Serial Casting as a Conservative Treatment for Adults with Upper Extremity Burn Contractures: A Prospective Longitudinal Study with a Criterion for Change.

Joint contractures and hypertrophic scars (HSc) are common complications following burn injuries, significantly impairing range of motion (ROM) and quality of life. While conservative interventions target either contractures or HSc, serial casting (SC) is typically reserved for patients who fail traditional therapy or are nonadherent. The purpose of this study was to estimate the extent to which ROM (regular and revised passive and active), scar characteristics (objective and subjective), and patient-reported UE function changes following an individually tailored SC treatment program after switching from a minimum of 3 days of usual care. This study employed a prospective longitudinal intervention design with a criterion for change. Participants with upper extremity (UE) joint passive ROM (PROM) loss of >15% were included. Measures were taken at baseline, pre-SC, every Monday and Friday thereafter, and 3 weeks post-casting. The QuickDASH and Patient Scar Assessment Scale were evaluated at baseline and 3 weeks post-casting. Eleven individuals (13 joints) were included in this study. Regular PROM, revised PROM and AROM and scar thickness improvements were statistically significant. Participants reported improvements in UE function for 11/13 joints (median 16%, range 9-21%) and scar impression for all scars (median 6, 4-10). Participants also perceived that SC reduces their rehabilitation burden. In conclusion, when possible, SC should be prioritised to increase PROM, reduce HSc thickness, and enhance patient-perceived UE function and scar outcome.