Effectiveness of early stretching exercises for range of motion of the shoulder joint,state of axillary scar and quality of recovery in burnt patients admitted to burns unit of the national hospital of Sri Lanka

Abstract

BACKGROUND: Burn injuries can result in long term impairment, limitation and restriction in participation in various activities in a patient’s life. The majority of burns occur in low- and middle-income countries and almost half occur in the Asian and south-east Asian regions. Axillary or shoulder burns often develop scar contracture with subsequent loss of shoulder movements and function. PURPOSE: This study was done to evaluate the effects of early stretching exercises programme on the range of' motion of the shoulder joint, state of axillary scar and quality of recovery in burnt patients in comparison to a control group. METHODS: A randomized controlled study was conducted in National hospital of Sri Lanka. Patient, from 15 to 55 years of age admitted to the burns unit with a total burn injury surface area (TBSA) of 10% to 45% involving the shoulder joint with axilla were selected. The subjects were randomized into two groups; intervention and a usual care control group. There were 110 patients in each group. A Study protocol was used in the management of intervention group for 14 days. The control group was subjected to usual protocol currently used in the unit.Range of Motion (ROM) was measured with a Universal Goniometer. Functional recovery (FR) was assessed with the Quick DASH questionnaire and the Abduction ladder. State of the axillary scar was assessed with the Vancouver Scar Scale (VSS). Data were obtained before and after the intervention phase on 3, 6 and 12 months of post burn period.RESULTS: The mean (SD) age of intervention group and control group were 29.76 [9. 81] and 30.3 l [9.45] respectively. The mean (SD) TBSA% of intervention group and control group were 26.15[9.45] and 24.60[9.56] respectively. There is a significant beneficial difference (p=0.000) in ROM, FR and the state of the axillary scar between the Intervention group and the control group. After 12 months of post burn, all the ROM which had been measured was h igher in subjects who were in the intervention group than in the control group. Mean scores of Quick DASH and the VSS values were less in the intervention group Compared to the control group. CONCLUSION: This study demonstrated that early sustained stretching exercise regime Significantly improved the ROM and functional recovery of the shoulder joint and scar condition of the axil1a after a severe axillary burn.