Comparison of different methods of compression for managing oedema following hand burn injury

Mr Dale Edwick1,2,3,4, Dr Dana Hince5, Mr Jeremy  Rawlins2,6, Professor Fiona  Wood1,2,7, Associate Professor Dale  Edgar1,2,3,4,7

1Fiona Wood Foundation, Murdoch, Australia, 2State Adult Burns Unit – Fiona Stanley Hospital, Murdoch, Australia, 3School of Physiotherapy – The University of Notre Dame Australia, Fremantle, Australia, 4Burn Injury Research Node – The University of Notre Dame Australia, Fremantle , Australia, 5Institute of Health Research – The University of Notre Dame Australia, Fremantle, Australia, 6Department of Plastic and Maxillofacial Surgery – Royal Perth Hospital, Perth, Australia, 7Burn Injury Research Unit – The University of Western Australia, Crawley, Australia

Abstract:

Background: Compression, a common treatment of choice for the management of oedema, is one intervention which is applied with little objective understanding of the optimal parameters of application or efficacy in a patient with an acute burn wound.

Aim: The aim of this study was to determine the effectiveness of different methods of compression for the management of hand oedema following burn injury. The hypothesis tested was: in acute hand burn injury, application of Coban will reduce oedema faster than an off the shelf compression glove.

Methods: A randomised control study of patients in the State Adult Burn Unit presenting with hand burn injury. Compression was randomised to one of two methods of application of Coban customised glove, or a third group receiving an off-the-shelf compression glove (control condition). Repeated volume measures of the hand were recorded using both water displacement volumetry, and a novel application of bioimpedance spectroscopy (BIS). The results were analysed using multi-level mixed effects regressions.

Results: Interim analysis on 79 patients (57 males) demonstrated significant reductions in hand volumes, using all compression methods. Both Coban applications resulted in increased rate of oedema reduction compared to the control glove (method x time interaction, p<0.0001 (BIS) and p=0.0099 (volumetry)).

Spiral application of Coban increased Rzero (impedance of extracellular fluid) by 11.9Ω (13.43%) (95% CI 10.14 to 13.66, p<0.0001). Pinch application of Coban decreased volume by 14.18mL (2.63%) (95% CI -15.71 to -12.64, p<0.0001).

Conclusion: Coban offers greater oedema reduction than off the shelf compression in acute burn wounds.


Biography:

Dale has been a Senior Physiotherapist in the State Adult Burns Unit at Fiona Stanley Hospital in Western Australia for the last 5 years. As part of his role as Clinical Research Fellow with the Fiona Wood Foundation, he is undertaking a PhD through the School of Physiotherapy at The University of Notre Dame Australia. His research is investigating proactive management of oedema following hand and minor burn injury, including the use of bioimpedance spectroscopy as an outcome measure.

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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