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Fanstone R, Price P. Burn contracture risk factors and measurement in low-middle income countries: A clinical perspective. Burns 2024; 50:466-473. [PMID: 37985269 DOI: 10.1016/j.burns.2023.09.007] [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: 04/20/2023] [Revised: 07/31/2023] [Accepted: 09/12/2023] [Indexed: 11/22/2023]
Abstract
We find a lack of high-quality published evidence on risk factors for burn contracture formation. The vast majority of research is from High Income Countries (HICs), where many potential risk factors are controlled for by standardised and high-quality healthcare systems. To augment the published literature, burn care professionals with Low Middle Income Countries (LMICs) experience were interviewed for their opinion on risk factors for burn contracture formation. Participants were also asked for their views on identification and measurement of contracture. Seventeen semi-structured interviews were conducted (13 burn surgeons and 4 therapists). The average length of experience in burn-care was 13 years. Participants represented Ghana, Ethiopia, Malawi, Nigeria, South Africa, Nepal, and India. Participants reported ninety risk factors. Risk factors were later collated according to topic: Non burn individual factors (n = 13), Burn injury factors (n = 14), Family and community factors (n = 9), Treatment factors (n = 18), Complications (n = 2), Healthcare capacity factors (n = 19) and Societal and environmental factors (n = 12). The top five most frequently cited risk factors were lack of splinting, lack of physiotherapy, lack of early excision and skin grafting, low socioeconomic status and presence of infection. Although participants had no doubts that they could recognise a contracture, none provided a standardised system of measurement or an operational definition of contracture. Burn care professionals have a wealth of experience and untapped knowledge of risk factors for burn contracture formation in their own population base, but many of the risk factors highlighted by participants have not yet been explored in the literature. Variations in clinicians' diagnosis and measurement of a burn contracture underscores the need for an agreed, standardised, simple and easily reproducible method of diagnosing and classifying burn contractures.
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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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Bettencourt K, Parry I, Yelvington M, Taylor S, Greenhalgh D, James MA. Comparison of Different Methods of Measuring Finger Range of Motion via Telehealth. J Hand Surg Am 2023:S0363-5023(23)00169-7. [PMID: 37269260 DOI: 10.1016/j.jhsa.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 03/07/2023] [Accepted: 03/20/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE This study examined the accuracy and reliability of measuring total motion of the fingers via telehealth using the following three different methods: (1) goniometry, (2) visual estimation, and (3) electronic protractor. Measurements were compared with in-person measurement, which was assumed to be the reference standard. METHODS Thirty clinicians measured finger range of motion from prerecorded videos of a mannequin hand with articulating fingers, which was posed in extension and flexion that simulated a telehealth visit, using a goniometer with results blinded to the clinician (blinded goniometry), visual estimation, and an electronic protractor, in random order. Total motion was calculated for each finger and for all four fingers in sum. The experience level, familiarity with measuring finger range of motion, and opinions of measurement difficulty were assessed. RESULTS Measurement with the electronic protractor was the only method equivalent to the reference standard within 20°. Remote goniometer and visual estimation did not fall within the acceptable error margin of equivalence, and both underestimated total motion. Electronic protractor also had the highest interrater reliability (intraclass correlation [upper limit, lower limit], 0.95 [0.92, 0.95]); goniometry (intraclass correlation, 0.94 [0.91, 0.97]) was nearly identical, whereas visual estimation (intraclass correlation, 0.82 [0.74, 0.89]) was much lower. Clinicians' experience and familiarity with range of motion measurements had no relationship with the findings. Clinicians reported visual estimation as the most difficult (80%) and electronic protractor as the easiest method (73%). CONCLUSIONS This study showed that traditional in-person forms of measurement underestimate finger range of motion via telehealth; a new computer-based method (ie, electronic protractor) was found to be more accurate. CLINICAL RELEVANCE The use of an electronic protractor can be beneficial to clinicians measuring range of motion in patients virtually.
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Affiliation(s)
- Kory Bettencourt
- Department of Clinical Research, Shriners Children's-Northern California, Sacramento, CA.
| | - Ingrid Parry
- Department of Occupational Therapy and Physical Therapy, Shriners Children's-Northern California, Sacramento, CA
| | - Miranda Yelvington
- Department of Rehabilitation, Arkansas Children's Hospital, Little Rock, AK
| | - Sandra Taylor
- Davis Clinical and Translational Science Center, University of California, Sacramento, CA
| | - David Greenhalgh
- Department of Burn Surgery, Shriners Children's-Northern California, Sacramento, CA
| | - Michelle A James
- Department of Orthopedics, Shriners Children's-Northern California, Sacramento, CA
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Mid-Term Follow-Up Study of Children Undergoing Autologous Skin Transplantation for Burns. Life (Basel) 2023; 13:life13030762. [PMID: 36983917 PMCID: PMC10053383 DOI: 10.3390/life13030762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/28/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023] Open
Abstract
Deep partial and full-thickness burns require surgical treatment with autologous skin grafts after necrectomy, which is the generally accepted way to achieve permanent wound coverage. This study sought to examine the grafted and donor areas of children who underwent autologous skin transplantation, using two assessment scales to determine the severity of the scarring and the cosmetic outcome during long-term follow-up. At the Surgical Unit of the Department of Paediatrics of the University of Pécs, between 1 January 2015 and 31 December 2019, children who had been admitted consecutively and received autologous skin transplantation were analyzed. Twenty patients met the inclusion criteria in this retrospective cohort study. The authors assessed the results using the Patient and Observer Scar Assessment Scale (POSAS) and the Vancouver Scar Scale (VSS). There was a significant difference in how parents and examiners perceived the children’s scars. In the evaluation of the observer scale, the most critical variables for the area of skin grafted were relief and thickness. Besides color, relief was the worst clinical characteristic on the patient scale. However, when medical professionals evaluated the donor site, significantly better results were obtained compared to the transplanted area (average observer scale score: 1.4 and 2.35, p = 0.001; VSS: 0.85 vs. 2.60, p < 0.001), yet it was similar to the graft site in the parents’ opinion (Patient Scale: 2.95 and 4.45, p = 0.181).
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Schouten HJ, Nieuwenhuis MK, van Baar ME, van der Schans CP, Niemeijer AS, van Zuijlen PPM. The degree of joint range of motion limitations after burn injuries during recovery. Burns 2022; 48:309-318. [PMID: 34955294 DOI: 10.1016/j.burns.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/01/2020] [Accepted: 01/08/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The aim of this study was to determine the degree of ROM limitations of extremities, joints and planes of motion after burns and its prevalence over time. METHOD The database of a longitudinal multicenter cohort study in the Netherlands (2011-2012) was used. From patients with acute burns involving the neck, shoulder, elbow, wrist, hip, knee and ankle joints that had surgery, ROM of 17 planes of motion was assessed by goniometry at 3, 6 weeks, 3-6-9 and 12 months after burns and at discharge. RESULTS At 12 months after injury, 12 out of 17 planes of motion demonstrated persistent joint limitations. The five unlimited planes of motion were all of the lower extremity. The most severely limited joints at 12 months were the neck, ankle, wrist and shoulder. The lower extremity was more severely limited in the early phase of recovery whereas at 12 months the upper extremity was more severely limited. CONCLUSION The degree of ROM limitations and prevalence varied over time between extremities, joints and planes of motion. This study showed which joints and planes of motion should be watched specifically concerning the development of scar contracture.
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Affiliation(s)
- H J Schouten
- Association of Dutch Burn Centers, Burn Centre, Red Cross Hospital Beverwijk, The Netherlands; Burn Centre and Dept of Plastic & Reconstructive Surgery, Red Cross Hospital, Beverwijk, The Netherlands; Department of Physiotherapy, Red Cross Hospital, Beverwijk, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Science's Amsterdam UMC (Location VUmc), Amsterdam, The Netherlands; The Dutch Working Group on Burn Rehabilitation, The Netherlands.
| | - M K Nieuwenhuis
- Association of Dutch Burn Centers, Burn Centre, Martini Hospital Groningen, The Netherlands; Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, The Netherlands; The Dutch Working Group on Burn Rehabilitation, The Netherlands
| | - M E van Baar
- Association of Dutch Burn Centers, Burn Centre, Maasstad Hospital Rotterdam, The Netherlands; Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - C P van der Schans
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences Groningen, The Netherlands; Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, The Netherlands; Health Psychology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - A S Niemeijer
- Association of Dutch Burn Centers, Burn Centre, Martini Hospital Groningen, The Netherlands; Research Institute, Martini Hospital Groningen, The Netherlands
| | - P P M van Zuijlen
- Burn Centre and Dept of Plastic & Reconstructive Surgery, Red Cross Hospital, Beverwijk, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Science's Amsterdam UMC (Location VUmc), Amsterdam, The Netherlands; The Dutch Working Group on Burn Rehabilitation, The Netherlands; Pediatric Surgical Centre, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands
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Anderson DI, Fordyce EM, Vrouwe SQ. The Quality of Survey Research in Burn Care: A Systematic Review. Burns 2022; 48:1825-1835. [DOI: 10.1016/j.burns.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 11/29/2021] [Accepted: 01/16/2022] [Indexed: 11/02/2022]
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Paper goniometer for contracture monitoring. BURNS OPEN 2021. [DOI: 10.1016/j.burnso.2021.08.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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The Relationship of Orofacial Pain and Dental Health Status and Oral Health Behaviours in Facial Burn Patients. Pain Res Manag 2021; 2021:5512755. [PMID: 34055118 PMCID: PMC8123994 DOI: 10.1155/2021/5512755] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/24/2021] [Accepted: 05/03/2021] [Indexed: 12/02/2022]
Abstract
This study aims to examine the association of orofacial pain and oral health status and oral health behaviours in facial burn patients. The participants in this cross-sectional study were randomly recruited from the Burn Care Center, Institute of Medical Sciences, Islamabad, Pakistan. An intraoral evaluation was carried out to record the DMFT and OHI-S. A self-administered questionnaire was used to collect information on sociodemographic status, brushing frequency, and dental visits. Orofacial pain during mandibular movement was assessed using the Visual Analogue Scale (VAS). Psychological status was assessed using the Generalized Anxiety Disorder Scale and Impact of Events Scale. ANOVA and simple and multiple linear regression tests were used to analyse the data. From the 90 facial burn patients included, the majority were below 34 years of age, female, single or divorced, and unemployed. The mean DMFT was 10.7, and 71% had poor oral hygiene. 56% of the participants had moderate-to-severe anxiety, and 68% had posttraumatic stress disorder. 53% of the participants had moderate-to-severe pain during mouth opening or moving the mandible with a mean score of 41.5. Analyses showed that orofacial pain was associated with less frequent brushing, irregular dental visits, greater DMFT score, and more plaque accumulation (OHI-S). It was also associated with employment status, the severity of a burn, anxiety, and stress. The treatment and management of dental and oral conditions in burn patients need judicious balance in controlling and accurate assessment of the pain and improving psychological problems in burn patients.
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Deflorin C, Hohenauer E, Stoop R, van Daele U, Clijsen R, Taeymans J. Response to Vercelli et al. re: "Physical Management of Scar Tissue: A Systematic Review and Meta-Analysis". J Altern Complement Med 2021; 27:374-376. [PMID: 33826859 DOI: 10.1089/acm.2020.29089.cde] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Carlina Deflorin
- Rehabilitation Research Laboratory (2rLab), Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Landquart/Manno, Switzerland
| | - Erich Hohenauer
- Rehabilitation Research Laboratory (2rLab), Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Landquart/Manno, Switzerland.,School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom.,International University of Applied Sciences THIM, Landquart, Switzerland
| | - Rahel Stoop
- Rehabilitation Research Laboratory (2rLab), Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Landquart/Manno, Switzerland
| | - Ulrike van Daele
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium.,Oscare, Organization for Burns, Scar After-Care and Research, Antwerp, Belgium
| | - Ron Clijsen
- Rehabilitation Research Laboratory (2rLab), Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Landquart/Manno, Switzerland.,School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom.,International University of Applied Sciences THIM, Landquart, Switzerland.,Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Health, Bern University of Applied Sciences, Berne, Switzerland
| | - Jan Taeymans
- Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Health, Bern University of Applied Sciences, Berne, Switzerland
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Course of prevalence of scar contractures limiting function: A preliminary study in children and adolescents after burns. Burns 2019; 45:1810-1818. [DOI: 10.1016/j.burns.2019.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 02/28/2019] [Accepted: 05/01/2019] [Indexed: 10/25/2022]
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Parry I, Richard R, Aden JK, Yelvington M, Ware L, Dewey W, Jacobson K, Caffrey J, Sen S. Goniometric Measurement of Burn Scar Contracture: A Paradigm Shift Challenging the Standard. J Burn Care Res 2019; 40:377-385. [DOI: 10.1093/jbcr/irz038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
ABSTRACT
Standard goniometry is the most commonly used method of assessing the range of motion (ROM) in patients with burn scar contracture. However, standard goniometry was founded on arthrokinematic principles and doesn’t consider the cutaneous biomechanical influence between adjacent joint positions and skin pliability to accommodate motion. Therefore, the use of standard goniometry to measure burn scar contracture is called into question. This prospective, multicenter, comparative study investigated the difference between standard goniometry, based on arthrokinematics and a revised goniometry protocol, based on principles of cutaneokinematics and functional positions to measure ROM outcome in burn survivors. Data were collected for 174 joints from 66 subjects at seven burn centers totaling 1044 measurements for comparison. ROM findings using the revised protocol demonstrated significantly more limitation in motion 38.8 ± 15.2% than the standard protocol 32.1 ± 13.4% (p < .0001). Individual analyses of the motions likewise showed significantly more limitation with revised goniometry compared with standard goniometry for 9/11 joint motions. Pearson’s correlation showed a significant positive correlation between the percentage of cutaneous functional units scarred and ROM outcome for the revised protocol (R2 = .05, p = .0008) and the Δ between the revised and standard protocols (R2 = .04, p = .0025) but no correlation was found with the standard goniometric protocol (R2 = .015, p = .065). The results of this study support the hypothesis that standard goniometry underestimates the ROM impairment for individuals whose motion is limited by burn scars. Having measurement methods that consider the unique characteristics of skin impairment and the impact on functional positions is an important priority for both clinical reporting and future research in burn rehabilitation.
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Affiliation(s)
- Ingrid Parry
- Department of Surgery, University of California, Davis, Sacramento
| | - Reg Richard
- US Army Institute of Surgical Research, San Antonio Texas (Retired)
| | - James K Aden
- Department of Graduate Medical Education, Brooks Army Medical Center, San Antonio, Texas
| | | | - Linda Ware
- Rehabilitation Services Department, Johns Hopkins Bayview Medical Center, Baltimore, Maryland
| | - William Dewey
- Department of the Army, U.S. Army Institute of Surgical Research, San Antonio, Texas
| | - Keith Jacobson
- Rehabilitation Therapy Services Department, North Carolina Jaycee Burn Center at UNC Healthcare,Chapel Hill
| | - Julie Caffrey
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Bayview Medical Center, Baltimore, Maryland
| | - Soman Sen
- Department of Surgery, University of California, Davis, Sacramento
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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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Rating scales for shoulder and elbow range of motion impairment: Call for a functional approach. PLoS One 2018; 13:e0200710. [PMID: 30067776 PMCID: PMC6070201 DOI: 10.1371/journal.pone.0200710] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 05/28/2018] [Indexed: 11/19/2022] Open
Abstract
Background To evaluate the effect of (new) treatments or analyse prevalence and risk factors of contractures, rating scales are used based on joint range of motion. However, cut-off points for levels of severity vary between scales, and it seems unclear how cut-off points relate to function. The purpose of this study was to compare severity ratings of different rating scales for the shoulder and elbow and relate these with functional range of motion. Methods Often used contracture severity rating scales in orthopedics, physiotherapy, and burns were included. Functional range of motion angles for the shoulder and elbow were derived from a recent synthesis published by our group. Shoulder flexion and elbow flexion range of motion data of patients three months after a burn injury were rated with each of the scales to illustrate the effects of differences in classifications. Secondly, the shoulder and elbow flexion range of motion angles were related to the required angles to perform over 50 different activities of daily living tasks. Results Eighteen rating scales were included (shoulder: 6, elbow: 12). Large differences in the number of severity levels and the cut-off points between scales were determined. Rating the measured range of motions with the different scales showed substantial inconsistency in the number of joints without impairment (shoulder: 14–36%, elbow: 26–100%) or with severe impairment (shoulder: < 10%–29%, elbow 0%–17%). Cut-off points of most scales were not related to actual function in daily living. Conclusion There is an urgent need for rating scales that express the severity of contractures in terms of loss of functionality. This study proposes a direction for a solution.
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Godleski M, Lee AF, Goverman J, Herndon DN, Suman OE, Kowalske KJ, Holavanahalli RK, Gibran NS, Esselman PC, Simko LC, Ryan CM, Schneider JC. Quantifying Contracture Severity at Hospital Discharge in Adults: A Burn Model System National Database Study. J Burn Care Res 2018; 39:604-611. [PMID: 29901805 PMCID: PMC9218764 DOI: 10.1093/jbcr/irx027] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Contracture is a common complication of burn injury and can cause significant barriers to functional recovery and rehabilitation. There are limited studies of quantitative range of motion after burn injury. The purpose of this study is to examine quantitative contracture outcomes by anatomical location, burn size, and length of stay in adults. Data were obtained from the Burn Model System National Database from 1994 to 2003. All adult patients with a joint contracture at acute discharge were included and 16 joint motions were examined. Contractures were reported as both mean absolute loss of normal range of motion in degrees and percent loss of normal range of motion. Analysis of variance was used to assess for a linear trend for contracture severity by burn size and length of stay. Data from 659 patients yielded 6,228 instances of contracture. Mean absolute loss of normal range of motion ranged from 20° to 65° representing an 18 to 45% loss of normal movement across the studied joint motions. In the majority of joint motions, contracture severity significantly increased with larger burn size and longer length of stay; however, wrist and many lower extremity joint movements did not demonstrate this trend. The data illustrate the quantitative assessment of range of motion deficits in adults with burn injury at discharge and the relation to burn size and length of stay.
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Affiliation(s)
- Matthew Godleski
- Department of Physical Medicine & Rehabilitation, Ross Tilley Burn Centre, St. John’s Rehab, University of Toronto, Toronto, Ontario, Canada
| | - Austin F. Lee
- Department of Surgery, Massachusetts General Hospital, Shriners Hospitals for Children, Harvard Medical School, Boston, Massachusetts
| | - Jeremy Goverman
- Department of Surgery, Massachusetts General Hospital, Shriners Hospitals for Children, Harvard Medical School, Boston, Massachusetts
| | - David N. Herndon
- Department of Surgery, University of Texas Medical Branch, Shriners Hospitals for Children, Galveston, Texas
| | - Oscar E. Suman
- Department of Surgery, University of Texas Medical Branch, Shriners Hospitals for Children, Galveston, Texas
| | - Karen J. Kowalske
- Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Radha K. Holavanahalli
- Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Nicole S. Gibran
- Department of Surgery, University of Washington, Seattle, Washington
| | - Peter C. Esselman
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Laura C. Simko
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Colleen M. Ryan
- Department of Surgery, Massachusetts General Hospital, Shriners Hospitals for Children, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey C. Schneider
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
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Cutaneous Functional Units Predict Shoulder Range of Motion Recovery in Children Receiving Rehabilitation. J Burn Care Res 2017; 38:106-111. [DOI: 10.1097/bcr.0000000000000429] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Prevalence of scar contractures after burn: A systematic review. Burns 2016; 43:41-49. [PMID: 27639820 DOI: 10.1016/j.burns.2016.08.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 06/07/2016] [Accepted: 08/02/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Burn scar contractures are the pathological outcome of excessive scarring and ongoing scar contraction. Impairment of joint range of motion is a threat to performing activities in daily living. To direct treatment strategies to prevent and/or correct such contractures, insight into the prevalence, course, and determinants is essential. METHODS A literature search was conducted including Pubmed, Cochrane library, CINAHL, and PEDro. Articles were included if they provided burn scar contracture data to calculate the point prevalence. The quality of the articles was scored. Data were extracted regarding study, subject and burn characteristics, method of scar contracture assessment, point prevalence, and possible determinants. RESULTS Nine articles and one abstract could be included for data extraction. The prevalence at discharge was 38-54%, but with a longer time after burn, the prevalence was lower. Contractures were more likely to occur in more severe burns, flame burns, children, female, the cervical spine, and the upper extremity. CONCLUSIONS The prevalence of burn scar contractures varies considerably between studies. When prevalence is unclear, it is also difficult to investigate potential determinants and evaluate changes in interventions. There is a need for extensive, well-designed longitudinal (inter)national studies that investigate prevalence of scar contractures, their evolvement over time, and risk factors.
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Lee KC, Dretzke J, Grover L, Logan A, Moiemen N. A systematic review of objective burn scar measurements. BURNS & TRAUMA 2016; 4:14. [PMID: 27574684 PMCID: PMC4964074 DOI: 10.1186/s41038-016-0036-x] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 03/29/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Problematic scarring remains a challenging aspect to address in the treatment of burns and can significantly affect the quality of life of the burn survivor. At present, there are few treatments available in the clinic to control adverse scarring, but experimental pharmacological anti-scarring strategies are now beginning to emerge. Their comparative success must be based on objective measurements of scarring, yet currently the clinical assessment of scars is not carried out systematically and is mostly based on subjective review of patients. However, several techniques and devices are being introduced that allow objective analysis of the burn scar. The aim of this article is to evaluate various objective measurement tools currently available and recommend a useful panel that is suitable for use in clinical trials of anti-scarring therapies. METHODS A systematic literature search was done using the Web of Science, PubMed and Cochrane databases. The identified devices were then classified and grouped according to the parameters they measured. The tools were then compared and assessed in terms of inter- and intra-rater reproducibility, ease of use and cost. RESULTS After duplicates were removed, 5062 articles were obtained in the search. After further screening, 157 articles which utilised objective burn scar measurement systems or tools were obtained. The scar measurement devices can be broadly classified into those measuring colour, metric variables, texture, biomechanical properties and pathophysiological disturbances. CONCLUSIONS Objective scar measurement tools allow the accurate and reproducible evaluation of scars, which is important for both clinical and scientific use. However, studies to evaluate their relative performance and merits of these tools are scarce, and there remain factors, such as itch and pain, which cannot be measured objectively. On reviewing the available evidence, a panel of devices for objective scar measurement is recommended consisting of the 3D cameras (Eykona/Lifeviz/Vectra H1) for surface area and volume, DSM II colorimeter for colour, Dermascan high-frequency ultrasound for scar thickness and Cutometer for skin elasticity and pliability.
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Affiliation(s)
- Kwang Chear Lee
- The Healing Foundation Burn Research Centre, University Hospital Birmingham Foundation Trust, Birmingham, B15 2TH UK
- School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Janine Dretzke
- Public Health, Epidemiology and Biostatistics, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Liam Grover
- School of Chemical Engineering, University of Birmingham, Birmingham, B15 2TT UK
| | - Ann Logan
- School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Naiem Moiemen
- The Healing Foundation Burn Research Centre, University Hospital Birmingham Foundation Trust, Birmingham, B15 2TH UK
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The effect of pressure and fabrication of pressure therapy gloves on hand sensitivity and dexterity. J Burn Care Res 2014; 36:e162-75. [PMID: 25094003 DOI: 10.1097/bcr.0000000000000117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pressure therapy gloves always affect the function and performance of hands but the effect is often neglected. In this study, fabrication and reduction factors (RFs) of pressure therapy gloves on hand dexterity and comfort perception are assessed by goniometer, Semmes-Weinstein monofilaments and Purdue Pegboard, as well as through daily activity tasks. A subjective rating scale was also used to record comfort perception. The repeated-measures multivariate analysis of variance and Friedman tests were used to compare hand function tests and comfort sensation results when different glove prototypes were worn in terms of fabrics and RFs. The results show that even though both fabric types and RFs of pressure gloves exert no significant effect on the tactile sensitivity of fingertips, the active range of motion and dexterity of the fingers in carrying out daily tasks and comfort perception are considerably affected. The adoption of a high RF of 20% in making of glove patterns can impact negatively on both hand functions and comfort perception, thus leading to unsatisfactory treatment adherence. Strong associations were found between the comfort performance and fabric properties, including surface roughness, bending rigidity, thermal conductivity and moisture retention. It has been suggested that fabric choice, anticipated fabric tensile behaviour and surface and thermal properties should also be taken into consideration when prescribing pressure therapy glove for treatment of hypertrophic scars.
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Sarı Z, Polat MG, Özgül B, Aydoğdu O, Camcıoğlu B, Acar AH, Yurdalan SU. The application of matrix rhythm therapy as a new clinical modality in burn physiotherapy programmes. Burns 2014; 40:909-14. [DOI: 10.1016/j.burns.2013.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 11/15/2013] [Accepted: 11/18/2013] [Indexed: 10/25/2022]
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Sar Z, Polat MG, Özgül B, Aydoğdu O, Camcoğlu B, Acar AH, Yurdalan SU. A Comparison of Three Different Physiotherapy Modalities Used in the Physiotherapy of Burns. J Burn Care Res 2013; 34:e290-6. [DOI: 10.1097/bcr.0b013e3182789041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
The background of this article is that assessment and quantification of skin color is important to health care; color is one indicator of overall health and is linked to oxygenation, tissue perfusion, nutritional status, and injury. The purpose is to describe how skin color varies across racial/ethnic groups so that the information can be applied to clinical practice. The method used is cross-sectional, descriptive design (n = 257). We recorded self-defined race/ethnicity and used a spectrophotometer to measure skin color at two anatomic sites. Skin color variables included L* (light/dark), a* (red/green), and b* (yellow/blue). As regards results, we found significant differences in L*, a*, and b* values by site and race/ethnicity in White, Asian, and Biracial participants. L*: F(3, 233) = 139.04, p < .01 and F(3, 233) = 118.47, p < .01. Black participants had significantly lower mean L* values and wider ranges of L*, a*, and b* as compared with other groups. In regard to application, these findings suggest that clinicians and researchers should plan and provide care based on skin color, rather than race/ethnicity.
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Wolf SE, Sterling JP, Hunt JL, Arnoldo BD. The year in burns 2010. Burns 2012; 37:1275-87. [PMID: 22075032 DOI: 10.1016/j.burns.2011.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 10/13/2011] [Indexed: 01/08/2023]
Abstract
For 2010, roughly 1446 original burn research articles were published in scientific journals using the English language. This article reviews those with the most impact on burn treatment according to the Editor of one of the major journals (Burns) and his colleagues. As in previous reviews, articles were divided into the following topic areas: epidemiology, demographics of injury, wound characterisation and treatment, critical care, inhalation injury, infection, metabolism and nutrition, psychological considerations, pain and itching management, rehabilitation and long-term outcomes, and burn reconstruction. Each paper is considered very briefly, and the reader is referred to full manuscripts for details.
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Affiliation(s)
- Steven E Wolf
- Division of Burn, Trauma, and Critical Care, Department of Surgery, University of Texas-Southwestern Medical Center, Dallas, TX 75390-9158, United States.
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Jones H. Clinimetrics of tristimulus colourimeters in scar assessment: a review of evidence. J Wound Care 2012; 21:30-5. [DOI: 10.12968/jowc.2012.21.1.30] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- H.G. Jones
- University Hospital of Wales, Cardiff, UK
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