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Risk factors for burn contractures in lower income countries / RUTHANN FANSTONE

Swansea University Author: RUTHANN FANSTONE

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DOI (Published version): 10.23889/SUthesis.61906

Abstract

Burns are a major cause of mortality and morbidity especially in low-middle income countries (LMICs). Burn contractures are particularly disabling and can occur in over 80% of burn survivors. Existing literature, predominantly from High-Income countries (HICs), demonstrates that risk factors for bur...

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Published: Swansea 2022
Institution: Swansea University
Degree level: Doctoral
Degree name: Ph.D
Supervisor: Bodger, Owen ; Price, Patricia
URI: https://cronfa.swan.ac.uk/Record/cronfa61906
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first_indexed 2022-11-14T16:00:23Z
last_indexed 2023-01-13T19:22:59Z
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spelling v2 61906 2022-11-14 Risk factors for burn contractures in lower income countries 6d0cd74a3d65e655ba07907d458863b2 RUTHANN FANSTONE RUTHANN FANSTONE true false 2022-11-14 Burns are a major cause of mortality and morbidity especially in low-middle income countries (LMICs). Burn contractures are particularly disabling and can occur in over 80% of burn survivors. Existing literature, predominantly from High-Income countries (HICs), demonstrates that risk factors for burn contractures are poorly understood, with little agreement on contracture definition or measurement. This study aimed to identify risk factors for burn contracture in LMICs to assist in future prevention strategies. Potential risk factors were identified from the literature and a survey of 17 clinicians with extensive LMIC experience. LMIC sources emphasised socioeconomic considerations more than burn or treatment factors, which predominate in HIC studies. An observational cross-sectional study of 48 adult burn survivors with 126 major joints at risk was undertaken in Bangladesh to evaluate 48 risk factors at person and joint levels, with alpha set at 0.05 for comparative analysis. At person level, employment status, self-discharge and fewer follow-up visits were associated with more severe contractures and greater movement loss. Full-thickness burns were associated with more severe contractures as was younger age at burn. Participants who knew about the risk of contracture development or received pressure treatment had less movement loss; refusal of skin graft was associated with greater movement loss. Joints which had pressure treatment had fewer contractures and grafted joints had less severe contractures. Anatomical location of the joint at risk also significantly affected contracture rates, with implications for the design of future risk factor studies. This thesis presents the most comprehensive framework of contracture risk factors reported to date and reveals important differences between current LMIC risk factors and those in HICs. More work is required to improve whole person and joint outcome measures for accurate determination of risk factors for burn contracture. Recommendations for future research and clinical practice are made. E-Thesis Swansea burns, burn injuries, contracture, risk factors, lower income countries 25 10 2022 2022-10-25 10.23889/SUthesis.61906 COLLEGE NANME COLLEGE CODE Swansea University Bodger, Owen ; Price, Patricia Doctoral Ph.D National Institute of Health Research (NIHR) 2024-07-11T15:12:43.8348565 2022-11-14T15:56:45.4048355 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine RUTHANN FANSTONE 1 61906__25773__4ffbe311c33d4804b7b4608fa559618b.pdf Fanstone_RuthAnn_PhD_Thesis_Final_Embargoed_Redacted_Signatures.pdf 2022-11-14T16:28:35.9376427 Output 38738235 application/pdf Version of Record true 2023-10-25T00:00:00.0000000 Copyright: The author, RuthAnn Fanstone, 2022. Released under the terms of a Creative Commons Attribution-Non-Commercial (CC-BY-NC) License. Third party content is excluded for use under the license terms. true eng https://creativecommons.org/licenses/by-nc/4.0/
title Risk factors for burn contractures in lower income countries
spellingShingle Risk factors for burn contractures in lower income countries
RUTHANN FANSTONE
title_short Risk factors for burn contractures in lower income countries
title_full Risk factors for burn contractures in lower income countries
title_fullStr Risk factors for burn contractures in lower income countries
title_full_unstemmed Risk factors for burn contractures in lower income countries
title_sort Risk factors for burn contractures in lower income countries
author_id_str_mv 6d0cd74a3d65e655ba07907d458863b2
author_id_fullname_str_mv 6d0cd74a3d65e655ba07907d458863b2_***_RUTHANN FANSTONE
author RUTHANN FANSTONE
author2 RUTHANN FANSTONE
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publishDate 2022
institution Swansea University
doi_str_mv 10.23889/SUthesis.61906
college_str Faculty of Medicine, Health and Life Sciences
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hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
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description Burns are a major cause of mortality and morbidity especially in low-middle income countries (LMICs). Burn contractures are particularly disabling and can occur in over 80% of burn survivors. Existing literature, predominantly from High-Income countries (HICs), demonstrates that risk factors for burn contractures are poorly understood, with little agreement on contracture definition or measurement. This study aimed to identify risk factors for burn contracture in LMICs to assist in future prevention strategies. Potential risk factors were identified from the literature and a survey of 17 clinicians with extensive LMIC experience. LMIC sources emphasised socioeconomic considerations more than burn or treatment factors, which predominate in HIC studies. An observational cross-sectional study of 48 adult burn survivors with 126 major joints at risk was undertaken in Bangladesh to evaluate 48 risk factors at person and joint levels, with alpha set at 0.05 for comparative analysis. At person level, employment status, self-discharge and fewer follow-up visits were associated with more severe contractures and greater movement loss. Full-thickness burns were associated with more severe contractures as was younger age at burn. Participants who knew about the risk of contracture development or received pressure treatment had less movement loss; refusal of skin graft was associated with greater movement loss. Joints which had pressure treatment had fewer contractures and grafted joints had less severe contractures. Anatomical location of the joint at risk also significantly affected contracture rates, with implications for the design of future risk factor studies. This thesis presents the most comprehensive framework of contracture risk factors reported to date and reveals important differences between current LMIC risk factors and those in HICs. More work is required to improve whole person and joint outcome measures for accurate determination of risk factors for burn contracture. Recommendations for future research and clinical practice are made.
published_date 2022-10-25T15:12:42Z
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