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The effects of burn injury on muscle strength in the acute and short term follow-up

(2012) Salet, M.C.W.

Background/objective:
After burn injury patients face several different challenges. In major burn survivors muscle wasting and loss of muscle strength interfere with rehabilitation. It has now been shown in mice that even small burns have a negative effect on muscle strength. The aims of the study were to develop a protocol to test muscle strength in burns patients, to investigate the changes in muscle strength in the acute and short term follow up period after a burn injury in humans and to identify any other factors that might influence muscle strength in burns patients.
Methods/design:.
One examiner performed hand-held dynamometer (HHD) measurements on both left and right biceps, triceps, deltoids, quadriceps and hamstring muscles using the make technique and grip strength testing using a JAMAR dynamometer. QuickDASH and LLFI questionnaires were also performed. Measurements were obtained at regular intervals after injury. To examine the reliability of both dynamometer protocols the intraclass correlation coefficient (ICC) and minimal detectable difference (MDD) were determined. The validity was assessed with random effects linear regression comparisons of gender, age, dominance, burned TBSA and pain score. To determine if there were changes in muscle strength over time a multivariable longitudinal regression (mixed model) was used. The strength values were compared to reference values from a healthy population.
Results:
Thirty patients were included from the Royal Perth Hospital burns service. The reliability of the protocol ranged from ICC 0.77 for quadriceps up to 0.96 for grip strength. The MDD ranged from 3.5 for deltoids up to 12.2 for quadriceps. When using this protocol it is possible to discriminate between the strengths of genders (all P<0.001); and dominance in the muscles where it is relevant (biceps (P=0.04), grip 0.001)). A mean increase in muscle strength for the biceps (0.10 kg per day) and quadriceps (0.17 kg per day) was detected. Compared to population reference values a trend was visible towards lower strength measurements in the sample with patients with burns.
Conclusions:
A reliable protocol was developed to test the muscle strength in patients with minor burns in the acute period following the injury. We have found that the strength of muscles is dependent on several variables and has a different development for each muscle group. The biceps and quadriceps muscles strength outcomes improve significantly over this period. If these improvements have clinical significance is yet to be determined.





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