BACKGROUND: Scar contracture is a well-known sequela of burns that is specifically relevant as it may limit function. Reports regarding the course of scar contractures, however, are scarce and, moreover, not focussed on function. This study describes the course of prevalence of scar contractures that limit function in children and adolescents after burns.METHOD: Range of motion (ROM) of extremity joints of 20 children and adolescents after burns were assessed at discharge (T0) and at six weeks (T1), three months (T2), and six months (T3) after discharge. A scar contracture limiting function was defined as a measured ROM lower than the functional ROM, i.e., ROM used to perform daily activities by unimpaired subjects.RESULTS: At discharge (T0), 89.5% of the subjects had one or more scar contractures that limited function. Six months later (T3), this prevalence was 76.5%. At discharge (T0), less function limiting scar contractures were found for the upper extremity (29.7%) than the lower extremity (53.3%). Over time, prevalence of contractures in both extremities fluctuated between 22% and 35%.CONCLUSIONS: The majority of children and adolescents (13/17) still had scar contractures limiting function six months after discharge (T3). Substantial longitudinal studies over a longer period of time are needed to increase our knowledge on the course of these scar contractures in order to support improvements in burn care.TRIAL REGISTRATION: The study is approved by the Regional Committee for Patient-Oriented Research Leeuwarden in the Netherlands (NL45917.099.13).
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BACKGROUND: To evaluate the effect of (new) treatments or analyse prevalence and risk factors of contractures, rating scales are used based on joint range of motion. However, cut-off points for levels of severity vary between scales, and it seems unclear how cut-off points relate to function. The purpose of this study was to compare severity ratings of different rating scales for the shoulder and elbow and relate these with functional range of motion.METHODS: Often used contracture severity rating scales in orthopedics, physiotherapy, and burns were included. Functional range of motion angles for the shoulder and elbow were derived from a recent synthesis published by our group. Shoulder flexion and elbow flexion range of motion data of patients three months after a burn injury were rated with each of the scales to illustrate the effects of differences in classifications. Secondly, the shoulder and elbow flexion range of motion angles were related to the required angles to perform over 50 different activities of daily living tasks.RESULTS: Eighteen rating scales were included (shoulder: 6, elbow: 12). Large differences in the number of severity levels and the cut-off points between scales were determined. Rating the measured range of motions with the different scales showed substantial inconsistency in the number of joints without impairment (shoulder: 14-36%, elbow: 26-100%) or with severe impairment (shoulder: < 10%-29%, elbow 0%-17%). Cut-off points of most scales were not related to actual function in daily living.CONCLUSION: There is an urgent need for rating scales that express the severity of contractures in terms of loss of functionality. This study proposes a direction for a solution.
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Scar contractures are a common complication after burn injuries. These contractures are characterized by impairment of joint mobility, leading to a risk for limitations during daily activities, and restrictions in participation in society. Qualifying its severity is not well established in burn care. This study, therefore, examined different approaches to determine the severity of limited mobility in the knee joint due to scar contracture.To determine the severity of burn scar contractures development of the knee over time, the following approaches were analyzed: prevalence, the degree of limitation, the ability to perform basic daily activities, and the need for reconstructive surgery. Range of motion data of the knee joint was extracted from a 12-month prospective multicenter cohort study in the Netherlands.Based on prevalence, mean degree of limitation, and the classification based on mathematical division, limitations in knee flexion would be seen as giving the most problems. On the other hand, when classified in terms of impact on function, limitations in extension were found to be giving most problems, although flexion limitations interfered slightly longer with the basic activities of standing, walking, and climbing stairs.Depending on the chosen approach, the severity of burn scar contractures is projected differently. Interpreting the severity of a burn scar contracture of the knee, preferably should be based on a function-based classification system of the degree of range of motion impairment, activity limitations and participation restrictions in society. Because that does justice to the real impact of burn scar contracture on the individual burn survivor.
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Key summary points Aim To describe a guidance on the management of post-acute COVID 19 patients in geriatric rehabilitation. Findings This guidance addresses general requirements for post-acute COVID-19 geriatric rehabilitation and critical aspects for quality assurance during the COVID-19 pandemic. Furthermore, the guidance describes relevant care processes and procedures divided in five topics: patient selection; admission; treatment; discharge; and follow-up and monitoring. Message This guidance is designed to provide support to care professionals involved in the geriatric rehabilitation treatment of post-acute COVID-19 patients.
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Breast cancer is the most prevalent form of cancer that affects women worldwide, posing a significant burden on public health. While advancements in early detection and improved treatments have led to a remarkable 90% five-year survival rate and an 83% ten-year survival rate, this has also resulted in more prophylactic mastectomies being performed. Despite advancements in breast-conserving techniques, immunotherapy, and hormone therapy, many women still undergo mastectomies as part of their cancer treatment. In all cases, this results in scarring, and additional side effects from treatment modalities may arise. The loss of a breast can profoundly impact health-related quality of life (HRQoL). Although HRQoL has improved greatly during the recent years, systematic and local therapy having side effects is not uncommon, and this needs more attention.
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When planning a study measuring the effects of a neurodevelopmental treatment (NDT), we were confronted with the methodological problem that while measuring the effects of NDT, a rival hypothesis is that the decision to implement the NDT might be related to the quality of nursing care. Therefore, we measured the quality of nursing care as a possible confounding variable in relation to this outcome study. The quality of nursing care was measured on 12 wards participating in the experimental and control groups of the outcome study. Data were collected from 125 patients and 71 nurses and patients' records. The findings showed no significant differences in the quality of nursing care between the 2 groups of wards (P = .49). This method may be useful to other researchers conducting outcome research and who are confronted with a similar methodological problem.
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Background There currently is no field test available for measuring maximal exercise capacity in people with stroke. Objective To determine the feasibility, reproducibility and validity of the Shuttle Test (ST) to measure exercise capacity in people with stroke. Design Longitudinal study design. Setting Rehabilitation department, day care centres from a nursing home and private practices specialized in neuro rehabilitation. Subjects People with subacute or chronic stroke. Interventions A standardized protocol was used to determine feasibility, reproducibility and validity of the 10-meter Shuttle Test (10mST). Main measures Number of shuttles completed, 1stVentilatory Threshold (1stVT). Results The associations of the number of shuttles completed and cardiopulmonary capacity as measured with a portable gas analyser were r > 0.7, confirming good convergent validity in subacute and chronic people with stroke. Criterion validity, however, indicates it is not a valid test for measuring maximal cardiopulmonary capacity (VO2max). Only 60% of participants were able to reach the 1stVT. Higher cardiopulmonary capacity and a higher total score of the lower extremity Motricity Index contributed significantly to a higher number of shuttles walked (p = 0.001). Conclusions The Shuttle Test may be a safe and useful exercise test for people after stroke, but may not be appropriate for use with people who walk slower than 2 km/h or 0.56 m/s.
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For deep partial-thickness burns no consensus on the optimal treatment has been reached due to conflicting study outcomes with low quality evidence. Treatment options in high- and middle-income countries include conservative treatment with delayed excision and grafting if needed; and early excision and grafting. The majority of timing of surgery studies focus on survival rather than on quality of life. This study protocol describes a study that aims to compare long-term scar quality, clinical outcomes, and patient-reported outcomes between the treatment options. A multicentre prospective study will be conducted in the three Dutch burn centres (Rotterdam, Beverwijk, and Groningen). All adult patients with acute deep-partial thickness burns, based on healing potential with Laser Doppler Imaging, are eligible for inclusion. During a nine-month baseline period, standard practice will be monitored. This includes conservative treatment with dressings and topical agents, and excision and grafting of residual defects if needed 14–21 days post-burn. The subsequent nine months, early surgery is advocated, involving excision and grafting in the first week to ten days post-burn. The primary outcome compared between the two groups is long-term scar quality assessed by the Patient and Observer Scar Assessment Scale 3.0 twelve months after discharge. Secondary outcomes include clinical outcomes and patient-reported outcomes like quality of life and return to work. The aim of the study is to assess long-term scar quality in deep partial-thickness burns after conservative treatment with delayed excision and grafting if needed, compared to early excision and grafting. Adding to the ongoing debate on the optimal treatment of these burns. The broad range of studied outcomes will be used for the development of a decision aid for deep partial-thickness burns, to fully inform patients at the point of consent to surgery and support optimal person-centred care.
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In this thesis we analyzed clinimetric measurement properties of physical fitness tests in wheelchair-using youth with SB. Furthermore, the amount of physical behavior in wheelchair-using youth with SB was quantified and associations with age, gender, VO2peak and Hoffer classification were evaluated. Finally, we described the factors associated with physical behavior in youth with SB and youth with physical disabilities, after which the evidence of interventions to improve physical behavior in youth with physical disabilities was analyzed. This last chapter presents the theoretical and clinical implications. At the end, methodological considerations and directions for further research will be discussed after which the overall conclusion is presented.
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Objective: To systematically review and critically appraise the literature on measurement properties of cardiopulmonary exercise test protocols for measuring aerobic capacity, VO2max, in persons after stroke. Data sources: PubMed, Embase and Cinahl were searched from inception up to 15 June 2016. A total of 9 studies were identified reporting on 9 different cardiopulmonary exercise test protocols. Study selection: VO2max measured with cardiopulmonary exercise test and open spirometry was the construct of interest. The target population was adult persons after stroke. We included all studies that evaluated reliability, measurement error, criterion validity, content validity, hypothesis testing and/ or responsiveness of cardiopulmonary exercise test protocols. Data extraction: Two researchers independently screened the literature, assessed methodological quality using the COnsensus-based Standards for the selection of health Measurement INstruments checklist and extracted data on measurement properties of cardiopulmonary exercise test protocols. Data synthesis: Most studies reported on only one measurement property. Best-evidence synthesis was derived taking into account the methodological quality of the studies, the results and the consistency of the results. Conclusion: No judgement could be made on which protocol is “best” for measuring VO2max in persons after stroke due to lack of high-quality studies on the measurement properties of the cardiopulmonary exercise test.
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