Serial casting versus positioning for the treatment of elbow contractures in adults with traumatic brain injury: a randomized controlled trial.

OBJECTIVE To compare the effects of serial casting with positioning for 1 hour per day for the treatment of elbow flexion contracture in adults with traumatic brain injury. DESIGN Pragmatic randomized controlled trial with concealed allocation and assessor blinding. SETTING Four brain injury rehabilitation units. SUBJECTS Twenty-six adults with elbow flexion contracture after traumatic brain injury participating in multidisciplinary inpatient rehabilitation. INTERVENTIONS Subjects were randomized to receive either serial casting or positioning for two weeks. In the subsequent four weeks subjects could be positioned for up to 1 hour/day. MAIN MEASURES Torque-controlled passive elbow extension was measured at baseline, post-intervention (two weeks), post-intervention plus one day, and at follow-up (four weeks post-intervention). RESULTS All 26 subjects completed the study. Post-intervention, serial casting reduced contracture by an average of 22 degrees (95% confidence interval (CI) 13 to 31; P <0.001) compared with the positioning group. One day later this effect had decreased to 11 degrees (95% CI 0 to 21 degrees; P= 0.052). The effect had almost completely disappeared at the four-week follow-up (mean 2 degrees, 95% CI -13 to 17; P= 0.782). CONCLUSIONS Serial casting induces transient increases in range of motion. These effects are not maintained.