Exercise training for improving outcomes post burns: a systematic review and meta-analysis

Mr Orlando Flores1, Dr. Zephanie Tyack2, Dr. Kellie  Stockton3, Dr. Robert Ware4, Dr. Jennifer Paratz1,5

1Burns, Trauma & Critical Care Research Centre. The University of Queensland, Brisbane, Australia, 2Centre for Children’s Burns and Trauma Research, Child Health Research Centre. The University of Queensland, Brisbane, Australia, 3Physiotherapy Department, Children’s Health Queensland, Brisbane, Australia, 4Menzies Health Institute Queensland, Griffith University, Brisbane, Australia, 5Rehabilitation Science, Griffith University, Brisbane, Australia


Introduction: A systematic review and meta-analysis was performed to determine the effectiveness of different modalities of exercise and to evaluate the safety of exercise-based interventions post-burns.

Methods: Six databases were searched from inception to December 2016. Relevant authors, key journals and reference lists of included studies were hand searched. Articles reporting on exercise interventions in patients post-burn, and considering physical, physiological or psychological outcomes were considered. Two authors independently screened 2,253 records with 19 articles meeting inclusion criteria. The quality of the evidence was assessed at the study level and at the outcome level.

Results: There were no significant differences post exercise training in VO2 peak (g=0.99; 95% CI -0.4 to 2.4: p=0.18), resting energy expenditure (g=-0.51; 95% CI -1.99 to 0.97: p=0.5) and muscle strength (g=0.51; 95% CI -0.03 to 1.05: p=0.07) between the groups. Evidence suggested exercise had a beneficial effect on body composition (g=0.59; 95% CI 0.05 to 1.14: p=0.03), need for surgical release of contractures (Risk Ratio=0.34; 95% CI 0.2 to 0.7; p=0.004) and health-related quality of life. However, a lack of evidence existed regarding the safety of exercise training post-burns. Unbiased effect size estimators (pooled Hedges’s g) with 95% confidence intervals were calculated if there were two or more trials with homogenous outcomes.

Conclusions: Limited evidence suggests that exercise has a beneficial effect on physical and physiological outcomes in patients post-burn. Further trials using high quality methodology are required, with focus on reporting of adverse events, health-related quality of life and psychological outcomes.


Orlando Flores is a PhD candidate in the last stage of his doctoral research project.
His thesis aimed to understand the role of different interventions in the management of metabolic changes occurring post burn injuries.

The use of exercise in burn rehabilitation. A worldwide survey of practice

Mr Orlando Flores1, Dr. Zephanie Tyack2, Dr. Kellie  Stockton3, Dr. Jennifer Paratz1,4

1Burns, Trauma and Critical Care Research Centre. The University of Queensland, Brisbane, Australia, 2Centre for Children’s Burns and Trauma Research, Child Health Research Centre. The University of Queensland, Brisbane, Australia, 3Physiotherapy Department, Children’s Health Queensland, Brisbane, Australia, 4Rehabilitation Science, Griffith University, Brisbane, Australia


Introduction: Exercise interventions have been used to enhance recovery of burn patients affected by hypermetabolism, muscle wasting and contractures. Although the benefits of exercise in burn population have been previously reported, the actual extent of the use of exercise in burn patients worldwide remains unknown. The purpose of this study was to identify the extent and characteristics of exercise use in specialised and non-specialised burn centres worldwide.

Methods: A web-based survey of 47 questions was developed and translated into Spanish and Chinese languages. Distribution of the surveys was made via email using personal contacts of the authors and through six scientific societies related to burn care. Data was analysed using descriptive statistics and comparisons of frequencies were analysed using Chi-square.

Results: One hundred and twenty nine surveys from 25 countries were completed (n = 96, 20 and 13 from the English, Chinese and Spanish versions respectively). The majority of the surveyed professionals worked in cities of 1 million inhabitants or more, and 93.8% worked in hospital-based burn centres. The majority of the surveyed professionals used exercise for rehabilitation of patients following burn injuries (94.58%). The extent of the use of exercise, type of interventions, and comparisons by region will be presented.

Conclusion: The criteria used for prescription and monitoring exercise in burns is variable and exercise programs offered are difficult to standardize. Further investigation is required to elucidate the access to exercise interventions post burns in remote areas and in less developed countries.


Orlando Flores is a PhD candidate in the last stage of his doctoral research project. His thesis aimed to understand the role of different interventions in the management of metabolic changes occurring post burn injuries.

Knowledge is power – developing an online resource of Paediatric burns specific exercises.

Mrs Claire Toose1, Ms Stephanie Wicks1, Ms Cheri Templeton1, Ms Anne Darton2, Ms Rachel Edmondson3, Ms Julie Bricknell3, Ms Joanne Glinsky4, Ms Lisa Harvey4

1The Children’s Hospital at Westmead, Westmead, Australia, 2Agency for Clinical Innovation Statewide Burns Injury Service, St Leonards, Australia, 3Royal North Shore Hospital, St Leonards , Australia, 4John Walsh Centre for Rehabilitation Research, University of Sydney, St Leonards , Australia


Rehabilitation following burn injury is a specialised area, with patient outcomes dependant on the prescription of an individually tailored and highly specific treatment program.

PTX or www.physiotherapyexercises.com is a freely available, web based resource that allows therapists to design exercise booklets for their patients that include pictures and instructions written by expert clinicians in that area. In 2017, PTX and NSW Burns specialist therapists developed a catalogue of appropriate, meaningful and specific exercises for the management of adult burns patients, which were added to the PTX resource. The same group have now embarked on developing a catalogue of specific exercises for managing paediatric patients following burn injury, as the exercises prescribed and treatment course is significantly different for the paediatric population. Paediatric burn survivors have been used to demonstrate each exercise, with both a sketch and photograph of the exercises available on the website to increase understanding.

The PTX website can be accessed by therapists all over the world and used to enhance their understanding of burn specific rehabilitation exercises, design exercise programs that appropriately meet therapy goals, provide printed or mobile app based copies of patient’s individualised exercise program, and monitor compliance with treatment. This is a valuable resource both for experienced burns clinicians who can use it to improve engagement with and effectiveness of their therapy program, and for less experienced clinicians who can use it as a guide to the types of exercises needed to effectively manage the contractile forces of burns scars in specific areas.


Claire Toose works as a Senior Burns Physiotherapist at The Children’s Hospital at Westmead. She has worked in Paediatric Burns for over 10 years, been involved in research in the area, worked collaboratively on projects as part of the NSW Statewide Burns Injury Service, and presented at ANZBA and ISBI in previous years.

“Its All Very Complex!”

Ms Nicole Alexander1, Ms Alison Baillie2, Ms Anna  Lucia3

1The Royal Children’s Hospital , Parkville , Australia, 2The Royal Children’s Hospital , Parkville , Australia, 3The Royal Children’s Hospital , Parkville , Australia


This eco map is a visual presentation of the complex systems surrounding a child who experienced a 20% flame burn to his neck, chest and arm and the linkages made to ensure best outcomes during and post admission at The Royal Children’s Hospital.
The patient presented with an intellectual disability and significant speech delay. The extent of his cognitive and speech delay was not fully understood by his family which initially impacted on our care. He has a complex social situation including history of family violence, substance abuse, and limited supports. He resides with his father and mother resides interstate.
This visual map highlights the complexity surrounding this patient and the multiple interventions accessed during his admission at RCH.
The complex nature of this patient resulted in non-compliance in post burns care with limited participation in therapy. Despite thorough discharge planning, minimal compliance continued in relation to stretches and scar management. He has significant bilateral anterior axilla and neck contractures resulting in restricted movement and limited function.
The ongoing work with this patient and family post discharge are represented with local supports working closely with the patient, family and RCH. This patient faces life long consequences in his physical appearance and mobility if the next stage of his treatment is not successful. By linking with local supports, networks and services our goal is to best prepare the patient and family both emotionally and developmentally for the next stage of his recovery and to reduce the risk of continued non-compliance post-surgery.


Anna has been a Social Worker for the past 18 years across community and health and worked within the Burns Unit at The Royal Children’s Hospital as a Senior Social Worker for the past 4 years.

Therapy-Related Outcome Measures in Burn Care: A Literature Review

Ms Pei Fen Seah1

1Department of Physiotherapy, Singapore General Hospital, , Singapore


The aim of medical care, including burn care, is to enable people to return to functional lives after illness or injury. With burns becoming increasingly survivable, enabling return to functionality has become a high priority. Measuring outcomes is essential for optimising and evaluating the quality of care. Outcome measures allow us to set and maintain standards of care within a service, monitor and compare services nationally and internationally, and interpret research and audit findings. Reflecting its importance, there has been an increasing amount of literature on outcomes for burns care in recent years and much of it is relevant to therapy. A documentation audit conducted on 20 randomly chosen burn injury cases admitted to Singapore General Hospital revealed the lack of consensus on and utilisation of therapy-related outcome measurement tools. To address this gap and select the most relevant therapy-related outcome measures, we conducted a literature review of outcome measures in the areas of joint mobility, strength, functional ability, scar and quality of life. With the employment of the most relevant outcome measures, clinicians and researchers will be able to better evaluate the effectiveness of therapeutic interventions and provide suggestions for further advancements in burn care.


Pei Fen is a Senior Physiotherapist with the Department of Physiotherapy, Singapore General Hospital. She graduated with a Diploma in Physiotherapy from Nanyang Polytechnic, Singapore, in 2008 and is currently pursuing Masters in Burn Care with Queen Mary University, London. Pei Fen has eight years of working experience in managing patients with Burns injuries and Plastic reconstruction surgeries, both in the acute and outpatient settings. In 2012, Pei Fen was awarded the Health Manpower Development Plan (HMDP) fellowship in rehabilitation for burns and reconstructive surgery, which she completed at Shriners Hospital-Galveston and UTMB Blocker Burn Unit, USA.


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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