E-Thesis 240 views
Risk factors for burn contractures in lower income countries / RUTHANN FANSTONE
Swansea University Author: RUTHANN FANSTONE
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DOI (Published version): 10.23889/SUthesis.61906
Abstract
Burns are a major cause of mortality and morbidity especially in low-middle income countries (LMICs). Burn contractures are particularly disabling and can occur in over 80% of burn survivors. Existing literature, predominantly from High-Income countries (HICs), demonstrates that risk factors for bur...
| Published: |
Swansea
2022
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| Institution: | Swansea University |
| Degree level: | Doctoral |
| Degree name: | Ph.D |
| Supervisor: | Bodger, Owen ; Price, Patricia |
| URI: | https://cronfa.swan.ac.uk/Record/cronfa61906 |
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| Abstract: |
Burns are a major cause of mortality and morbidity especially in low-middle income countries (LMICs). Burn contractures are particularly disabling and can occur in over 80% of burn survivors. Existing literature, predominantly from High-Income countries (HICs), demonstrates that risk factors for burn contractures are poorly understood, with little agreement on contracture definition or measurement. This study aimed to identify risk factors for burn contracture in LMICs to assist in future prevention strategies. Potential risk factors were identified from the literature and a survey of 17 clinicians with extensive LMIC experience. LMIC sources emphasised socioeconomic considerations more than burn or treatment factors, which predominate in HIC studies. An observational cross-sectional study of 48 adult burn survivors with 126 major joints at risk was undertaken in Bangladesh to evaluate 48 risk factors at person and joint levels, with alpha set at 0.05 for comparative analysis. At person level, employment status, self-discharge and fewer follow-up visits were associated with more severe contractures and greater movement loss. Full-thickness burns were associated with more severe contractures as was younger age at burn. Participants who knew about the risk of contracture development or received pressure treatment had less movement loss; refusal of skin graft was associated with greater movement loss. Joints which had pressure treatment had fewer contractures and grafted joints had less severe contractures. Anatomical location of the joint at risk also significantly affected contracture rates, with implications for the design of future risk factor studies. This thesis presents the most comprehensive framework of contracture risk factors reported to date and reveals important differences between current LMIC risk factors and those in HICs. More work is required to improve whole person and joint outcome measures for accurate determination of risk factors for burn contracture. Recommendations for future research and clinical practice are made. |
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| Keywords: |
burns, burn injuries, contracture, risk factors, lower income countries |
| College: |
Faculty of Medicine, Health and Life Sciences |