77 Functional Outcomes in Patients with Hand Burns Receiving Long Term Hand Therapy

Abstract

Abstract Introduction Sparse data exists on functional outcomes of patients receiving outpatient therapy after admission with hand burns. The purpose of our study is to evaluate the effectiveness of long-term outpatient occupational therapy (OT) on hand joint range of motion (ROM), activities of daily living (ADL) status, and pain after burn injury. Methods All patients with hand burns admitted to a single ABA verified burn center from January 2015 to May 2016 with properly documented outpatient OT follow up were included. Demographics (TBSA, hand dominance, mechanism), interventions (time-to-surgery, procedures), and long-term outcomes (further procedures, pain, ROM, contractures, scars, ADL) were evaluated. The effect of patient demographics and interventions on outcomes were evaluated with descriptive statistics and multivariate logistic regression. Results Of 61 patients with hand burns, 43 were referred for outpatient therapy, but only 31% (n=19) consistently presented for follow up. Mean age was 37±14 years, 74% (n=14) were male, and mean TBSA was 12%±17. Surgical management was required in 63% (n=12), and the mean time-to-surgery was 16±37 days from injury. Contractures occurred in 16% (n=3), 11% (n=2) had hypertrophic scarring, and 21% (n=4) developed both contractures and hypertrophic scarring. Of these patients, 21% (n=4) required further surgical intervention, including 3 contracture releases and 1 triamcinolone injection. Mean OT follow up was 16±14 weeks. As of the last OT note, 84% (n=16) had independent ADL function, 16% (n=3) required assistance, and none were poorly functioning. Likewise, 47% (n=9) had normal ROM, 53% (n=10) were within functional limits, and none had poor ROM. 79% (n=15) demonstrated improvement of ADL function, and 84% (n=16) had improvement of ROM. At OT intake, 68% (n=13) reported pain as a major limitation, but by end of therapy, only 21% (n=4) were limited by pain. Those with contractures or hypertrophic scars were 9.9 times less likely to have improvement in ADL status (p=.03, RR 9.9, CI 1.3–67). Conclusions Most patients referred for hand therapy after burn injury return to functional independence and have functional ROM. Applicability of Research to Practice Referral to and compliance with dedicated long-term hand therapy leads to improvements to ADL and ROM in patients admitted with hand burn injuries.