Physiotherapeutic and dietetic parameters in burns patients modelling a multidisciplinary approach to burns practice: A bi-disciplinary illustration of interrelated factors

Objective: Early mobilisation and early enteral feeding after burn injury are two of the most important treatment therapies for optimal recovery. These factors form a part of a team approach, but research has historically focused on one discipline at a time and its effects in isolation; integrated inter-disciplinary influences are not typically studied. This observational study combines strategies and outcomes from the disciplines of nutrition and physiotherapy in an attempt to part-way exemplify the team approach. Methods: Patients were recruited through the Burns Unit records and divided into two groups: Group 1 constituted burn patients who were mobilised before surgery and Group 2 constituted burn patients who were mobilised after surgery. Results: Patients mobilised after surgery had significantly greater burn surface area, significantly fewer days to wait for surgery (3.4 vs 6.9 days, p < 0.01), significantly more days to mobilise after burn injury (13 vs 2.3 days, p < 0.05), and significantly more time to achieve independent mobilization (42 vs 19.5 days, p < 0.05); they had a significantly longer stay in intensive care (10.8 vs 4.1 days, p < 0.05), and a longer hospital stay (p < 0.05). These patients also had significantly greater episodes of diarrhoea (11.6 vs 4.1 episodes, p < 0.05), significantly lower albumin levels and more days on antibiotics compared with the group of patients who were mobilised before surgery (p < 0.05). Patients mobilised after surgery waited longer to be enterally fed (89 days vs 62.5 days), and although this was not statistically significant, it may be clinically significant. There were significant correlations between independent mobilisation and diarrhoea, independent mobilisation and albumin, length of stay and diarrhoea (p < 0.05). Regression analysis showed hours taken to commence enteral feeding and days in ICU predicted diarrhoea (p < 0.05). Conclusions: This study illustrates the combined approach of two disciplines and their interrelated factors. Mobilisation appears to interrelate with nutrition factors, and this includes diarrhoea (which is likely a manifestation of gut effects due to the nature and timing of substrate delivery). A few factors were revealed in this interrelation that have not been documented previously in burns, namely the associations between mobilisation, diarrhoea, and serum albumin. Team members need to ensure inclusion of key recommendations from other disciplines when a particular, crucial factor from one discipline cannot be applied. Results in this study need to be interpreted with caution due to the small sample size, the use of statistical applications with sample size, and the retrospective nature of the study. A larger, more rigorous prospective research study is required to confirm these results. Crown Copyright (c) 2020 Published by Elsevier Ltd. All rights reserved.