Serial Casting for Burns Contracture
Recruiting in Palo Alto (17 mi)
+1 other location
Age: Any Age
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: Centre hospitalier de l'Université de Montréal (CHUM)
Disqualifiers: Frostbite, Neurological disorder, Psychiatric, others
No Placebo Group
Approved in 1 Jurisdiction
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.
12345How 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.
12346Eligibility 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
+1 more
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.
+4 more
Trial 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)
Participant Groups
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.
1Treatment groups
Experimental Treatment
Group I: Serial casted jointExperimental Treatment1 Intervention
Tailored serial casting intervention following 1 week of usual care
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
Montreal Burn UnitMontreal, Canada
Hôpital de réadaptation Villa MédicaMontreal, Canada
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Who Is Running the Clinical Trial?
Centre hospitalier de l'Université de Montréal (CHUM)Lead Sponsor
References
Serial casting: a method for treating burn contractures. [2006]The purpose of this study was to assess the effectiveness of serial casting of burn contractures that were resistant to traditional methods of treatment such as paraffin therapy, massage, exercise, and splinting. Serial casting was used to increase the range of motion in 35 joints in 15 patients with burns. A mean increase of 54% was achieved. Casting provided immediate results with minimal complications and was accepted well by patients. Casts were easy to apply and effective even with noncompliant patients. They also delayed or eliminated the need for surgical correction.
Serial casting of the lower extremity to correct contractures during the acute phase of burn care. [2019]Severe contractures that develop early following a burn may not improve with splinting and exercise treatment. An alternative treatment is serial casting, which has been used to promote increased range of motion, to facilitate patient compliance with positioning, and to prevent the patient from scratching the burned area. This case report describes the use of serial casting for resolution of ankle plantar-flexion contractures that occurred in the acute phase of burn injury. The child described in this case report sustained a 49% total body surface area scald burn and developed contractures within 1 week after injury. The contractures, which were not corrected with thermoplastic splints, improved with casting from 45 degrees of plantar flexion to neutral dorsiflexion over 2 months with biweekly cast changes. The patient had multiple skin grafts and progressed in functional activities. Serial casting is a conservative and effective modality in correcting contractures resulting from burns. Further documentation of the efficacy of this treatment approach is necessary to support its use in burn care throughout various stages of healing.
Serial casting as a technique to correct burn scar contractures. A case report. [2019]Serial casting is a fast, relatively simple, and inexpensive way to effectively correct burn scar contractures. Plaster casts provide circumferential pressure and a prolonged stretch to contracted tissue and cannot be removed by the patient. When casts are applied well and padded appropriately, there is little risk of pressure areas, since the casts are conforming and do not slip distally. Serial casting may be a successful alternative when low-force dynamic splinting cannot be sized small enough for a child, or when patient compliance is unreliable. A case study of a 2-year-old male patient with severe plantar-flexion contractures of the ankles is presented.
Serial Casting as an Effective Method for Burn Scar Contracture Rehabilitation: A Case Series. [2023]Guidelines and protocols for orthoses in burn scar contracture rehabilitation are limited. The current study aims to determine the optimal frequency of casting, potentially facilitating the development of a serial casting protocol. Previous literature supporting casting has low generalizability due to methodology limitations. Seven patients with burn scar contracted joints, who did not respond to traditional therapy, were recruited in this study. Patients were serially casted once, three times, or five times a week. Joint range of motion was maximized with stretching and exercise techniques before every new cast application. Across all patients, active range of motion increased from 65.8 ± 27.8° to 108.1 ± 23.3° with casting; or from 57.8 ± 16.2% to 96.7 ± 2.9% of normal. Similarly, scars improved from 9.5 ± 1.5 to 4.9 ± 1.4 on the Modified Vancouver Scar Scale score. This therapeutic effect was achieved within an average of 8.5 ± 3.7 d and 4.0 ± 2.2 new cast applications. Given the study findings, the procedures outlined could be used to develop a standardized serial casting protocol for burn scar contracture rehabilitation.
The effects of serial casting on lower limb function for children with Cerebral Palsy: a systematic review with meta-analysis. [2021]Lower limb serial casting is commonly used therapeutically in paediatric clinical practice with some evidence to support its efficacy. This systematic review aimed to determine the effects of serial casting in isolation or combination with other therapies for the management of lower limb dysfunction in children with Cerebral Palsy (CP).
Outcomes for patients with infantile idiopathic scoliosis by casting table type. [2022]Serial casting is an effective treatment for infantile idiopathic scoliosis. The most common casting table types are Mehta, Risser, and spica tables. We compared major curve correction between patients with infantile idiopathic scoliosis treated using pediatric hip spica tables versus Risser or Mehta tables.