Rehabilitation and Scar Management in the after care of the burn patient.

Part II: Level of evidence

Rehabilitation and Scar Management in the after care of the burn patient.

Part II: Level of evidence

BABI anniversary symposium november 2007

Eric Van den KerckhoveSophie Verhaeghe

Michael CasaerChristophe Remy

Physiotherapy items in the after care of a burn patient

1. Exercising, training and ambulation

2. Mobilisations and oedema control

3. Positioning and splinting

4. Scar management

Physiotherapy items in the after care of a burn patient

1. Exercising, training and ambulation

2. Mobilisations and oedema control

3. Positioning and splinting

4. Scar management

Physiotherapy items in the after care of a burn patient

1. Exercising, training (and ambulation)-Mobility and ADL-Muscle strength and cardiovascular condition!

(24 - 48h after trauma)

Physiotherapy items in the after care of a burn patient

1. Exercising, training (and ambulation)-Mobility and ADL-Muscle strength and cardiovascular condition!

(24 - 48h after trauma)

Considered Evidence Based (children)

Physiotherapy items in the after care of a burn patient

2. Mobilisations and oedema control-Prevention & treatment contractures (type?)

-Delayed healing & scarring and calcification

Physiotherapy items in the after care of a burn patient

2. Mobilisations and oedema control-Prevention & treatment contractures (type?)

-Delayed healing & scarring and calcification

Considered Best Practice

Physiotherapy items in the after care of a burn patient

3. Positioning and splinting-Prevention & treatment contractures and decubitus-Static versus dynamic

Physiotherapy items in the after care of a burn patient

3. Positioning and splinting-Prevention & treatment contractures and decubitus-Static versus dynamic

Considered Best Practice

Physiotherapy items in the after care of a burn patient

4. Scar management - Pressure Therapy-Prevention & treatment of hypertrophic scars-Hastening healing, flattening and itch reduction

Physiotherapy items in the after care of a burn patient

4. Scar management - Pressure Therapy-Prevention & treatment of hypertrophic scars-Hastening healing, flattening and itch reduction

Considered Best Practice

Ischemia

Physiotherapy items in the after care of a burn patient

4. Scar management - Silicone-Prevention & treatment of hypertrophic scars-Erythema, pliability, optimizing pressure

Physiotherapy items in the after care of a burn patient

4. Scar management - Silicone-Prevention & treatment of hypertrophic scars-Erythema, pliability, optimizing pressure

Considered Evidence Based (gel sheeting)

Hydration

Physiotherapy items in the after care of a burn patient

4. Scar management - Massage -Treatment of (hypertrophic) scars-Pliability, itch reduction

Physiotherapy items in the after care of a burn patient

4. Scar management - Massage -Treatment of (hypertrophic) scars-Pliability, itch reduction

Considered Best Practice

Metabolism

Physiotherapy items in the after care of a burn patient

4. Scar management - Moisturizers-Treatment of scars-Itch reduction

Physiotherapy items in the after care of a burn patient

4. Scar management - Moisturizers-Treatment of scars-Itch reduction

Considered Best Practice

Hydration and restoration

Physiotherapy items in the after care of a burn patient

4. Scar management - Others (LPG, Laser, Thermal cure,...)-Treatment of scars-Clinical findings (itch,parameters,wellbeing)

Physiotherapy items in the after care of a burn patient

4. Scar management - Others (LPG, Laser, Thermal cure,...)-Treatment of scars-Clinical findings (itch,parameters,wellbeing)

Considered Option

Evidence based Best practice Option

Training & exercising & ambulation x (children)

Mobilisations & oedema control x

Splinting & positioning x

Scar management - massage x

- pressure therapy x

- silicone sheeting x

- moisturizers x

Others - thermal cure resorts x

- LPG x

- Laser x

(- corticosteroid injections) (x)

Summary (1/2)

LEVEL OF EVIDENCE FOR THERAPY

OBJECTIVE ASSESSMENT Evidence based Best practice Option

- Color - Chromameter

- Fotospectrometer

x

x

- Thickness - US highfrequency x

- Pliability - Cutometer

- Dermalab

x

x

- Others

(e.g. water vapour, laser doppler, t°, …)

x

Summary (2/2)

LEVEL OF EVIDENCE FOR ASSESSMENT

SUBJECTIVE ASSESSMENT Evidence based Best practice Option

- POSAS x

- VSAS x

Conclusion

Only limited evidence for different therapeutical strategies that are used in the rehabilitation and after

care of a burn patient

thereforeguidelines can be controversial

Conclusion

Only limited evidence for different therapeutical strategies that are used in the rehabilitation and after

care of a burn patient

thereforeguidelines can be controversial