rehabilitation and scar management in the after care of the burn patient. part ii: level of evidence...
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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