Preoperative Serial Casting, Education, and Therapy for Dupuytren's Contracture

Dupuytren's disease is a common and progressively disabling condition affecting the connective tissue of the palm of the hand. It causes fibrosis of the palmar fascia, which can lead to one or more fingers becoming incapable of full extension, adopting a fixed flexion contracture. This loss of extension can significantly impair hand function and limit daily activities. While surgery (typically fasciectomy) remains the most effective treatment for Dupuytren's contracture, outcomes are often less favourable when the deformity involves the proximal interphalangeal joint, particularly in severe cases where the contracture exceeds 30 degrees.

This feasibility study investigates whether a short course of preoperative therapy, delivered before surgery, can help improve recovery and outcomes after Dupuytren's Fasciectomy. The intervention includes:

* Heat application * Stretching and massage * Serial casting - a method of gently lengthening tight tissue by applying and adjusting a soft cast weekly prior to surgery The treatment is designed to gently lengthen tight tissues and increase joint range of movement in the affected fingers prior to surgery, with the goal of improving movement and function after surgery.

We are recruiting approximately 20 adult patients from Dorset County Hospital NHS Foundation Trust who:

* Are scheduled for Dupuytren's Fasciectomy * Have a PIP joint contracture of 30 degrees or more

Participants will be randomly assigned to one of two groups:

* Intervention group: Will receive the four-week preoperative therapy programme plus an education session covering disease pathology, surgical objectives, postoperative expectations, pain, and recovery milestones. * Control group: Will receive the same education programme only, with no added preoperative therapy.

After surgery, all participants will follow standard postoperative therapy and attend follow-up appointments up to 12 weeks post-op, where we will collect outcome measures including:

* Finger range of motion * Hand function (using the Michigan Hand Outcomes Questionnaire - MHQ) * Grip strength * Patient satisfaction * Completion and retention rates throughout the study To understand how practical and acceptable this approach is in real-world clinical settings, we will also conduct interviews with patients and healthcare professionals to explore their experiences and suggestions for improvement.

As a feasibility study, the goal is not to test effectiveness, but to assess whether a larger, definitive trial is achievable. Specifically, we aim to:

* Determine who is suitable and willing to take part * Identify the most relevant outcome measures * Evaluate participation and follow-up rates * Understand acceptability from both patients and clinicians * Estimate the resources and planning needed for a full-scale trial If this study shows that the intervention is feasible and well-received, we aim to proceed with a multi-centre randomised controlled trial to evaluate the effectiveness of preoperative therapy as part of standard care for Dupuytren's fasciectomy.

This research is a collaboration between Dorset County Hospital NHS Foundation Trust and Bournemouth University, with active involvement and guidance from a Patient and Public Involvement steering group made up of individuals with lived experience of Dupuytren's disease and the healthcare professionals involved in their care.

• Active range of movement of the affected finger(s) [Срок оценки: From enrolment 4 weeks preoperatively, till final follow-up at 12 weeks postoperatively]
• Passive range of movement (PROM) of the affected finger(s) [Срок оценки: From enrolment 4 weeks preoperatively, till final follow-up at 12 weeks postoperatively]
• Grip strength of the affected hand [Срок оценки: From enrolment 4 weeks preoperatively, till final follow-up at 12 weeks postoperatively]
• Michigan Hand Questionnaire (MHQ) [Срок оценки: From enrolment 4 weeks preoperatively, till final follow-up at 12 weeks postoperatively]
• Patient-Specific Functional Scale (PSFS) [Срок оценки: From enrolment 4 weeks preoperatively, till final follow-up at 12 weeks postoperatively]
• Barriers and facilitators to adherence [Срок оценки: From enrolment 4 weeks preoperatively, till final follow-up at 12 weeks postoperatively]
• Sample size estimation [Срок оценки: From enrolment 4 weeks preoperatively, till final follow-up at 12 weeks postoperatively]