Home-Based Telerehabilitation Effective for Patients With Burn Injuries

Home-based telerehabilitation (HBT) is comparable to in-person physical therapy exercise programs for clinical outcomes in patients with burn injuries, according to findings from a study published in Burns.

The single-center, controlled, noninferiority pilot trial randomly assigned participants to receive a 6-week physical therapy exercise program delivered either by HBT or in-person and conducted by a physical therapist with burn experience.

Patients were enrolled from a center in Brisbane, Australia, from January 2019 through March 2021, with recruitment paused from March to May 2020 owing to COVID-19 restrictions. Eligible participants were aged 18 years and older, admitted with partial or full thickness burns, and had a burn size of less than 25% total body surface area (%TBSA) with a burn location requiring outpatient physical therapy management.

The primary outcome was burn-specific health-related quality of life assessed with the Burn Specific Health Scale–Brief (BSHS-B) questionnaire.

A total of 23 patients in the HBT group (mean [SD] age, 48.4 [14.2] years; 69.6% men) and 22 in the IP group (mean age, 45.1 [16] years; 68.2% men) had recorded outcome measures at weeks 6 and 12, respectively. The completion of the exercise programs was comparable between the 2 groups.

No significant within-group or between-group differences were observed regarding changes in BSHS-B score over time. Noninferiority at week 6 (mean difference [MD], 0.84; 95% CI, -11.34 to 13.03) and week 12 (MD, 9.1; 95% CI, -1.46 to 19.65), respectively, was inconclusive, as the upper bound of the 95% CI was outside the predetermined noninferiority margin.

Statistically significant improvement in the Assessment of Quality of Life–4 Dimension score, pain severity, and quadriceps strength were observed in both groups during the intervention period, and significant improvement in Brisbane Burn Scar Impact Profile for Adults Version 1.0 overall impact occurred in the HBT group.

Achievement of full range of motion (ROM) at all affected joints indicated a significant between-group difference. No significant difference in full ROM was found at completion of the intervention (week 6: IP 64% vs HBT 52%, P =.436). At the end of the study, a significantly higher percentage of participants in the IP group achieved full ROM at all joints vs the HBT group (week 12: IP 100% vs HBT 70%, P =.005).

The 2 groups had high levels of satisfaction (median scores >9.8/10) for their intervention, with no significant differences between the groups. Therapist satisfaction with HBT was high, with median scores for all items greater than 8.9/10. No adverse events occurred during the HBT sessions.

The study is limited by the single-site design and small sample size, and the trial did not meet the preplanned recruitment targets owing to early termination. Also, the final sample size may have contributed to the large variances and wide 95% confidence intervals in the outcome measures and inconclusive nature of the noninferiority analysis.

“Telerehabilitation appears to be a safe, effective, and clinically viable option to manage patients with burn injuries, especially those who are unable to access in-person services within their local community after hospitalization,” stated the study authors. “Further studies are required to confirm noninferiority, further explore ROM outcomes, and investigate the effectiveness of a telerehabilitation program for patients with greater than 25% TBSA burns.”

Reference

Plaza A, Paratz J, Cottrell M. A 6-week physical therapy exercise program delivered via home-based telerehabilitation is comparable to in-person programs for patients with burn injuries: a randomized, controlled, noninferiority clinical pilot trial. Burns. Published online August 28, 2022. doi:https://doi.org/10.1016/j.burns.2022.08.014