Impact of ROM Exercises on Pain and Functional Ability in Patients With Second -Degree Burns
Conditions
Keywords
Range of motion exercises , Pain , Functional ability , Burn injury
Brief summary
The goal of this quasi-experimental study is to evaluate the effect of range of motion (ROM) exercises on pain and functional ability among adult patients of both genders with second-degree burn injuries affecting the upper and/or lower extremities. The main questions addressed by the study are: Do range of motion exercises reduce pain levels among patients with second-degree burn injuries? Do range of motion exercises improve the functional ability of burned upper and/or lower extremities among patients with second-degree burn injuries? A comparison between the study group receiving range of motion exercises and the control group receiving routine care will be conducted to evaluate the effects of range of motion exercises on pain levels and functional ability. Study participants will undergo the following procedures: Assessment of pain levels before implementing range of motion exercises. Assessment of the functional ability of burned upper and/or lower extremities before implementing range of motion exercises. Implementation of range of motion exercises for the study group according to the study protocol. Provision of routine care to the control group. Post-intervention assessment of pain levels and functional ability to evaluate changes following the intervention.
Detailed description
Burn injuries represent a significant global public health concern because of their potential to cause physical impairment, prolonged hospitalization, psychological distress, and reduced quality of life. The consequences of burn injuries extend beyond the initial tissue damage and may include persistent pain, restricted mobility, muscle weakness, joint stiffness, scar formation, and limitations in daily activities. These complications may affect functional independence and increase the need for rehabilitation and supportive care. Second-degree burns, also known as partial-thickness burns, involve the epidermis and part of the dermis. These burns are classified into superficial partial-thickness and deep partial-thickness burns according to the depth of tissue involvement. Superficial partial-thickness burns commonly present with blisters, a moist wound surface, and significant pain. Healing generally occurs within approximately two to three weeks, depending on the extent of the injury and the healing process. Deep partial-thickness burns extend further into the dermis and may require a longer healing period, with an increased risk of scarring and functional impairment. Pain is one of the most common and distressing symptoms experienced by patients with burn injuries. Burn-related pain may arise from the initial injury, wound care procedures, tissue healing, and restricted movement. Pain intensity varies according to the depth, extent, and location of the burn, as well as the stage of recovery. Persistent pain may limit movement, reduce participation in rehabilitation activities, and interfere with the performance of activities of daily living. Burn injuries affecting the upper and lower extremities may lead to restricted joint mobility, muscle weakness, scar contractures, and impaired functional performance. Such limitations can interfere with essential daily activities, including dressing, bathing, eating, grooming, walking, and personal hygiene. Functional impairment may be particularly significant when burns involve the hands, arms, legs, or joints, where adequate mobility is essential for independent movement and self-care. Range of motion (ROM) exercises are therapeutic movements designed to maintain or improve joint mobility, preserve flexibility, and reduce movement restrictions. These exercises are generally classified into three types: active range of motion (AROM), passive range of motion (PROM), and active-assisted range of motion (AAROM). AROM exercises involve independent joint movement performed by the patient. PROM exercises involve joint movement performed by a healthcare professional without active participation from the patient. AAROM exercises involve active movement with assistance from a healthcare professional when additional support is required to complete the movement. ROM exercises may play an important role in the rehabilitation of patients with burn injuries by maintaining joint mobility, minimizing stiffness, and supporting the recovery of functional movement. Appropriate exercises may facilitate the gradual restoration of movement in affected extremities and support the performance of daily activities. The selection and implementation of exercises depend on the patient's clinical condition, the location and extent of the burn, and any relevant medical contraindications. The evaluation of pain and functional ability is essential for determining the potential benefits of ROM exercises among patients with second-degree burn injuries. Assessment of pain intensity and the functional performance of affected upper and lower extremities before and after the intervention can help identify changes associated with the exercise program. Comparison of outcomes between the study group receiving ROM exercises and the control group receiving routine care will provide information regarding the effectiveness of ROM exercises in reducing pain and improving functional ability among patients with second-degree burn injuries. Despite the importance of rehabilitation in burn care, further evaluation of the effects of range of motion (ROM) exercises on pain and functional ability among patients with second-degree burn injuries is warranted. Assessing changes in pain intensity and the functional ability of affected upper and lower extremities may provide valuable evidence regarding the role of ROM exercises in improving rehabilitation outcomes. Therefore, the present study aims to evaluate the effects of ROM exercises on pain and functional ability among patients with second-degree burn injuries through a comparison between a study group receiving ROM exercises and a control group receiving routine care.
Interventions
A structured, individualized ROM exercise program will be implemented for study group with second-degree burn injuries affecting the upper or lower extremities. The program will be conducted three times daily for three consecutive weeks. Each targeted joint movement will be repeated 10 times and maintained for 30 seconds within the available pain-free range of motion. Exercises will target the shoulders, elbows, and wrists of the upper extremities and the hips, knees, and ankles of the lower extremities, according to the location of the burn injury. The exercises will be demonstrated and supervised by the researcher during hospitalization and performed according to the study protocol
Sponsors
Al-Azhar University
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Masking description
This study will be conducted using an open-label design. No masking procedures will be implemented, as participants, care providers, the principal investigator, and outcome assessors will be aware of group allocation.
Intervention model description
The principal investigator will be responsible for participant recruitment and group allocation through individual face-to-face interviews, with an average of four patient evaluations per week. A purposive sample of 80 eligible patients will be recruited and divided into two groups: a study group (n = 40) and a control group (n = 40), without random assignment. Baseline Assessment Before the implementation of the intervention, baseline assessments will be conducted for participants in both groups. Pain intensity will be assessed using the Numeric Pain Rating Scale (NPRS). Functional ability of the affected upper and/or lower extremities will be assessed using the Upper Extremity Functional Index (UEFI) and the Lower Extremity Functional Scale (LEFS), according to the location of the burn injury. Intervention Protocol: Range of Motion Exercises Analgesic Management: Participants in both groups will receive analgesic medications prescribed by the attending physicians according to hospita
Eligibility
Sex/Gender
ALL
Age
18 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* Adult patients (18 to 60 years old) from both genders recently diagnosed with second degree burn injury. * The burn in upper limb and/or lower limb injury.
Exclusion criteria
* Neurological problems such as a history of joint problems (rheumatoid arthritis, osteoarthritis, and any joint abnormality), serious fracture, amputation and severe infection. * Contraindications to ROM such as chronic obstructive pulmonary disease (COPD) and deep venous thrombosis (DVT).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Patient's Structured Interview Questionnaire | Baseline assessment before the intervention | It will be divided into two parts and written in the Arabic language. Part 1: Patient's demographic characteristics It aims to assess patient' age, gender, marital status, degree of education …. etc. Part 2: Medical health profile It aims to assess information on the patient's present history, past history. It will include cause of burn, degree of burn, percent of burn, first aid, skin graft, limb affected, date of admission and date of discharge. |
| Change in Pain Intensity | Baseline assessment before the intervention and follow-up assessment at the end of 3 weeks. | Pain Numeric Rating Scale It will be used to assess the patient's level of pain through asked the patient to make four pain ratings from 0 to 10 score, corresponding to current, no pain, mild, moderate and severe pain experienced. Scoring system * 0 (no pain) * 3 (mild pain) * 4 - 6 (moderate pain) * 7- 10 (severe pain) |
| Change in Functional Ability of the Affected upper Extremities | Baseline and 3 weeks after the intervention | Upper Extremity Functional Index (UEFI) It will be used to assess upper extremities functional abilities of patients with burn injury in performing activities of daily living. The scale lists 20 activities, and the patient gives a score to each based on the difficulty they have completing that activity. The maximum possible score is 80 points, indicating very high function. The minimum possible score is 0 points, indicating very low function. This scale has 5-point rating scale, ranging from 0 to 4. 0 indicates extreme difficulty or unable to perform activity while 4 indicates no difficulty. A lower score indicates that the person is reporting increased difficulty with the daily activities as a result of their limb condition. * (0 - 9) extreme extremity functional limitation. * (10 - 31) severe extremity functional limitation. * (32 - 52) moderate extremity functional limitation. * (53 - 79) mild extremity functional limitation. * (80) no extremity functional limitation. |
| Change in Functional Ability of the Affected lower Extremities | Baseline and 3 weeks after the intervention | Lower Extremity Functional Scale (LEFS) It will used to assess the functional limitation of a patient with lower extremities burn injury. The scale lists 20 activities, and the patient gives a score to each based on the difficulty they have completing that activity. This scale has 5-point rating scale, ranging from 0 to 4. 0 indicates extreme difficulty or unable to perform activity while 4 indicates no difficulty. A lower score indicates that the person is reporting increased difficulty with the daily activities as a result of their limb condition. * (0 - 9) extreme extremity functional limitation. * (10 - 31) severe extremity functional limitation. * (32 - 52) moderate extremity functional limitation. * (53 - 79) mild extremity functional limitation. * (80) no extremity functional limitation. |
Contacts
CONTACTFatin A Ahmed, Bachelor Degree of Nursing
CONTACTManal S Hassan, PhD
STUDY_DIRECTORManal Hassan, PhD
Professor of Medical Surgical Nursing, Faculty of Nursing, Ain Shams University, Cairo, Egypt.
STUDY_DIRECTORAbeer W Aziz, PhD
Professor of Medical Surgical Nursing, Faculty of Nursing, Ain Shams University, Cairo, Egypt.
Outcome results
None listed