The effectiveness of non-invasive burns interventions on scar-related outcomes: A systematic review

Dr. Zephanie Tyack1, Jodie Wiseman1, Angela Thynne2, Dr. Jason Wasiak3, Prof. Roy Kimble1,4, Dr. Megan Simons1,5

1 Centre for Children’s Burns and Trauma Research, Children’s Health Research Centre, 62 Graham Street South Brisbane, QLD, 4101. z.tyack@uq.edu.au; jodie.wiseman@uqconnect.edu.au
2 Occupational Therapy Private Practice, Royal Brisbane and Women’s Hospital, Professor Stuart Pegg Adult Burns Unit, Brisbane,  athynne@fas.com.au
3 Department of Radiation Oncology, The Epworth Hospital, Richmond, Australia, Jason.Wasiak@epworth.org.au
4 Surgical Directorate – Lady Cilento Children’s Hospital, 501 Stanley Street South Brisbane, QLD, 4101, royk@uq.edu.au
5 Occupational Therapy Department – Lady Cilento Children’s Hospital, 501 Stanley Street South Brisbane, QLD, 4101, megan.simons@health.qld.gov.au

Background

Several systematic reviews of burn scar interventions such as pressure garments and silicone products exist.  However, no systematic review has examined the effectiveness of a broad range of non-invasive interventions from hospital presentation to long term follow-up on scar-related outcomes.

Methods/Design

A systematic review was conducted by searching the databases of EMBASE, Medline and CINAHL (1990 – 2015).   The results of randomised controlled trials (RCT) of children or adults with the potential to scar or with burn scarring were included. Primary outcomes included sensory and physical scar outcomes and reconstructive procedures. Two independent reviewers screened the titles and abstracts, reviewed full text papers, rated the quality of studies using the Cochrane risk of bias tool, and extracted data from the included studies.

Results

After screening 1641 titles and abstracts, 39 RCT were included.  Interventions included silicone products (10 RCT), pressure garments (5 RCT), creams (5 RCT), dressings (5 RCT), medication (3 RCT), adherence education programs (2 RCT), and exercise/activity programs (2 RCT). Only 1 RCT of an adherence education program was deemed high quality.  Two of the highest quality RCT of silicone products supported itch reduction and two of the highest quality studies for pressure garments supported redness reduction with moderate to large effect sizes. Only 11 RCT involved children.

Conclusion

Some non-invasive interventions seem promising for their impact on isolated physical or sensory scar-related outcomes. Further high quality RCT’s of all non-invasive interventions are required particularly those focusing on the effectiveness of acute interventions (e.g. dressings and exercise).

Key Words

Burns, scar management, pressure garments, silicone, systematic review

Biography

Dr Tyack is a Research Fellow with the Centre for Children’s Burns and Trauma Research.  Her research interest areas are the health-related quality of life, burn scarring, and the burden of disease in people with chronic diseases including burns.  She is also involved in studies investigating comorbidity and complex chronic diseases.

About ANZBA

ANZBA is a not for profit organisation and the peak body for health professionals responsible for the care of the burn injured in Australia and New Zealand. ANZBA encourages higher standards of care through education, performance monitoring and research.

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