Functional Outcomes in Patients with Full Thickness Hand Burns

BACKGROUND: There has been previous work objectively examining the severe contractures that develop with hand burns, but few have correlated severity with functional outcome. While contracture definitions exist for restrictions in range of motion (ROM), they have not been linked to prognostic use and functional outcome. OBJECTIVE: The objective of this study is to correlate severity of hand contracture in joints of the hand with differences in functional outcomes scores at discharge. METHODS: This multicenter study uses the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) database, otherwise known as the Burn Injury Model Systems (BMS) National Database. A sample of 95 patients with ROM measurements and the SF-36 physical component score (PCS) to measure functional outcome was used. Patients were grouped by ROM into mild, moderate, or severe contracture definitions. Inclusion criteria included those with burn injuries as defined by the American Burn Association who had recorded ROM deficits. Patients with post-injury amputations were excluded. Statistical analyses were conducted to compare the maximum severity of contracture in both hands on the PCS when the maximum contracture was classified as mild, moderate, or severe. Secondary analysis was used to also compare PCS between mild and moderate versus severe contracture groups. RESULTS: There was no significant difference in PCS for mild, moderate or severe contracture (p = 0.858). There was a downward trend noted in the means between each contracture group, as well as several outliers in the moderate contracture group. Secondary analysis between a combined mild and moderate versus severe contracture group showed no significant difference in PCS between the two groups (p = 0.654) CONCLUSION: The results of this study suggest that although there is a downward trend in PCS that correlates with severity of contracture, the difference in functional outcome as measured by the PCS is not significant between the different ratings of contracture severity. Future studies involving long-term PCS