74 The Effectiveness of Serial Casting in Obtaining Maximum Range in Burn Scar Contracted Joints

Abstract

Abstract Introduction Recovery from burn scar contracture demands significant time and resources from patients and healthcare providers. Few studies have explored how serial casting improves recovery. The aim is to present preliminary data illustrating the benefits of serial casting in burn scar contracture rehabilitation. Methods Six burn patients (8 joints) that did not respond to traditional conservative therapy were included. Joints were x-rayed to rule out heterotopic ossification/joint abnormality before casting. Patients were casted 5x, 3x or 1x/week. Initial session consisted of measuring baseline range of motion (ROM) prior to physiotherapy intervention (PTI) (heat, active ROM with end range overpressure, joint glides, and progressive resistive exercises) and plaster cast application by Occupational Therapy. Following sessions involved measuring ROM post cast removal, and before PTI and new cast application. Scar contractures were photographed weekly and assessed using the Modified Vancouver Scar Scale (MVSS). Results On average, casting started 93.67±20.31 days post burn injury and lasted 8.90±1.23 days. Mean time between cast changes was 2.30±0.25 days; on average, each joint was casted 4.30±0.65 times. MVSS score (pre/post serial casting:9.70±0.47 / 4.70±0.42, p< 0.0001) and ROM as a percentage of total (pre/post serial casting:56.30±5.12% / 96.40±0.90%, p< 0.0001) showed improvements from pre to post casting. Post casting, average ROM gained was 43.70±6.60 degrees and average percentage of ROM regained was 96.38±0.87%. Each joint consumed a mean of 6.56±1.22 therapy hours and $45.13±12.15 in materials. Conclusions Serial casting produced rapid gains in ROM to near full ROM in burn scar contracted joints. Correspondingly scar pliability, height, and pigmentation improved. Serial casting can be effective and initiated early in scar maturation. Applicability of Research to Practice Serial casting can be a standard technique in rehabilitation of burn scar contracture. It is easy to adopt due to low material cost, easy therapist training, and low time demands from patients and therapists. It can delay or prevent the need for contracture release surgery (in the case of 3 patients). Based on therapist observations, it can lead to increased treatment compliance due to rapid effectiveness.