When to Start Rehabilitation in Full-Thickness Burns
Rehabilitation should begin on day one of admission for patients with full-thickness burns, not after wound healing or hospital discharge. 1
Immediate Initiation (Day 1)
Start rehabilitation interventions immediately upon admission once the patient is medically stable, as this is a critical element in daily burn care that directly impacts long-term functional outcomes. 1, 2 The rehabilitation process is not a post-healing activity but an integral component of acute burn management that runs parallel to medical stabilization and wound care. 1
Key Early Rehabilitation Goals
- Maintain range of motion through positioning and early mobilization to prevent contracture development from day one. 1, 3
- Minimize contracture formation through splinting, positioning, and therapeutic exercises initiated in the acute phase. 1, 3
- Prevent deconditioning by beginning reconditioning activities as soon as medically appropriate to prepare patients to function within their physical abilities. 2
- Address activities of daily living early, encouraging maximum independence with assistive devices as needed. 2, 3
Medical Stability Requirements
While rehabilitation starts immediately, the patient must be medically stable enough to participate. This means:
- Hemodynamic stability following initial fluid resuscitation for severe burns. 4
- Adequate pain control using multimodal analgesia to allow participation in rehabilitation activities. 4
- Ability to identify rehabilitation goals, which indicates sufficient cognitive function to engage in the process. 4
Multidisciplinary Team Approach
Rehabilitation requires a coordinated team approach from admission, not individual practitioners working in isolation. 1 This team should include:
- Physicians managing medical complications and coordinating care. 3
- Physical therapists for mobility, strengthening, and range of motion. 3
- Occupational therapists for functional activities and activities of daily living. 3
- Nursing staff incorporating rehabilitation principles into daily care. 2
Common Pitfalls to Avoid
Do not wait for wound healing or skin graft take before starting rehabilitation, as this delay leads to preventable contractures and functional disability. 1, 2 Burns can leave patients with severely debilitating contractures when rehabilitation is delayed or inadequate. 1
Do not view rehabilitation as separate from acute burn care—all team members providing daily care should incorporate rehabilitation principles and view the patient holistically with consideration for final functional outcomes. 2
Do not underestimate the importance of early intervention—the initial vital phases of preventing and controlling scarring processes begin immediately and directly impact long-term function. 2
Continuation Beyond Acute Phase
Rehabilitation continues for months to years after the initial injury, extending well beyond hospital discharge. 1 The process encompasses physical, psychological, and social aspects of recovery, as burn patients commonly experience difficulties in all these areas. 1