Authors (including presenting author) :
Chan RWY, Wong EYW, Tsui AYY, Cheung EYY, Chan BTW, Chau RMW
Affiliation :
Physiotherapy Department, Kowloon Hospital
Introduction :
Electrophysical Therapy(EPT) provides various physiological responses in facilitating recovery. The reported therapeutic effects of widely used simple superficial thermotherapy includes reduction of pain and disability(1) & maintenance of mitochondrial function and attenuation of disused muscles atrophy(2). Hydrocollator MHP is commonly adopted for this application in physiotherapy. After an application for 15 minutes, skin temperature is expected to rise between 37-42°C in reaching therapeutic temperature. Protective thermal nociceptors were active when skin temperature falls below 15-18°C or rises above 45°C(3). However, with human body biased sensitivity to cold than warmth & adaptation upon continuous exposure to thermal stimulus(3), patients are vulnerable to burn risk. SAFE-Programme has been launched to uphold quality and safety of EPT.
Objectives :
To review & enhance current practice on safe effective use of moist thermotherapy.
Methodology :
The temperature of the hydrocollator water and MHP were recorded for a week. MHP was wrapped in standard 8 layers of towel and was applied either to the lower back or elbow for 15 minutes. Skin temperature was recorded at start and end of application and highest temperature was attained.
Result & Outcome :
In compliance to the recommendation of the hydrocollator manufacturer, the water temperature of the hydrocollator was set at 74°C with resulting average temperature of MHP at 70.5°C. The highest superficial skin temperature ranges from 43.4-48.4°C were recorded. Research suggested that at 48°C the skin of adults required an average of 5-minute exposure for burn(4). Hence adjustment was made with consideration of the reference of thermostat sensitivity(74°C±5°F). The hydrocollator temperature was tuned down to between 68-72°C. After the adjustment, the average water temperature of the hydrocollator was 70.5°C with that of MHP at 67°C. The highest skin temperature measured from 39.8-41.3°C, were recorded, staying within recommended therapeutic temperature range and safely below the burn-threshold temperature(44°C) by recent review(5).
By fine-tuning the hydrocollator temperature to between 68-72°C based on manufacturer’s recommendation, literatures on human physiology & clinical research evidences together with empirical verification, safe & effective application of thermotherapy was assured. Apparently simple modalities such as MHP may induce paradoxical impression of risk-free but related burn incidents in domestic or even hospital settings were reported. This SAFE-programme with evidence-based conscientious act contributed to the persistent zero incidence and safe culture in department.
References
(1) French_SD, Cameron_M, Walker_BF, Reggars_JW, Esterman_AJ. Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD004750. DOI: 10.1002/14651858.CD004750.pub2.
(2) Hafen PS, Abbott K, Bowden JA, Lopiano R, Hancock CR & Hyldahl RD. (2019). Daily heat treatment maintains mitochondrial function and attenuates atrophy in human skeletal muscle subjected to immobilization. Journal of Applied Physiology.
(3) Jones L. (2009). Thermal touch. Scholarpedia, 4(5), 7955. Retrieved from http://www.scholarpedia.org/article/Thermal_touch
(4) Moritz AR, & Henriques Jr F. (1947). Studies of thermal injury: II. The relative importance of time and surface temperature in the causation of cutaneous burns. The American journal of pathology, 23(5), 695.
(5) Martin N & Falder S. (2017). A review of the evidence for threshold of burn injury. Burns, 43(8), 1624-1639.
