Burn rehabilitation: State of the science

In most areas, there is not a strong level of evidence to support the usual standard of care interventions in burn rehabilitation. There is, though, good evidence to support the use of oxandrolone in the acute management of burn injury, exercise in a pediatric population, and the use of pain medications (fentanyl) to treat procedure-related pain. The most concerning area in which treatment is not supported by the literature is the treatment of hypertrophic scarring. Pressure garment treatment is utilized at many burn centers, but there is no level I or level II literature to support its use. In fact, articles that studied pressure garments found no significant difference with the use of high-pressure garments compared with lower-pressure garments or no pressure. The study of the prevention and treatment of hypertrophic scarring is an important area of needed research in burn rehabilitation. To study the effects of pressure garments, there is also a need for an objective measurement of the diagnosis and measure of severity of hypertrophic scarring. There is also the need for studies examining intervention for the prevention and treatment of contractures and joint deformities. For psychological complications and interventions, there is fair evidence that hypnosis and immersive VR pain management interventions are effective as adjuncts to pharmacologic treatment. Although research in the area is still scant, VR technology has produced impressive reductions in pain during wound care and acute physical therapy procedures. For PTSD, depression, and body image complications, there is no evidence for burn-specific interventions. Thus, there is a great need for intervention research that adapts treatment methods from other populations to the needs of patients with burn injuries.