Burns – Occupational Therapy Evidence-based Interventions

Commonly used occupational therapy interventions for burns include:

  • Physical activity and conditioning
  • Pain management
  • Scar management
  • Orthoses and Splints
  • Participation in Occupations

Physical Activity and Conditioning

Occupational therapists can promote therapeutic activities and exercise to help correct impairments and improve musculoskeletal function. Specific bottom-up strategies include addressing strength, flexibility (ROM), endurance, stability, and balance to promote functioning in a pain-free state. Aerobic exercise may be incorporated as well and include functional activities such as walking for occupations.

Muscle strength has been shown to be significantly lower in burn patients compared to healthy controls. A structured exercise program can provide substantial improvements in both children and adults.

Widely used assessment parameters in practice include:

  • Range of Motion (75%)
  • Manual Muscle Testing (61%)
  • Quality of Life (61%)
  • Oxygen Consumption (17%)
  • Lean Body Mass (6%)
  • Patient Tolerance (6%)
  • 6-Minute Walk Test (4%)
  • Borg’s Rating of Perceived Exertion (2%)
  • Grip Strength (2%)
  • Other Scales (1%)

Home exercise programs are often prescribed upon discharge (88%) of participants. Exercises may include resistive activities and should also incorporate cardiopulmonary conditioning exercises based on the patient’s preferences. Cardiopulmonary activity has been shown to contribute to faster recovery of functional independence after burns.

Pain Management

Common complaints:

  1. Tingling
  2. Stiffness
  3. Cold
  4. Numbness
  5. Warmth
  6. Pins and Needles
  7. Electric Shock
  8. Other sensations: cramping, itching, etc.

Interventions and modalities that may be effective for pain management after burns include:

  • Ultrasound (0.125 to 3 watt/cm2, 1-3 MHz) – commonly used to promote wound healing during the inflammatory, proliferative, and remodeling phases.
  • Electric stimulation and laser treatment (LT) – which accelerates the reactions needed for quality fibroblast activity and healing.
  • Virtual Reality – evidence of VR used in conjunction with pharmacological analgesics to help reduce both pain and anxiety during painful dressing changes and therapy sessions.10 

Other methods include: music therapy, guided imagery, biofeedback, progressive muscle relaxation11 , and other distractions (e.g., tablet games).12  The OT should also provide needed psychological support throughout all stages of recovery as survivors may experience body image issues, anxiety, depression, nightmares and hallucinations depending on the total body surface area of the burns.13 

Strategies should address itching (pruritus) for patients with burns (87% of patients). Topical treatments may alleviate symptoms. These include aloe vera, vaseline-based creams, cocoa butter, mineral oil, hydrogel sheets, topical glucocorticoids, silicone gels, compression garments, and massage therapy.14 

Scar Management

Scar Characteristics:

  • Location
  • Height: thickness, thinness
  • Texture: normal, smooth, dry, firm, lump, callous, soft, supple, scabby, shiny, wrinkled
  • Color and pigmentation15 

Addressing risk factors:

  • Infection
  • Anatomic location
  • Burn severity
  • Burn depth

Wound Healing stages:

  1. Inflammation
  2. Proliferation
  3. Remodeling

OT Management:

  • Edema management (including wraps)
  • Range of motion exercises16 
  • Elevation
  • Splinting in antideformity position: Intrinsic plus for the hand17 
  • Scar massage for management and hypersensitivity
  • Pressure garments – shown to decrease hypertrophic scar height18 
  • Laser therapy19 20 


Splinting may be used throughout all phases of recovery as appropriate. OTs commonly splint in the antideformity position to manage tissue lengthening.21  Early splinting is key to recovery and to prevent contractures. Patients who wear splints for longer durations, e.g., 6 months, have less of a chance of developing scar contractures. Splinting types for burns include: static, progressive, and dynamic. Overall, splints should be simple, consider the wound depth, and range of motion. OTs should educate patients and staff on the wearing schedule and how to check for proper fit as well as be re-evaluated regularly. A commonly used schedule is 2 hours on and 2 hours off.22  Specific splints are beyond the scope of this article.


Burns can significantly impact one’s ability to return to meaningful occupations. Occupational therapists can use the therapeutic use of self and a holistic approach to treatment to promote occupational engagement.23  In acute care, OTs often address basic ADLs. However, other occupations such as return to work and social integration are important as well.24 

One consideration when working with burn survivors is their physical appearance. Be sensitive and ask if they are mentally prepared to see themselves in the mirror instead of having them caught by surprise. Seeing themselves may contribute to stress, anxiety, and depression if too early.

A useful measure is the COPM for burns to address the aspect of meaningful occupations through rehabilitation.25  The Occupational Adaptation model can be useful for the burn population as it is holistic and focuses on enhancing the individual’s ability to adapt to occupational challenges.26  Other commonly used measures include the FIM and CARE Tool in rehabilitation.

Clients should be encouraged to play a role in decision-making and to be made to feel in control. For example, patients may decide on the length and type of therapy they choose to participate in that is meaningful to them in addition to the commonly addressed BADLs.

Novel methods such as Wiihab and VR may be beneficial as they provide distractions and help to promote healing and rehabilitation. Don’t be afraid to use your creativity in therapy for patients with burns – have a little fun with it!

In closing, although these four aspects of burns are typically addressed, they are not the only aspects. By using a patient-centered and holistic approach with a focus on prevention, healing, and participation in meaningful occupations, occupational therapists can provide a valuable service to this population as they overcome major physical and mental barriers to recovery.


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  15. : L.L. Jones, et al., Outcomes important to burns patients during scar management and how they compare to the concepts captured in burn-specific patient reported outcome measures, Burns (2017), https://doi.org/10.1016/j.
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  19. Laser resurfacing and remodeling of hypertrophic burn scars: the results of a large, prospective, before-after cohort study, with long-term follow-up. Hultman CS, Friedstat JS, Edkins RE, Cairns BA, Meyer AA Ann Surg. 2014 Sep; 260(3):519-29; discussion 529-32.
  20. Biology and principles of scar management and burn reconstruction. Tredget EE, Levi B, Donelan MB Surg Clin North Am. 2014 Aug; 94(4):793-815.
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  25. Mc Kittrick, A., Jones, A., Lam, H., & Biggin, E. (2021). A feasibility study of the Canadian Occupational Performance Measure (COPM) in the burn cohort in an acute tertiary facility. Burns.
  26. Schkade & Schultz, 1992