Multidisciplinary staff perceived barriers and enablers to early mobilization of patients with burns in the ICU

Enablers and barriers to participation in physical activity programs while hospitalized after burn injury: The patient perspective

BACKGROUND

Physical activity is an essential component of burn rehabilitation; however, the patient experience of factors that contribute to physical activity participation while hospitalized after burn injury has not yet been described. This study aimed to identify enablers and barriers to participation in physical activity while hospitalized after burn injury from the patient perspective.

METHODS

A qualitative descriptive study design was undertaken. Purposive sampling was used to recruit adults with burn injuries admitted to the burn center between February and July 2022. Semi-structured interviews were conducted by a research assistant not involved in clinical care, audio-recorded and transcribed verbatim. All de-identified transcripts were analyzed using an inductive thematic approach and organized into major themes.

RESULTS

Twenty participants (18 males) with average age of 47 years and mean burn size of 13.8 % total body surface area were included. Factors which influenced patients' ability to participate in physical activity were summarized into six major themes: 1) Burn injury factors; 2) Patient factors; 3) Staff support; 4) Family support; 5) Peer support; 6) Environmental factors. Pain, fear of causing further pain or harm and beliefs regarding the need for rest to achieve wound healing were identified as major barriers to physical activity performance. Family support and supportive care from staff were highly valued enablers.

CONCLUSION

This is the first study to describe the patient experience of physical activity participation while hospitalized after a burn injury. Understanding the patient perspective is integral to developing appropriate multi-component interventions to promote increased physical activity early after burn injury.

Bridging Knowledge Gaps: Enhancing Burn Wound Management Through Evidence-Based Educational Interventions in Outpatient Settings

BackgroundKnowledge deficits in burn wound management among healthcare providers often lead to inconsistent practices and adverse patient outcomes. This study assessed how well a brief, evidence-based educational module affected the confidence and knowledge of Jordanian healthcare professionals.MethodsA pre-post intervention was conducted with 22 healthcare providers across two hospitals in Jordan. Participants attended a 25-min educational session focusing on evidence-based burn care practices. Knowledge and confidence were assessed before and immediately after the session, with follow-up testing conducted 5 weeks later. Paired Student's t-tests were used in the statistical analysis to assess score changes.ResultsThe mean knowledge score significantly increased from 3.8 ± 1.2 at baseline to 6.4 ± 1.1 immediately post-intervention (p = 0.001), with sustained improvement at 5 weeks (mean score: 6.2 ± 1.0, p = 0.001). Confidence levels also showed significant gains, rising from 2.3 ± 0.7 to 3.6 ± 0.6 (p = 0.001) post-intervention. These findings demonstrate the effectiveness of targeted education in addressing critical knowledge gaps and improving provider confidence.ConclusionThe results strongly support the need for integrating structured, evidence-based training modules in burn wound management to standardize practices, improve outcomes, and foster sustained learning among healthcare providers.

Effects of rehabilitation treatments jointly considered by physiatrists and rehabilitation therapists in patients with severe burn injury

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.

Early ambulation impacts on quality-of-life outcomes positively after lower limb burn injury: A group trajectory analysis

INTRODUCTION

Despite the challenges of providing burn care throughout the 2.5MKm2 jurisdiction of Western Australia, early intervention after injury remains a key premise of the multidisciplinary model of care applied by the State Adult Burn Unit (SABU) team. In particular, contemporary guidelines support the facilitation of early ambulation after lower limb burn and skin grafting. Thus, this study aimed to evaluate the association between the timing of ambulation after burn and surgery on quality of life (QoL) outcomes.

METHODS

Data from 1707 lower limb burn patients aged ≥ 18, admitted to the SABU between February 2011- December 2019, were included. Self-reported QoL longitudinal outcomes were assessed using the Short Form 36 and Burn Specific Health Scale Brief. Three recovery trajectories were defined according to their QoL outcome responses, mapped out to one year. Early ambulation was defined as occurring within 48 h of acute burn or surgery, as per SABU routine practice.

RESULTS

Early ambulation was shown to have a positive association to the higher QoL trajectory group (>75% of cohort), though not statistically significant for the Physical Component (PCS) and Mental health Component (MCS) summary scores of the SF36; however, ambulation pathway was associated with adjusted long-term BSHS-B QoL outcomes. The least favorable trajectory of long-term recovery of the physical aspects of QoL was seen in those with higher TBSA and complications and increasing age and comorbidities. In contrast, the mental health components of QoL were robust to all those factors, apart from pre-existing comorbidities.

CONCLUSION

Early ambulation after lower limb burn, and surgery, was positively associated with early and long-term QoL outcomes. Recovery trajectory is strongly indicated by where the patient journey begins after early acute care. The optimal physical QoL recovery trajectory was shared by those who were younger with reduced TBSA; complications; and, comorbidities whereas the mental health QoL trajectories were only impacted by comorbidities.