Status of adult inpatient burn rehabilitation in Europe: are we neglecting metabolic outcomes?
- Burns & Trauma Vol. 9, Issue 1, (2021)
- 作者机构：
1. Multidisciplinary Metabolic Research Unit (M2RUN)
2. University of Antwerp
3. Multidisciplinary Edema Clinic, Antwerp University Hospital
4. OSCARE, Organisation for burns, scar after-care and research
- 作者简介：
- 基金信息：
DOI：10.1093/burnst/tkaa039
CLC：Published：2021，
Published Online：1 March 2021，
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David R Schieffelers, Eric van Breda, Nick Gebruers, Jill Meirte, Ulrike Van Daele, Status of adult inpatient burn rehabilitation in Europe: are we neglecting metabolic outcomes?, Burns & Trauma, Volume 9, 2021, tkaa039, https://doi.org/10.1093/burnst/tkaa039
摘要
Abstract
BackgroundHypermetabolism
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.MethodsAn 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.ResultsFifty-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).ConclusionThis 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.
关键词
Keywords
Burn careBurn rehabilitationExerciseEarly mobilizationHypermetabolismAdults
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