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Yoshida A, Yamamoto M, Li-Tsang CWP, Iwatsuki K, Hirata H. A systematic review assessing the effectiveness of hand therapy programmes in adults with burns using the International Classification of Functioning, Disability and Health framework. NAGOYA JOURNAL OF MEDICAL SCIENCE 2022; 84:689-704. [PMID: 36544605 PMCID: PMC9748324 DOI: 10.18999/nagjms.84.4.689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/20/2022] [Indexed: 12/24/2022]
Abstract
This systematic review aimed to confirm the effectiveness of hand therapy programmes using the International Classification of Functioning, Disability and Health framework for each of the three phases of the wound healing process in adults with burns. A systematic review was conducted to determine the efficacy of different hand therapy programmes in the management of burnt hands. Two independent reviewers conducted a literature search using the PubMed and Cumulative Index to Nursing and Allied Health Literature databases for original articles reporting effectiveness of hand therapy programmes for adults with burns. Only randomized and non-randomized controlled trials were selected using the Mixed Methods Appraisal Tool. Demographic and clinical data including medical history, burn depth, and hand therapy programme were extracted. Outcome measures were reviewed based on the International Classification of Functioning, Disability and Health framework for acute, convalescence, and chronic phases of rehabilitation. Sixteen articles and 15 hand therapy programmes were identified, which included studies showing improvements in different parameters in the framework. In the acute and convalescence phases, improvements were found in health condition, body functions and structures, activities, and participation. In the chronic phase, improvements were shown only in body functions and structures. Environmental factors in the framework were not reported for all the phases. This review demonstrated the efficacy of hand therapy programmes in adults with burns in terms of the health condition, body function, activities, and participation during acute and convalescence phases but only the body function in the chronic phase.
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Affiliation(s)
- Akihito Yoshida
- Department of Prevention & Rehabilitation Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Michiro Yamamoto
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Cecilia W P Li-Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Katsuyuki Iwatsuki
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hitoshi Hirata
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Edger-Lacoursière Z, Deziel E, Nedelec B. Rehabilitation interventions after hand burn injury in adults: A systematic review. Burns 2022; 49:516-553. [PMID: 35662480 DOI: 10.1016/j.burns.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/04/2022] [Accepted: 05/09/2022] [Indexed: 11/15/2022]
Abstract
The aim of this review was to summarise the current evidence regarding the effectiveness of rehabilitation interventions in improving hand function, range of motion (ROM), hand strength, scar outcome, return to work, level of impairment/disability, level of burn knowledge and decreasing edema following hand burns in adult burn survivors. This review provides evidence-based support for the use of rehabilitation interventions for burn rehabilitation professionals. The following data sources were searched: MEDLINE, EMBASE and CINAHL from their inception up to February 2021, reference lists from all the included full-text articles were screened for additional relevant publications and monthly Google Scholar searches until December 23rd 2021 to make sure all new pertinent published articles after February 2021 would be included. Thirty-five studies were included in this review including 14 RCTs. Most of the included studies were Level 4 (46%; 16/35) and Level 2 (40%; 14/35) evidence. Only four studies were classified as Level 3 (14%; 5/35) evidence and none were considered Level 1. Most studies received a score of 5-9 (54%; 19/35) (Moderate quality). Fourteen studies received a score of ≥ 10 (40%; 14/35) (High quality) and only 2 studies received a score of< 5 (6%; 2/35) (Low quality). Articles were categorized according to the primary outcome targeted by the intervention. Clinical recommendations on higher-level evidence interventions are presented. This review supports the clinical practice of the following interventions: 1) The use of adhesive compression wraps for patients who have increased edema to increase hand function and ROM; 2) The use of compression (adhesive compressive wrap, compression bandage or intermittent compression pump) to decrease hand edema following burn injury; 3) Participating in general rehabilitation to increase hand function and patient perceived level of disability; 4) The use of an orthosis to increase ROM and a dynamic MCP orthosis to increase hand function; 5) If available, incorporate the use of VR based rehabilitation to increase hand function and hand strength; 6) The use of paraffin to increase hand PROM; 7) The use of gels to reduce hand scar thickness; 8) The use of an education component in rehabilitation to increase the level of burn knowledge. The limitations of this study are also discussed. Further research with robust methodology is needed to investigate the potential benefits of treatment interventions included in this review.
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Affiliation(s)
- Zoë Edger-Lacoursière
- School of Physical and Occupational Therapy, McGill University, Montreal, QC H3A 0G4, Canada; Hôpital de Réadaptation Villa Medica, Montreal, QC H2X 1C9, Canada; Centre Professionnel d'Ergothérapie, Montreal, QC H1N 1E5, Canada
| | - Erika Deziel
- Centre Professionnel d'Ergothérapie, Montreal, QC H1N 1E5, Canada
| | - Bernadette Nedelec
- School of Physical and Occupational Therapy, McGill University, Montreal, QC H3A 0G4, Canada; Hôpital de Réadaptation Villa Medica, Montreal, QC H2X 1C9, Canada.
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Joo SY, Lee SY, Cho YS, Yi S, Seo CH. Clinical Utility of an Exoskeleton Robot Using Three-Dimensional Scanner Modeling in Burn Patient: A Case Report. J Burn Care Res 2021; 42:1030-1034. [PMID: 33881533 DOI: 10.1093/jbcr/irab060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Hands are the part of the body that are most commonly involved in burns, and the main complications are finger joint contractures and nerve injuries. Hypertrophic scarring cannot be avoided despite early management of acute hand burn injuries, and some patients may need the application of an exoskeleton robot to restore hand function. To do this, it is essential to individualize the customization of the robot for each patient. Three-dimensional (3D) technology, which is widely used in the field of implants, anatomical models, and tissue fabrication, makes this goal achievable. Therefore, this report is a study on the usefulness of an exoskeleton robot using 3D technology for patients who lost bilateral hand function due to burn injury. Our subject was a 45-year-old man with upper limb dysfunction of 560 days after a flame and chemical burn injury, with resultant impairment of manual physical abilities. After wearing an exoskeleton robot made using 3D printing technology, he could handle objects effectively and satisfactorily. This innovative approach provided considerable advantages in terms of customization of size and reduction in manufacturing time and costs, thereby showing great potential for use in patients with hand dysfunction after burn injury.
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Affiliation(s)
- So Young Joo
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Republic of Korea
| | - Seung Yeol Lee
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Republic of Korea
| | - Yoon Soo Cho
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Republic of Korea
| | - Sangho Yi
- Mand.ro Co., Ltd., Bucheon, Republic of Korea
| | - Cheong Hoon Seo
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Republic of Korea
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Hoefnagel AL, Timmermann TN, Riga A, Kaye MB, Braunecker S, Mongan PD. A Unique Treatment for Compartment Syndrome After Intravenous Catheter Extravasation: A Case Report. A A Pract 2021; 15:e01496. [PMID: 34185027 DOI: 10.1213/xaa.0000000000001496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Intravenous cannulation is performed on nearly every patient presenting for an anesthetic. Complications of the procedure include infiltration and extravasation, which can have a varied impact on the patient. Here, we present a case of severe intravenous (IV) extravasation, resulting in compartment syndrome of the hand. Rather than treating the compartment syndrome with fasciotomies as is standard, we utilized compression therapy via an Esmarch surgical dressing wrapped distal to proximal on the effected limb, which resulted in marked decrease in swelling and return of perfusion to the hand.
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Affiliation(s)
| | | | - Andrew Riga
- Orthopedic Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida
| | - Marc B Kaye
- Orthopedic Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida
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Dargan D, Kazzazi D, Limnatitou D, Cochrane E, Stubbington Y, Shokrollahi K, Ralston D. Acute Management of Thermal Hand Burns in Adults: A 10-Year Review of the Literature. Ann Plast Surg 2021; 86:517-531. [PMID: 33675628 DOI: 10.1097/sap.0000000000002755] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Advances in the evidence base of acute thermal hand burns help to guide the management of these common injuries. The aim of this literature review was to evaluate recent evidence in the field over 10 years. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols methodology was used as a guide for this literature review. PubMed, MEDLINE, EMBASE, CINAHL, and Google Scholar were searched for English language articles related to hand burns published between 2009 and 2018 inclusive, and the Cochrane Library was reviewed. Exclusion criteria were as follows: participants younger than 18 years, scar or contracture management, rehabilitation, outcomes assessment, late reconstruction, and electrical or chemical burns. RESULTS An initial search retrieved 6493 articles, which was narrowed to 403 full-text articles that were reviewed independently by 3 of the authors and categorized. Of 202 included articles, there were 8 randomized controlled trials and 2 systematic reviews. Six evidence-based guidelines were reviewed. Referral of hand burns to specialist centers, use of telemedicine, early excision and grafting, and immediate static splintage have been recommended. Enzymatic debridement results in earlier intervention, more accurate burn assessment, preservation of vital tissue, and fewer skin grafts, and ideally requires regional anesthesia. Guidance on escharotomy emphasizes indication, technique and adequate intervention, and potential for enzymatic debridement. Inclusion of topical negative pressure, dermal regenerative templates, acellular dermal matrices, and noncellular skin substitutes in management has helped improve scar and functional outcomes. DISCUSSION The results of this literature review demonstrate that multiple national and international societies have published burns guidelines during the decade studied, with aspects directly relevant to hand burns, including the International Society for Burn Injuries guidelines. There are opportunities for evidence-based quality improvement across the field of hand burns in many centers. CONCLUSIONS More than 200 articles globally in 10 years outline advances in the understanding of acute management of thermal hand burns. Incorporating the evidence base into practice may facilitate optimization of triage referral pathways and acute management for hand burns.
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Affiliation(s)
| | - Diana Kazzazi
- From the Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital
| | | | - Elliott Cochrane
- From the Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital
| | | | - Kayvan Shokrollahi
- Mersey Regional Burns Centre, St Helens and Knowsley Teaching Hospitals NHS Trust, Whiston Hospital, Merseyside, Prescot, United Kingdom
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Edwick DO, Hince DA, Rawlins JM, Wood FM, Edgar DW. Randomized Controlled Trial of Compression Interventions for Managing Hand Burn Edema, as Measured by Bioimpedance Spectroscopy. J Burn Care Res 2020; 41:992-999. [DOI: 10.1093/jbcr/iraa104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Abstract
Compression, a common treatment of choice for the management of edema, is one intervention that is applied with little objective understanding of the optimal parameters of application or efficacy in acute burn wounds. The aim of this study was to determine the effectiveness of different methods of compression for the management of hand edema following burn injury. The primary hypothesis tested was that in acute hand burn injury, the application of cohesive bandage will reduce edema faster than a generic compression glove. It is a randomized controlled study of 100 patients presenting with hand burn injury. Compression was randomized to one of the three methods of application: 1) spiral application of Coban to fingers, figure of eight to hand and wrist; 2) pinch application of Coban to fingers, spiral application to hand and wrist; or 3) a generic compression glove (control condition). Bioimpedance spectroscopy was used to measure hand volumes. Hand and wrist range of movement, pain scores, and QuickDASH were recorded. One hundred patients (68 males) demonstrated significant reductions in hand volumes, using all compression methods. Both methods of applying Coban resulted in significantly greater reductions in edema compared to the generic compression glove. Notwithstanding compression method, all range of movement measures improved, with significant improvement in thumb opposition (P = .046), hand span (P = .020), and wrist flexion (P = .020). QuickDASH decreased between sessions (P < .001). Different methods of applying Coban are superior to generic compression gloves for managing acute hand burn edema.
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Affiliation(s)
- Dale O Edwick
- State Adult Burns Unit, Fiona Stanley Hospital, Murdoch, Western Australia
- Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Western Australia
- Burn Injury Research Node, The University of Notre Dame Australia, Fremantle, Western Australia
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia
| | - Dana A Hince
- Institute of Health Research, The University of Notre Dame Australia, Fremantle, Western Australia
| | - Jeremy M Rawlins
- State Adult Burns Unit, Fiona Stanley Hospital, Murdoch, Western Australia
- Department of Plastic and Maxillofacial Surgery, Royal Perth Hospital, Western Australia
| | - Fiona M Wood
- State Adult Burns Unit, Fiona Stanley Hospital, Murdoch, Western Australia
- Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Western Australia
- Burn Injury Research Unit, University of Western Australia, Perth
| | - Dale W Edgar
- State Adult Burns Unit, Fiona Stanley Hospital, Murdoch, Western Australia
- Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Western Australia
- Burn Injury Research Node, The University of Notre Dame Australia, Fremantle, Western Australia
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia
- Burn Injury Research Unit, University of Western Australia, Perth
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Effects of Virtual Reality-Based Rehabilitation on Burned Hands: A Prospective, Randomized, Single-Blind Study. J Clin Med 2020; 9:jcm9030731. [PMID: 32182742 PMCID: PMC7141182 DOI: 10.3390/jcm9030731] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/28/2020] [Accepted: 03/04/2020] [Indexed: 12/22/2022] Open
Abstract
Hands are the most frequent burn injury sites. Appropriate rehabilitation is essential to ensure good functional recovery. Virtual reality (VR)-based rehabilitation has proven to be beneficial for the functional recovery of the upper extremities. We investigated and compared VR-based rehabilitation with conventional rehabilitation (CON) in patients with burned hands. Fifty-seven patients were randomized into a VR or CON group. Each intervention was applied to the affected hand for four weeks, and clinical and functional variables were evaluated. Hand function was evaluated before intervention and four weeks after intervention using the Jebsen-Taylor hand function test (JTT), Grasp and Pinch Power Test, Purdue Pegboard test (PPT), and Michigan Hand Outcomes Questionnaire (MHQ). The JTT scores for picking up small objects and the MHQ scores for hand function, functional ADL, work, pain, aesthetics, and patient satisfaction were significantly higher in the VR group than in the CON group (p < 0.05). The results suggested that VR-based rehabilitation is likely to be as effective as conventional rehabilitation for recovering function in a burned hand. VR-based rehabilitation may be considered as a treatment option for patients with burned hands.
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