Physical and quality of life outcomes of patients with isolated hand burns--a prospective audit

A Holistic Approach to Burn Rehabilitation Managed With Split Skin Grafting in an Elderly Woman: A Case Report

This study aims to provide a holistic approach to burn rehabilitation that prioritizes patient care, pain management, mental health, and functional improvement. A 71-year-old woman visited the Physiotherapy Outpatient Department with the main concerns of burns on her right hand, limited movement in the fourth and fifth fingers for two months, swelling on her right hand, and wound contracture. She underwent split skin grafting at the hospital. The case study findings demonstrated the effects of physiotherapy interventions on the burn subject, specifically regarding scar formation improvement, functional ability enhancement, and pain reduction. This case study revealed that administering the mentioned workout to the individual proved advantageous, with pain decreasing on the visual analog scale (VAS) from 10/10 before to 8/10 after implementing cryotherapy, splinting technique, and active range of motion (AROM) exercise. Healthcare professionals can enhance the well-being of senior burn victims by incorporating evidence-based techniques and creative approaches in the rehabilitation process.

Long-Term Functional Outcomes after Hand Burns: A Monocentric Controlled Cohort Study

Background: Hand burns are involved in 80-90% of severe burn injuries. Even though hands correspond to a small total burn surface area (TBSA) of less than 5%, the loss of their functionality has a significant impact on the patient's life. Studies that provide long-term results regarding hand functionality after hand burns are scarce. Therefore, this study aimed to investigate functional long-term results in a patient-centric approach regarding burn depth, unilateral and bilateral hand involvement, and (non-)isolated hand burns as potential influencing factors in patients with hand burns. Methods: We conducted a controlled cohort study of patients with burned hands treated at our department between 2005 and 2022. Healthy age-, sex-, and handedness-matched participants were used as controls. Data on the demographics, burn-related injuries, and treatments were collected. For a patient-centric approach, we used the Disabilities of the Arm, Shoulder, and Hand Questionnaire (Quick-DASH) and the Michigan Hand Questionnaire (MHQ) as patient-reported outcome measures for functional long-term evaluation, and the Patient and Observer Scar Assessment Scale (patient scale) for assessing long-term scar quality. Results: We enrolled 61 patients with 88 affected hands and 63 matched control participants. Up to 77.1% of the participants were male, with a mean age of 50.7 (±15.5) years and a follow-up of 8.1 (±4.7) years. The mean TBSA was 13.9% (±15.8), with 72.4% of the hands presenting with deep partial-thickness and full-thickness burns and most of the patients had only one hand affected (55.7%). The hand burn patients perceived significantly worse long-term functional scores in every domain of the MHQ as well as in the "overall function" and "work" of the Quick-DASH. Superficial hand burns negatively affected the two-handed activities of daily living (p = 0.013) and aesthetic appearance (p = 0.005) when both hands were involved. Isolated hand burns were associated with more difficulties in work performance (p = 0.03), whereas patients with bilateral hand involvement perceived more pain (p = 0.025). Conclusions: The patients with hand burns can achieve satisfactory long-term functional outcomes over time, but they do not reach the same long-term hand functionality as the healthy matched control group. Our study revealed that factors such as burn depth, unilateral or bilateral hand involvement, and (non-)isolated hand burns indeed have an impact on certain aspects of perceived long-term hand functionality.

Return-to-employment for working-aged adults after burn injury: A mixed methods scoping review

BACKGROUND

This scoping review aimed to identify the barriers, facilitators and benefits of returning to work following burn injury, outcome measures used, management strategies, and models of care.

OBJECTIVE

To provide a comprehensive overview about working-aged adults returning to their preinjury employment after burn injury.

METHODS

We followed a pre-determined scoping review protocol to search MEDLINE, CINAHL, Embase, PsycINFO, PubMed, Scopus, CCRCT and CDSR databases between 2000 to December 2023. Papers reporting primary data from previously employed adults with cutaneous burn injuries were included.

RESULTS

In all, 90 articles met the review criteria. Return-to-work was both an outcome goal and process of recovery from burn injury. Physical and psychological impairments were identified barriers. Job accommodations and modifications were important for supporting the transition from hospital to workplace. Employment status and quality of life sub-scales were used to measure return-to-work.

CONCLUSIONS

Consistent definitions of work and measurements of return-to-employment after burn injury are priorities for future research. Longitudinal studies are more likely to capture the complexity of the return-to-employment process, its impact on work participation and changes in employment over time. The social context of work may assist or hinder return-to-work more than physical environmental constraints. Equitable vocational support systems would help address disparities in vocational rehabilitation services available after burn injury.

A comparison of the epidemiology of isolated and non-isolated hand burns

Hand burns are common and treatment individualized, however given large volumes in some centers, pattern recognition may help optimize service provision. We performed a single center retrospective review from 2014 to 2018 of hand burns in patients aged 16 and over. Burns confined to the hands were considered isolated. We found 1163 patients (790 male, 68%), with 853 isolated (9% bilateral) and 310 non-isolated (35% bilateral) hand burns, and 12% were sustained in industrial workplaces. Most isolated burns received first aid (72%) and were scalds (41%) or contact (23%). Many presented to hospital by car (73%) and most were treated as outpatients (92%). Non-isolated burns were mainly flash (38%) or flame burns (25%, p < 0.01), with 66% given first aid, 49% used ambulances (p < 0.01) and 54% underwent hospital admission (p < 0.01). Non-isolated injuries had more full thickness involvement (p < 0.01), 13% were resuscitation burns and 10% received intensive care. Isolated and non-isolated burns are distinct clinical entities, as are unilateral and bilateral injuries. Isolated burns are usually unilateral scalds or contact burns, suited to outpatient treatment. Non-isolated burns are often flash or flame, bilateral, often needing ambulances, admission, and interventions. First aid can be improved, and consideration given to inpatient rehabilitation of bilateral hand burns.

Patterns and predictors of hand functional recovery following pediatric burn injuries: Prospective cohort study

PURPOSE

To describe the pattern of hand functional recovery in the first six months following the discharge of children with burn injury, and to identify the predictors affecting this recovery.

MATERIALS AND METHODS

This was a prospective, comparative, follow-up cohort study in which hand functional outcome, was assessed during 9 months follow-up on 37 children with burn injuries involving the upper extremity with total body service area (TBSA<35%). Thirty-six matched healthy children were participated to compare the differences between children with burn and healthy children regarding the hand functional outcome. Hand function assessments included total active motion (TAM), grip strength and Jebsen Hand Function Test (JHFT) were conducted at hospital discharge, 3, and 6 months follow-up after discharge.

RESULTS

We found a trend towards an increase in the TAM scores over time (P<0.001), and were excellent in 5.41%, at discharge and increased to 18.92% and 40.54% at 3 and 6-month following discharge. The hand grip strength and JHFT showed significant improvement over time after 6 months (P<0.001). Regression analysis revealed that time to surgery, engagement in rehabilitation services, hand dominance, age and TBSA were the predictors of hand functional recovery and accounted 74% for TAM, 0.79 and 0.86 for total JHFT scores and grip strength.

CONCLUSIONS

the TAM, grip strength and JHFT were significantly improved after 3-month and these improvements were more evident at 6-month following discharge. Identification of the predictors may help therapists in the development of an effective rehabilitation programs.

Instruments to assess function or functionality in adults after a burn injury: A systematic review

INTRODUCTION

Assessment of functionality or function, through valid and reliable instruments, is essential during rehabilitation of adults after a burn injury. Currently, there is no consensus in the literature regarding the most appropriate tool that should be used to assess function or functionality; there is also no synthesis of the current studies published in this area.

OBJECTIVES

To investigate and report the instruments used to assess function or functionality in adults after a burn injury; to identify the characteristics and evidence on their measurement properties; and to evaluate their clinical utility.

METHODS

We systematically searched the literature via six electronic databases and via screening reference lists of relevant studies. The review was registered in PROSPERO (CRD42016048065) and reported according to the PRISMA statement. Studies in which function or functionality of upper and/or lower limbs of adults after a burn injury was assessed were included. Exclusion criteria comprised studies in pediatric populations and conference abstracts.

RESULTS

Thirty-four studies were included. Twelve questionnaires and seven objective tests for function or functionality were identified. Three specific tools were found; four generic instruments have been validated in burns. Nine studies evaluated the instruments' measurement properties, presenting at least one property classified as 'fair' quality. Finally, 18 instruments demonstrated clinical utility.

CONCLUSION

This systematic review demonstrated that most instruments used to assess function or functionality in adults with a burn injury have not been specifically developed for this population and had their measurement properties poorly studied. Conversely, almost all instruments had clinical utility.

Cross-cultural translation, adaptation and validation of the Burnt Hand Outcome Tool (BHOT) from English to French Canadian

BACKGROUND

The Burnt Hand Outcome Tool (BHOT) is a comprehensive tool assessing the multiple impacts of hand burn injuries which makes it essential to burn care practice, but is currently only available in English.

OBJECTIVES

To create a French-Canadian cross-cultural adaptation of the BHOT and to assess its content and construct convergent validity.

METHODS

The BHOT was translated and culturally adapted according to evidence-based principles for patient-reported outcome measures. The steps included translation to French (BHOT-F), backward translation, expert committee review, and cognitive debriefing with 5 adult participants. A pre-final version of the BHOT-F was then administered to 39 adult participants with hand burn injuries to assess construct convergent validity using the shortened Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH). Content validity was evaluated based on comments from the expert committee and participant burn survivors.

RESULTS

The BHOT-F was modified during the adaption process to ensure its clarity. The Cronbach's alpha value of 0.935 demonstrates the excellent internal consistency of the BHOT-F. The BHOT-F and the QuickDASH were strongly correlated (p < 0.01). Content validity was deemed satisfactory and recommendations are reported for future research.

CONCLUSIONS

The BHOT-F demonstrates adequate clinimetric properties to be used in clinical practice.

Health related quality of life in adults after burn injuries: A systematic review

OBJECTIVES

Measurement of health-related quality of life (HRQL) is essential to qualify the subjective burden of burns in survivors. We performed a systematic review of HRQL studies in adult burn patients to evaluate study design, instruments used, methodological quality, and recovery patterns.

METHODS

A systematic review was performed. Relevant databases were searched from the earliest record until October 2016. Studies examining HRQL in adults after burn injuries were included. Risk of bias was scored using the Quality in Prognostic Studies tool.

RESULTS

Twenty different HRQL instruments were used among the 94 included studies. The Burn Specific Health Scale-Brief (BSHS-B) (46%), the Short Form-36 (SF-36) (42%) and the EuroQol questionnaire (EQ-5D) (9%) were most often applied. Most domains, both mentally and physically orientated, were affected shortly after burns but improved over time. The lowest scores were reported for the domains 'work' and 'heat sensitivity' (BSHS-B), 'bodily pain', 'physical role limitations' (SF-36), and 'pain/discomfort' (EQ-5D) in the short-term and for 'work' and 'heat sensitivity', 'emotional functioning' (SF-36), 'physical functioning' and 'pain/discomfort' in the long-term. Risk of bias was generally low in outcome measurement and high in study attrition.

CONCLUSION

Consensus on preferred validated methodologies of HRQL measurement in burn patients would facilitate comparability across studies, resulting in improved insights in recovery patterns and better estimates of HRQL after burns. We recommend to develop a guideline on the measurement of HRQL in burns. Five domains representing a variety of topics had low scores in the long-term and require special attention in the aftermath of burns.

Increased burn healing time is associated with higher Vancouver Scar Scale score

Increased burn wound healing time has been shown to influence abnormal scarring. This study hypothesised that scar severity increases commensurate to the increase in time to healing (TTH) of the wound. Wound healing and scar data from burn patients treated by the Burn Service of Western Australia at Royal Perth Hospital were examined. The relationship between TTH and scar severity, as assessed by the modified Vancouver Scar Scale (mVSS), was modelled using regression analysis. Interaction terms evaluated the effect of surgery and total body surface area - burn (TBSA) on the main relationship. Maximum likelihood estimation was used to account for potential bias from missing independent variable data. The sample had a median age of 34 years, TTH of 24 days, TBSA of 3% and length of stay of five days, 70% were men and 71% had burn surgery. For each additional day of TTH, the mVSS score increased by 0.11 points (P ≤ 0.001) per day in the first 21 days and 0.02 points per day thereafter (P = 0.004). The relationship remained stable in spite of TBSA or surgical intervention. Investigation of the effect of missing data revealed the primary model underestimated the strength of the association. An increase in TTH within 21 days of injury is associated with an increase in mVSS or reduced scar quality. The results confirm that efforts should be directed toward healing burn wounds as early as possible.

Effects of early versus delayed excision and grafting on the return of the burned hand function

Background:

Despite a general consensus regarding the impacts of early excision and grafting (EE and G) of burned hand on the reducing of treatment cost and hospital stay, there are some controversial issues about its effect on the outcome of hand function. This study conducted to compare the results of the EE and G and delayed skin grafting in deep hand burns regarding the hand functional outcome.

Materials and Methods:

This study was conducted from April 2012 to November 2013 in sixty patients with deep thermal burns of the dorsal hand with total body surface area (TBSA) <20% who were admitted to special burn hospital. After standard primary burn care and resuscitation, necessary procedures (EE and G or more conservative treatment) were performed based on the patients’ conditions. The patients were placed into early excision (No. =30) and delayed excision group (No. =30). Total active motion (TAM) of fingers, grip strength of the hand and the assessment of disabilities of the arm, shoulder and hand questionnaire, were measured in all patients 6 months after grafting.

Results:

The average percentage of TBSA in the EE and G group was more than the delayed excision group (17.34% ±5.12% vs. 15.64% ±5.83%), this difference was not significant (P = 0.23). After 6 months, the average of the TAM and grip strength in the EE and G group was significantly more than that of the delayed group (P < 0.0001 and P = 0.019).

Conclusion:

The present study showed that EE and G with proper physical therapy and rehabilitation management provides a higher functional outcome in dorsal deep burned hand.

Factors predicting health status and recovery of hand function after hand burns in the second year after hospital discharge

INTRODUCTION

Hands are the most commonly burnt body part given humans' innate response to guard their face from injury, and are known to have detrimental functional and psychological consequences. Conflicting evidence exists regarding the impact of hand burns on long-term health status and global functioning. The objective of this study was to identify patient and clinical characteristics that predict health status and hand function of people at 12-24 months after hand burn.

METHODS

The Burns Specific Health Scale-Brief (BSHS-B) and the Brief Michigan Hand Outcome Questionnaire (Brief MHQ) were administered to community-dwelling adults who were between one and two years after admission to a statewide burns service for burns including one or both hands. Demographic, injury, and treatment data were collected to identify which factors predict health status and hand function in the second year after admission. Linear regression analyses adjusted for total burn surface area and burn depth were conducted to identify important predictors or outcomes.

RESULTS

The sample (n=41) was 80.5% male, with a mean age of 44.5 years and total body surface area (TBSA) of 8.4%. Psychiatric illness (regression coefficient -56.6, confidence interval (95% CI) -76.70, -36.49) and female gender (-20.3; 95% CI -0.77, -40.29) were key predictors of poorer global health status on the BSHS-B. Females also scored worse on body image (-5.35; 95% CI -1.83, -8.87) and work (-4.13; 95% CI -0.64, -7.62) domains of BSHS-B. The need for reconstructive or secondary surgery (-38.84; 95% CI -58.04, -19.65) and female gender (-16.30; 95% CI -4.03, -28.57) were important predictors of poorer hand function.

CONCLUSION

Women and those with a history of psychiatric illness are particularly vulnerable to poorer outcomes in health status and/or hand function after burns, and may benefit from more intensive rehabilitation support and long-term follow-up.

A preliminary report: The new protocol of managing acute partial-thickness hand burns

Background:

Optimal hand function recovery is the key to the successful management of hand burns. It starts with a timely burns coverage in the acute setting. A new hand burns protocol has been introduced to cover hand burn wounds within 24 hours after admission. BiobraneTM and split skin graft (SSG) are the coverage methods for partial-thickness burns. A three-year prospective study is being carried out to evaluate the short- and long-term clinical and functional outcomes of the two treatment modalities. This paper reports the preliminary short-term results of the first 34 hand burns of the study.

Methodology:

This report includes consecutive hand burns patients admitted between September 2014 and May 2015. The recruited hand burns patients underwent clinical and functional assessments seven days after the coverage with either SSG or BiobraneTM. Statistical analysis was performed to evaluate the outcomes.

Results and discussion:

Eleven burnt hands were treated with SSG and 23 with BiobraneTM. The clinical and functional outcomes, including range of motion, power and sensitivity, were similar in both treatment groups. Further study to recruit more patients is necessary to ascertain the significance of the above findings. More importantly, long-term functional outcomes have to be assessed to conclude the treatment efficacy of early hand burns coverage with BiobraneTM or SSG.

Acute burns of the hands - physiotherapy perspective

BACKGROUND

Acute burns of the hands are complex and may impact on various aspects of a person's life. Physiotherapy rehabilitation and restoration of hand function is critical for the patient's independence and re-integration into society.

PURPOSE

This study aimed to explore the perceptions and experiences of physiotherapists in the management of patients with their hand burn injuries.

METHOD

Five focus groups consisting of physiotherapists and physiotherapy assistants working with burn injured patients from each of the five selected public hospitals in KwaZulu-Natal were recruited. An explorative qualitative approach was adopted.

RESULTS

Physiotherapists emphasised that the acute management of the hand was trivialised due to a primary focus on the survival of the burn sufferer. Therapists identified several factors that determined the patients' level of participation and motivation in therapy one of which was the procedural pain experienced. The role of the therapists' within the rehabilitation framework was found to be critical to their recovery however there appeared to be a breakdown in the collaboration and communication among health care professionals to the detriment of effective intervention.

CONCLUSION

A multidisciplinary team approach is the foundation in the management of acute burn injuries and during the trajectory of the trauma care continuum.

Reliability and Validity of the Japanese Version of the Michigan Hand Outcomes Questionnaire: A Comparison with the DASH and SF-36 Questionnaires

Background: The Michigan Hand Outcomes Questionnaire (MHQ) has shown reliability, validity and responsiveness and has been used to assess surgical outcomes mainly in North America. We established a Japanese version of the MHQ and evaluated its reliability and validity compared with both the short-form 36 (SF-36) questionnaire and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire in a Japanese-speaking population.

Methods: The MHQ was cross-culturally adapted to a Japanese version according to guidelines. Sixty-eight patients with hand conditions were enrolled in this study and answered the MHQ, DASH questionnaire and SF-36 questionnaire. The MHQ was completed again with an interval of one or two weeks. Reproducibility and internal consistency were statistically assessed by the test-retest method and calculating Cronbach's alpha. Spearman's rank correlation was calculated to assess associations between the MHQ and the SF-36 questionnaire as well as the DASH questionnaire.

Results: The intraclass correlation coefficients of MHQ subscales ranged from 0.68 to 0.93. Aesthetics subscale of the left hand showed the lowest intraclass correlation but still a good correlation. Cronbach's alpha values of the MHQ ranged from 0.81 to 0.96 for all subscales. The absolute values of Spearman's rank correlation coefficient between MHQ subscales and DASH function/symptoms scores ranged from 0.49 to 0.82. Spearman's correlation coefficients of the MHQ total score to subscales of the SF-36 questionnaire ranged from 0.42 to 0.68. The strongest correlations were found between work performance of the MHQ and rolephysical of the SF-36 questionnaire.

Conclusions: The Japanese version of the MHQ has adequate instrument properties for assessing hand outcomes compared with the SF-36 questionnaire as well as the DASH questionnaire.

Long term outcomes data for the Burns Registry of Australia and New Zealand: Is it feasible?

BACKGROUND

Incorporating routine and standardised collection of long term outcomes following burn into burn registries would improve the capacity to quantify burn burden and evaluate care.

AIMS

To evaluate methods for collecting the long term functional and quality of life outcomes of burns patients and establish the feasibility of implementing these outcomes into a multi-centre burns registry.

METHODS

Five Burns Registry of Australia and New Zealand (BRANZ) centres participated in this prospective, longitudinal study. Patients admitted to the centres between November 2009 and November 2010 were followed-up at 1, 6, 12 and 24-months after injury using measures of burn specific health, health status, fatigue, itch and return to work. Participants in the study were compared to BRANZ registered patients at the centres over the study timeframe to identify participation bias, predictors of successful follow-up were established using a Generalised Estimating Equation model, and the completion rates by mode of administration were assessed.

RESULTS

463 patients participated in the study, representing 24% of all BRANZ admissions in the same timeframe. Compared to all BRANZ patients in the same timeframe, the median %TBSA and hospital length of stay was greater in the study participants. The follow-up rates were 63% at 1-month, 47% at 6-months; 40% at 12-months, and 21% at 24-months after injury, and there was marked variation in follow-up rates between the centres. Increasing age, greater %TBSA and opt-in centres were associated with greater follow-up. Centres which predominantly used one mode of administration experienced better follow-up rates.

CONCLUSIONS

The low participation rates, high loss to follow-up and responder bias observed indicate that greater consideration needs to be given to alternative models for follow-up, including tailoring the follow-up protocol to burn severity or type.

Classification of quality of life subscales within the ICF framework in burn research: identifying overlaps and gaps

OBJECTIVE

Quality of life (QOL) is one of the leading outcomes in burn care research. This study classifies subscales of common QOL measures within the International Classification of Functioning disability and health (ICF) framework to determine to which extent the measures are complementary or overlapping and to investigate whether the instruments are able to describe the full spectrum of patients' functioning.

METHODS

A literature search was performed to determine the most frequently used questionnaires in burn research. The subscales of the three mostly used questionnaires were classified within the ICF framework.

RESULTS

Two generic measures, the Short Form-36 items (SF-36) and the European Quality of Life 5 Dimensions (EQ-5D), and a disease specific measure, the Burn Specific Health Scale-Brief (BSHS-B), were analyzed. The BSHS-B covered most domains and was the only scale that included personal factors. The SF-36 included only one domain in the activity limitations and similar to the EQ-5D no contextual factors were included. Environmental factors were not addressed in the questionnaires, even though these may have an impact on the quality of life in patients with burns.

CONCLUSION

To capture the full spectrum of dysfunctioning a combination of the BSHS-B with a generic questionnaire seems obligatory. However still some domains of functioning remain uncovered.

Validity and reliability of the FIM instrument in the inpatient burn rehabilitation population

OBJECTIVE

To provide evidence of construct validity for the FIM instrument in the inpatient rehabilitation burn population.

DESIGN

Confirmatory factor analysis and item response theory were used to assess construct validity. Confirmatory factor analysis was performed on a 2-factor model of the FIM instrument and on a 6-subfactor model. Mokken scale analysis, a nonparametric item response theory, was performed on each of the FIM instrument's 2 major factors, motor and cognitive domains. Internal consistency using Cronbach alpha and Molenaar and Sijtsma's statistic was also examined.

SETTING

Inpatient rehabilitation facilities.

PARTICIPANTS

Data from the Uniform Data System for Medical Rehabilitation for patients with an impairment code of burn injury from the years 2002 to 2011 were used for this analysis. A total of 7569 subjects were included in the study.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Comparative fit index results for the confirmatory factor analyses and adherence to assumptions of the Mokken scale model.

RESULTS

Confirmatory factor analysis provided a comparative fit index of .862 for the 2-factor model and .941 for the 6-subfactor model. Mokken scale analysis showed scalability coefficients of .681 and .891 for the motor and cognitive domains, respectively. Measures of internal consistency statistic gave values of >.95 for each major domain of the FIM instrument.

CONCLUSIONS

The FIM instrument has evidence of validity and reliability as an outcome measure for patients with burn injuries in the inpatient rehabilitation setting. The 6-subfactor model provides a better fit than the 2-factor model by confirmatory factor analysis. There is evidence that the motor and cognitive domains each form valid unidimensional metrics based on nonparametric item response theory.