609 Combined Physical, Occupational, and Psychotherapies in the Holistic Care of the Burn

Abstract

Abstract Introduction Burn patients often experience pain and fear of the recovery process, negatively impacting their engagement in necessary treatments for maximal functional outcomes. Patients routinely exhibit aversions toward physical and occupational therapies (PT and OT). As a result, therapists have been tasked with managing the patient’s psychological reactions while simultaneously providing rehabilitation. We developed a program for our psychologist to co-treat patients with burn physical and occupational therapists to directly address the painful or feared aspects of burn recovery. These multidisciplinary visits offer in-vivo interventions for managing patient distress and allows therapists the ability to focus solely on their specialized interventions. Methods This program has been active for 12 months and was created during therapy to aid a patient with high distress during PT and OT. Therapists now work with psychology to co-treat improving patient engagement in rehabilitative interventions. During co-treatment, the patients are able to engage in PT and OT more effectively and achieve short-term goals. The burn center psychologist and therapists have developed an interventional method to explore potential generalization of co-treatment effectiveness. Patients are identified based on high need for psychological support during therapy sessions. Each patient case is reviewed and discussed to develop individualized treatment plans and establish goals. Through qualitative review of each co-treatment visit, common barriers have been identified as well as strategies to improve engagement and compliance. Results The common barriers encountered had a high association with a history of traumatic experiences and avoidant coping/low distress tolerance. The most effective co-treatment interventions included: collaboratively setting patient goals with PT, OT and psychology; scheduling patient therapy with burn psychology in advance; teaching distress tolerance skills to manage anticipatory and in-vivo distress related to rehabilitation. Conclusions Treating the emotional aspects of burn recovery during moments of acute distress is integral for holistic patient care. This multidisciplinary approach offers patients increased involvement through collaboratively tailored treatment planning and improved ability to tolerate distressing aspects of recovery. Additionally, therapists were taught various approaches to improve patient engagement and adherence.