The effect of burn severity on functional capacity in patients with burn injury

Quantification of changes in functional capacity and muscle strength in patients: a burn intensive care unit cohort study

BACKGROUND

Regular functional status and muscle strength assessments should be performed with burn victims.

OBJECTIVE

To evaluate the functionality and peripheral muscle strength of burn patients admitted to the hospital.

METHODS

A longitudinal and prospective study was conducted from March to November 2019, including adult burn victims who were admitted to the ICU and discharged from the hospital. Patients were assessed on admission, every 10 days, at discharge from the ICU and from the hospital. Functionality was assessed using the Chelsea Critical Care Physical Assessment (CPAx) and the Functional Independence Measure (FIM). Muscle strength was assessed using the Medical Research Council (MRC) scale and handgrip dynamometry.

RESULTS

41 patients were included, 27 men and 14 women, with a median age of 41 (IQR [28-56]) years, mean TBSA of 19 (SD ± 12) percent, mean Abbreviated Burn Severity Index (ABSI) of 6 (SD ± 2) and the mean ICU time was 29 (SD ± 9) days. The CPAx, FIM and MRC evaluations improved (P < 0.0001) when compared to admission to the ICU and at hospital discharge, while the dynamometry showed no statistical difference. The ABSI only showed an association with the length of stay.

CONCLUSION

The CPAX scale was sensitive to changes in functionality throughout the hospital stay in severely burned patients, in the present study. The assessment of global muscle strength was more sensitive than handgrip strength and the ABSI was associated with length of stay in this population.

Six-minute walk test in burned subjects: Applicability, reproducibility and performance at hospital discharge

INTRODUCTION

Despite its clinical relevance in several populations, there is no evidence on applicability of the 6-min walk test (6MWT) in burned subjects.

OBJECTIVES

To verify the applicability and reproducibility of the 6MWT in burned individuals and to analyze patients' performance in this test at hospital discharge.

METHODS

In a cross-sectional study, burned individuals performed two 6MWT at hospital discharge, according to international standardization. In addition to walked distance, physiological and symptomatic variables were collected. Clinical history and demographic data were also recorded.

RESULTS

One hundred individuals were evaluated (70 men, 10 [6-18]% total body surface area burned). There was excellent agreement between the two 6MWT (ICC = 0.97). However, 73% of subjects increased the walked distance in the second test (23 [-9-47]m or 5 [-2-10]%; P = 0.001). Considering the best 6MWT, the walked distance was 488 [396-718]m (80 [65-92]%pred), and 51% of the individuals had limited functional exercise capacity. Additionally, participants without lower limb involvement presented better 6MWT than others (P < 0.0001).

CONCLUSION

The 6MWT was applicable, well tolerated and reproducible at hospital discharge in burned individuals. However, there was considerable learning effect between the first and second test. Finally, the reduced exercise capacity observed reinforces need for early rehabilitation in this population.