The evidence for the effectiveness of nonpharmacological intervention strategies administered during physiotherapy for reducing pain in patients who have suffered burn injuries: A Systematic Review

Background: The goal of physiotherapy for burn patients is to achieve maximal physical and functional recovery, but the rehabilitation process can often increase the amount of pain a patient experiences. Burn patients rely heavily on pharmacological analgesic, but pain perceptions remain uncontrolled. The inadequate pain control for the burn population is a globally recognized health issue. In turn, there is a need for therapeutic interventions to manage the various types of pain experienced as result of a burn injury. Therefore, physiotherapy needs to incorporate non-pharmacological strategies in addition to standard physical therapy sessions to manage pain. Aim: The aim of this systematic review is to evaluate the effectiveness of interventions used during physiotherapy for reducing pain in patients recovering from burn injuries. Objective: The objective is to evaluate the effectiveness of hypnosis, progressive muscle relaxation, laser therapy (LT), virtual reality (VR), purposeful play, whole body vibration (WBV), interactive video games (IVG), music, ultrasound (UT), and matrix rhythm therapy (MRT) on reducing pain for patients with burn injuries during physiotherapy. In turn, this review will summarize the interventions that were the most effective. Methodology: Using keyword combinations, literature searches were conducted with a variety of electronic databases including PubMed, Scopus, MEDLINE and CINAHL. Eligible publications included studies, which had evaluated the effectiveness of strategies used to decrease pain for burn patients during physiotherapy treatment. Included studies were published in English up to April 2018 and required to have the full text available. Methodological quality of included articles was evaluated using the Caldwell et al. (2011) framework. Each appraisal question received a numerical value 0-2; the maximum score was 36 and the quality scale range was: poor 0-12, good 13-24 and very good 25-36. Results: Of the initial 2309 studies identified, 28 full articles were screened and 16 met the inclusion criteria. One article was of good quality and 15 were of very good quality. Ten of the included studies reported that interventions had reduced pain for burn patients during physiotherapy. Of the included articles, one study using hypnosis, one study using progressive muscle relaxation, one study using WBV and two studies using LT were effective in reducing pain. The majority (3/4 studies) using VR, and one out of four studies using IVG also provided pain relief. Seven of the included studies reported no significant effect for interventions in pain management including: one study using music, one study using UT and two studies using MRT. Conclusion: Strategies used during physiotherapy can be effective in reducing pain incurred as a result of a burn injury. Therefore, non-pharmacological strategies provided during physiotherapy could be used in conjunction with analgesia to assist in pain management. Future studies will however need to include larger sample sizes, provide long-term follow-ups, and utilize more randomized control trials