Rehabilitation of the Burned Hand

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.

With limited resources for rehabilitation, burn therapists throughout the world rely on local resources, professional creativity and community relationships to create solutions to help their patients recover. The demands of helping a burn survivor achieve an optimal outcome drive the burn therapist to create tools and strategies that effectively solve common problems after burn injury.

The International Society for Burn Injury (ISBI) invited burn therapists from around the world to describe the innovations that they have created to solve burn rehabilitation problems. The submissions were provided through an online form and inclusion of photographs was encouraged. Each submission was reviewed in a blinded manner by an expert panel of three independent rehabilitation therapists from the ISBI Rehabilitation Committee. The submissions were reviewed for originality, utility, quality and safety, then edited and compiled to be shared and disseminated throughout the world.

A total of 77 innovations were submitted for review. 71 were accepted for publication (92%) and given the opportunity to publish in Burns Open. Clinicians from 15 countries submitted innovations. The innovations were categorized as: Orthosis, Scar Management, Techniques, Activities of Daily Living Devices, Educational Tools and Prosthesis. Nineteen submissions were translated from Spanish to English.

Creative and innovative ideas using local resources are turned into patient solutions by experienced burn therapists around the world. However, because such innovations don’t reach widespread investigation or production, the ideas remain in a silo in the local area when they could be of use to therapists in other cultures. This project resulted in a book of “Innovative Solutions in Burn Rehabilitation from Around the World,” that was printed and is now available as this Special Edition in Burns Open. Future work would include expanding on the book with more innovative solutions and translating it into multiple languages to improve access and usability throughout the world.

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.

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

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.

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.

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

Post burn contractures are a common occurrence after severe burn injuries. In more than 80% of all burns, the hand is involved (Fufa et al., 2014). This article aims to emphasize on the need of detailed pre-operative scrutiny of hand deformities and guide a burn surgeon in obtaining optimal hand function and avoid pit falls at different stages of management of hand burns. The study is a prospective, non-randomized, observational study of patients presenting with post burn deformities of hand(s) requiring surgical intervention. McCauley’s classification of burn scar contracture in hand was used to classify the post burn deformities. A total of 1021 patients with 23 cases of both hands (total, 1044 hands) were included over a period of 60 months (5 years) from Jan 2015 to Dec 2019. A total of 449 cases (43%) were reconstructed with STSG, FTSG in 261 (25%) cases, Z-plasty in 86 (8.2%) cases, FTSG & Z-plasty in 136 (13%) cases, local, loco-regional and distant flaps in 98 (9.3%) and 14 (1.3%) cases required amputations for uncorrectable deformities. Overall functional improvement in the study was satisfactory, with good recovery in 689 (66%) resurfacing procedures, average recovery in 282 (27%) procedures and poor recovery in only 73 (7%) procedures. Preoperative assessment, surgical planning and meticulous execution, extensive physiotherapy, proper splintage and regular follow-up at least for 3 to 5 years after operation are the secrets of better functional recovery.