ORCID Profile
0000-0003-2543-1467
Current Organisation
Alfred Health
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Publisher: Elsevier BV
Date: 06-09-2021
DOI: 10.51893/2021.3.OA3
Abstract: OBJECTIVE: To describe the protocol and statistical analysis plan for the Treatment of Invasively Ventilated Adults with Early Activity and Mobilisation (TEAM III) trial. DESIGN: An international, multicentre, parallel-group, randomised controlled phase 3 trial. SETTING: Intensive care units (ICUs) in Australia, New Zealand, Germany, Ireland, the United Kingdom and Brazil. PATIENTS: 750 adult patients expected to receive mechanical ventilation for more than 48 hours. INTERVENTIONS: Early activity and mobilisation delivered to critically ill patients in an ICU for up to 28 days compared with standard care. MAIN OUTCOME MEASURES: The primary outcome is the number of days alive and out of hospital at 180 days after randomisation. Secondary outcomes include ICU-free days, ventilator-free days, delirium-free days, all-cause mortality at 28 and 180 days after randomisation, and functional outcome at 180 days after randomisation. RESULTS: Recruitment at 46 research sites passed 576 patients in March 2021. Final collection of all 180-day outcome data for the target of 750 patients is anticipated by May 2022. CONCLUSIONS: Consistent with international guidelines, a detailed protocol and prospective analysis plan has been developed for the TEAM III trial. This plan specifies the statistical models for evaluating primary and secondary outcomes, defines covariates for adjusted analyses, and defines methods for exploratory analyses. Application of this protocol and statistical analysis plan to the forthcoming TEAM III trial will facilitate unbiased analyses of the clinical data collected. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT03133377.
Publisher: Oxford University Press (OUP)
Date: 02-04-2019
DOI: 10.1093/PTJ/PZZ057
Abstract: As the older population increases, more older people are exposed to trauma. Frailty can be used to highlight patients at risk of a poorer outcome. The objectives of this study were to compare 2 frailty measures with regard to concordance, floor and ceiling effects, and construct and predictive validity and to determine which is more valid and clinically applicable in a critically ill trauma population. This was a prospective observational study. Patients were included if admitted to an intensive care unit (ICU) under a trauma medical unit and ≥ 50 years old. Frailty was determined using 2 frailty measures, the Frailty Phenotype (FP) and Clinical Frailty Scale (CFS). One hundred people were enrolled their mean age was 69.2 years (SD = 10.4) and 81% had major trauma (as determined with the Injury Severity Score). Frailty was identified with the FP in 22 participants and with the CFS in 13 participants. The 2 frailty measures had an excellent correlation (Spearman rank correlation coefficient = 0.77 95% confidence interval = 0.66–0.85). Both the FP and the CFS had large floor effects but no ceiling effects. The FP and CFS showed construct validity, with frailty being significantly associated with increasing age, requiring an aid to mobilize, and more falls and hospital admissions. Frailty on the FP was predictive of ICU and hospital mortality, whereas frailty on the CFS was predictive of hospital mortality. The limitations of this study include the use of a single site, small s le size, and collection of frailty measures retrospectively. Measuring frailty in a trauma ICU population was feasible, with excellent correlation between the 2 frailty measures. Both showed aspects of construct and predictive validity however, the FP identified frailty in more participants and was associated with more comorbidities and higher mortality at ICU discharge. Therefore, the FP might be more clinically relevant in this population.
Publisher: Elsevier BV
Date: 05-2019
DOI: 10.1016/J.AUCC.2018.05.005
Abstract: Early mobilisation in the intensive care unit (ICU) has been consistently reported as feasible and safe with minimal adverse events however, invasive mechanical ventilation patients are rarely actively mobilised. An expert consensus group developed and published recommendations using a traffic light system on safety criteria to promote active mobilisation of invasive mechanical ventilation patients. The aim of this study was to determine whether, in clinical practice, the safety consensus recommendations resulted in (1) increased early mobilisation in patients assessed as appropriate to mobilise based on the risk classification and (2) early mobilisation without adverse events. A prospective observational study of 100 patients requiring invasive mechanical ventilation (IMV) for greater than 24 h admitted to the ICU at The Alfred Hospital. Patients were assessed daily (Monday to Friday) to determine their ability to perform early mobilisation. Data were collected on 100 patients, resulting in 280 physiotherapy-patient interactions during IMV. Of the 100 patients, five patients actively mobilised out of bed during IMV. No adverse event occurred during active physiotherapy-patient interactions. There were 15 physiotherapy-patient interactions that had a low risk of an adverse event, and on nine (60.0%) of these physiotherapy-patient interactions, patients were actively mobilised out of bed with the main reported barrier being time constraints. Of 208 physiotherapy-patient interactions where there were significant potential risks of an adverse event identified for mobilising, active out of bed mobilisation did not occur, with sedation being reported as the main barrier in 170 (82%) patients. The translation of expert consensus recommendations for early mobilisation into clinical practice was poor. Clinicians were safe and conservative in the implementation of early mobilisation during IMV.
Publisher: Elsevier BV
Date: 09-2018
DOI: 10.1016/J.HRTLNG.2018.07.009
Abstract: The intensive care unit mobility scale (IMS) is reliable, valid and responsive. Establishing the minimal important difference (MID) of the IMS is important in order to detect clinically significant changes in mobilization. To calculate the MID of the IMS in intensive care unit patients. Prospective multi center observational study. The IMS was collected from admission and discharge physiotherapy assessments. To calculate the MID we used anchor based methods (global rating of change) and two distribution-based methods (standard error of the mean and effect size). We enrolled 184 adult patients mean age 62.0 years, surgical, trauma, and medical. Anchor based methods gave a MID of 3 with area under the curve 0.94 (95% CI 0.89-0.97). The two distribution based methods gave a MID between 0.89 and 1.40. These data increase our understanding of the clinimetric properties of the IMS, improving its utility for clinical practice and research.
Publisher: Elsevier BV
Date: 05-2020
Publisher: Elsevier BV
Date: 07-2023
No related grants have been discovered for Claire Tipping.