Comparison of the Effects of Stretching and Splinting in Improving the Range of Motion and Functional Status for Prevention of Post-Burn Axillary Contracture

Abstract

Background: Burn injuries often lead to severe complications, including axillary contractures, which can significantly restrict shoulder movement and impact quality of life. The rehabilitation strategies for managing post-burn axillary contractures, particularly stretching and splinting, have been the subject of much research, given their potential to improve shoulder range of motion and functional status. Objective: This study aims to compare the effects of stretching combined with splinting versus splinting alone on the range of motion and functional status in patients with post-burn axillary contracture, to determine the most effective treatment modality for preventing the development of contractures. Methods: A single-blinded randomized clinical trial was conducted at the Burn and Plastic Surgery Department of Mayo Hospital, Lahore, over six months. Forty patients aged 20-50 years with Type 1 to Type 3 axillary contractures and shoulder abduction ranging from 20 to 100 degrees were enrolled. Participants were randomly assigned to either Group A (stretching plus splinting) or Group B (splinting alone). Outcomes were measured using the Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire and goniometry for shoulder motion range, before and after the interventions. Statistical analysis was performed using SPSS version 25, with paired and independent T-tests applied for within and between-group comparisons, respectively. Results: The stretching group demonstrated significant improvements in shoulder motion ranges: flexion (91.00 ± 19.97 to 98.75 ± 19.75, p<0.000), extension (34.50 ± 12.13 to 41.85 ± 12.70, p<0.000), abduction (94.50 ± 26.84 to 103.50 ± 25.97, p<0.000), external rotation (34.15 ± 18.79 to 42.85 ± 18.87, p<0.000), and internal rotation (33.95 ± 11.05 to 42.90 ± 11.03, p<0.000). The DASH scores improved from 21.35 ± 3.58 to 31.30 ± 3.48 (p<0.000). Similar improvements were noted in the splinting group but were more pronounced in the stretching group. Between-group analysis revealed significant differences in favor of the stretching group for all measures of shoulder motion and DASH scores. Conclusion: The study concluded that stretching, when combined with splinting, is more effective than splinting alone in improving shoulder range of motion and functional status in patients with post-burn axillary contracture. These findings suggest that incorporating stretching into the rehabilitation protocols for burn survivors could significantly enhance recovery outcomes.