Movement and Mobility protocols after surgical management of burn injuries: An audit of current practice at the Royal Brisbane and Women’s Hospital

Ms Anita Plaza1, Ms Phillipa  Ault1, Ms Marnie Macfie1, Mrs Brooke Mulliss1, Ms Catherine Sharpe1, Mrs Joanne  Alexander1, Mrs Charlotte Jackson1, Ms Jacinta Weber1, Ms Catherine Anderson1, Ms Gemma Allinson1, Ms Michelle Cottrell1

1Royal Brisbane And Women’s Hospital, Australia

Abstract:

Despite growing evidence for the benefits of early mobilisation, there are no clear mobilisation guidelines for the various surgical interventions used in burn management.  Early mobilisation, within 3 days, is recommended after split skin graft (SSG) procedures, however, there are no mobility recommendations for other skin substitutes.

The aim of this project was therefore to conduct an audit of the current mobility practices post burn surgery at the Professor Stuart Pegg Adult Burn Centre, Royal Brisbane and Women’s Hospital (RBWH).

Methods: A retrospective chart audit was conducted and included all patients who were admitted to the RBWH, required surgery for management of a burn injury between 1st July 2017 and 31st December 2018, and survived to hospital discharge.  Patient demographics, burn surgery specific data, ROM and mobility commencement timeframes, patient outcome data, rehabilitation requirements and complication rates were collected.

Results: 480 patients with 662 surgical procedures were included in this audit.  Mean age 39 years (range 14-84), mean %TBSA 6.4% (range 0.1-86) and mean hospital length of stay (LOS) 12 days (range 1-300).  Meshed SSGs were the most frequently performed surgical procedures (64.4%, n=426) with allograft used in 10.7% (n=71) and other skin substitutes used in 7.3% (n=48) of cases.  The mean time to commencement of ROM for meshed SSGs was 3.5 days (range 0-14) with the mean start time of full weight-bearing mobilisation (FWBMob) being 2.4 days (range 0 to 20).  For widely meshed grafts (4:1) with allograft overlay, the mean time to commence ROM was 4.3 days (range: 3-13) and FWBMob was 6 days (range 4-21).  For Biodegradable Temporising Matrix (BTM).BTM, mean ROM commencement after application was 7.6 days (range 6-15 days) and the mean time to FWBMob was 11.3 days (range 6-28 days).  For Biobrane, mean ROM commencement was 3.4 days (range 1-7) and mean time to FWBMob was 5.2 days (range 1-10).  The relationships between early mobilisation and patient outcomes, hospital complications, LOS and rehabilitation requirements will also be explored.

Conclusion: Outcomes from this audit may positively influence patient outcomes post burn injury by contributing to the reduction of complications associated with bed rest and immobilisation.


Biography:

Phillipa Ault is a physiotherapist working at the Royal Brisbane and Women’s Hospital.  She has over 5 years experience working in the area and has published previously on the effectiveness of scar massage for hypertrophic scarring.

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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