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 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 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 the wound healing, and the treatment lasted for 3 months. Before treatment and after treatment of 3 months, 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 method test, one-way analysis of variance, least significant difference test, Bonferroni correction, paired ttest, and Kruskal-Wallis test. Results: The ratio of excellent and good of the motion range of the hand joint 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 (P>0.05), and 4/13, 6/14, and 14/16 respectively after treatment of 3 months (χ2=10.773, P 0.05). After treatment of 3 months, the upper limb function score of patients was significantly higher in pressure glove+functional training+CPM system group than in pressure glove alone group (P<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 (P<0.05 or P<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 (P<0.05). Compared with those before treatment, the upper limb function scores and hand scar scores of patients in pressure glove alone group, pressure glove+functional training group, and pressure glove+functional training+CPM system group were significantly increased after treatment of 3 months (t=-5.295, -7.252, -15.342, 13.361, 16.982, 40.334, P<0.01). 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 (P<0.05 or P<0.01). The differences of upper limb function score and hand scar score of patients in pressure glove+functional training group were significantly higher than those in pressure glove alone group (P<0.05). Conclusions: Hand CPM system combined with functional training and pressure glove 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.