Bilateral Neuronavigated TBS-20Hz TMS brought more than two-thirds of treatment refractory depressed patients to remission. TBS-20Hz may be critical for obtaining higher remission rates. Controlled trials are warranted.

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Introduction The prescription of splints (orthoses) to help protect vulnerable structures and maintain range of motion after skin grafting is an integral and important part of burn recovery. The degree to which a patient adheres to wearing a prescribed orthosis is believed to play a major role in outcome. However, orthoses may be uncomfortable or undesirable to wear, affecting a patient’s adherence. At our burn center, orthosis application and wear is heavily dependent on staff when patients are in the ICU. As patients move to the acute ward, the responsibility for orthotic use is shared by family and staff and as outpatients, caregivers are primarily responsible. The purpose of our study was to use temperature sensors implanted in the orthoses to objectively determine compliance rates with splint wear during these three different stages of burn recovery. Methods Pediatric patients with skin grafting to the hands who were prescribed a hand splint had a temperature sensing device implanted into their orthosis when it was fabricated and prescribed for wear. The sensors detected higher temperatures when the orthosis was on the patient and lower temperatures when it was not, providing an objective means to determine frequency and duration of wear. The data collected for each patient was compared to the prescribed time as noted in the medical record by the treating therapist. Data was analyzed using descriptive statistics and one-way ANOVA. Results Data were recorded for an average of 50 days for 12 patients using 17 splints during three continuous phases of care: ICU, acute ward, outpatient. Patients in ICU wore their splints 10.4 hours per 24 hour period, resulting in a 102% hourly compliance based on the prescribed wear time. During acute ward care, patients wore their splints for 7.6 hours (89% hourly compliance). As outpatients, subjects wore their splints an average of 6.7 hours (82% hourly compliance). There was no statistical difference in orthotic adherence between the phases of care. Daily compliance (days worn/ days prescribed) showed a similar trend: ICU=100%, ward=90%, OP=88%. Patients or their caregivers were asked to rate their own adherence with splinting at 8 weeks after injury using a 1–4 Likert scale. All but one patient reported the highest level of compliance and described use “as instructed by therapist” (92%). Conclusions This is the first study to objectively measure patient adherence with wearing orthoses over the course of burn recovery. Results show high level of adherence in ICU but demonstrate declining adherence as the patient and caregiver assume more responsibility. This study highlights potential areas for improvement in patient education during transition of care from inpatient, and highlights the need for better understanding of the barriers that exist for long-term orthotic use after hospitalization. Applicability of Research to Practice Prevention of contracture with splints.