Rehabilitation interventions after hand burn injury in adults: A systematic review

The aim of this review was to summarise the current evidence regarding the effectiveness of rehabilitation interventions in improving hand function, range of motion (ROM), hand strength, scar outcome, return to work, level of impairment/disability, level of burn knowledge and decreasing edema following hand burns in adult burn survivors. This review provides evidence-based support for the use of rehabilitation interventions for burn rehabilitation professionals. The following data sources were searched: MEDLINE, EMBASE and CINAHL from their inception up to February 2021, reference lists from all the included full-text articles were screened for additional relevant publications and monthly Google Scholar searches until December 23rd 2021 to make sure all new pertinent published articles after February 2021 would be included. Thirty-five studies were included in this review including 14 RCTs. Most of the included studies were Level 4 (46%; 16/35) and Level 2 (40%; 14/35) evidence. Only four studies were classified as Level 3 (14%; 5/35) evidence and none were considered Level 1. Most studies received a score of 5-9 (54%; 19/35) (Moderate quality). Fourteen studies received a score of ≥ 10 (40%; 14/35) (High quality) and only 2 studies received a score of< 5 (6%; 2/35) (Low quality). Articles were categorized according to the primary outcome targeted by the intervention. Clinical recommendations on higher-level evidence interventions are presented. This review supports the clinical practice of the following interventions: 1) The use of adhesive compression wraps for patients who have increased edema to increase hand function and ROM; 2) The use of compression (adhesive compressive wrap, compression bandage or intermittent compression pump) to decrease hand edema following burn injury; 3) Participating in general rehabilitation to increase hand function and patient perceived level of disability; 4) The use of an orthosis to increase ROM and a dynamic MCP orthosis to increase hand function; 5) If available, incorporate the use of VR based rehabilitation to increase hand function and hand strength; 6) The use of paraffin to increase hand PROM; 7) The use of gels to reduce hand scar thickness; 8) The use of an education component in rehabilitation to increase the level of burn knowledge. The limitations of this study are also discussed. Further research with robust methodology is needed to investigate the potential benefits of treatment interventions included in this review.