilization being the most prevalent (53.2%) followed by active in-bed exercises (13.6%). Reported barriers for mobilization included hemodynamic instability followed by limited time for assistance. At hospital discharge, the 6MWD was 270(136) meters. A positive correlation was found between handgrip evaluation and 6MWD and a negative correlation with hospital length of stay. CONCLUSIONS Mobilization therapy of patients with burns in the ICU was characterized by a low mobility level during MV with a low functional status at hospital discharge.
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Affiliation(s)
- Thaís Borgheti de Figueiredo
- Department of Physiotherapy, Communication Science and Disorders, Occupational Therapy, University of São Paulo, Rua Cipotânea, 51, Cidade Universitária - CEP 05360-000, São Paulo, SP, Brazil.
| | - Key Fujisaki Utsunomiya
- Department of Physiotherapy, Communication Science and Disorders, Occupational Therapy, University of São Paulo, Rua Cipotânea, 51, Cidade Universitária - CEP 05360-000, São Paulo, SP, Brazil.
| | - Amanda Maria Ribas Rosa de Oliveira
- Burn ICU, Hospital das Clínicas da Faculdade de Medicina, University of São Paulo, Rua Dr. Ovídio Pires de Campos, 225 - Cerqueira César - CEP 05403-010, São Paulo, SP, Brazil.
| | - Ruy Camargo Pires-Neto
- Department of Physiotherapy, Communication Science and Disorders, Occupational Therapy, University of São Paulo, Rua Cipotânea, 51, Cidade Universitária - CEP 05360-000, São Paulo, SP, Brazil.
| | - Clarice Tanaka
- Department of Physiotherapy, Communication Science and Disorders, Occupational Therapy, University of São Paulo, Rua Cipotânea, 51, Cidade Universitária - CEP 05360-000, São Paulo, SP, Brazil.
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21
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Smith RR, Hill DM, Hickerson WL, Velamuri SR. Analysis of factors impacting length of stay in thermal and inhalation injury. Burns 2019; 45:1593-1599. [PMID: 31130323 DOI: 10.1016/j.burns.2019.04.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 04/16/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Several studies have analyzed single or combinations of variables for impact on length of stay (LOS) in thermally-injured patients. The objective of this study was to evaluate a multitude of established variables and potentially identify novel variables associated with LOS in a single study. METHODS This two-year, retrospective study included all patients admitted to the burn center between January 2015 and December 2016. Exclusions included death during admission, lack of thermal or inhalation injury, age less than 18 years, readmission(s), and if pregnant or incarcerated. Baseline demographics and pertinent data were collected using electronic medical records. Regression analysis was used to determine the most predictive variables. RESULTS Six hundred twenty-nine patients were admitted during the inclusion period and 354 patients remained for analysis after exclusion. Univariable analysis revealed 32 variables significantly associated with LOS. Using multivariable regression, the best-fit baseline demographic model included: percent total body surface area (TBSA) injured, lower/middle socioeconomic status, clotting disorders, anemia, admission serum creatinine, and percent third degree injured (r2 = 0.557). The best-fit combined model (incorporating baseline demographics and early in-hospital variables) included: acute kidney injury, infection and received vasopressor(s), percent TBSA injured, admission serum ethanol level, maximum C-reactive protein, and maximum total bilirubin (r2 = 0.828). CONCLUSIONS There are multiple factors associated with the increased LOS seen in patients with thermal and inhalation injury. This study confirmed and identified novel factors not previously discussed in the literature that were significantly associated with LOS. Expansion of the data submitted to the National Burn Repository and the Burn Quality Improvement Program may be warranted. This study confirms claims from previous studies on inadequacy of current data submitted for benchmarking and under-reimbursement for the care of such a complex population.
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Affiliation(s)
- Rebecca R Smith
- Department of Clinical Pharmacy, Regional One Health, 877 Jefferson Avenue, Memphis, TN 38103, USA.
| | - David M Hill
- Department of Clinical Pharmacy, Regional One Health, 877 Jefferson Avenue, Memphis, TN 38103, USA; Department of Burn Research, Firefighters Regional Burn Center, Regional One Health, 877 Jefferson Avenue, Memphis, TN 38103, USA; Department of Clinical Pharmacy, College of Pharmacy, University of Tennessee Health Science Center, 881 Madison Avenue, Memphis, TN 38103, USA.
| | - William L Hickerson
- Department of Plastic Surgery, Firefighters Regional Burn Center, Regional One Health, 877 Jefferson Avenue, Memphis, TN 38103, USA; Department of Plastic Surgery, College of Medicine, University of Tennessee Health Science Center, 910 Madison Avenue, Memphis, TN 38103, USA.
| | - Sai R Velamuri
- Department of Plastic Surgery, Firefighters Regional Burn Center, Regional One Health, 877 Jefferson Avenue, Memphis, TN 38103, USA; Department of Plastic Surgery, College of Medicine, University of Tennessee Health Science Center, 910 Madison Avenue, Memphis, TN 38103, USA.
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22
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Tan J, Chen J, Zhou J, Song H, Deng H, Ao M, Luo G, Wu J. Joint contractures in severe burn patients with early rehabilitation intervention in one of the largest burn intensive care unit in China: a descriptive analysis. BURNS & TRAUMA 2019; 7:17. [PMID: 31139664 PMCID: PMC6526598 DOI: 10.1186/s41038-019-0151-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 03/22/2019] [Indexed: 01/17/2023]
Abstract
Background Joint contracture is the major clinical complication in burn patients, especially, the severe burn patients. This study aimed to investigate the number and severity of joint contractures in patients with burns affecting greater than or equal to 50% of the total body surface area (TBSA) undergoing early rehabilitation in a burn intensive care unit (BICU). Methods We analyzed burn patients with burns affecting greater than or equal to 50% of the TBSA admitted to a BICU who received early rehabilitation within 7 days post-injury from January 2011 to December 2015. Demographic and medical information was collected. The range of motion (ROM) of different joints was measured 1 month post-admission. Spearman’s correlation coefficient and logistic regression analysis was used to determine predictors of the presence and severity of contractures. Result The average affected TBSA of the included burn patients was 67.4%, and the average length of stay in the BICU was 46.2 ± 28.8 days. One hundred and one of 108 burn patients (93.5%) developed at least one joint contracture. The ROM in 67.9% of the affected joints was mildly limited. The majority of contractures in severe burn patients were mild (37.7%) or moderate (33.2%). The wrist was the most commonly affected joint (18.2%), followed by the shoulder, ankle, hip, knee, and elbow. A predictor of the presence of contractures was the length of hospital stay (p = 0.049). The severe contracture was related to the area of full-thickness burns, the strict bed rest time, and the duration of rehabilitation in BICU. The length of rehabilitation stay (days) in patients with moderate contracture is 54.5% longer than that in severe contracture (p = 0.024) Conclusion During the long stay in BICU, the length of rehabilitation stay in a BICU could decrease the severity of contractures from severe to moderate in the patients with equal to 50% of the TBSA. Hence, this research reveals the important role of early rehabilitation interventions in severe burn patients. Electronic supplementary material The online version of this article (10.1186/s41038-019-0151-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jianglin Tan
- 1Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injuries, Chongqing Key Laboratory for Disease Proteomics, Southwest Hospital, Third Military (Army) Medical University, Chongqing, 400038 China
| | - Jian Chen
- 1Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injuries, Chongqing Key Laboratory for Disease Proteomics, Southwest Hospital, Third Military (Army) Medical University, Chongqing, 400038 China
| | - Junyi Zhou
- 1Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injuries, Chongqing Key Laboratory for Disease Proteomics, Southwest Hospital, Third Military (Army) Medical University, Chongqing, 400038 China
| | - Huapei Song
- 1Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injuries, Chongqing Key Laboratory for Disease Proteomics, Southwest Hospital, Third Military (Army) Medical University, Chongqing, 400038 China
| | - Huan Deng
- 1Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injuries, Chongqing Key Laboratory for Disease Proteomics, Southwest Hospital, Third Military (Army) Medical University, Chongqing, 400038 China
| | - Ming Ao
- 1Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injuries, Chongqing Key Laboratory for Disease Proteomics, Southwest Hospital, Third Military (Army) Medical University, Chongqing, 400038 China
| | - Gaoxing Luo
- 1Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injuries, Chongqing Key Laboratory for Disease Proteomics, Southwest Hospital, Third Military (Army) Medical University, Chongqing, 400038 China
| | - Jun Wu
- 1Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injuries, Chongqing Key Laboratory for Disease Proteomics, Southwest Hospital, Third Military (Army) Medical University, Chongqing, 400038 China.,2Department of Burns, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080 China
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23
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Abstract
A major burn is a severe injury with a global impact. Our system of medical evacuation has led to the survival of many severely injured service members. Burn rehabilitation is a complex and dynamic process and will not be linear. Recovery requires a comprehensive, interdisciplinary team-based approach, individually designed to maximize function, minimize disability, promote self-acceptance, and facilitate survivor and family reintegration into the community.
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Affiliation(s)
- Alan W Young
- Complementary and Integrative Medicine Service, Department of Pain Management, Brooke Army Medical Center, JBSA, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA; Rehabilitation Medicine, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
| | - William Scott Dewey
- Rehabilitation Services, Army Burn Center, U.S. Army Institute of Surgical Research, JBSA, 3698 Chambers Pass Suite B, Fort Sam Houston, TX 78234-7767, USA
| | - Booker T King
- Medical Corps US Army, Army Burn Center, U.S. Army Institute of Surgical Research, JBSA, 3698 Chambers Pass Suite B, Fort Sam Houston, TX 78234-7767, USA
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24
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Leung J, Smith S, Kalpakjian C. Functional Outcomes of Acute Inpatient Rehabilitation in Patients With Chronic Graft-Versus-Host Disease. PM R 2017; 10:567-572. [PMID: 29141183 DOI: 10.1016/j.pmrj.2017.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 10/30/2017] [Accepted: 11/02/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Growing numbers of allogeneic stem cell transplants and improved posttransplant care have led to an increase of individuals with chronic graft-versus-host disease (cGVHD). Although cGVHD leads to functional impairment for many, there is limited literature regarding the benefits of acute inpatient rehabilitation for patients with cGVHD. OBJECTIVE To assess Functional Independence Measure (FIM) outcomes of patients with cGVHD during acute inpatient rehabilitation and to compare inpatient rehabilitation outcomes with patients with burn injuries, a rehabilitation patient population with similar comorbidities. DESIGN Retrospective chart review. SETTING Acute rehabilitation center at a large academic medical center. PATIENTS (OR PARTICIPANTS) A total of 37 adult patients with cGVHD and 30 with burn injuries admitted to inpatient rehabilitation from 2010 to 2015. METHODS OR INTERVENTIONS Linear regression analysis to evaluate group (cGVHD versus burn) differences in functional gains. Effect size and minimal detectable change at the 90% confidence level (MDC90) were used to evaluate change in FIM outcomes. MAIN OUTCOME MEASUREMENTS Total FIM gain, motor FIM gain, and FIM efficiency. RESULTS Patients with cGVHD had statistically significant lower functional gains than patients with burn injuries, with an average of 11.66 fewer total FIM points (P ≤ .001), 10.54 fewer motor FIM points (P = .01), and 2.45 units less of FIM efficiency (P = .01). At the time of discharge, 7 (18%) patients with cGVHD exceeded the MDC90 values for total FIM gain versus 9 (30%) patients with burn injuries (P = .26). Eight (21%) patients with cGVHD exceeded the MDC90 for motor FIM gain versus 13 (43%) patients with burn injuries (P = .048). Effect sizes for patients with cGVHD and with burn injury were moderate to large, respectively, with patients with burn injuries having nearly twice the magnitude of gains as patients with cGVHD. CONCLUSIONS Despite achieving more modest functional gains than patients with burn injuries, patients with cGVHD improved in function after acute inpatient rehabilitation. If replicated in larger studies, patients with functional impairment from cGVHD can be considered for inpatient rehabilitation. Future work should also determine minimal clinically important differences in function gain from inpatient rehabilitation for patients with cGVHD. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Jason Leung
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, 325 E. Eisenhower Parkway, Suite 200, Ann Arbor, MI 48108
| | - Sean Smith
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, 325 E. Eisenhower Parkway, Suite 200, Ann Arbor, MI 48108
| | - Claire Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, 325 E. Eisenhower Parkway, Suite 200, Ann Arbor, MI 48108
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25
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Yousuf Y, Jeschke MG, Shah A, Sadri AR, Datu AK, Samei P, Amini-Nik S. The response of muscle progenitor cells to cutaneous thermal injury. Stem Cell Res Ther 2017; 8:234. [PMID: 29041952 PMCID: PMC5646146 DOI: 10.1186/s13287-017-0686-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 08/02/2017] [Accepted: 10/02/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Severe burn results in a systemic response that leads to significant muscle wasting. It is believed that this rapid loss in muscle mass occurs due to increased protein degradation combined with reduced protein synthesis. Alterations in the microenvironment of muscle progenitor cells may partially account for this pathology. The aim of this study was to ascertain the response of muscle progenitor cells following thermal injury in mice and to enlighten the cellular cascades that contribute to the muscle wasting. METHODS C57BL/6 mice received a 20% total body surface area (TBSA) thermal injury. Gastrocnemius muscle was harvested at days 2, 7, and 14 following injury for protein and histological analysis. RESULTS We observed a decrease in myofiber cross-sectional area at 2 days post-burn. This muscle atrophy was compensated for by an increase in myofiber cross-sectional area at 7 and 14 days post-burn. Myeloperoxidase (MPO)-positive cells (neutrophils) increased significantly at 2 days. Moreover, through Western blot analysis of two key mediators of the proteolytic pathway, we show there is an increase in Murf1 and NF-κB 2 days post-burn. MPO-positive cells were also positive for NF-κB, suggesting that neutrophils attain NF-κB activity in the muscle. Unlike inflammatory and proteolytic pathways, the number of Pax7-positive muscle progenitor cells decreased significantly 2 days post-burn. This was followed by a recovery in the number of Pax7-positive cells at 7 and 14 days, suggesting proliferation of muscle progenitors that accompanied regrowth. CONCLUSION Our data show a biphasic response in the muscles of mice exposed to burn injury, with phenotypic characteristics of muscle atrophy at 2 days while compensation was observed later with a change in Pax7-positive muscle progenitor cells. Targeting muscle progenitors may be of therapeutic benefit in muscle wasting observed after burn injury.
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Affiliation(s)
- Yusef Yousuf
- Institute of Medicine Science, University of Toronto, Toronto, Canada.,Sunnybrook Research Institute, Sunnybrook's Trauma, Emergency & Critical Care (TECC) Program, Ross Tilley Burn Centre, M7-161, Lab: M7-140, 2075 Bayview Ave., Toronto, ON, M4N 3 M5, Canada
| | - Marc G Jeschke
- Institute of Medicine Science, University of Toronto, Toronto, Canada.,Sunnybrook Research Institute, Sunnybrook's Trauma, Emergency & Critical Care (TECC) Program, Ross Tilley Burn Centre, M7-161, Lab: M7-140, 2075 Bayview Ave., Toronto, ON, M4N 3 M5, Canada.,Department of Surgery, Division of Plastic Surgery, University of Toronto, Toronto, Canada.,Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Ahmed Shah
- Sunnybrook Research Institute, Sunnybrook's Trauma, Emergency & Critical Care (TECC) Program, Ross Tilley Burn Centre, M7-161, Lab: M7-140, 2075 Bayview Ave., Toronto, ON, M4N 3 M5, Canada
| | - Ali-Reza Sadri
- Institute of Medicine Science, University of Toronto, Toronto, Canada.,Sunnybrook Research Institute, Sunnybrook's Trauma, Emergency & Critical Care (TECC) Program, Ross Tilley Burn Centre, M7-161, Lab: M7-140, 2075 Bayview Ave., Toronto, ON, M4N 3 M5, Canada
| | - Andrea-Kaye Datu
- Sunnybrook Research Institute, Sunnybrook's Trauma, Emergency & Critical Care (TECC) Program, Ross Tilley Burn Centre, M7-161, Lab: M7-140, 2075 Bayview Ave., Toronto, ON, M4N 3 M5, Canada
| | - Pantea Samei
- Sunnybrook Research Institute, Sunnybrook's Trauma, Emergency & Critical Care (TECC) Program, Ross Tilley Burn Centre, M7-161, Lab: M7-140, 2075 Bayview Ave., Toronto, ON, M4N 3 M5, Canada
| | - Saeid Amini-Nik
- Sunnybrook Research Institute, Sunnybrook's Trauma, Emergency & Critical Care (TECC) Program, Ross Tilley Burn Centre, M7-161, Lab: M7-140, 2075 Bayview Ave., Toronto, ON, M4N 3 M5, Canada. .,Laboratory in Medicine and Pathobiology, University of Toronto, Toronto, Canada. .,Department of Surgery, Division of Plastic Surgery, University of Toronto, Toronto, Canada.
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26
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Jacobson K, Fletchall S, Dodd H, Starnes C. Current Concepts Burn Rehabilitation, Part I: Care During Hospitalization. Clin Plast Surg 2017; 44:703-712. [PMID: 28888296 DOI: 10.1016/j.cps.2017.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This article summarizes current interventions for several of the most common challenges faced by patients during their rehabilitation from burn injury. These include preservation of range of motion through scar contracture management, and achieving maximal independence through exercise, and training in activities of daily living.
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Affiliation(s)
- Keith Jacobson
- Rehabilitation Therapy Services, NC Jaycee Burn Center, 101 Manning Drive, CB #7600, Chapel Hill, NC 27599, USA.
| | - Sandra Fletchall
- Burn Rehabilitation, Firefighters Burn Center, 890 Madison Avenue, TG 043, Memphis, TN 380103, USA
| | - Heather Dodd
- Rehabilitation Therapy Services, NC Jaycee Burn Center, 101 Manning Drive, CB #7600, Chapel Hill, NC 27599, USA
| | - Carrie Starnes
- Rehabilitation Therapy Services, NC Jaycee Burn Center, 101 Manning Drive, CB #7600, Chapel Hill, NC 27599, USA
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27
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Li H, Zhou J, Peng Y, Zhang J, Peng X, Luo Q, Yuan Z, Yan H, Peng D, He W, Wang F, Liang G, Huang Y, Wu J, Luo G. The progress of Chinese burn medicine from the Third Military Medical University-in memory of its pioneer, Professor Li Ao. BURNS & TRAUMA 2017; 5:16. [PMID: 28573147 PMCID: PMC5450149 DOI: 10.1186/s41038-017-0082-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 05/12/2017] [Indexed: 12/30/2022]
Abstract
Professor Li Ao was one of the founders of Chinese burn medicine and one of the most renowned doctors and researchers of burns in China. He established one of the Chinese earliest special departments for burns at Third Military Medical University (TMMU) in 1958. To memorialize Professor Li Ao on his 100th birthday in 2017 and introduce our extensive experience, it is our honor to briefly review the development and achievement of the Chinese burn medicine from TMMU. The epidemiology and outcomes of admitted burn patients since 1958 were reviewed. Furthermore, main achievements of basic and clinical research for the past roughly 60 years were presented. These achievements mainly included the Chinese Rule of Nine, fluid resuscitation protocol, experience in inhalation injury, wound treatment strategies, prevention and treatment of burn infections, nutrition therapy, organ support therapies, and rehabilitation. The progress shaped and enriched modern Chinese burn medicine and promoted the development of world burn medicine.
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Affiliation(s)
- Haisheng Li
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University, Gaotanyan Street no.29, Shapingba District, Chongqing, 400038 China
| | - Junyi Zhou
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University, Gaotanyan Street no.29, Shapingba District, Chongqing, 400038 China
| | - Yizhi Peng
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University, Gaotanyan Street no.29, Shapingba District, Chongqing, 400038 China
| | - Jiaping Zhang
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University, Gaotanyan Street no.29, Shapingba District, Chongqing, 400038 China
| | - Xi Peng
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University, Gaotanyan Street no.29, Shapingba District, Chongqing, 400038 China
| | - Qizhi Luo
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University, Gaotanyan Street no.29, Shapingba District, Chongqing, 400038 China
| | - Zhiqiang Yuan
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University, Gaotanyan Street no.29, Shapingba District, Chongqing, 400038 China
| | - Hong Yan
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University, Gaotanyan Street no.29, Shapingba District, Chongqing, 400038 China
| | - Daizhi Peng
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University, Gaotanyan Street no.29, Shapingba District, Chongqing, 400038 China
| | - Weifeng He
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University, Gaotanyan Street no.29, Shapingba District, Chongqing, 400038 China
| | - Fengjun Wang
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University, Gaotanyan Street no.29, Shapingba District, Chongqing, 400038 China
| | - Guangping Liang
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University, Gaotanyan Street no.29, Shapingba District, Chongqing, 400038 China
| | - Yuesheng Huang
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University, Gaotanyan Street no.29, Shapingba District, Chongqing, 400038 China
| | - Jun Wu
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University, Gaotanyan Street no.29, Shapingba District, Chongqing, 400038 China
| | - Gaoxing Luo
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University, Gaotanyan Street no.29, Shapingba District, Chongqing, 400038 China
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