title: Orofacial Contracture Management: Current Patterns of Clinical Practice in Australian and New Zealand Adult Burn Units.
abstract: Burn injury to the face can lead to scarring and contractures that may impair oral competence for articulation, feeding, airway intubation access, oral/dental hygiene, aesthetics, and facial expression. Although a range of therapy interventions has been discussed for preventing contracture formation, there is minimal information on current practice patterns. This research examined patterns of clinical practice for orofacial burns management during a 4-year period to determine the nature and extent of clinical consistency in current care. Allied health clinicians involved in orofacial contracture management in Australia and New Zealand were surveyed at two time points (2010 and 2014). Twenty and 23 clinicians, respectively, across a range of allied health professions completed the surveys. Both surveys revealed multiple allied health disciplines, predominantly occupational therapy, speech language pathology, and physiotherapy, were involved orofacial burn management. A high degree of variation was observed across clinical practices in the 2010 survey. In the 2014 survey, although, greater consistency in practice patterns was observed with more clinicians commencing intervention earlier, with greater treatment intensity observed and more treatment modalities being used. Furthermore, in 2014, there was an increased use of assessment tools and clinical indicators to guide patient treatment. Agreement regarding clinical practice pathways for orofacial contracture rehabilitation is still emerging, and treatment continues to be predominantly guided by clinical experience. There is an urgent need for treatment efficacy research utilizing validated outcome measure tools to inform clinical consensus and practice guidelines.
authors.affiliation: From the *Speech Pathology Department and Burns Unit, Concord Repatriation General Hospital, Concord, New South Wales, Australia; †School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia; ‡Speech Pathology Department, The Alfred Hospital, Melbourne, Victoria, Australia; §The University of Queensland, School of Health and Rehabilitation Sciences, and Centre for Functioning and Health Research, Queensland Health, Melbourne, Queensland, Australia; ‖Speech Pathology Department, The Alfred Hospital, Melbourne, Victoria, Australia; and ¶Burns Unit, Concord Repatriation General Hospital, Concord, New South Wales, Australia.
authors.forename: Nicola A
authors.initials: NA
authors.lastname: Clayton
authors.forename: Gulsen
authors.initials: G
authors.lastname: Ellul
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Ward
authors.forename: Amanda
authors.initials: A
authors.lastname: Scott
authors.forename: Peter K
authors.initials: PK
authors.lastname: Maitz
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001315:Australia; D002053:Burn Units / Q000458:organization & administration*; D002056:Burns / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D003286:Contracture / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D005151:Facial Injuries / Q000209:etiology / Q000534:rehabilitation*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D009520:New Zealand; D017063:Outcome Assessment, Health Care; D026741:Physical Therapy Modalities; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000639:trends; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires