Background Skeletal muscle wasting is one of the systemic hallmarks of severe burn injuries. The underlying mechanisms of muscle wasting post-burn, and in particular the differences between muscle fiber types, are not well understood. This study aimed to investigate the protein signaling pathways involved in skeletal muscle atrophy following severe burn injury. Methods 11 rats were submitted to sham injury and 11 rats to a severe burn (40% total body surface area burn) using the Walker-Mason burn model. Muscle samples from predominantly type II m. extensor digitorum longus (EDL) and predominantly type I m. soleus (SOL) were collected 40 days post-burn. Body and muscle weights, immunohistochemistry and Western blotting were used to assess anthropometric differences and the expression of key proteins involved in protein imbalance causing muscle wasting. Results Rats with severe burn injury showed less body weight gain (39.73 ± 10.97 g vs 77.12 ± 4.83 g; p < 0.01) and lower muscle wet weights of both SOL (123.1 ± 3.63 mg vs 102.7 ± 3.67 mg; p < 0.001) and EDL (127.9 ± 2.95 mg vs 110.3 ± 2.80 mg; p < 0.001) compared to sham-treated rats. Immunohistochemical analysis revealed no significant differences in fiber type distribution between the groups. Western blot analysis showed altered expression of proteins involved in protein synthesis and proteolysis pathways, with differences between SOL and EDL muscles. In SOL, severe burns induce inhibition of anabolic pAkt (p < 0.0001) and eEF2 signaling (p < 0.05), while in EDL increased levels of pAkt (p < 0.01) were found. Catabolic E3 ligases MURF1,2,3 and Atrogin-1 show higher activation in SOL after severe burn injury (p < 0.0001; both) but not in EDL, where decreases were found (p < 0.0001; p < 0.001; respectively). Analysis of myokines post-burn in SOL show lower expression of Decorin (p < 0.0001) and higher of myostatin (p < 0.0001), but in EDL both myostatin and irisin expressions were lower (p < 0.001; p < 0.05; respectively). Conclusions Severe burn injury resulted in skeletal muscle wasting, as evidenced by decreased body weight gain in growing rats and reduced muscle weights. Protein signaling pathways related to protein synthesis and proteolysis are dysregulated in muscles of burned rats, with significant differences between slow- and fast-twitch muscles. Further research is needed to understand the long-term effects of postburn metabolism on skeletal muscle protein balance and develop targeted therapies to prevent muscle wasting in burn survivors.

The chemotherapeutic agent doxorubicin (DOX) leads to the loss of skeletal muscle and adipose tissue mass, contributing to cancer cachexia. Experimental research on the molecular mechanisms of long-term DOX treatment is modest, and its effect on both skeletal muscle and adipose tissue has not been studied in an integrative manner. Dexrazoxane (DEXRA) is used to prevent DOX-induced cancer-therapy-related cardiovascular dysfunction (CTRCD), but its impact on skeletal muscle and adipose tissue remains elusive. Therefore, this study aimed to investigate the long-term effects of DOX on adipose tissue and skeletal muscle metabolism, and evaluate whether DEXRA can mitigate these effects. To this end, 10-week-old male C57BL6/J mice (n = 32) were divided into four groups: (1) DOX, (2) DOX-DEXRA combined, (3) DEXRA and (4) control. DOX (4 mg/kg weekly) and DEXRA (40 mg/kg weekly) were administered intraperitoneally over 6 weeks. Indirect calorimetry was used to assess metabolic parameters, followed by a molecular analysis and histological evaluation of skeletal muscle and adipose tissue. DOX treatment led to significant white adipose tissue (WAT) loss (74%) and moderate skeletal muscle loss (Gastrocnemius (GAS): 10%), along with decreased basal activity (53%) and energy expenditure (27%). A trend toward a reduced type IIa fiber cross-sectional area and a fast-to-slow fiber type switch in the Soleus muscle was observed. The WAT of DOX-treated mice displayed reduced Pparg (p < 0.0001), Cd36 (p < 0.0001) and Glut4 (p < 0.05) mRNA expression—markers of fat and glucose metabolism—compared to controls. In contrast, the GAS of DOX-treated mice showed increased Cd36 (p < 0.05) and Glut4 (p < 0.01), together with elevated Pdk4 (p < 0.001) mRNA expression—suggesting reduced carbohydrate oxidation—compared to controls. Additionally, DOX increased Murf1 (p < 0.05) and Atrogin1 (p < 0.05) mRNA expression—markers of protein degradation—compared to controls. In both the WAT and GAS of DOX-treated mice, Ppard mRNA expression remained unchanged. Overall, DEXRA failed to prevent these DOX-induced changes. Collectively, our results suggest that DOX induced varying degrees of wasting in adipose tissue and skeletal muscle, driven by distinct mechanisms. While DEXRA protected against DOX-induced CTRCD, it did not counteract its adverse effects on skeletal muscle and adipose tissue.

BACKGROUND: Many adult dancers suffer from low back pain (LBP), which interferes with their movement strategies. A group that merits further attention are adolescent dancers as high levels of physical activity are associated with a higher risk to develop LBP. OBJECTIVE: The aims of this cross-sectional study were (i) to investigate if delayed bone maturation and aberrant menstrual cycle were present in pre-professional female adolescent dancers and (ii) whether these ailments or other physical impairments could be related to LBP. OUTCOME MEASURES: Bone maturation, menstrual cycle, hypermobility, scoliosis, and LBP. METHODS: Eligible female dancers were recruited among dancers aged 14-18 yrs in a secondary school specialized in dance. One-way ANOVA was used for the variables to determine significant differences between groups and the repeated measures ANOVA test was used to determine the significant differences within groups. Significance level was determined at 0.05. RESULTS: Fifteen out of 50 dancers reported a history of LBP. Significant differences were observed between calendar age and skeletal age in adolescent dancers (p<0.05). A considerable proportion of dancers showed delayed bone maturation (32%) or an aberrant menstrual cycle (53%), but this was not related to LBP (p>0.05). Scoliosis and generalized joint hypermobility were also not related to LBP (p>0.05). However, dancers with a history of LBP started dancing 2 years earlier (p<0.01), had significantly less hip internal rotation (p<0.05), and showed asymmetrical hip ROM (p<0.05). CONCLUSION: Based on the results of current study, delayed bone maturation and menstrual cycle disorders are common in pre-professional female dancers, but this was not related to LBP. Additionally, out of 27 variables, only starting dance activities under age 6 years old, showing hip asymmetry, and showing less internal hip rotation may be contributing factors for the development of LBP in pre-professional dancers. Med Probl Perform Art 2024;39(4):162-168.

Background: Despite being a stable component of burn rehabilitation at later stages of recovery, exercise training is not commonly provided during the acute phase of burns. A lack of evidence surrounding its efficacy and safety in severely burned adults has hampered its implementation in acute burn care. The aim of this study was to investigate the capacity of early exercise training to modulate parameters of postburn muscle wasting and quality of life. Methods: Adults <65 years of age with burns >= 40% total burn surface area (TBSA) were randomly allocated to either receive early exercise (n = 29) in addition to standard care or standard care alone (n = 29). Early exercise involved resistance and aerobic training, which commenced as early as possible and lasted for a duration of 6 to 12 weeks, in line with burn center length of stay. Ultrasound-derived quadriceps muscle layer thickness (QMLT) and rectus femoris cross-sectional area (RF-CSA), lower limb muscle force, Eurocol Quality of Life-5 Dimensions and Burn Specific Health Scale Brief (BSHS-B) were assessed 6 and 12 weeks after baseline. Mixed models were fitted to compare between-group changes over time. Results: A total of 58 adults [42 (95% confidence interval 40-45) years old; 40-94% TBSA range, 86% previously mechanically ventilated] participated in this study. Exercise commenced 7 days [IQR (interquartile range) 5-9] after burn center admission with an attendance rate of 93%. Allocation to the exercise group had a protective effect on the loss of muscle size from baseline to 6 weeks of follow-up (QMLT: beta-coefficient: 0.05 cm, p = 0.010; RF-CSA: beta-coefficient: 0.05 cm(2), p = 0.045), and resulted in an improved recovery from 6 to 12 weeks (QMLT: beta-coefficient: 0.04 cm, p = 0.01; RF-CSA: beta-coefficient: 0.06 cm(2), p < 0.001). Muscle force increased significantly more in the exercise group than in the control group (beta-coefficient: 3.102 N, p < 0.001) between 6 and 12 weeks. Besides a marginally significant effect for the BSHS-B domains 'affect' and 'interpersonal relationships' between 6 and 12 weeks, no benefits were observed in the other assessed quality-of-life measures. No serious adverse events were reported in the exercise group. Conclusions: The results of this study support the use of early exercise training as a feasible and efficacious therapeutic strategy to manage burn-related changes in muscle size and strength in adults with acute severe burn injury.

Fibrosis is characterized by scarring and hardening of tissues and organs. It can affect every organ system, and so could result in organ failure due to the accumulation of extracellular matrix proteins. Previous studies suggest that mechanical forces (such as shockwave therapy, SWT) initiate a process of mechanotransduction and thus could regulate fibrosis. Nevertheless, it is largely unexamined which pathways are exactly involved in the application of SWT and can regulate fibrosis. The present article seeks to elucidate the underlying effect of SWT on fibrosis. Evidence shows that SWT activates macrophage activity, fibroblast activity, collagen amount and orientation and apoptosis, which ultimately lead to an adaptation of inflammation, proliferation, angiogenesis and apoptosis. The included articles reveal that other proteins and pathways can be activated depending on the energy levels and frequency of SWT. These findings demonstrate that SWT has beneficial effects on fibrosis by influencing the proteins and pathways. Based on these data, which highlights the underlying mechanisms, we can make preliminary conclusions about the treatment modalities of SWT in scar formation, such as the energy levels and frequencies that are necessary to prevent or treat fibrotic tissue.

Purpose This study aimed to investigate the difference in absolute and fat free mass (FFM)-adjusted resting energy expenditure (mREE) and body composition (body weight, fat mass (FM), FFM) between breast cancer survivors (BCs) and controls. Correlations with body composition were analyzed. We examined if survival year, or being metabolically dysfunctional were predictive variables. Methods A cross-sectional analysis was conducted on 32 BCs ≤5 years post treatment and 36 healthy controls. Indirect calorimetry measured absolute mREE. Body composition was determined by BOD POD. FFM-adjusted mREE was calculated (mREE/FFM). The Harris-Benedict equation was used to predict REE and determine hyper−/hypometabolism (mREE/pREE). The database of the multidisciplinary breast clinic of the University Hospital of Antwerp was consulted for survival year and metabolic dysfunctions. Results BCs have similar absolute mREE and greater FFM-adjusted mREE compared to controls. Absolute mREE and body composition between BCs differed; adjusted mREE was similar. FFM correlated significantly with absolute mREE in BCs. A significant interaction term was found between survival year and FM for absolute mREE. Conclusion BCs have similar absolute mREE, but higher FFM-adjusted mREE. Differences in body composition between BCs are suggested to cause inter-individual variations. We suggest that increased FFM-adjusted mREE is caused by metabolic stress related to cancer/treatment. Accurate measurement of REE and body composition is advised when adapting nutritional strategies, especially in patients at risk for developing metabolic dysfunctions.

Following burns a sustained catabolic stress response is activated, resulting in skeletal muscle wasting. A better understanding of the underlying mechanisms of postburn skeletal muscle wasting is essential for the development of preventive and/or therapeutic strategies. Six weeks old female rats underwent a sham, 10% or 40% total body surface area scald burn. Ten days post-injury, severely burned animals gained significantly less weight compared to sham treated and minor burned animals, reflected in a significantly lower ratio of muscle to total body weight for Soleus (SOL) and Extensor Digitorum Longus (EDL) in the severely burned group. Postburn, total fiber number was significantly lower in EDL, while in SOL the amount of type1 fibers significantly increased and type2 fibers significantly decreased. No signs of mitochondrial dysfunction (COX/SDH) or apoptosis (caspase-3) were found. In SOL and EDL, eEF2 and pAKT expression was significantly lower after severe burn. MURF1,2,3 and Atrogin-1 was significantly higher in SOL, whilst in EDL MURF1,2,3 was significantly lower postburn. In both muscles, FOXO3A was significantly lower postburn. This study identified postburn changes in muscle anthropomorphology and proteins involved in pathways regulating protein synthesis and breakdown, with more pronounced catabolic effects in SOL.

Background Breast cancer (BC) is the most prevalent tumor in women. Improvements in treatment led to declined mortality, resulting in more survivors living with cancer- or therapy-induced comorbidities. In this study, we investigated the impact of neoplasia and chemotherapy on resting energy expenditure (REE) and body composition, in relation to cancer-related fatigue. Inflammatory parameters were checked as possible explanation for changes in REE. Methods Fifty-six women participated: 20 women with BC and 36 healthy controls. Patients were assessed at baseline (T0) and follow-up (T1) after 12 weeks of chemotherapy. Controls were measured once. REE was assessed with indirect calorimetry: body composition (body weight, fat mass, fat-free mass) by air plethysmography. The multidimensional fatigue index (MFI-20) was used to analyze fatigue. Baseline measurements of patients were compared to results of the healthy controls with the independent-samples T -test. The paired-samples T -test investigated the effects of chemotherapy from T0 to T1. A Pearson correlation analysis was conducted between REE, body composition, and fatigue and between REE, body composition, and inflammatory parameters. A linear regression analysis was fitted to estimate the contribution of the significantly correlated parameters. The measured REE at T0 and T1 was compared to the predicted REE to analyze the clinical use of the latter. Results At baseline, patients with BC had significantly higher REE in the absence of differences in body composition. From baseline to T1, REE and body weight did not change. In contrast, fat-free mass declined significantly with concordant increase in fat mass. Fatigue deteriorated significantly. C-reactive protein at baseline predicted the change in energy expenditure. Predicted REE significantly underestimated measured REE. Conclusions Women with BC have higher REE in the tumor-bearing state compared to healthy controls. Chemotherapy does not affect REE but alters body composition. Predictive equations are invalid in the BC population. Results of our study can be used to implement personalized nutritional interventions to support energy expenditure and body composition and minimize long-term comorbidities.

After a severe burn injury, a systemic stress response activates metabolic and inflammatory derangements that, among other, leads to muscle mass loss (muscle wasting). These negative effects on skeletal muscle continue for several months or years and are aggravated by short-term and long-term disuse. The dynamic balance between muscle protein synthesis and muscle protein breakdown (proteolysis) is regulated by complex signalling pathways that leads to an overall negative protein balance in skeletal muscle after a burn injury. Research concerning these molecular mechanisms is still scarce and inconclusive, understanding of which, if any, molecular mechanisms contribute to muscle wasting is of fundamental importance in designing of therapeutic interventions for burn patients as well. This review not only summarizes our present knowledge of the molecular mechanisms that underpin muscle protein balance but also summarizes the effects of exercise on muscle wasting post-burn as promising strategy to counteract the detrimental effects on skeletal muscle. Future research focusing on the pathways causing post-burn muscle wasting and the different effects of exercise on them is needed to confirm this hypothesis and to lay the foundation of therapeutic strategies.

AIMS: Low back pain (LBP) is a common health problem in pre-professional dancers which could hamper the dancers’ professional career. However, pre-professional dancers are not often studied, although they may have their own pain perceptions and coping strategies towards LBP. Considering the biopsychosocial nature of LBP, it is important to increase the understanding of these perceptions and coping strategies. The aim of this qualitative research study was to explore the dancers’ perceptions about LBP and their coping strategies when they suffered from LBP. METHODS: Eighteen pre-professional dancers with and without LBP from different dance schools in Belgium were included in this study. Participants were invited for an in-depth online video interview. These in-depth interviews were based on a topic list. Afterwards, the interview transcripts were analyzed thematically. RESULTS: Two primary themes emerged from the data: 1) perceptions of LBP and 2) coping strategies which dancers applied when they suffered from LBP. The perceptions about LBP were related to two different themes: “it’s all about the body” and “it’s all about the psychosocial and contextual factors.” In addition, the coping strategies were divided into “active coping strategies” and “passive coping strategies,” whereas the most popular coping strategies were stretching exercises and passive coping strategies such as massages or heating cream. CONCLUSION: Although LBP has clearly been shown to be a biopsychosocial phenomenon, this qualitative study showed that dancers mainly considered biomedical factors as contributing factors to LBP. Additionally, instead of relying on coping strategies aimed at directly improving pain or trying to treat LBP on the basis of a single-cause diagnosis, it is important to consider the biopsychosocial origin of LBP in the management plans.

Objectives: Exercise training during the acute phase of burns is difficult to implement but offers potential benefits. This multicenter trial explored the effects of an exercise program on muscular changes and quality of life during burn center stay. Methods: Fifty-seven adults with burns ranging between 10% and 70% TBSA were allocated to receive either standard of care (n = 29), or additionally exercise (n = 28), consisting of resistance and aerobic training, commenced as early as possible according to safety cri- teria. Muscle wasting (primary outcome), quantified by ultrasound-derived quadriceps muscle layer thickness (QMLT) and rectus femoris cross-sectional area (RF-CSA), muscle strength and quality of life (Burn Specific Health Scale-Brief (BSHS-B) and EQ-5D-5L) were assessed at baseline, four and eight weeks later, or hospital discharge. Mixed models were used to analyze between-group changes over time with covariates of interest added in stepwise forward modeling. Results: The addition of exercise training to standard of care induced significant im- provements in QMLT, RF-CSA, muscle strength and the BSHS-B subscale hand function (ss- coefficient. 0.055 cm/week of QMLT, p = 0.005). No added benefit was observed for other quality-of-life measures. Conclusions: Exercise training, administered during the acute phase of burns, reduced muscle wasting, and improved muscle strength throughout burn center stay. (c) 2023 Elsevier Ltd and ISBI. All rights reserved.

Abstract Background Nutritional support is often based on predicted resting energy expenditure (REE). In patients, predictions seem invalid. Indirect calorimetry is the gold standard for measuring EE. For assessments over longer periods (up to days), room calorimeters are used. Their design makes their use cumbersome, and warrants improvements to increase utility. Current study aims to compare data on momentary EE, obtained by a basic respiration room vs. classical ventilated hood. The objective is to compare results of the basic room and to determine its 1)reliability for measuring EE and 2)sensitivity for minute changes in activity. Methods Two protocols (P1; P2)(n = 62; 25 men/37 women) were applied. When measured by hood, participants in both protocols were in complete rest (supine position). When assessed by room, participants in P1 were instructed to stay half-seated while performing light desk work; in P2 participants were in complete rest mimicking hood conditions. The Omnical calorimeter operated both modalities. Following data were collected/calculated: Oxygen uptake ( $$\dot{\mathrm{V}}$$ V ˙ O2(ml/min)), carbon dioxide production ( $$\dot{\mathrm{V}}$$ V ˙ CO2ml/min), 24h_EE (kcal/min), and respiratory exchange ratio (RER). Statistical analyses were done between modalities and between protocols. The agreement between 24h_EE, $$\dot{\mathrm{V}}$$ V ˙ O2 and $$\dot{\mathrm{V}}$$ V ˙ CO2 obtained by both modalities was investigated by linear regression. Reliability analysis on 24h_EE determined ICC. Results No significant differences were found for 24h_EE and $$\dot{\mathrm{V}}$$ V ˙ O2. $$\dot{\mathrm{V}}$$ V ˙ CO2 significantly differed in P1 + P2, and P2 (hood > room). RER was significantly different (hood > room) for P1 + P2 and both protocols individually. Reliability of 24h_EE between modalities was high. Modality-specific results were not different between protocols. Discussion/conclusion The room is valid for assessing momentary EE. Minute changes in activity lead to a non-significant increase in EE and significant increase in RER. The significant difference in $$\dot{\mathrm{V}}$$ V ˙ CO2 for hood might be related to perceived comfort. More research is necessary on determinants of RER, type (intensity) of activity, and restlessness. The design of the room facilitates metabolic measurements in research, with promising results for future clinical use.

Objectives: Despite the impact of muscle wasting after burn, tools to quantify muscle wasting are lacking. This multi-centre study examined the utility of ultrasound to measure muscle mass in acute burn patients comparing different methodologies. Methods: B-mode ultrasound was used by two raters to determine feasibility and inter-rater reliability in twenty burned adults following admission. Quadriceps muscle layer thickness (QMLT) and rectus femoris cross-sectional area (RF-CSA) were measured, comparing the use of i) a single versus average measurements, ii) a proximal versus distal location for QMLT, and iii) a maximum-versus no-compression technique for QMLT. Results: Analysis of twenty burned adults (50 years [95%CI 42-57], 32%TBSA [95%CI 23-40]) yielded ICCs of > 0.97 for QMLT (for either location and compression technique) and > 0.95 for RF-CSA, using average measurements. Relative minimal detectable changes were smaller using no-compression than maximum-compression (6.5% vs. 15%). Using no -compression to measure QMLT was deemed feasible for both proximal and distal locations (94% and 96% of attempted measurements). In 9.5% of cases maximum-compression was not feasible. 95% of RF-CSA measurements were successfully completed.Conclusion: Ultrasound provides feasible and reliable values of quadriceps muscle architecture that can be adapted to clinical scenarios commonly encountered in acute burn settings.(c) 2022 Elsevier Ltd and ISBI. All rights reserved.

Background: Compression is a cornerstone modality in edema treatment. Different types of bandages are available in clinical practice. Short-stretch bandages are commonly used; however, newer technologies such as the two-component compression system are available as well. This study assesses the pressure curves and static and dynamic stiffness (Static Stiffness Index [SSI] and Dynamic Stiffness Index [DSI]) of two different two-component compression systems, Coban and CoFlex, for edema treatment. Methods and Results: For this prospective cohort study, 12 healthy volunteers were recruited. The healthy volunteers wore both two-component compression systems for 48 hours. Pressure sensors (PicoPress®; Microlab, Italy) were placed at 10 and 25 cm above the internal malleolus and 10 pressure readings were used to obtain pressure curves. The SSI and DSI were assessed. Additionally, comfort (ICC compression questionnaire) and adverse events were assessed as well. Both two-component compression systems exert a sufficient amount of sub-bandage pressure, although CoFlex exerts systematically significantly lower pressure in comparison with Coban. This difference in sub-bandage pressure remains constant over 48 hours. Both two-component compression systems are sufficiently stiff (stiffness >15 mmHg) and remain stiff over time. Conclusions: Both two-component compression systems have pressure curves that are high enough to motivate their use in the treatment of chronic edema. Additionally, both systems were found to be comfortable and have clinically effective SSI and DSI values.

Currently, no standardised screening tools nor established interventions are available to address the characteristics of back pain (BP) specifically in horse riders. Therefore, the aim of this case-control study is to explore sport-specific and functional characteristics of BP in horse riders. 16 professional and 16 amateur riders (25±7 years) participated in two questionnaires (a sport-specific questionnaire and the Oswestry Disability Index questionnaire) and were examined via the physical functional movement screening (FMS) and Luomajoki’s motor control (MC) screening. The lifetime prevalence of BP was as high as 81%, and spinal discomfort in horse riders was mainly located in the lumbar spine. Professional riders revealed significantly higher prevalence of BP in the last month before assessment (P=0.014) than amateur riders. Compared to horse riders using dressage or multiple saddle types, show jumping riders (n=10) who only use jumping saddles (P=0.027) also revealed higher BP prevalence. Horse riders with lower scores on the FMS and MC screening, and thereby with more movement dysfunctions, were found to experience higher levels of pain (r=-0.582, P=0.001; r=-0.404, P=0.024, respectively) and disability caused by BP (r=-0.688; P<0.001; r=-0.474; P=0.006, respectively). Both physical screening tools are found to be clinically relevant enabling investigators to identify objective functional characteristics related to BP in horse riders. The high prevalence of BP in riders is a clinically important finding that should be explored further to elucidate the causes and subsequently guide occupational health in horse riders.

Recent Advancements in Hematology: Knowledge, Methods and Dissemination is a series of commentary article which is published on a biannual basis by the editorial board of the journal Hemato [...]

Communication in the field of biomedical research today involves professionals of numerous backgrounds, including researchers, doctors, public administrators, politicians, and health journalists [...]

This study is the first to examine prosthesis design and appearance in healthy children towards prosthesis for children using a questionnaire. 119 typically developing children between the age of seven and twelve years were included. Their reactions were evoked by priming them to several types of assistive devices. Most of the participants clearly preferred the electrical prosthesis, proving the uncanny valley is applicable to primary school children. The life-like prosthesis was chosen three times more in the girl group, in contrast with the boys who rather prefer the robotic prosthesis and the self-drafted prosthesis. As age increased, a shift was observed from appearance to functionality. Results can be used to minimize stigma and enhance compliance of assistive aids in children with an upper limb reduction.

Background: Hypermetabolism, muscle wasting and insulin resistance are challenging yet important rehabilitation targets in the management of burns. In the absence of concrete practice guidelines, however, it remains unclear how these metabolic targets are currently managed. This study aimed to describe the current practice of inpatient rehabilitation across Europe. Methods: An electronic survey was distributed by the European Burn Association to burn centres throughout Europe, comprising generic and profession-specific questions directed at therapists, medical doctors and dieticians. Questions concerned exercise prescription, metabolic management and treatment priorities, motivation and knowledge of burn-induced metabolic sequelae. Odds ratios were computed to analyse associations between data derived from the responses of treatment priorities and knowledge of burn-induced metabolic sequelae. Results: Fifty-nine clinicians with 12.3 +/- 9 years of professional experience in burns, representing 18 out of 91 burn centres (response rate, 19.8%) across eight European countries responded. Resistance and aerobic exercises were only provided by 42% and 38% of therapists to intubated patients, 87% and 65% once out-of-bed mobility was possible and 97% and 83% once patients were able to leave their hospital room, respectively. The assessment of resting energy expenditure by indirect calorimetry, muscle wasting and insulin resistance was carried out by only 40.7%, 15.3% and 7.4% respondents, respectively, with large variability in employed frequency and methods. Not all clinicians changed their care in cases of hypermetabolism (59.3%), muscle wasting (70.4%) or insulin resistance (44.4%), and large variations in management strategies were reported. Significant interdisciplinary variation was present in treatment goal importance ratings, motivation and knowledge of burn-induced metabolic sequelae. The prevention of metabolic sequelae was regarded as the least important treatment goal, while the restoration of functional status was rated as the most important. Knowledge of burn-induced metabolic sequelae was linked to higher importance ratings of metabolic sequelae as a therapy goal (odds ratio, 4.63; 95% CI, 1.50-14.25; p <0.01). Conclusion: This survey reveals considerable non-uniformity around multiple aspects of inpatient rehabilitation across European burn care, including, most notably, a potential neglect of metabolic outcomes. The results contribute to the necessary groundwork to formulate practice guidelines for inpatient burn rehabilitation.