title: Treating burn-associated joint contracture: results of an inpatient rehabilitation stretching protocol.
abstract: The prevention and treatment of scar contracture is critical after significant burn injuries to avoid functional impairment. However, descriptions of specific contracture treatment interventions and outcomes are limited. Our objective is to provide detailed information and range of motion outcomes regarding the use of an intensive stretching protocol for burn-associated contracture. As part of a quality improvement measure, all patients admitted to inpatient rehabilitation with burn injury were treated with at least 1 hour of daily stretching by experienced therapists and were tracked with standardized range of motion measurements. Eighty-eight joint contractures were treated across nine patients for up to 4 weeks. The average weekly improvement in range of motion was 8.2 degrees (95% confidence interval [CI], 6.5-9.9). The largest gains were seen in the first week of treatment with an average improvement of 11.2 degrees (95% CI, 8.7-13.6). Eighteen digit contractures were treated across four patients. The average weekly improvement in flexion was 7.2 mm (95% CI, 5.2-9.1) again with larger gains in the first week of treatment-12.8 mm (95% CI, 10.3-15.4). Thumb opposition improved across five patients in the first week with an average improvement of 1.4 on the opposition scale (95% CI, 0.4-2.5). Intensive stretching by experienced therapists yielded significant improvements in joint range of motion for patients with burn-associated joint contracture. Defining specific burn contracture interventions remains a key goal in advancing burn rehabilitation in the future.
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Colorado, Denver, CO, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Godleski
authors.forename: Amy
authors.initials: A
authors.lastname: Oeffling
authors.forename: Angela K
authors.initials: AK
authors.lastname: Bruflat
authors.forename: Emily
authors.initials: E
authors.lastname: Craig
authors.forename: David
authors.initials: D
authors.lastname: Weitzenkamp
authors.forename: Gordon
authors.initials: G
authors.lastname: Lindberg
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use; D053587:Arthrometry, Articular; D002056:Burns / Q000150:complications* / Q000601:surgery; D002921:Cicatrix / Q000150:complications; D003286:Contracture / Q000209:etiology / Q000534:rehabilitation*; D005260:Female; D006760:Hospitalization; D006801:Humans; D004091:Hydromorphone / Q000627:therapeutic use; D007592:Joint Diseases / Q000209:etiology / Q000534:rehabilitation*; D008297:Male; D008691:Methadone / Q000627:therapeutic use; D008875:Middle Aged; D052580:Muscle Stretching Exercises; D010098:Oxycodone / Q000627:therapeutic use; D010146:Pain / Q000188:drug therapy; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D016038:Skin Transplantation; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D010098:Oxycodone; D004091:Hydromorphone; D008691:Methadone