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1.
Rev Infirm ; 68(256): 25-27, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31870474

RESUMO

At the patient's bedside 24 hours a day, the nurse is at the heart of the rehabilitation management of the severely burnt patient: installation, technical dressings, supervision of postures and placement of compressors, to limit the functional consequences to the type of retractable and hypertrophic scars. The nurse takes care of the patient in this long journey leading to social reintegration; from accompaniment to autonomy and acceptance of self-image.


Assuntos
Queimaduras , Bandagens , Queimaduras/psicologia , Queimaduras/reabilitação , Queimaduras/terapia , Humanos , Autoimagem
2.
Zhonghua Shao Shang Za Zhi ; 35(11): 804-810, 2019 Nov 20.
Artigo em Chinês | MEDLINE | ID: mdl-31775469

RESUMO

Objective: To explore the development trajectories of quality of life and acceptance of disability of burn patients in the rehabilitation treatment stage and the influencing factors. Methods: Totally 207 burn patients, including 157 males and 50 females, aged (40±13) years, who were in the rehabilitation treatment stage were selected by convenient sampling method from October 2016 to July 2017 in the Department of Burns of Fujian Medical University Union Hospital for this longitudinal study. At discharge and 1, 3, and 6 months after discharge, the patient's quality of life and acceptance of disability were scored using the Burn Specific Health Scale-Brief and Chinese Version of Acceptance of Disability Scale-Revised respectively. Taking the intercept, the slope, and the curve slope as latent variables, the latent second growth curve model was constructed for the quality of life and the acceptance of disability. The robust maximum likelihood estimation (MLR) method was used to estimate the mean, the variance, and the covariance, so as to analyze the discharge level, the growth rate, the acceleration, and the correlation among them. Taking the acceptance of disability, the gender, the cause of burn, the severity of burn, the existence of complications, the payment way, and the education level as covariates, the latent second growth curve model was constructed for the quality of life. The MLR method was used to estimate the influence of covariates on the discharge level, the growth rate, and the acceleration of the quality of life. Results: At discharge and 1, 3, and 6 months after discharge, the quality of life scores of patients were (102±36), (111±36), (118±37), and (122±37) points respectively, and the acceptance of disability scores were (73±17), (75±17), (77±17), and (78±18) points respectively. The estimated mean intercept of the quality of life and the acceptance of disability were 101.680 and 72.993 respectively at discharge, both of which showed a curve increasing trend in 1, 3, and 6 months after discharge (estimated mean slope=11.024, 3.086, t=15.376, 7.476, P<0.01), and the increasing rate (acceleration) gradually slowed down (estimated mean curve slope=-1.393, -0.426, t=-13.339, -4.776, P<0.01). There were significant individual differences in the discharge level and the acceleration of quality of life of patients (estimated intercept variance=1 174.527, t=9.332; estimated curve slope variance=2.379, t=6.402; P<0.01). There were significant individual differences in the discharge level, the growth rate, and the acceleration of patients' acceptance of disability (estimated intercept variance=267.017, t=9.262; estimated slope variance=32.264, t=2.356; estimated curve slope variance=0.882, t=2.939; P<0.05 or P<0.01). There was no significant correlation among the discharge level, the growth rate, and the acceleration of the quality of life and those of the acceptance of disability of patients (estimated intercept and slope=37.273, -1.457, t=0.859, -0.131; estimated intercept and curve slope=-6.712, -0.573, t=-1.089, -0.248; estimated slope and curve slope=-5.494, -5.988, t=-0.930, -2.512; P>0.05). Among the time-constant covariates, only the severity of burn and the presence of complications had a significant impact on the quality of life of patients at discharge (estimated intercept=-10.721, 5.522, t=-6.229, 1.977, P<0.05 or P<0.01). At discharge and 1, 3, and 6 months after discharge, the level of acceptance of disability had a positive impact on the quality of life of patients (standardized regression coefficient=0.616, 0.669, 0.681, 0.678, t=18.874, 21.660, 22.824, 22.123, P<0.01). Conclusions: The initial levels of quality of life and acceptance of disability of burn patients in the rehabilitation treatment stage are relatively low, both with a curve increasing trend over time, and the increasing rate gradually slows down. Patients with complications and serious burns have poor quality of life at discharge, while the acceptance of disability has a positive impact on the quality of life.


Assuntos
Queimaduras/psicologia , Queimaduras/reabilitação , Qualidade de Vida , Adaptação Psicológica , Adulto , Queimaduras/fisiopatologia , Pessoas com Deficiência/psicologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade
3.
Zhonghua Shao Shang Za Zhi ; 35(11): 821-823, 2019 Nov 20.
Artigo em Chinês | MEDLINE | ID: mdl-31775473

RESUMO

Scar contracture after burn on the back of hand can easily lead to the limitation of flexion function of fingers, which seriously affects daily life activities. Generally, comprehensive rehabilitation treatment is adopted for scar contracture on the back of hand, among which wearing braces is an effective treatment method. However, some braces will limit the normal finger joints or must wait until all the affected fingers heal before they can be worn, and the wearing operation is quite complicated. In order to solve these problems, the author designed and made a finger flexion band, which was used to stretch the patients with limited flexion of finger caused by scar contracture after burn on the back of hand, and achieved good therapeutic effect. According to the measured hand size, the finger flexion band is cut and spliced from the fabric commonly used in daily life. The finger flexion band is designed with finger sleeve, which will not limit the normal finger joints, can interfere with the healed finger in advance, fix the corresponding fingers better, and improve the treatment comfort, especially for children who do not cooperate with the braces wearing. This finger flexion band is simple to make, cheap, convenient to use, and suitable for clinical promotion.


Assuntos
Queimaduras/reabilitação , Cicatriz/reabilitação , Contratura/reabilitação , Traumatismos da Mão/reabilitação , Aparelhos Ortopédicos , Dedos , Humanos
4.
Handchir Mikrochir Plast Chir ; 51(5): 394-400, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31574549

RESUMO

Injuries to the hands occur disproportionately more frequently in thermal accidents. The aim of ICF-oriented rehabilitation of burn injured hands is to return as much sensory and gripping functionality as possible or to develop everyday practical compensation mechanisms. Often the expectations of functionality and aesthetics for the burn injured are clouded by the clinical picture of edema, epithelial defects, contractures and hypertrophic scarring but, multimodal therapy options and interdisciplinary thinking are the means by which the rehab team can address and alleviate these concerns.


Assuntos
Queimaduras , Cicatriz Hipertrófica , Traumatismos da Mão , Queimaduras/reabilitação , Traumatismos da Mão/reabilitação , Humanos , Traumatismos do Punho
5.
Rev. bras. cir. plást ; 34(3): 349-354, jul.-sep. 2019. ilus
Artigo em Inglês, Português | LILACS | ID: biblio-1047152

RESUMO

Introdução: A produção e a distribuição de pele humana pelos Bancos de Pele do Brasil é insuficiente para atender a demanda do país, suprindo menos de 1% da necessidade para tratar as vítimas de queimaduras. O objetivo do trabalho foi apresentar a elaboração e o desenvolvimento da implantação do primeiro Banco de Pele Animal do Brasil para tratamento da queimadura. Métodos: Trata-se de um estudo metodológico. O Banco de Pele Animal Aquático foi elaborado, desenvolvido e instalado a partir do desenvolvimento do processamento de pele da tilápia, da revisão sistemática de estudos referentes a banco de pele animal, de visitas à pscicultura em Jaguaribara-CE, da visita técnica aos bancos de pele humana no Brasil, de consulta técnica e de treinamento no Banco de Pele de Recife, da observação de todas as fases de processamento da pele de tilápia e da identificação da estrutura física da área onde ocorrem todos os processos. Resultados: Além da produção e da distribuição da pele da tilápia para os estudos em vítima de queimaduras, o banco está processando mais de 5000 peles de tilápia e encontra-se em fase de distribuição desta pele para estudos multicêntricos em outros estados e outras especialidades, que desenvolvem pesquisas nas áreas de ginecologia, ortopedia, endoscopia, estomaterapia, cirurgia vascular, odontologia e veterinária. Conclusão: este trabalho possibilitou a elaboração, o desenvolvimento e a implementação do primeiro Banco de Pele Animal do país e o primeiro Banco de Pele Aquática do mundo.


Introduction: The production and distribution of human skin by Brazilian skin banks is insufficient to meet the country's demand, supplying less than 1% of the need for treating burn victims. The objective of this work was to present the elaboration and development of the first animal skin bank of Brazil for the treatment of burns. Methods: This methodological study elaborated, developed, and installed The Aquatic Animal Skin Bank in terms of the development of tilapia skin processing after a systematic review of studies referring to animal skin banks based on visits to the pisciculture center in Jaguaribara-CE, technical visits to human skin banks in Brazil, technical consultation and training in the Recife Skin Bank, the observation of all phases of tilapia skin processing, and the identification of the physical structure of the area where the processes occur. Results: In addition to the production and distribution of tilapia skin for studies on burn victims, the bank is processing more than 5000 tilapia skin samples and is in the distribution phase of this skin for multicentric studies in other states and specialties including gynecology, orthopedics, endoscopy, stomatherapy, vascular surgery, dentistry, and veterinary medicine. Conclusion: This work enabled the elaboration, development, and implementation of Brazil's first animal skin bank and the world's first aquatic skin bank.


Assuntos
Animais , História do Século XXI , Materiais Biocompatíveis , Materiais Biocompatíveis/uso terapêutico , Curativos Biológicos , Queimaduras , Tilápia , Pele Artificial , Ciclídeos , Pesqueiros , Materiais Biocompatíveis/análise , Curativos Biológicos/normas , Curativos Biológicos/provisão & distribução , Queimaduras/reabilitação , Tilápia/cirurgia , Pele Artificial/normas , Ciclídeos/cirurgia , Pesqueiros/normas
6.
Zhonghua Shao Shang Za Zhi ; 35(7): 537-539, 2019 Jul 20.
Artigo em Chinês | MEDLINE | ID: mdl-31357825

RESUMO

Objective: To observe the influences of different follow-up methods on rehabilitation and compliance of patients with severe scar after burns. Methods: From January 2012 to May 2016, medical records of 116 patients with severe scar after burns who were admitted to our unit, discharged after wound healing and conforming to the criteria, were retrospectively analyzed. They were divided into face-to-face follow-up group [n=59, 45 males and 14 females, aged (36±9) years] and routine follow-up group [n=57, 44 males and 13 females, aged (35±9) years] based on different follow-up methods they received. On the day of discharge and in post discharge month (PDM) 1, 3, and 6, the Vancouver Scar Scale (VSS) was used to evaluate the hypertrophic scar in joints, Activities of Daily Living (ADL) scale was used to evaluate the disability of patients in the 2 groups. In PDM 1, 3, and 6, Medical Compliance Behavior Questionnaire was used to investigate the medical compliance behaviors of patients in the 2 groups. Data were processed with chi-square test, t test with Bonferroni correction, and analysis of variance for repeated measurement. Results: (1) The VSS score of patients in face-to-face follow-up group on the day of discharge was (11.1±0.7) points, which was close to (11.7±0.7) points of routine follow-up group (t=2.021, P>0.05). The VSS scores of patients in face-to-face follow-up group in PDM 1, 3, and 6 were (10.5±0.6), (8.6±0.7), and (4.7±0.5) points, which were significantly lower than (11.4±0.7), (10.9±1.0), and (9.4±0.8) points of routine follow-up group respectively (t=2.034, 2.033, 2.042, P<0.05 or P<0.01). (2) The ADL score of patients in face-to-face follow-up group on the day of discharge was close to that of routine follow-up group (t=1.781, P>0.05). The ADL scores of patients in face-to-face follow-up group in PDM 1, 3, and 6 were higher than those of routine follow-up group respectively (t=9.683, 8.584, 9.772, P<0.01). (3) The compliance rates of consisted rehabilitation, reasonable diet, and timing consultation of patients in face-to-face follow-up group were better than those of routine follow-up group respectively (χ(2)=19.015, 13.251, 8.652, P<0.01). Conclusions: Compared with routine follow-up by phone, face-to-face follow-up can do better in evaluating the scar condition and ADL of patients with severe scar after burns, and improve the medical compliance rates of patients, which is worthy of clinical promotion.


Assuntos
Queimaduras/reabilitação , Cicatriz Hipertrófica/reabilitação , Cooperação do Paciente , Atividades Cotidianas , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
7.
Zhonghua Shao Shang Za Zhi ; 35(6): 428-433, 2019 Jun 20.
Artigo em Chinês | MEDLINE | ID: mdl-31280535

RESUMO

Objective: To observe the therapeutic effects of Archimedes sling system in the rehabilitation of knee joint flexion dysfunction of patients after deep burns. Methods: Thirty-seven patients with knee joint flexion dysfunction after deep burn, conforming to the study criteria and hospitalized in Burn Rehabilitation Center of Tongren Hospital of Wuhan University & Wuhan Third Hospital from March 2015 to December 2017, were recruited in this prospective controlled study. According to the order of admission, 18 odd-numbered patients and 19 even-numbered patients were enrolled in conventional treatment (CT) group [13 males and 5 females, aged (42±10) years] and sling treatment (ST) group [13 males and 6 females, aged (37±10) years] respectively. Patients in group CT were conventionally conducted with knee joint mobilization treatment, continuous passive motion treatment, and pressure therapy, while patients in group ST were conducted with supine knee joint flexion and extension training and micro-squat short arc resistance training with Archimedes sling system besides CT. Patients in the 2 groups were treated for 6 months, and 1 course of treatment was 1 month. Before treatment and after 6 months of treatment, the knee joint active motion range was measured and the difference value was calculated, the American Hospital for Special Surgery (HSS) knee joint score was used to assess the functional disorder of patients, and the self-function satisfaction of patients were evaluated with modified Likert Scale. Data were processed with independent sample t test, paired sample t test, and chi-square test. Results: (1) Before treatment, the difference value of knee joint active motion range of patients in group CT was (45±11)°, which was similar to (44±12)° in group ST (t=-0.206, P>0.05). After 6 months of treatment, the difference value of knee joint active motion range of patients in group ST was (89±14)°, which was obviously higher than (75±12)° in group CT (t=0.897, P<0.01). The difference values of knee joint active motion range of patients in groups CT and ST after 6 months of treatment were obviously higher than those before treatment (t=-13.394, -29.459, P<0.01). (2) Before treatment, the HSS knee joint score of patients in group CT was (40±10) points, which was similar to (36±11) points in group ST (t=0.816, P>0.05). After 6 months of treatment, the HSS knee joint score of patients in group ST was (68±13) points, which was obviously higher than (57±10) points in group CT (t=0.162, P<0.01). The HSS knee joint score of patients in groups CT and ST after 6 months of treatment were obviously higher than those before treatment (t=-12.410, -30.559, P<0.01). (3) Before treatment, the self-function satisfaction scores of patients in the two groups were similar (t=0.140, P>0.05). After 6 months of treatment, the self-function satisfaction score of patients in group ST was obviously higher than that in group CT (t=3.103, P<0.01). The self-function satisfaction scores of patients in groups CT and ST after 6 months of treatment were obviously higher than those before treatment (t=-11.697, -29.029, P<0.01). Conclusions: The Archimedes sling system can effectively increase the difference value of knee joint active motion range, alleviate the degree of knee joint dysfunction, and enhance the self-function satisfaction of patients on the basis of conventional rehabilitation treatment for patients with knee joint flexion dysfunction after deep burns.


Assuntos
Queimaduras/reabilitação , Articulação do Joelho/fisiopatologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto , Idoso , Queimaduras/terapia , Terapia por Exercício/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Amplitude de Movimento Articular , Resultado do Tratamento
8.
Burns ; 45(5): 1005-1013, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31203869

RESUMO

OBJECTIVE: The objective for this manuscript is two-fold: determine the scope of clinical rehabilitation research involving burn-injured persons and assess whether research outcomes include function, return to needed, and desirable routines. Has this research addressed rehabilitation needs of the burn injured? METHODS: We performed a scoping review of literature (1990-2016) using the method of Arksey and O'Malley. Search terms included "rehabilitation", "function", "burn injury" and "work". Two independent reviewers identified articles that met criteria for abstract and full review. Variables of interest were counts of the number of intervention studies, studies performed in outpatient settings/inpatient settings, or both; count of the distribution of outcome measures that included impairment, function, participation, return to prior roles and percent of burns rehabilitation publications as a function of total rehabilitation articles published. RESULTS: Sixty-four articles were selected for review and 22 employed an intervention. Nine articles were intervention trials that used functional measures. Of the 22 intervention trials 3 (14%) were performed while subjects were inpatients, 9 (41%) while they were outpatients, and 10 (45%) while they were both. There were 67 articles that met inclusion for work-related studies. Fourteen were intervention trials, 9 utilized functional outcomes and 5 used impairment outcomes exclusively. Less than 1% of clinical rehabilitation research addresses burns injury and <1% of the randomized trials in rehabilitation relates to burn injury CONCLUSIONS: There are few studies, few intervention trials and among these, very few that use function or return to community based activity as outcomes for people with burn injury.


Assuntos
Queimaduras/reabilitação , Qualidade de Vida , Recuperação de Função Fisiológica , Retorno ao Trabalho , Participação Social , Queimaduras/fisiopatologia , Humanos
9.
Zhonghua Shao Shang Za Zhi ; 35(5): 351-355, 2019 May 20.
Artigo em Chinês | MEDLINE | ID: mdl-31154732

RESUMO

Objective: To investigate the early diagnosis method of pulmonary embolism in patients with skin and soft tissue defects after trauma. Methods: From January 2011 to July 2014, 5 patients with skin and soft tissue defects and pulmonary embolism after trauma were admitted to Department of Plastic Surgery and Burns of the Affiliated Drum Tower Hospital of Nanjing University Medical School, including 4 males and 1 female, aged 26-68 years. The medical records of the 5 patients were retrospectively analyzed. Hierarchical screening of patients with suspected pulmonary embolism was performed after admission for 4-45 days. Computed tomography pulmonary angiography (CTPA) was performed immediately in 2 patients who had hemodynamic disorder and were able to tolerate CTPA, and pulmonary embolism was confirmed. Clinical risk assessment was conducted for the other 3 patients who had no obvious hemodynamic disorder and only had clinical manifestations of pulmonary embolism such as chest tightness and dyspnea. Among the 3 patients, two of them were assessed as high risk possibility by clinical risk assessment and diagnosed with pulmonary embolism by CTPA immediately. The other one patient's clinical risk assessment was moderate risk possibility, but D-dimer was positive, and the patient was diagnosed with pulmonary embolism by CTPA immediately. Wound exudation of all patients was collected within 1 week after admission for microbial culture, and wound debridement and skin grafting were performed according to the wound condition. The color Doppler ultrasonography of blood vessel on lower extremity was performed to determine deep venous thrombosis of lower extremity after appearance of symptoms of pulmonary embolism. The patient was immediately given urokinase or recombinant tissue plasminogen activator by intravenous infusion for thrombolysis after definite diagnosis of pulmonary embolism. The activated partial thromboplastin time (APTT) was monitored after treatment, and standardized anticoagulation began when APTT was equal to or lower than 70 seconds. The treatment results of patients, D-dimer measurement value, bed time before definite diagnosis of pulmonary embolism, number of patients underwent wound debridement during hospitalization, definite diagnosis time of pulmonary embolism after wound debridement, and number of patients with deep venous thrombosis of lower extremity and wound infection were recorded. Results: Wounds with skin and soft tissue defects of all patients were completely healed, all skin grafts survived well, pulmonary embolism recovered well after timely treatment, and the trunk and branches of involved pulmonary artery recovered blood supply. The course of disease ranged from 1 month to 3 months. The measurement value of D-dimer was 2.4-31.7 mg/L, and the measurement values of D-dimer of 4 patients were equal to or higher than 5.0 mg/L. The bed time before definite diagnosis of pulmonary embolism was 4-46 days, with an average of 23.2 days. Four patients underwent wound debridement during hospitalization. The definite diagnosis time of pulmonary embolism after the wound debridement was 14-40 days, with an average of 20.5 days. Four patients were diagnosed with deep venous thrombosis of lower extremity. All patients had wound infection, and the bacteria causing wound infection included Pseudomonas aeruginosa of 2 cases, Staphylococcus aureus of 2 cases, and Enterococcus faecalis of 1 case. Conclusions: In the diagnosis process of pulmonary embolism in patients with skin and soft tissue defects after trauma, D-dimer positive, long-term bed rest, experiencing operation during hospitalization, and with deep vein thrombosis and wound infection can be regarded as the key points for diagnosis. When a patient has clinical symptoms of pulmonary embolism and the above conditions, the clinician should promptly perform hierarchical screening, select the corresponding examination to confirm pulmonary embolism, and immediately perform thrombolysis for the patient with pulmonary embolism according to the patient's tolerance, thereby improving patient survival rate.


Assuntos
Embolia Pulmonar/diagnóstico , Transplante de Pele , Lesões dos Tecidos Moles/reabilitação , Lesões dos Tecidos Moles/cirurgia , Adulto , Idoso , Queimaduras/reabilitação , Queimaduras/cirurgia , Diagnóstico Precoce , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ativador de Plasminogênio Tecidual , Cicatrização
10.
Fisioterapia (Madr., Ed. impr.) ; 41(3): 115-122, mayo-jun. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183086

RESUMO

Introducción: La recuperación de las actividades de la vida diaria de los pacientes quemados depende de una atención oportuna y eficaz, incluyendo la rehabilitación física. Objetivo: Evaluar la efectividad funcional de la rehabilitación temprana en pacientes con quemaduras en miembros inferiores. Métodos: Este es un estudio retrospectivo, longitudinal, observacional y analítico en el cual se evaluó la asociación que existe entre el número de sesiones de fisioterapia y diferentes variables de desenlace relacionadas con la funcionalidad del paciente quemado de miembros inferiores. Se realizaron de manera secuencial análisis uni-, bi- y multivariados para conocer las características de distribución en el primero, y la significación estadística en el segundo y tercero. Resultados: La información derivada de 32 pacientes que cumplieron con los criterios del estudio reveló una asociación simple entre la recuperación de los arcos de movilidad, sedestación, bipedestación y marcha con el número de sesiones de fisioterapia, sin que se favorezca la fuerza muscular. El análisis multivariado evidenció una correlación positiva entre el número de sesiones de fisioterapia y la sedestación, pero negativa cuando se asoció la ventilación mecánica con la bipedestación/marcha asistida. Conclusión: La aplicación de fisioterapia temprana contribuye directamente con la recuperación funcional del paciente quemado; sin embargo, es indispensable considerar que el estado catabólico de los individuos entorpece el progreso motriz


Introduction: Recovery of activities of daily living in burn patients depend on timely and effective care, including physical rehabilitation. Aim: To evaluate functional activity in lower limb burn patients after early rehabilitation. Methods: A retrospective, longitudinal, and analytic trial was conducted in order to assess the association between the number of physiotherapy sessions and the functional outcome in lower limb burn patients. Uni-, bi-, and multivariate analyses were performed in order to determine the distribution characteristics of the sample, and any significant association between variables. Results: After a review of data from 32 patients that fulfilled trial enrolment criteria, a simple association was shown between complete joint motion, sitting position, standing and walking vs. the number of physiotherapy sessions, but failed to maintain or improve muscle strength. Multivariate analysis demonstrated a positive correlation between the number of physiotherapy sessions and sitting position, but a negative one when mechanical ventilation was related to standing/walking. Conclusion: The early administration of physiotherapy helps in the functional recovery of burn patients; nevertheless it is critical to consider that catabolic processes impair motion


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Queimaduras/reabilitação , Extremidade Inferior , Modalidades de Fisioterapia , Resultado do Tratamento , Estudos Retrospectivos , Estudos Longitudinais , Análise Multivariada , Intervalos de Confiança
12.
Burns ; 45(5): 1094-1101, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30827852

RESUMO

BACKGROUND: The management of post-burn pain and pruritus remain a potent challenge because of their bad effects on health-related quality of life (HRQOL). The main purpose of this study was to evaluate the impacts of low-energy extracorporeal shockwave therapy (low-energy ESWT) in the management of pain, pruritus, and HRQOL in patients with burn. METHODS: Forty-five adult patients with burn, their age ranged from 18 to 55 years, were included in the study, they randomly assigned into 22 patients in the study group (low-energy ESWT) and 23 patients in the placebo group. The study group received low-energy ESWT (0.05-0.20mJ/mm2, a frequency of 4Hz with total shocks from 1000 to 2000 shocks) once per week for 4 successive weeks, while the placebo group received ESWT without energy. Both groups received traditional physical therapy program of selective different exercises (respiratory, range of motion, endurance, strengthening, balance, mobilization, stretching, and gait training) 3days per week for 4 weeks. Numerical Rating Scale (NRS) for pain and for pruritus, Pressure Pain Threshold (PPT), 12-Item Pruritus Severity Scale (12-PSS), and Burn Specific Health Scale-Brief (BSHS-B) were measured before and after treatment procedures in both groups. RESULTS: NRS were decreased significantly in the study group than in the placebo group (P<0.05). PPT, 12-PSS, and BSHS-B scores were improved more significantly in the study group than in the placebo group (P<0.05) while body image and burn associated issues were improved at the same level in both groups (P>0.05). CONCLUSION: The findings suggest that low-energy ESWT with traditional regular physical therapy may relive post-burn pain and pruritus, and improve HRQOL, particularly in adult patients with burn.


Assuntos
Queimaduras/reabilitação , Tratamento por Ondas de Choque Extracorpóreas/métodos , Manejo da Dor/métodos , Prurido/terapia , Qualidade de Vida , Adolescente , Adulto , Queimaduras/complicações , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Modalidades de Fisioterapia , Prurido/etiologia , Adulto Jovem
13.
Burns ; 45(5): 1102-1111, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30833098

RESUMO

BACKGROUND: The objective evaluation of scar quality plays a crucial role in improving burn surgery and scar rehabilitation. Suction-based skin measurements were proposed as a method to objectively determine the mechanical properties of scars, yet their use is limited, in particular for paediatric burn care. A new device was developed which provides essential advantages for scar assessment. The aim of this study was to assess its reliability, intra- and interobserver variability. METHODS: The new device, "Nimble", consists of a lightweight probe that measures the negative pressure needed to obtain a predefined tissue elevation, revealing information on the stiffness of the tissue. 29 former paediatric burn patients were included. Three observers measured the tissue stiffness of a predefined location on the scar and on healthy skin using the Nimble, and the established suction device, the Cutometer®. The reliability of both instruments in distinguishing between healthy skin and scar was assessed by means of the intraclass correlation coefficient. RESULTS: The Nimble successfully differentiated between scar tissue and healthy skin in 92%, the Cutometer in 80% of the patients (p<0.05). Inter- and intraobserver variability of the Nimble (ICCs) were excellent. For the majority of the calculated ICC values the Nimble exceeded the Cutometer®. CONCLUSION: The new device enables reliable and safe measurement of the stiffness of scars. Measurements are less susceptible to patient non-compliance and observer dependency. The Nimble might therefore constitute an easy to use tool for the systematic assessment of scars, thus supporting decision-making in paediatric burn care.


Assuntos
Queimaduras/reabilitação , Cicatriz/fisiopatologia , Elasticidade , Desenho de Equipamento , Pele/fisiopatologia , Adolescente , Queimaduras/complicações , Criança , Pré-Escolar , Cicatriz/etiologia , Tomada de Decisão Clínica , Feminino , Humanos , Lactente , Masculino , Variações Dependentes do Observador , Pressão , Reprodutibilidade dos Testes
14.
Burns ; 45(2): 293-302, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30732865

RESUMO

INTRODUCTION: Burns affecting the head and neck (H&N) can lead to significant changes in appearance. It is postulated that such injuries have a negative impact on patients' social functioning, quality of life, physical health, and satisfaction with appearance, but there has been little investigation of these effects using patient reported outcome measures. This study evaluates the effect of H&N burns on long-term patient reported outcomes compared to patients who sustained burns to other areas. METHODS: Data from the National Institute on Disability, Independent Living, and Rehabilitation Research Burn Model System National Database collected between 1996 and 2015 were used to investigate differences in outcomes between those with and without H&N burns. Demographic and clinical characteristics for adult burn survivors with and without H&N burns were compared. The following patient-reported outcome measures, collected at 6, 12, and 24 months after injury, were examined: satisfaction with life (SWL), community integration questionnaire (CIQ), satisfaction with appearance (SWAP), short form-12 physical component score (SF-12 PCS), and short form-12 mental component score (SF-12 MCS). Mixed regression model analyses were used to examine the associations between H&N burns and each outcome measure, controlling for medical and demographic characteristics. RESULTS: A total of 697 adults (373 with H&N burns; 324 without H&N burns) were included in the analyses. Over 75% of H&N injuries resulted from a fire/flame burn and those with H&N burns had significantly larger burn size (p<0.001). In the mixed model regression analyses, SWAP and SF-12 MCS were significantly worse for adults with H&N burns compared to those with non-H&N burns (p<0.01). There were no significant differences between SWL, CIQ, and SF-12 PCS. CONCLUSIONS: Survivors with H&N burns demonstrated community integration, physical health, and satisfaction with life outcomes similar to those of survivors with non-H&N burns. Scores in these domains improved over time. However, survivors with H&N burns demonstrated worse satisfaction with their appearance. These results suggest that strategies to address satisfaction with appearance, such as reconstructive surgery, cognitive behavior therapy, and social skills training, are an area of need for survivors with H&N burns.


Assuntos
Queimaduras/psicologia , Traumatismos Craniocerebrais/psicologia , Lesões do Pescoço/psicologia , Qualidade de Vida , Adulto , Queimaduras/fisiopatologia , Queimaduras/reabilitação , Traumatismos Craniocerebrais/fisiopatologia , Traumatismos Craniocerebrais/reabilitação , Traumatismos Faciais/fisiopatologia , Traumatismos Faciais/psicologia , Traumatismos Faciais/reabilitação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço/fisiopatologia , Lesões do Pescoço/reabilitação , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Aparência Física , Sobreviventes
15.
Zhonghua Shao Shang Za Zhi ; 35(2): 81-85, 2019 Feb 20.
Artigo em Chinês | MEDLINE | ID: mdl-30798572

RESUMO

Objective: Burn rehabilitation medicine in China has made great progress in recent years. This article reviews the development history of burn rehabilitation medicine in China from three stages of the initial period, the starting stage, and the development period by looking back to the history. Besides, the article is written according to the milestone events in the development of burn rehabilitation medicine, such as article publishing, guideline making, monograph publication, establishment of rehabilitation association, rehabilitation conference holding. By summarizing successful experience in the past and analyzing the challenge we face, the authors wish all the colleagues committed to burn prevention and treatment work together to make the burn rehabilitation medicine in China better in the future.


Assuntos
Unidades de Queimados/história , Queimaduras/reabilitação , Queimaduras/terapia , Tratamento de Emergência/tendências , Aniversários e Eventos Especiais , Unidades de Queimados/tendências , China , Face , História do Século XX , História do Século XXI , Humanos , Reabilitação
16.
Disabil Rehabil ; 41(6): 714-719, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-29207887

RESUMO

OBJECTIVE: To understand health professionals' perspectives of burn care and rehabilitation. DESIGN: Qualitative and semi-structured interviews. SETTING: Australian burn and rehabilitation units. PARTICIPANTS: Twenty-two clinicians working in burns units across disciplines and healthcare settings. RESULTS: The data portrayed the health professionals' perspectives of burn care and rehabilitation in Australia. Three themes were identified: (1) interprofessional collaboration; (2) integrated community care, and (3) empowering patients to self-care. CONCLUSION: Burn care and rehabilitation remains a complex and a challenging area of care with limited access to burn services especially in rural and remote areas. Interprofessional training and education of health professionals involved with the complex care of burn injury remains a key element to support and sustain the long-term rehabilitation requirements for patients and their families. Empowering patients to develop independence early in their rehabilitation is fundamental to their ongoing recovery. A burns model of care that embraces a multidisciplinary collaboration and integrated care across the continuum has the potential to positively impact recovery and improve health outcomes. Implications for rehabilitation Burn care and rehabilitation remains a complex and challenging area of care. Managing the rehabilitation phase after burn injury can be as complex as managing the acute phase. Interprofessional collaboration, integrated community care, and empowering patients to self-care are key elements for sustaining the rehabilitation of adults with burn injuries.


Assuntos
Unidades de Queimados , Queimaduras , Assistência de Longa Duração , Telerreabilitação , Adulto , Atitude do Pessoal de Saúde , Austrália/epidemiologia , Queimaduras/epidemiologia , Queimaduras/reabilitação , Queimaduras/terapia , Humanos , Assistência de Longa Duração/métodos , Assistência de Longa Duração/organização & administração , Assistência de Longa Duração/psicologia , Pessoa de Meia-Idade , Modelos Organizacionais , Participação do Paciente , Sistemas de Apoio Psicossocial , Pesquisa Qualitativa , População Rural , Telerreabilitação/métodos , Telerreabilitação/organização & administração
17.
Burns ; 45(1): 157-164, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30322737

RESUMO

Hand burns cause functional impairment. Leap motion control (LMC), a kind of virtual reality games, employs a novel system that provides biofeedback and training of fine motor function and functional skills. In this study, we hypothesized that LMC would improve burned hand function. Sixteen participants were allocated to either the LMC group or the control group. The LMC group played 20min identical leap motion video games after 40min traditional occupational therapy (OT). The control group received traditional OT for 60min. Both groups received interventions 2 days a week for 4 months. A series of questionnaires were administered, including BSHS-B, QuickDASH, iADL, and Barthel index. Data on baseline characteristics including joint range of motion (ROM), grip and pinch strength, and scar thickness were obtained. Furthermore, we used the Mann-Whitney U test and Wilcoxon signed-rank test for comparison, as appropriate. We found improvements in BSHS-B, QuickDASH, and iADL in the LMC group (all p<0.05) compared to those in the control group. In the LMC-trained hand, the ROM of the thumb IP joint and pinch strength increased, whereas the scar thickness over the first dorsal interossei muscle decreased (p<0.05). In conclusion, leap motion training could help patients with hand burns to increase finger ROM, decrease scar thickness, and improve hand function.


Assuntos
Biorretroalimentação Psicológica/métodos , Queimaduras/reabilitação , Cicatriz/reabilitação , Traumatismos da Mão/reabilitação , Terapia Ocupacional/métodos , Jogos de Vídeo , Realidade Virtual , Adolescente , Adulto , Queimaduras/fisiopatologia , Cicatriz/fisiopatologia , Desastres , Explosões , Feminino , Traumatismos da Mão/fisiopatologia , Força da Mão , Humanos , Masculino , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Taiwan , Adulto Jovem
18.
Burns ; 45(1): 114-119, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30279019

RESUMO

OBJECTIVE: Severe burns cause hypermetabolic responses and prolonged hospitalization, resulting in loss of body mass and muscle strength. This study aimed to determine whether long-term gains in lean body mass (LBM) after structured exercise programs are functionally meaningful and related to greater muscle strength in severely burned children. STUDY DESIGN: LBM and muscle strength were measured at discharge and at 6, 12, 24, and 36 months after burn in 349 children. Body composition, including LBM, was measured via dual-emission X-ray-absorptiometry. Peak torque was measured using Biodex dynamometer at varying angular velocities (90, 120, 150, 180°/s). Pearson correlation analysis evaluated the association between LBM and peak torque. RESULTS: LBM progressively increased from discharge (32.5±11.5kg) to 36 months following injury (40.2±12.3kg). Peak torque and peak torque/LBM increased from discharge (56.4±34.0Nm and 1.7±34.0Nmkg-1) to 36 months after burn (102.3±43.8Nm and 2.5±0.7Nmkg-1, p<0.01 for both). LBM and peak torque at all angular velocities showed moderate/strong correlations, with 120°/s being the strongest (all time-points: R2≥0.57). CONCLUSION: In severely burned children participating in a rehabilitative exercise program, gains in LBM over time are related to increases in muscle strength, suggesting that gained muscle mass is functional. Measurement of muscle strength at an angular velocity of 120°/s best reflects gains in LBM and should be considered for reliable measure of strength in future studies.


Assuntos
Composição Corporal , Queimaduras/reabilitação , Terapia por Exercício , Músculos Isquiotibiais/fisiologia , Força Muscular , Músculo Quadríceps/fisiologia , Torque , Absorciometria de Fóton , Adolescente , Criança , Feminino , Humanos , Joelho , Masculino , Dinamômetro de Força Muscular , Músculo Esquelético/diagnóstico por imagem
19.
Phys Med Rehabil Clin N Am ; 30(1): 111-132, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30470416

RESUMO

A major burn is a severe injury with a global impact. Our system of medical evacuation has led to the survival of many severely injured service members. Burn rehabilitation is a complex and dynamic process and will not be linear. Recovery requires a comprehensive, interdisciplinary team-based approach, individually designed to maximize function, minimize disability, promote self-acceptance, and facilitate survivor and family reintegration into the community.


Assuntos
Queimaduras/reabilitação , Queimaduras/classificação , Queimaduras/psicologia , Humanos , Militares
20.
Burns ; 45(4): 825-834, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30545694

RESUMO

INTRODUCTION: For severe burns patient care presents a considerable challenge, necessitating an integrated multi-disciplinary approach that utilises a range of treatments. The period of care post-discharge can be lengthy and complex, and include scar management, occupational and physiotherapies, psychological support, and further surgery. How successfully the patient negotiates this complex care regimen is critical to their long-term recovery and in doing so they would appear to employ approaches recognised as "self-management" in other chronic conditions. However their exact nature and how they are used has yet to be explicitly explored amongst chronic burn patients. METHODS: Semi-structured interviews were conducted with 24 patients to discuss their experiences of long-term burn treatment as part of a broader mixed- methods feasibility study of the use of pressure garment therapy in preventing hypertrophic scarring after burn injury. The topic guide included questions on the patient experience of their care post discharge, including pressure garment therapy and other scar management techniques; and their expectations and experiences of treatment and recovery. The data were analysed using an established framework of self-management processes. RESULTS: Burns patients employ many of the same processes of self-management as those experiencing more widely recognised chronic diseases or illnesses. This is despite the prospect of gradual improvement amongst burns patients absent in those with incurable chronic conditions. The key processes of self-management they share are the ability to focus on their illness needs, activate the appropriate resources and coming to terms with the consequences of living with either the physical or psychological consequences of their condition. CONCLUSION: Modern burn care is technologically advanced and delivered by a highly trained, multi-disciplinary team, yet the level of its success relies on the ability of the patient to independently fulfil a number of health-related tasks and activities once leaving hospital. Considering the potential cost-savings to health services and the prospect of improved outcomes for patients capable of self-management our work is an important first step in more precisely understanding the use of self-management amongst burns patients, and the level of implicit or explicit support currently offered by their care providers.


Assuntos
Assistência ao Convalescente , Queimaduras/reabilitação , Autogestão , Adulto , Inglaterra , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Adulto Jovem
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