Effects of early exercise on the number of joint release interventions in children with severe burns

Introduction: Studies in burned children have demonstrated an increase in lean body mass (LBM) and muscle strength as a result of exercise implemented at 6 months postburn. We hypothesized that earlier exercise (at 3 months postburn) would provide similar benefits and decrease the number of surgeries joint contractures. We investigated a group of patients involved in a supervised, hospital-based exercise program, in combination to physical and occupational therapy (PTEX group), and a group receiving home-prescribed physical and occupational exercises (H group) alone Methods: At admission, patients with ≥40% total body surface area burns were randomized to a PTEX (n=13) or to a H group (n=10). We assessed changes in leg muscle strength and LBM before and after the 3-months training program with isokinetic dynamometry and with dual-energy X-ray absorptiometry, respectively Additionally, we blindly examined both groups at 6 months post completion of exercise, to determine the number of surgical interventions in lower extremity joints. Differences within and between groups were evaluated by paired and unpaired t-tests, and nonparametric tests when appropriate. Statistical significance was set at <0.05 Results: We found a significant improvement in muscle strength of 82% in the PTEX group versus 62% in the H group, as well as a 6% improvement in LBM in the PTEX group versus relatively no change in the H group. After the exercise program, the percentage of patients requiring surgical release in lower extremity joints was less in the PTEX group (8%) than in the H group (40%) Conclusions: A supervised exercise and physiotherapy program as soon after discharged from the burn unit appears to decrease the severity of major joint contractures resulting in a lesser need to intervene surgically to improve function Applicability of Research to Practice: Post-burn scarring is a serious clinical problem in severely burned patients; the use of exercise to reduce contractures is a low-cost, practical approach.