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INTRODUCTION: Pressure therapy used to be considered as the mainstay non-invasive treatment of hypertrophic scar. However, the maturation process of hypertrophic scar during pressure therapy process has seldom be reported. Moreover, although early application of pressure therapy after burn injuries is reco6mmended, minimal evidence exists to support it. This study aimed to examine the maturation trajectory of post-burn hypertrophic scars in a 6-month monitored pressure therapy intervention programme and investigate the difference in the trajectory between patients receiving early intervention and patients receiving late intervention. METHODS: Thirty-four patients with sixty-five post-burn hypertrophic scar samples were recruited for the study. All the subjects were treated with a 6-month pressure therapy programme with the pressure dosage regulated using a newly developed pressure therapy system, the Smart Pressure Monitored Suits. The selected scars were assessed with MiniScan XE Spectrocolorimeter on scar pigmentation, and Terason t3000 portable ultrasound imaging equipment on scar thickness. The Vancouver Scar Scale (VSS) was used to evaluate pigmentation, pliability, vascularity and height of the scars. Subjects' report of pain and itch was documented. Assessments were conducted before treatment began and then monthly during the 6 month-intervention process. Patients were further divided into two groups according to the time of intervention post-burn injuries to review differences in the maturation trajectory between those who received early versus late treatment (early intervention group, prescribed within 60days after injuries; late intervention group, prescribed after 61 days). The changes of scar features were recorded to formulate the recovery trajectory of scar, and the outcomes of intervention between the early and the late groups were compared. RESULTS: Pre- and post-treatment comparison demonstrated significant improvement in scar pigmentation, thickness, VSS scores and scores of pain and itch (p<0.01) for the early intervention group. For the later intervention, only scar lightness, yellowness, VSS scores and scores of pain and itch was found with significant improvement (p<0.01). The improvement in these scar characteristics was sustained over time during the treatment process. The early group demonstrated superior effect in improving scar lightness, yellowness (p<0.01), thickness (p<0.01), pigmentation score (p<0.05) and pain score (p<0.01) than the late group in comparison between the two groups at similar post-burn timing. CONCLUSIONS: Hypertrophic scars appeared to undergo continuous improvement in the appearance, pain and itch over time during the process of a monitored pressure intervention programme. Early application of pressure therapy after burn injury may contribute to better outcomes as shown by their faster recovery than those with late intervention. In order to achieve the best outcomes, regular evaluation and adjustment for optimal interface pressure is necessary.

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OBJECTIVE: To determine the physical, functional and psychosocial rehabilitation needs of the injured survivors of the 2013 earthquake in Ya'an, China. DESIGN: Cross-sectional survey. METHODS: A total of 143 injured survivors (80 males, 63 females, mean age 41.4 years (standard deviation (SD) 20.2)) were recruited for the study. A questionnaire was designed to collect their demographic and environmental information. Manual muscle testing and active range of motion (AROM) were used to assess physical function. The Modified Barthel Index was used to assess activities of daily living (ADL) and the Post-Traumatic Stress Disorder - Self Rating Scale was used to assess psychological status. The rehabilitation needs of the injured survivors were identified based on the assessment results. RESULTS: Physical problems of the back and lower limbs were more severe than those of the upper limbs, as measured by MMT and AROM. Various degrees of dependence in ADL were measured in 74.2% of subjects, and psychological distress was present in more than 50% of subjects. Rehabilitation training prescribed by local therapists included functional training (74.8%), exercises (49.0%), provision of splints (44.8%), etc. Psychological interventions were re-commended to most of the patients. There were high levels of need for assistive devices, and home and community modifications. CONCLUSION: There is a high level of need for early rehabilitation in hospital, followed by continued home and community rehabilitation services, particularly for injured survivors who are returning to villages with very limited resources.

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To investigate the effect of pressure therapy (PG), silicone gel sheeting (SGS), and combined therapy on the management of posttraumatic hypertrophic scar (HS) using a randomized controlled clinical trial. A total of 104 subjects with HS mostly resulting from burns and scald injuries (63 men and 41 women; average age: 21.8 +/- 18.7 years) were recruited from Jiangsu People's First Affiliated Hospital in Nanjing, China. The mean scar formation period was 14.9 +/- 30.8 months. All subjects were randomly allocated into four groups, namely the PG, SGS, combined PG and SGS groups, and single-blinded control group for the treatment of 6 months. Standardized scar assessments (pigmentation, vascularity, thickness, pain, and itchiness) were conducted before the intervention, 2, 4, and 6 months of the intervention, and 1 month after completion of the program, respectively, to observe the progress of the treatments. The results showed that the combined therapy seemed to be more effective in improving the thickness of scar after 2 months of intervention (P < .001). After 6 months of intervention, both the combined therapy group and the PG group showed significant improvement in scar thickness. The improvement in scar thickness was most significant in the combined therapy group. SGS was found to be more effective in alleviating the pain and pruritus rather than the scar thickness. This randomized clinical trial has demonstrated the evidence of the effect of combined PG and gel intervention on posttraumatic HS. The PG group showed an improvement in scar thickness too. Further studies are needed to investigate the biomechanical and physiological effect that PG and gel sheeting would exert on the scar tissues.

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INTRODUCTION: A pilot return-to-work program based on the concept of work readiness and three-month job placement with support was developed to enable people with occupational deafness to return to the workforce. METHODS: A convenient sample of six male persons with occupational deafness completed the program. A Pretest-Posttest Single Group Design was utilized to measure the program outcome. Two instruments: the Chinese version of SF-36 Health Assessment Questionnaire and the Chinese version of Lam's Assessment of Stage of employment readiness were used to measure the participants' health status and their work readiness respectively. RESULTS: The preliminary findings indicated that the six participants showed improvement in their general health and work readiness. The employment outcome indicated that three of the participants had secured a job and another two participants had attained job offers. CONCLUSION: This pilot study suggested that a systematic vocational rehabilitation program can facilitate persons with occupational deafness to return to the workforce. Further research using a controlled investigation with larger sample size is recommended for evidence-based practice even though the results of this return-to-work program appear promising.

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This study investigated the psycho-social factors among injured workers and the influence of their psycho-social profile on the readiness of return to work. Sixty-four subjects with injuries on the upper limbs or lower limbs, low back pain, or cumulative trauma disorder were recruited. The workers' profiles (self-perceived physical health, mental health, and work readiness) together with the impact and types of work injury on the workers' perceived wellness were measured. The regression model of work readiness was constructed to develop a theoretical background for predicting work readiness based on different factors. The results showed that injured workers with chronic injury such as low back pain or cumulative trauma had poorer self-perception of physical health and psycho-social/mental health compared to those with direct trauma. The regression analysis further affirmed that self-perceived pain and physical functioning were significant factors influencing the readiness for returning to work. Workers with low back pain were found to have lower motivation for returning to work. Other factors such as the non-verbal intelligence of the injured workers, their anxiety level, and the support they received from family members were found to have some indirect impact on their ability to return to work, but this was not statistically proven.

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