Risk factors for burn contractures: A cross-sectional study in a lower income country

Fanstone, RuthAnn; Price, Patricia; Bodger, Owen; Potokar, Tom; Karim, Mohammad Rabiul; FANSTONE, RUTHANN; Potokar, Tom

doi:10.1016/j.burns.2023.09.003

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Risk factors for burn contractures: A cross-sectional study in a lower income country

RuthAnn Fanstone

, Patricia Price

, Owen Bodger

, Tom Potokar, Mohammad Rabiul Karim Khan, RUTHANN FANSTONE, Tom Potokar

Burns, Volume: 50, Issue: 2, Pages: 454 - 465

Swansea University Authors: Owen Bodger , RUTHANN FANSTONE, Tom Potokar

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DOI (Published version): 10.1016/j.burns.2023.09.003

Abstract

Risk factors for burn contractures require further study, especially in low and middle-income countries (LMICs); existing research has been predominantly conducted in high income countries (HICs). This study aimed to identify risk factors for burn contractures of major joints in a low-income setting...

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Published in:	Burns
ISSN:	0305-4179
Published:	Elsevier BV 2024
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URI:	https://cronfa.swan.ac.uk/Record/cronfa64577
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first_indexed	2023-09-20T12:46:58Z
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This study aimed to identify risk factors for burn contractures of major joints in a low-income setting. Potential risk factors (n=104) for burn contracture were identified from the literature and a survey of clinicians with extensive experience in low and middle-income countries (LMIC). An observational cross-sectional study of adult burn survivors was undertaken in Bangladesh to evaluate as many of these risk factors as were feasible against contracture presence and severity. Forty-eight potential risk factors were examined in 48 adult patients with 126 major joints at risk (median 3 per participant) at a median of 2.5 years after burn injury. Contractures were present in 77% of participants and 52% of joints overall. Contracture severity was determined by measurement of loss of movement at all joints at risk. Person level risk factors were defined as those that were common to all joints at risk for the participant and only documented once, whilst joint level risk factors were documented for each of the participant’s included joints at risk. Person level risk factors which were significantly correlated with loss of range of movement (ROM) included employment status, full thickness burns, refusal of skin graft, discharged against medical advice, low frequency of follow up and lack of awareness of contracture development. Significant joint level risk factors for loss of ROM included anatomical location, non-grafted burns, and lack of pressure therapy. This study has examined the largest number of potential contracture risk factors in an LMIC setting to date. A key finding was that risk factors for contracture in low-income settings may differ substantially from those seen in high income countries, which has implications for effective prevention strategies in these countries. Better whole person and joint outcome measures are required for accurate determination of risk factors for burn contracture. 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spelling	v2 64577 2023-09-20 Risk factors for burn contractures: A cross-sectional study in a lower income country 8096440ab42b60a86e6aba678fe2695a 0000-0002-4022-9964 Owen Bodger Owen Bodger true false 6d0cd74a3d65e655ba07907d458863b2 RUTHANN FANSTONE RUTHANN FANSTONE true false 9a95e66967473650e9ed68f7cad7c681 0000-0001-9282-8128 Tom Potokar Tom Potokar true false 2023-09-20 HDAT Risk factors for burn contractures require further study, especially in low and middle-income countries (LMICs); existing research has been predominantly conducted in high income countries (HICs). This study aimed to identify risk factors for burn contractures of major joints in a low-income setting. Potential risk factors (n=104) for burn contracture were identified from the literature and a survey of clinicians with extensive experience in low and middle-income countries (LMIC). An observational cross-sectional study of adult burn survivors was undertaken in Bangladesh to evaluate as many of these risk factors as were feasible against contracture presence and severity. Forty-eight potential risk factors were examined in 48 adult patients with 126 major joints at risk (median 3 per participant) at a median of 2.5 years after burn injury. Contractures were present in 77% of participants and 52% of joints overall. Contracture severity was determined by measurement of loss of movement at all joints at risk. Person level risk factors were defined as those that were common to all joints at risk for the participant and only documented once, whilst joint level risk factors were documented for each of the participant’s included joints at risk. Person level risk factors which were significantly correlated with loss of range of movement (ROM) included employment status, full thickness burns, refusal of skin graft, discharged against medical advice, low frequency of follow up and lack of awareness of contracture development. Significant joint level risk factors for loss of ROM included anatomical location, non-grafted burns, and lack of pressure therapy. This study has examined the largest number of potential contracture risk factors in an LMIC setting to date. A key finding was that risk factors for contracture in low-income settings may differ substantially from those seen in high income countries, which has implications for effective prevention strategies in these countries. Better whole person and joint outcome measures are required for accurate determination of risk factors for burn contracture. Recommendations for planning and reporting on future contracture risk factor studies are made. Journal Article Burns 50 2 454 465 Elsevier BV 0305-4179 Burn contractures, risk factors, cross-sectional study, Low middle-income countries, Bangladesh 1 3 2024 2024-03-01 10.1016/j.burns.2023.09.003 http://dx.doi.org/10.1016/j.burns.2023.09.003 In Press COLLEGE NANME Health Data Science COLLEGE CODE HDAT Swansea University SU Library paid the OA fee (TA Institutional Deal) This research was funded by the National Institute for Health Research (NIHR) (project reference:16.137.110) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK government. 2024-04-03T09:55:42.3931121 2023-09-20T13:42:19.2902243 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine RuthAnn Fanstone 0000-0002-8144-4580 1 Patricia Price 0000-0003-3767-0131 2 Owen Bodger 0000-0002-4022-9964 3 Tom Potokar 4 Mohammad Rabiul Karim Khan 5 RUTHANN FANSTONE 6 Tom Potokar 0000-0001-9282-8128 7 64577__29872__320afbcfc7144aa38917fef2052ca0c0.pdf 64577VoR.pdf 2024-04-03T09:55:00.7108631 Output 1406600 application/pdf Version of Record true This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). false eng http://creativecommons.org/licenses/by/4.0/
title	Risk factors for burn contractures: A cross-sectional study in a lower income country
spellingShingle	Risk factors for burn contractures: A cross-sectional study in a lower income country Owen Bodger RUTHANN FANSTONE Tom Potokar
title_short	Risk factors for burn contractures: A cross-sectional study in a lower income country
title_full	Risk factors for burn contractures: A cross-sectional study in a lower income country
title_fullStr	Risk factors for burn contractures: A cross-sectional study in a lower income country
title_full_unstemmed	Risk factors for burn contractures: A cross-sectional study in a lower income country
title_sort	Risk factors for burn contractures: A cross-sectional study in a lower income country
author_id_str_mv	8096440ab42b60a86e6aba678fe2695a 6d0cd74a3d65e655ba07907d458863b2 9a95e66967473650e9ed68f7cad7c681
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author	Owen Bodger RUTHANN FANSTONE Tom Potokar
author2	RuthAnn Fanstone Patricia Price Owen Bodger Tom Potokar Mohammad Rabiul Karim Khan RUTHANN FANSTONE Tom Potokar
format	Journal article
container_title	Burns
container_volume	50
container_issue	2
container_start_page	454
publishDate	2024
institution	Swansea University
issn	0305-4179
doi_str_mv	10.1016/j.burns.2023.09.003
publisher	Elsevier BV
college_str	Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id	facultyofmedicinehealthandlifesciences
hierarchy_top_title	Faculty of Medicine, Health and Life Sciences
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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
url	http://dx.doi.org/10.1016/j.burns.2023.09.003
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description	Risk factors for burn contractures require further study, especially in low and middle-income countries (LMICs); existing research has been predominantly conducted in high income countries (HICs). This study aimed to identify risk factors for burn contractures of major joints in a low-income setting. Potential risk factors (n=104) for burn contracture were identified from the literature and a survey of clinicians with extensive experience in low and middle-income countries (LMIC). An observational cross-sectional study of adult burn survivors was undertaken in Bangladesh to evaluate as many of these risk factors as were feasible against contracture presence and severity. Forty-eight potential risk factors were examined in 48 adult patients with 126 major joints at risk (median 3 per participant) at a median of 2.5 years after burn injury. Contractures were present in 77% of participants and 52% of joints overall. Contracture severity was determined by measurement of loss of movement at all joints at risk. Person level risk factors were defined as those that were common to all joints at risk for the participant and only documented once, whilst joint level risk factors were documented for each of the participant’s included joints at risk. Person level risk factors which were significantly correlated with loss of range of movement (ROM) included employment status, full thickness burns, refusal of skin graft, discharged against medical advice, low frequency of follow up and lack of awareness of contracture development. Significant joint level risk factors for loss of ROM included anatomical location, non-grafted burns, and lack of pressure therapy. This study has examined the largest number of potential contracture risk factors in an LMIC setting to date. A key finding was that risk factors for contracture in low-income settings may differ substantially from those seen in high income countries, which has implications for effective prevention strategies in these countries. Better whole person and joint outcome measures are required for accurate determination of risk factors for burn contracture. Recommendations for planning and reporting on future contracture risk factor studies are made.
published_date	2024-03-01T09:55:39Z
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Risk factors for burn contractures: A cross-sectional study in a lower income country

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