Effects of hand continuous passive motion system combined with functional training and pressure gloves in treating early scar contracture after burn on the back of the hand

Objective To observe the effects of hand continuous passive motion (CPM) system combined with functional training and pressure gloves in treating early scar contracture after burn on the back of the hand. Methods A retrospective cohort study was conducted in 43 patients who met the inclusion criteria and were admitted to the First Affiliated Hospital of Air Force Medical University from June 2017 to December 2019 with scar contracture after deep partial-thickness to full-thickness burn on the back of the hand. According to the treatment methods applied, 13 patients were enrolled into pressure glove alone group (9 males and 4 females, aged (31±6) years), 14 patients were enrolled into pressure glove+functional training group (11 males and 3 females, aged (30±5) years), and 16 patients were enrolled into pressure glove+functional training+CPM system group (10 males and 6 females, aged (29±5) years). All the patients in the three groups received skin grafting on the back of the hand. The corresponding rehabilitation treatment was started 6-8 days after wound healing, and the treatment lasted for 3 months. Before treatment and after 3 months of treatment, the total active motion range of the hand was measured to evaluate the motion range of the hand joint and the ratio of excellent and good was calculated; the Carroll upper limb function evaluation method was used to evaluate the upper limb function score, and the difference before and after treatment was calculated; the Vancouver Scar Scale was used to evaluate the scar score, and the difference before and after treatment was calculated. Data were statistically analyzed with chi-square test, Fisher's exact probability test, McNemar's exact probability test, one-way analysis of variance, Bonferroni correction, least significant difference test, Kruskal-Wallis test, and paired sample

test. Results The ratio of excellent and good of the motion range of the hand joint of patients in pressure glove alone group, pressure glove+functional training group, and pressure glove+functional training+CPM system group were 2/13, 2/14, and 3/16 respectively before treatment, and 4/13, 6/14, and 14/16 respectively after 3 months of treatment. The ratio of excellent and good of the motion range of the hand joint of patients was significantly higher in pressure glove+functional training+CPM system group than in the other two groups after 3 months of treatment (

<0.05 or

<0.01). Compared with that before treatment, the ratio of excellent and good of the motion range of the hand joint of patients in pressure glove+functional training+CPM system group was significantly increased after 3 months of treatment (

<0.01). Before treatment, the upper limb function score and hand scar score of patients in the three groups were similar (

=0.598, 0.035,

>0.05). After 3 months of treatment, the upper limb function score of patients was significantly higher in pressure glove+functional training+CPM system group than in pressure glove alone group (

<0.05); the hand scar score of patients was significantly lower in pressure glove+functional training group and pressure glove+functional training+CPM system group than in pressure glove alone group (

<0.05 or

<0.01), and the hand scar score of patients was significantly lower in pressure glove+functional training+CPM system group than in pressure glove+functional training group (

<0.05). Compared with those before treatment, the upper limb function scores of patients were significantly increased (

=-5.295, -7.252, -15.342,

<0.01) and the hand scar scores of patients were significantly decreased (

=13.361, 16.982, 40.334,

<0.01) in pressure glove alone group, pressure glove+functional training group, and pressure glove+functional training+CPM system group after 3 months of treatment. The differences in upper limb function score and hand scar score of patients before and after treatment in pressure glove+functional training+CPM system group were significantly higher than those in pressure glove+functional training group and pressure glove alone group (

<0.05 or

<0.01). The differences in upper limb function score and hand scar score of patients before and after treatment in pressure glove+functional training group were significantly higher than those in pressure glove alone group (

<0.05). Conclusions Hand CPM system combined with functional training and pressure gloves can significantly improve the motion range of hand joint in treating early scar contracture after burn on the back of the hand, with better restoration of hand function and improvement of hand scar. Its effect is better than routine rehabilitation treatment such as functional training, etc., which is worthy of clinical reference.