Rehabilitation in adults with burn injury: an overview of systematic reviews

To systematically evaluate evidence from published systematic reviews for the effectiveness of rehabilitation interventions in adults with burn injury. A comprehensive literature review conducted using medical and health science electronic databases up to 31 July 2022. Two independent reviewers selected studies, extracted data, and assessed methodological study quality using A Measurement Tool to Assess Systematic Reviews (AMSTAR-2), and the certainty of evidence for reported outcomes using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool. Twenty-one systematic reviews evaluated five categories of interventions: physical, psychological, technology-aided modalities, educational and occupational programs, complementary and alternative medicine. Outcomes included fitness level, hand function, oedema, pain, pruritus, psychological state, quality of life, range of motion, return to work, strength, scar characteristics, level of impairment and burn knowledge. The methodological quality was rated as “critically low” for all reviews. Quality of evidence for the effectiveness of evaluated interventions ranged from “moderate to very low.” Beneficial effects of inhaled aromatherapy and extracorporeal shockwave therapy on pain reduction; inhaled or massage aromatherapy, music therapy on anxiety were reported. Safety of interventions was not evaluated, due to the lack of adverse event reporting in primary studies and the included reviews. Burn injury is a leading cause of severe morbidity, and long-term disability, with significant health and economic burden. There is emerging evidence to support the use of complementary and alternative medicine interventions (such as aromatherapy and music therapy) for alleviating anxiety. Extracorporeal shockwave therapy with comprehensive rehabilitation therapy has positive effects on pain reduction. These interventions may be considered as adjunctive tools to enhance burn rehabilitation care and improve patient outcomes. However, further robust studies are required to strengthen the evidence, explore adverse effects and associated cost efficiency.</p

Video_2_A Human Sensory Pathway Connecting the Foot to Ipsilateral Face That Partially Bypasses the Spinal Cord.MP4

Human sensory transmission from limbs to brain crosses and ascends through the spinal cord. Yet, descriptions exist of ipsilateral sensory transmission as well as transmission after spinal cord transection. To elucidate a novel ipsilateral cutaneous pathway, we measured facial perfusion following painfully-cold water foot immersion in 10 complete spinal cord-injured patients, 10 healthy humans before and after lower thigh capsaicin C-fiber cutaneous conduction blockade, and 10 warm-immersed healthy participants. As in healthy volunteers, ipsilateral facial perfusion in spinal cord injured patients increased significantly. Capsaicin resulted in contralateral increase in perfusion, but only following cold immersion and not in 2 spinal cord-injured patients who underwent capsaicin administration. Supported by skin biopsy results from a healthy participant, we speculate that the pathway involves peripheral C-fiber cross-talk, partially bypassing the cord. This might also explain referred itch and jogger's migraine and it is possible that it may be amenable to training spinal-injured patients to recognize lower limb sensory stimuli.</p

Video_3_A Human Sensory Pathway Connecting the Foot to Ipsilateral Face That Partially Bypasses the Spinal Cord.MP4

Human sensory transmission from limbs to brain crosses and ascends through the spinal cord. Yet, descriptions exist of ipsilateral sensory transmission as well as transmission after spinal cord transection. To elucidate a novel ipsilateral cutaneous pathway, we measured facial perfusion following painfully-cold water foot immersion in 10 complete spinal cord-injured patients, 10 healthy humans before and after lower thigh capsaicin C-fiber cutaneous conduction blockade, and 10 warm-immersed healthy participants. As in healthy volunteers, ipsilateral facial perfusion in spinal cord injured patients increased significantly. Capsaicin resulted in contralateral increase in perfusion, but only following cold immersion and not in 2 spinal cord-injured patients who underwent capsaicin administration. Supported by skin biopsy results from a healthy participant, we speculate that the pathway involves peripheral C-fiber cross-talk, partially bypassing the cord. This might also explain referred itch and jogger's migraine and it is possible that it may be amenable to training spinal-injured patients to recognize lower limb sensory stimuli.</p

Video_1_A Human Sensory Pathway Connecting the Foot to Ipsilateral Face That Partially Bypasses the Spinal Cord.MP4

Human sensory transmission from limbs to brain crosses and ascends through the spinal cord. Yet, descriptions exist of ipsilateral sensory transmission as well as transmission after spinal cord transection. To elucidate a novel ipsilateral cutaneous pathway, we measured facial perfusion following painfully-cold water foot immersion in 10 complete spinal cord-injured patients, 10 healthy humans before and after lower thigh capsaicin C-fiber cutaneous conduction blockade, and 10 warm-immersed healthy participants. As in healthy volunteers, ipsilateral facial perfusion in spinal cord injured patients increased significantly. Capsaicin resulted in contralateral increase in perfusion, but only following cold immersion and not in 2 spinal cord-injured patients who underwent capsaicin administration. Supported by skin biopsy results from a healthy participant, we speculate that the pathway involves peripheral C-fiber cross-talk, partially bypassing the cord. This might also explain referred itch and jogger's migraine and it is possible that it may be amenable to training spinal-injured patients to recognize lower limb sensory stimuli.</p

Application of the extended technology acceptance model to explore clinician likelihood to use robotics in rehabilitation

Evidence suggests that patients with upper limb impairment following a stroke do not receive recommended amounts of motor practice. Robotics provide a potential solution to address this gap, but clinical adoption is low. The aim of this study was to utilize the technology acceptance model as a framework to identify factors influencing clinician adoption of robotic devices into practice. Mixed methods including survey data and focus group discussions with allied health clinicians whose primary caseload was rehabilitation of the neurologically impaired upper limb. Surveys based on the technology acceptance measure were completed pre/post exposure to and use of a robotic device. Focus groups discussions based on the theory of planned behaviour were conducted at the conclusion of the study. A total of 34 rehabilitation clinicians completed the surveys with pre-implementation data indicating that rehabilitation clinicians perceive robotic devices as complex to use, which influenced intention to use such devices in practice. The focus groups found that lack of experience and time to learn influenced confidence to implement robotic devices into practice. This study found that perceived usefulness and perceived ease of use of a robotic device in clinical rehabilitation can be improved through experience, training and embedded technological support. However, training and embedded support are not routinely offered, suggesting there is a discordance between current implementation and the learning needs of rehabilitation clinicians.IMPLICATIONS FOR REHABILITATIONPatients do not receive adequate amounts of upper limb motor practice following a stroke, and although robotic devices have the potential to address this gap, clinical adoption is low.The technology acceptance model identified that clinicians perceive robotic devices to be complex to use with current implementation efforts failing to consider their training needs.Implementation adoption of robotic devices in rehabilitation should be supported with adequate training and technological support if sustainable practice change is to be achieved. Patients do not receive adequate amounts of upper limb motor practice following a stroke, and although robotic devices have the potential to address this gap, clinical adoption is low. The technology acceptance model identified that clinicians perceive robotic devices to be complex to use with current implementation efforts failing to consider their training needs. Implementation adoption of robotic devices in rehabilitation should be supported with adequate training and technological support if sustainable practice change is to be achieved.</p