The effectiveness of adherence interventions in patients with burns: A systematic review

Ms Jessica Killey1, Dr Megan Simons1,2, Professor Roy Kimble1,2, Dr Zephanie Tyack1

1Centre for Children’s Burns and Trauma Research, UQ, South Brisbane, Australia, 2Lady Cilento Children’s Hospital, South Brisbane, Australia


Background: Treatments targeting scarring post burns may be time-consuming and difficult for patients to follow. A broad systematic review was conducted to establish interventions that improve adherence in patients with skin injuries or conditions and to ascertain their effectiveness. This paper will focus on the results of studies examining burns.

Methods: MEDLINE, EMBASE, CINAHL and Web of Science were searched for randomised-controlled trials and non-randomised study designs. Adults and children with skin injuries (burn, surgical or traumatic wounds/scars) or skin conditions (psoriasis, atopic dermatitis and acne) were included, with adherence as the primary outcome. Two independent reviewers screened, extracted data and completed the Cochrane risk of bias tool.

Findings: Seventeen randomised controlled trials (RCTs) with populations including burns (n = 2), lacerations (n = 1), psoriasis (n = 5), atopic dermatitis (n = 2) and acne (n = 7) were included. A narrative synthesis of results was completed. Two RCTs in adults with burns found that educational packages (online, video, written and verbal components) significantly improved self-reported adherence to silicone or pressure garments. However, these two trials had a high or unclear risk of bias. Large standardised mean differences (SMD) [SMD = 2.01 (95%CI: 1.02, 3.01); 1.50 (95%CI: 0.91, 2.08)] favoured the educational intervention groups.

Discussion: Educational interventions in patients with burns are promising but results should be interpreted cautiously due to a high risk of bias. Interventions that may increase adherence to treatment in burns will be discussed from the broader systematic review findings.

Trial registration PROSPERO ID 95082


Jessica Killey is an occupational therapist who has previously worked with adults with burn injuries. She is currently completing her PhD which is focussed on optimising adherence to scar treatments in children with burns and their families.

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