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Risk factors for burn contractures: A cross-sectional study in a lower income country

RuthAnn Fanstone Orcid Logo, Patricia Price Orcid Logo, Owen Bodger Orcid Logo, Tom Potokar, Mohammad Rabiul Karim Khan, RUTHANN FANSTONE, Tom Potokar Orcid Logo

Burns, Volume: 50, Issue: 2, Pages: 454 - 465

Swansea University Authors: Owen Bodger Orcid Logo, RUTHANN FANSTONE, Tom Potokar Orcid Logo

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Abstract

Risk factors for burn contractures require further study, especially in low and middle-income countries (LMICs); existing research has been predominantly conducted in high income countries (HICs). This study aimed to identify risk factors for burn contractures of major joints in a low-income setting...

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Published in: Burns
ISSN: 0305-4179
Published: Elsevier BV 2024
Online Access: Check full text

URI: https://cronfa.swan.ac.uk/Record/cronfa64577
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Abstract: Risk factors for burn contractures require further study, especially in low and middle-income countries (LMICs); existing research has been predominantly conducted in high income countries (HICs). This study aimed to identify risk factors for burn contractures of major joints in a low-income setting. Potential risk factors (n=104) for burn contracture were identified from the literature and a survey of clinicians with extensive experience in low and middle-income countries (LMIC). An observational cross-sectional study of adult burn survivors was undertaken in Bangladesh to evaluate as many of these risk factors as were feasible against contracture presence and severity. Forty-eight potential risk factors were examined in 48 adult patients with 126 major joints at risk (median 3 per participant) at a median of 2.5 years after burn injury. Contractures were present in 77% of participants and 52% of joints overall. Contracture severity was determined by measurement of loss of movement at all joints at risk. Person level risk factors were defined as those that were common to all joints at risk for the participant and only documented once, whilst joint level risk factors were documented for each of the participant’s included joints at risk. Person level risk factors which were significantly correlated with loss of range of movement (ROM) included employment status, full thickness burns, refusal of skin graft, discharged against medical advice, low frequency of follow up and lack of awareness of contracture development. Significant joint level risk factors for loss of ROM included anatomical location, non-grafted burns, and lack of pressure therapy. This study has examined the largest number of potential contracture risk factors in an LMIC setting to date. A key finding was that risk factors for contracture in low-income settings may differ substantially from those seen in high income countries, which has implications for effective prevention strategies in these countries. Better whole person and joint outcome measures are required for accurate determination of risk factors for burn contracture. Recommendations for planning and reporting on future contracture risk factor studies are made.
Item Description: In Press
Keywords: Burn contractures, risk factors, cross-sectional study, Low middle-income countries, Bangladesh
College: Faculty of Medicine, Health and Life Sciences
Funders: This research was funded by the National Institute for Health Research (NIHR) (project reference:16.137.110) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK government.
Issue: 2
Start Page: 454
End Page: 465