Outcomes Assessment After Hand Burns

An Occupation-Based Review of Outcome Measures Used to Assess Hand Function After Burn Injury

While occupation began as the central concept of occupational therapy at the dawn of the profession, the use of occupation throughout the therapy process, including assessment, has wavered in recent decades. Occupation is defined as meaningful and purposeful activities that individuals do to occupy their time and attention. The use of occupation-based assessments is vital to establishing care with an occupational focus. The purpose of this article is to review the outcome assessment tools commonly used in the burn literature to evaluate hand function and critique the presence of occupation in each assessment using the Occupation-Based Practice Assessment. Knowledge of the occupational nature of assessments is important to the delivery of an occupational therapy evaluation comprised of a battery of assessments inclusive of discrete measures of movement as well as performance-based tools to represent the person from an occupational perspective. Many outcome measures used in upper extremity burn rehabilitation are discrete in nature and do not measure occupations of clients. The Suitcase Packing Activity may be a viable addition to an assessment battery to address this essential need.

Physical Medicine Applications in Hand Burns: Treatment or Rehabilitation

The aim of this study is to investigate the contribution of concurrent physical therapy to the preservation of hand function in patients with hand burns. This retrospective cohort study included the records of adult patients who presented with hand burns between July 1, 2020, and December 1, 2021. A total of 67 of 1578 burn patients who attended the clinic were included in this study. The patients' age, sex, total BSA with burns, causative agent, depth of burn on the hand, right or left hand, location of the burned area on the hand, treatment applied, healing time of the burn on the hand, limitation of movement, the joint restrictions, contractures, and compliance with physical therapy were assessed and recorded. Among the 67 patients included, 82.1% (n = 55) had no limitation in terms of their joint range of motion, whereas 17.9% (n = 12) had a limitation of movement in their finger joints. When the prevalence of movement limitation was examined by gender, such limitation was found to be more common in females (P = .041). Moreover, contractures were found to occur more frequently in patients with full-thickness burns (P = .032). It was also found that the limitation of movement was more severe in patients with skin grafts (P = .044). In addition, it was observed that the recovery time of the burn area was longer in those patients who had movement limitations (P = .004). In this study, we found that applying early physical therapy to patients after burn injuries facilitated the recovery of hand functions.

Dermal substrate application in the treatment of pediatric hand burns: clinical and functional outcomes

BACKGROUND

Hand burn injuries are common among pediatric patients. Management of deep partial thickness and full thickness hand burns varies by center, with some favoring upfront autografting and others using dermal substrates (DS) as biologic dressings to accelerate burn wound healing. Achieving best outcomes is critical in children given the propensity of burn wound scars to affect hand function as a child grows and develops. Given potential complications associated with autografting in children, our center often prefers to treat pediatric hand burns initially with DS, with subsequent autografting if there is failure to heal. In this case series, we examined the outcomes of this practice.

METHODS

We conducted a retrospective review of pediatric burn patients with <10% total body surface area (TBSA) burns who underwent application of DS to hand burn injuries between 2013 and 2021. Burn mechanism, patient demographics, wound treatment details, healing and functional outcomes, and complications were collected. Descriptive statistics were computed.

RESULTS

Fifty patients with hand burns and overall <10% TBSA burns underwent application of DS to hands. Median age at the time of injury was 4.1 years (IQR: 1.8, 10.7) and 29 patients (58%) were male. Eighteen (36%) patients had bilateral hand burns, 10 (20%) had burns to their dominant hand, 6 (12%) their non-dominant hand, and 16 (32%) had unestablished or unknown hand dominance. Subsequent autografting was required in 5 (10%) patients treated initially with DS; four of these patients had full thickness injuries. Five (10%) patients developed contracture at the site of DS application for which two underwent scar release with tissue rearrangement, one underwent laser treatment, and two were managed conservatively. Most patients had splints (94%), or compression garments (54%) prescribed to aid in functional recovery.

CONCLUSION

Children with hand burns who underwent DS application healed well with few requiring autografting or developing contractures. Most patients who needed autografting had deeper injuries. Most patients who developed a contracture required additional procedural intervention. Recognizing factors that contribute to the need for autografting after initial treatment with DS can help direct intervention decisions in pediatric patients with hand burn injuries.

Rehabilitation Management of the Burned Hand

Burns to the hands constitute a small total surface area burn, but can result in significant functional challenges and disability. The complexity of multiple anatomical structures and intricate interplay of bones, muscles, and connective tissues requires specialized knowledge of how burns of the hand can affect function and independence. This article will provide an evidence-based overview of rehabilitation of the burned hand across the burn care continuum including a focus on evaluation, pain management, treatment interventions, and outcome assessment. Additionally, various deficits that can put the hand at significant risk for loss of function will be discussed. Finally, the authors will address the special considerations and treatment caveats of addressing the pediatric hand burn.

Deep palm burn treated with enzymatic debridement followed by autologous skin cell suspension: a case study

Despite improvements in treatment methods and outcomes, burns remain one of the principal causes of mortality and morbidity worldwide. Burns involving the hands are estimated to occur in >80% of people with burns. Hand burns have also been associated with long-term social, psychological and physical consequences that can impede a patient's full reintegration to the community and decrease their overall quality of life. Clinically, when the trajectory towards complete re-epithelialisation stalls in deep burn wounds of the hand, skin grafting is indicated, but cosmetic problems often remain. A recent publication highlighted common complications for burns involving the hand such as scar disturbances (26%) and scar contractures (14%). Innovative approaches with the potential to reduce the occurrence of complicating scar disturbances and contractures are sought by healthcare providers specialising in burns. This case report describes a novel approach to wound closure using a topical concentrate of proteolytic enzymes followed by the application of an autologous skin cell suspension. This combination was effective in achieving early and complete re-epithelialisation of a deep burn of the palm of a 28-year-old male patient, while potentially affording a favourable impact on hypertrophic scarring or scar contracture.

Unforeseen Heat: An Accidental Superficial Partial-Thickness Hand Burn Utilizing a New Convection Oven

Thermal burns remain a significant public health concern, and it is crucial to understand the potential risks associated with everyday activities involving heated objects or surfaces. It has been found that males have a higher susceptibility to hand burns, but when it comes to burns caused by hot liquids, females tend to be more frequently affected. Cooking remains the predominant activity associated with a higher incidence of accidental hand burns. Prompt medical attention and appropriate management are essential in mitigating the severity of burn injuries. This case report presents a previously healthy 55-year-old female that sustained a superficial partial-thickness burn to the dorsal aspect of her right hand while preparing a meal in her kitchen with her brand-new convection oven. This was her first time using a convection oven, unaware of the fans and rapidly circulating hot air within the oven. We discuss the need for a comprehensive approach to wound care, including topical antimicrobial agents, dressings, pain management, and monitoring for potential complications to achieve favorable outcomes and minimize long-term sequelae. Prevention remains the cornerstone in reducing burn injuries. Awareness campaigns, safety guidelines, and educational initiatives aimed at promoting responsible handling of hot objects should be implemented. Simple preventive measures, such as using appropriate protective equipment such as oven mitts, being mindful of oven temperatures, and maintaining a safe distance from heated surfaces, can significantly reduce the risk of household thermal burns.

Use of Virtual Reality in Burn Rehabilitation: A Systematic Review and Meta-analysis

OBJECTIVES

We systematically reviewed published clinical trials to evaluate the effectiveness of virtual reality (VR) technology on functional improvement, pain relief, and reduction of mental distress among burn patients undergoing rehabilitation.

DATA SOURCES

Systematic searches were conducted in 4 databases, including PubMed, the Cochrane Library, Embase, and Web of Science, from inception to August 2021.

STUDY SELECTION

Randomized controlled trials (RCTs) evaluating any type of VR for the rehabilitation in burn patients with dysfunction were included.

DATA EXTRACTION

Two reviewers evaluated the eligibility, and another 2 reviewers used the Cochrane risk of bias assessment tool to assess the risk of bias. The extracted data included the main results of rehabilitation evaluation (quality of life [QOL], work performance, range of motion [ROM] of joints, hand grip and pinch strength, pain, fun, anxiety), the application performance of VR (realness and presence), adverse effects (fatigue and nausea), and characteristics of the included studies. Heterogeneity was evaluated using the chi-square tests and I² statistics. Random- or fixed-effects models were conducted to pool the effect sizes expressed as standardized mean differences (SMDs).

DATA SYNTHESIS

Sixteen RCTs with 535 burn patients were included. VR-based interventions were superior to usual rehabilitation in QOL and work performance of burn patients and produced positive effect on the average gain of ROM (SMD=0.72) as well. VR was not associated with improved hand grip and pinch strength (SMD=0.50, 1.22, respectively) but was associated with reduced intensity, affective, and cognitive components of pain (SMD=-1.26, -0.71, -1.01, respectively) compared with control conditions. Ratings of fun in rehabilitation therapy were higher (SMD=2.38), and anxiety scores were lower (SMD=-0.73) than in control conditions.

CONCLUSIONS

VR-based burn rehabilitation significantly improves the QOL and work performance of burn patients, increases the ROM gain in the joints, reduces the intensity and unpleasantness of pain and the time spent thinking about pain, increases the fun in the rehabilitation therapy, reduces the anxiety caused by the treatment, and has no obvious adverse effects. However, it did not significantly improve hand grip or pinch strength.

Epidemiology And Outcome Assessment Of Hand Burns: A 3-Year Retrospective Analysis In A Burn Unit

A great number of burns affect the hands, either as part of a more extensive burn or as an isolated injury. These injuries can lead to physical, social and psychological consequences that may reduce quality of life and make difficult the return to work. The goal of this study was to investigate the main epidemiologic characteristics of adult patients with hand burns admitted to a dedicated burn centre, evaluate the outcomes of the treatment, and identify the predictors associated with the worst outcomes. This study found that a considerable amount of burn victims admitted had hand burns (41.5%). Males are more likely to be injured in general, but females are more prevalent in burns by hot liquids. The most common comorbidity was hypertension, followed by dyslipidemia and type II diabetes. Cooking is the activity associated with more accidental victims. Most injuries did not require surgical intervention. Approximately two-thirds of the patients did not have any important sequelae. The most common complications were scar disturbances (26%) and scar contractures (14%). The need for surgery, a higher number of surgeries and higher surface area burn were associated with the worst outcomes. It is imperative to establish a burn prevention education program nationwide, encompassing water temperature control in households, the use of anti-burn equipment, and the replacement of old electrical/ heating equipment.

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.

Burn Specific Health Scale - Brief - Brazil and International Classification of Functioning, Disability and Health in burn patients

With better burn trauma survival rates, quality of life and functionality have become important outcomes in the evaluation of burn patients.The objective of this study was to evaluate the quality of life of burn survivors using the Burn Specific Health Scale-Brief-Br and their function and health using the International Classification of Functioning Disability and Health (ICF) in order to assess whether there is a correlation in the results obtained between the two instruments. A cross-sectional study with 80 burn patients who underwent outpatient follow-up was completed. Quality of life was assessed using the BSHS-B-Br, an instrument translated and validated in Brazilian Portuguese. Based on ICF category concepts, a data collection tool was used with "yes" and "no" answers. A "yes" answer represented the "8" qualifier, indicating a problem without a specific order of magnitude. Both instruments were self-applied in standardized conditions without complications during the process. Results were analyzed through Spearman's rank correlation coefficients. The BSHS-B-Br had an average score of 127.12 (SD ± 23.03). The correlation was moderate between the total BSHS-B-Br score and the answers of ICF for body functions (r= -0.53; p <0.001) and environmental factors (r= -0.50; p <0.001). It was weak for body structures (r= -0.47; p <0.001) and for activities and participation (r= -0.43; p <0.001). This study found a moderate correlation between the results of the Burn Specific Health Scale - Brief - Brazil and the International Classification of Functioning, Disability and Health for burn patients showing that both instruments provide complementary information about burned patients.

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.

Effectiveness of incorporating occupational therapy in rehabilitation of hand burn patients

One of the main goals in the rehabilitation process of patients with burn to their hands is their return to society and their professional occupation, which has a direct positive influence on these patients' quality of life. The goal of this research project was to investigate the effect of early intervention with occupational therapy in patients with burns to their hands. The study included 30 patients with second or third degree hand burns. Patients were added to the study 12 days after their burn wounds and grafted areas had healed. They had 3 sessions of occupational therapy per week for 8 weeks. These sessions included active and passive range of motion exercises, active resistive exercises, stretching exercises and practicing activities of daily living. Functionality of the hand was assessed before and after the 8 weeks of occupational therapy using the DASH questionnaire. The average initial DASH score before intervention with occupational therapy was 60.9, and after 8 weeks of occupational therapy it was 33.9 (average difference between the pre-intervention and post-intervention DASH scores is 27 points, p < 0.001). After 8 weeks of occupational therapy, patients performed activities of daily living with a lot less difficulty, and an increase in functionality of the hands was observed. This study suggests that early intervention with rehabilitative therapies is advantageous and may result in improved hand function.

Dental health status and oral health behaviours of patients with facial burn in Pakistan

Background

There is a limited understanding about the oral health of patients with facial burn, hence the aim was to describe the oral health status and the related risks factors.

Methods

This cross-sectional study had randomly and systematically recruited facial burn patients from the Burn Care Center, Pakistan Institute of Medical Sciences, Islamabad, from June of 2016 to July of 2017. Intraoral examination recorded the DMFT, CPI and OHI-S. Information on the socio-demographic status, self-perceived oral health, oral health behaviours were collected using a self-administered questionnaire and; the burn characteristics were obtained from the patients’ medical record. The t-test, ANOVA, SLR, and chi-square test were used to examine the relationship between oral health and each factor. A parameter was derived from the clinical indices using the principal component analysis and used in the multiple linear regression analysis to determine the important factors associated with oral health status.

Results

A total of 271 burn patients (69% female and 31% male) had participated in the study. All of the participants had caries with mean DMFT = 10.96 (95%CI: 10.67, 11.25). There were 59.0% (95%CI: 53.15, 64.93%) and 66.1% (95%CI: 60.38, 71.73%) of the participants who had periodontitis and poor oral hygiene respectively. About 79 and 80% of the participants rated their dental and periodontal status as poor. About 78% reported brushing once daily and 89% did not practice regular dental visit. The DMFT, CPI and OHI-S were associated with the burn characteristics and oral health behaviours (p < 0.05). Dental anxiety, cost and social issues were the most cited reasons for not utilising oral health services. Greater burn severity, the longer time elapsed since the burn incident, and dental anxiety were associated with poorer oral health status and; brushing twice or more and regular dental visit, with better status (p < 0.01).

Conclusion

Patients with oro-facial burn injury had a generally poor oral health and, the risks are greater in those with a more severe and wider area of injury, the longer time elapsed since the burn incident and dental anxiety; but a good oral hygiene practice and regular dental visits were protective against the risk.