Preoperative Serial Casting, Stretching, and Massage Therapy Package for Dupuytren's Patients with Severe Proximal Interphalangeal Joint Contracture: A Feasibility Study Protocol for a Randomised Trial

Abstract Background: Dupuytren’s disease (DD) can lead to fixed flexion contractures of the digits. Although Dupuytren’s fasciectomy (DF) is the standard treatment, outcomes for proximal interphalangeal joint (PIPJ) contractures remain variable. Preoperative therapy may improve soft-tissue extensibility and optimise surgical outcomes, yet its use in hand surgery is largely unexplored. Serial casting has shown potential to improve passive PIPJ extension, but no randomised controlled trials (RCT) have evaluated its use before DF. This feasibility trial aims to determine whether a future RCT of a preoperative therapy protocol, including serial casting, is practical and acceptable. Methods: This single-centre, two-arm, parallel-group randomised feasibility trial will recruit adults with PIPJ contracture >30° awaiting DF. Participants will be randomised 1:1 to an intervention or control group. The intervention comprises a four-week preoperative protocol including heat, stretching, massage, and weekly circumferential thermoplastic casts. All participants will receive a standardised education session. A blinded assessor will collect baseline and 12-week postoperative outcomes: active and passive PIPJ range of motion (ROM), grip strength, and Michigan Hand Questionnaire (MHQ) scores. Qualitative interviews will explore acceptability and experience. Feasibility will be assessed using predefined traffic-light criteria evaluating recruitment, eligibility, randomisation, adherence, retention, acceptability, and maintenance of blinding. Outcomes: Primary outcomes relate to feasibility of trial processes. Secondary outcomes include changes in ROM, grip strength, MHQ scores, and qualitative insights into acceptability. Data will be used to refine study procedures and estimate effect size. Conclusion: This feasibility study will determine whether a full RCT evaluating a preoperative therapy protocol for DF is feasible, acceptable, and appropriately designed.