Serial Casting for Burns Contracture

Recruiting at 1 trial location

Overseen By Zoë Edger-Lacoursière, MSc

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: Centre hospitalier de l'Université de Montréal (CHUM)

Disqualifiers: Frostbite, Neurological disorder, Psychiatric, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 3

12 Participants Needed

Trial Summary

What is the purpose of this trial?

The use of a splint, serial casting and passive stretching have been described in the literature as conservative interventions to manage joint contractures after burn injury. There is a paucity of literature investigating the effect of serial casting on scar contractures following upper extremity (UE) burn injury in adults and a lack of studies using strong methodological approaches. There are also no studies investigating the effect of casting on hypertrophic scars (HSc) and on self-reported UE function. This study is a longitudinal case series design with a criteria for change on the use of serial casting for the treatment of upper extremity burn contractures. The purpose of this study is to estimate the extent to which range of motion (AROM and PROM), scar characteristics and patient-reported upper-extremity function changes following an individually-tailored serial casting treatment program after switching from one week of usual care and to determine if these changes can be maintained 3 weeks after stopping serial casting, for adult burn survivors who developed an upper-extremity joint contracture greater than 15% normal range of motion within 1-year post-burn. This study will be a longitudinal case series design with a criteria for change. A minimum of 12 participants will be recruited from the "Centre d'expertise pour les victimes de brûlures graves de l'ouest du Québec" (CEVBGOQ) and will undergo one week of "usual care". If the PROM of the joint does not improve after one week of usual care, the participant will start the serial casting process, which will be prescribed by the treating OT. PROM/AROM and scar characteristics will be measured using a revised goniometry protocol that incorporates cutaneokinematics (CKM) principles and precise skin measures (DermaScan C, Cutometer®, Mexameter® and Tewameter®) at baseline, every Monday and Friday of the treatment weeks and 3 weeks after treatment cessation. Self-reported UE function and satisfaction related to scarring will be assessed at baseline and 3 weeks after treatment cessation using the QuickDASH and the patient satisfaction assessment scale (PSAS). Analysis on ROM and scar characteristic will be conducted using a graphical representation with a projected "usual care" regression line to count how many outcomes were over the line once the treatment was introduced. This study will contribute to building evidence for the use of serial casting following UE burn contractures in the adult population.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of the treatment Tailored serial casting intervention for burns contracture?

Research shows that serial casting can effectively improve movement in joints affected by burn contractures, with studies reporting significant increases in range of motion and improvements in scar appearance. It is a simple, cost-effective method that can work even when other treatments fail, and it may reduce the need for surgery. ^{1 2 3 4 5}

How does the treatment of serial casting for burn contractures differ from other treatments?

Serial casting is unique because it provides continuous pressure and stretch to the contracted tissue, which helps increase the range of motion and can be effective even when traditional methods like massage, exercise, and splinting fail. It is a non-surgical option that can be particularly useful for patients who are noncompliant or when other devices cannot be sized appropriately, offering immediate results with minimal complications. ^{1 2 3 4 6}

Research Team

Bernadette Nedelec, PhD

Principal Investigator

CRCHUM

Eligibility Criteria

This trial is for adult burn survivors who have lost more than 15% of their normal range of motion in joints like fingers, wrists, or elbows due to fire, flame, or scald burns. They must understand English or French and be able to follow the study's procedures. People with frostbite, chemical/electrical burns, certain psychiatric/cognitive disorders, neurological injuries from the burn, pre-existing conditions affecting movement, heterotopic ossification or when stretching is not advised cannot join.

Inclusion Criteria

I am 16 years old or older.

I am a burn survivor with significant movement loss in my hand or arm.

Have provided informed consent

Exclusion Criteria

I have been diagnosed with bone growth in abnormal places.

I cannot understand English or French.

I have had frostbite, chemical, or electrical burn injuries.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

1 week

1 visit (in-person)

Usual Care

Participants receive one week of usual care to assess improvement in PROM

1 week

1 visit (in-person)

Serial Casting Treatment

Participants undergo tailored serial casting intervention if no improvement in PROM is observed

Tailored to patient's needs

Visits every Monday and Friday

Follow-up

Participants are monitored for changes in ROM, scar characteristics, and self-reported function 3 weeks after treatment cessation

3 weeks

1 visit (in-person)

Treatment Details

Interventions

• Tailored serial casting intervention

Trial Overview The trial tests a tailored serial casting treatment on adults with upper extremity burn contractures. It compares one week of usual care followed by serial casting if there's no improvement in joint movement. The effects on scar characteristics and self-reported arm function are measured over time and compared against expected outcomes without this intervention.

Participant Groups

Group I: Serial casted joint Experimental Treatment 1 Intervention

Tailored serial casting intervention following 1 week of usual care

Who Is Running the Clinical Trial?

Centre hospitalier de l'Université de Montréal (CHUM)

Lead Sponsor

Trials

389

Recruited

143,000+

Findings from Research

In a study involving 15 patients with burn contractures, serial casting resulted in a significant mean increase of 54% in joint range of motion, demonstrating its effectiveness over traditional treatments.

The method was well-accepted by patients, had minimal complications, and successfully delayed or eliminated the need for surgical intervention, making it a practical option even for noncompliant patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Serial casting: a method for treating burn contractures. Bennett, GB., Helm, P., Purdue, GF., et al.[2006]

Serial casting was successfully used to treat severe ankle plantar-flexion contractures in a child with a 49% total body surface area scald burn, improving the range of motion from 45 degrees of plantar flexion to neutral dorsiflexion over 2 months.

This case report suggests that serial casting can be an effective alternative to splinting and exercise for correcting contractures after burns, highlighting the need for further research to validate its efficacy in burn care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Serial casting of the lower extremity to correct contractures during the acute phase of burn care. Johnson, J., Silverberg, R.[2019]

Serial casting is an effective and low-cost method for correcting burn scar contractures, providing consistent pressure and stretch to the affected tissue without the risk of patient removal.

In a case study of a 2-year-old with severe ankle contractures, serial casting was highlighted as a viable alternative to dynamic splinting, especially when patient compliance is a concern.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Serial casting as a technique to correct burn scar contractures. A case report. Ridgway, CL., Daugherty, MB., Warden, GD.[2019]

In a study involving seven patients with burn scar contractures, serial casting significantly improved joint range of motion from an average of 65.8° to 108.1° and reduced scar severity on the Modified Vancouver Scar Scale from 9.5 to 4.9.

The therapeutic effects were achieved within an average of 8.5 days and 4 new cast applications, suggesting that a standardized serial casting protocol could be developed for effective burn scar contracture rehabilitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Serial Casting as an Effective Method for Burn Scar Contracture Rehabilitation: A Case Series. Schetzsle, S., Lin, WWC., Purushothaman, P., et al.[2023]

A systematic review of 25 studies involving children with Cerebral Palsy found that lower limb serial casting effectively improves ankle dorsiflexion range of motion, reduces hypertonicity, and enhances functional gait outcomes in the short to mid-term.

While serial casting combined with botulinum toxin type-A showed greater improvements in ankle dorsiflexion compared to casting alone, it did not significantly impact overall gross motor function, indicating that while beneficial, the clinical significance of the additional improvement may be limited.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effects of serial casting on lower limb function for children with Cerebral Palsy: a systematic review with meta-analysis. Milne, N., Miao, M., Beattie, E.[2021]

In a study of 52 children under 3 years old with infantile idiopathic scoliosis, serial casting effectively corrected major spinal curves, with an average initial curve of 47° and significant improvements observed after treatment.

There was no significant difference in curve correction between those treated with pediatric hip spica tables and those treated with Risser or Mehta tables, indicating that the type of casting table used does not impact the effectiveness of the treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Outcomes for patients with infantile idiopathic scoliosis by casting table type. Marrache, M., Prasad, N., Thompson, GH., et al.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

Serial casting: a method for treating burn contractures. [2006]

2. United States pubmed.ncbi.nlm.nih.gov

Serial casting of the lower extremity to correct contractures during the acute phase of burn care. [2019]

3. United States pubmed.ncbi.nlm.nih.gov

Serial casting as a technique to correct burn scar contractures. A case report. [2019]

4. England pubmed.ncbi.nlm.nih.gov

Serial Casting as an Effective Method for Burn Scar Contracture Rehabilitation: A Case Series. [2023]

5. England pubmed.ncbi.nlm.nih.gov

The effects of serial casting on lower limb function for children with Cerebral Palsy: a systematic review with meta-analysis. [2021]

6. England pubmed.ncbi.nlm.nih.gov

Outcomes for patients with infantile idiopathic scoliosis by casting table type. [2022]