Impact of Early Versus Delayed Physiotherapy on Functional, Pain, and Psychological Outcomes in Adult Burn Patients

Abstract

Background: Burn injuries can lead to chronic disability, chronic pain and psychological trauma, especially in low-resource communities where rehabilitation facilities are often not provided promptly. This study aimed to assess the benefits of early physiotherapy started within 72 hours after admission on functional recovery, pain and psychological outcomes for burn patients.

Methodology: This is a quasi-experimental study in the Burn Care Centre, Pakistan Institute of Medical Sciences (PIMS), Islamabad, from January to August 2023. All 100 burn patients were divided into two comparison groups according to physiotherapy timing of initiation: early (T1) and late (T2). The physiotherapy for Group A was initiated within 72 hours from admission, and in Group B, after 10 days. The rehabilitation protocol consisted of passive range of motion exercises, isometric muscle strengthening, respiratory exercises and pain management. The outcomes measured were muscle strength (Medical Research Council [MRC] score), mobility, functional independence, pain (Visual Analogue Scale [VAS]), anxiety and depression (Hospital Anxiety and Depression Scale [HADS]), and joint flexibility at discharge and three months after discharge.

Results: Patients with early physiotherapy had significantly higher muscle strength, mobility, and functional independence and pain scores at discharge than patients with delayed physiotherapy. Mean HADS anxiety scores decreased from 8.1 ± 2.0 to 5.2 ± 1.5, while HADS depression scores declined from 7.5 ± 1.8 to 4.6 ± 1.4 (both p < 0.001). Failure to achieve a straight joint at discharge was similar between the groups, but early physiotherapy group showed significantly better joint flexibility at three months (92.1% ± 3.8% vs. 78.5% ± 5.2%; p<0.001).

Conclusion: Early physiotherapy intervention (within 72 hours of burn injury) helps to improve functional outcomes, lessen pain and improve psychological outcomes. The results are in favor of the integration of early rehabilitation into the standard care of burns, especially in developing countries where the benefits of timely physiotherapy on long-term patient outcomes could be significant.

Keywords: Contractures, Early Physiotherapy, Low-resource setting, Pain, Rehabilitation