Background:Hypermetabolism,muscle wasting and insulin resistance are challenging yet important rehabilitation targets in the management of burns.In the absence of concrete practice guidelines,however,it remains unclea...Background:Hypermetabolism,muscle wasting and insulin resistance are challenging yet important rehabilitation targets in the management of burns.In the absence of concrete practice guidelines,however,it remains unclear how these metabolic targets are currently managed.This study aimed to describe the current practice of inpatient rehabilitation across Europe.Methods:An electronic survey was distributed by the European Burn Association to burn centres throughout Europe,comprising generic and profession-specific questions directed at therapists,medical doctors and dieticians.Questions concerned exercise prescription,metabolic management and treatment priorities,motivation and knowledge of burn-induced metabolic sequelae.Odds ratios were computed to analyse associations between data derived from the responses of treatment priorities and knowledge of burn-induced metabolic sequelae.Results:Fifty-nine clinicians with 12.3±9 years of professional experience in burns,representing 18 out of 91 burn centres(response rate,19.8%)across eight European countries responded.Resistance and aerobic exercises were only provided by 42%and 38%of therapists to intubated patients,87%and 65%once out-of-bed mobility was possible and 97%and 83%once patients were able to leave their hospital room,respectively.The assessment of resting energy expenditure by indirect calorimetry,muscle wasting and insulin resistance was carried out by only 40.7%,15.3%and 7.4%respondents,respectively,with large variability in employed frequency and methods.Not all clinicians changed their care in cases of hypermetabolism(59.3%),muscle wasting(70.4%)or insulin resistance(44.4%),and large variations in management strategies were reported.Significant interdisciplinary variation was present in treatment goal importance ratings,motivation and knowledge of burn-induced metabolic sequelae.The prevention of metabolic sequelae was regarded as the least important treatment goal,while the restoration of functional status was rated as the most important.Knowledge of burn-induced metabolic sequelae was linked to higher importance ratings of metabolic sequelae as a therapy goal(odds ratio,4.63;95%CI,1.50–14.25;p<0.01).Conclusion:This survey reveals considerable non-uniformity around multiple aspects of inpatient rehabilitation across European burn care,including,most notably,a potential neglect of metabolic outcomes.The results contribute to the necessary groundwork to formulate practice guidelines for inpatient burn rehabilitation.展开更多
Background:Despite being a stable component of burn rehabilitation at later stages of recovery,exercise training is not commonly provided during the acute phase of burns.A lack of evidence surrounding its efficacy and...Background:Despite being a stable component of burn rehabilitation at later stages of recovery,exercise training is not commonly provided during the acute phase of burns.A lack of evidence surrounding its efficacy and safety in severely burned adults has hampered its implementation in acute burn care.The aim of this study was to investigate the capacity of early exercise training to modulate parameters of postburn muscle wasting and quality of life.Methods:Adults<65 years of age with burns≥40%total burn surface area(TBSA)were randomly allocated to either receive early exercise(n=29)in addition to standard care or standard care alone(n=29).Early exercise involved resistance and aerobic training,which commenced as early as possible and lasted for a duration of 6 to 12 weeks,in line with burn center length of stay.Ultrasound-derived quadriceps muscle layer thickness(QMLT)and rectus femoris cross-sectional area(RF-CSA),lower limb muscle force,Eurocol Quality of Life-5 Dimensions and Burn Specific Health Scale Brief(BSHS-B)were assessed 6 and 12 weeks after baseline.Mixed models were fitted to compare between-group changes over time.Results:A total of 58 adults[42(95%confidence interval 40-45)years old;40-94%TBSA range,86%previously mechanically ventilated]participated in this study.Exercise commenced 7 days[IQR(interquartile range)5-9]after burn center admission with an attendance rate of 93%.Allocation to the exercise group had a protective effect on the loss of muscle size from baseline to 6 weeks of follow-up(QMLT:β-coefficient:0.05 cm,p=0.010;RF-CSA:β-coefficient:0.05 cm2,p=0.045),and resulted in an improved recovery from 6 to 12 weeks(QMLT:β-coefficient:0.04 cm,p=0.01;RF-CSA:β-coefficient:0.06 cm2,p<0.001).Muscle force increased significantly more in the exercise group than in the control group(β-coefficient:3.102 N,p<0.001)between 6 and 12 weeks.Besides a marginally significant effect for the BSHS-B domains‘affect’and‘interpersonal relationships’between 6 and 12 weeks,no benefits were observed in the other assessed quality-of-life measures.No serious adverse events were reported in the exercise group.Conclusions:The results of this study support the use of early exercise training as a feasible and efficacious therapeutic strategy to manage burn-related changes in muscle size and strength in adults with acute severe burn injury.展开更多
基金DRS is funded through a doctoral fellowship by the Research Foundation Flanders(FWO)[11B8619N].
文摘Background:Hypermetabolism,muscle wasting and insulin resistance are challenging yet important rehabilitation targets in the management of burns.In the absence of concrete practice guidelines,however,it remains unclear how these metabolic targets are currently managed.This study aimed to describe the current practice of inpatient rehabilitation across Europe.Methods:An electronic survey was distributed by the European Burn Association to burn centres throughout Europe,comprising generic and profession-specific questions directed at therapists,medical doctors and dieticians.Questions concerned exercise prescription,metabolic management and treatment priorities,motivation and knowledge of burn-induced metabolic sequelae.Odds ratios were computed to analyse associations between data derived from the responses of treatment priorities and knowledge of burn-induced metabolic sequelae.Results:Fifty-nine clinicians with 12.3±9 years of professional experience in burns,representing 18 out of 91 burn centres(response rate,19.8%)across eight European countries responded.Resistance and aerobic exercises were only provided by 42%and 38%of therapists to intubated patients,87%and 65%once out-of-bed mobility was possible and 97%and 83%once patients were able to leave their hospital room,respectively.The assessment of resting energy expenditure by indirect calorimetry,muscle wasting and insulin resistance was carried out by only 40.7%,15.3%and 7.4%respondents,respectively,with large variability in employed frequency and methods.Not all clinicians changed their care in cases of hypermetabolism(59.3%),muscle wasting(70.4%)or insulin resistance(44.4%),and large variations in management strategies were reported.Significant interdisciplinary variation was present in treatment goal importance ratings,motivation and knowledge of burn-induced metabolic sequelae.The prevention of metabolic sequelae was regarded as the least important treatment goal,while the restoration of functional status was rated as the most important.Knowledge of burn-induced metabolic sequelae was linked to higher importance ratings of metabolic sequelae as a therapy goal(odds ratio,4.63;95%CI,1.50–14.25;p<0.01).Conclusion:This survey reveals considerable non-uniformity around multiple aspects of inpatient rehabilitation across European burn care,including,most notably,a potential neglect of metabolic outcomes.The results contribute to the necessary groundwork to formulate practice guidelines for inpatient burn rehabilitation.
基金co-financed with support of a doctoral fellowship to DRS by the Research Foundation Flanders(FWO)[11B8619N]the National Key R&D Program[2022YFC24030]and NSFC[82172214]to JW,and a travel grant by the University of Antwerp to DRS。
文摘Background:Despite being a stable component of burn rehabilitation at later stages of recovery,exercise training is not commonly provided during the acute phase of burns.A lack of evidence surrounding its efficacy and safety in severely burned adults has hampered its implementation in acute burn care.The aim of this study was to investigate the capacity of early exercise training to modulate parameters of postburn muscle wasting and quality of life.Methods:Adults<65 years of age with burns≥40%total burn surface area(TBSA)were randomly allocated to either receive early exercise(n=29)in addition to standard care or standard care alone(n=29).Early exercise involved resistance and aerobic training,which commenced as early as possible and lasted for a duration of 6 to 12 weeks,in line with burn center length of stay.Ultrasound-derived quadriceps muscle layer thickness(QMLT)and rectus femoris cross-sectional area(RF-CSA),lower limb muscle force,Eurocol Quality of Life-5 Dimensions and Burn Specific Health Scale Brief(BSHS-B)were assessed 6 and 12 weeks after baseline.Mixed models were fitted to compare between-group changes over time.Results:A total of 58 adults[42(95%confidence interval 40-45)years old;40-94%TBSA range,86%previously mechanically ventilated]participated in this study.Exercise commenced 7 days[IQR(interquartile range)5-9]after burn center admission with an attendance rate of 93%.Allocation to the exercise group had a protective effect on the loss of muscle size from baseline to 6 weeks of follow-up(QMLT:β-coefficient:0.05 cm,p=0.010;RF-CSA:β-coefficient:0.05 cm2,p=0.045),and resulted in an improved recovery from 6 to 12 weeks(QMLT:β-coefficient:0.04 cm,p=0.01;RF-CSA:β-coefficient:0.06 cm2,p<0.001).Muscle force increased significantly more in the exercise group than in the control group(β-coefficient:3.102 N,p<0.001)between 6 and 12 weeks.Besides a marginally significant effect for the BSHS-B domains‘affect’and‘interpersonal relationships’between 6 and 12 weeks,no benefits were observed in the other assessed quality-of-life measures.No serious adverse events were reported in the exercise group.Conclusions:The results of this study support the use of early exercise training as a feasible and efficacious therapeutic strategy to manage burn-related changes in muscle size and strength in adults with acute severe burn injury.
