ORCID Profile
0000-0001-8591-3228
Current Organisations
Fiona Stanley Hospital
,
Universidade Federal de Pernambuco
,
University of Notre Dame Australia
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Publisher: Elsevier BV
Date: 12-2017
DOI: 10.1016/J.BURNS.2017.04.022
Abstract: The control of edema in burn injured patients is a priority as it can impede the wound healing process. Bioimpedance spectroscopy (BIS) has been identified as a method of swelling assessment that has merit after burns. The aim of this study was to examine the reliability and validity of BIS in the measurement of localised burn wound edema across (1) different dressing conditions (no dressing, non silver and silver dressings) and (2) three electrode positions. BIS resistance (R) was hypothesised to be inversely proportional to fluid (edema) volume. BIS was collected in triplicate for all conditions of interest. BIS repeated measures demonstrated excellent concordance for all BIS resistance variables (R
Publisher: Elsevier BV
Date: 02-2017
DOI: 10.1016/J.BURNS.2016.07.021
Abstract: Session-rating of perceived exertion (RPE) is a method frequently utilised in exercise and sports science to quantify training load of an entire aerobic exercise session. It has also been demonstrated that session-RPE is a valid and reliable method to quantify training load during resistance exercise, in healthy and athletic populations. This study aimed to investigate the effectiveness of session-RPE as a method to quantify exercise intensity during resistance training in patients with acute burns. Twenty burns patients (mean age=31.65 (±10.09) years), with a mean TBSA of 16.4% (range=6-40%) were recruited for this study. Patients were randomly allocated to the resistance training (n=10) or control group (n=10). All patients completed a four week resistance training programme. Training load (session-RPE×session duration), resistance training session-volume and pre-exercise pain were recorded for each exercise session. The influence of age, gender, %TBSA, exercise group (resistance training vs. control), pre-exercise pain, resistance training history and session-volume on training load were analysed using a multilevel mixed-effects linear regression. Session-volume did not influence training load in the final regression model, however training load was significantly greater in the resistance training group, compared with the control group (p<0.001). Pre-exercise pain significantly influenced training load, where increasing pain was associated with a higher session-RPE (p=0.004). Further research is indicated to determine the exact relationship between pain, resistance training history, exercise intensity and session-RPE and training load before it can be used as a method to monitor and prescribe resistance training load in acute burns patients.
Publisher: American Physical Society (APS)
Date: 22-09-2014
Publisher: Elsevier BV
Date: 09-2016
DOI: 10.1016/J.BURNS.2016.03.028
Abstract: Lower limb injuries account for up to 40% of all burns in Western Australia and affect physical function. Lower limb specific functional assessments are available to monitor recovery, yet no scale has been assessed for use in burns. The Lower Limb Functional Index (LLFI) which is validated in musculoskeletal patients was investigated for applicability in burn. Reliability was assessed using Cronbach's alpha, principal components analysis and Rasch analysis. Validity was assessed using Spearman's correlation coefficient with quality of life assessments (BSHS-B & SF-36) and physical assessments (TUG & ankle ROM). Regression analysis was performed with burn severity measures, time of recovery and location of the burn. The LLFI-10 was applied 1368 times on 739 patients at regular time points. It was internally consistent (α>0.8) and unidimensional. Associations were demonstrated with the BSHS-B and SF-36 (rho=-0.56 to -0.72, p<0.001), TUG (rho=0.41, p<0.001) and ankle ROM (rho=-0.31 to -0.35, p<0.001). The LLFI-10 also showed associations (p<0.001) with time since injury (rho=-0.29), age (rho=0.12) and TBSA (rho=0.12). The LLFI-10 is a reliable and valid tool to assess function in lower limb burns. This study supports the use of the LLFI-10 as part of a battery of assessment for lower limb burn recovery.
Publisher: Oxford University Press (OUP)
Date: 2016
Publisher: Research Square Platform LLC
Date: 07-12-2022
DOI: 10.21203/RS.3.RS-2223815/V1
Abstract: Background: Diabetes-related foot ulcers result in significant mortality, morbidity and economic costs. Pressure offloading is important for ulcer healing, but patients with diabetes-related foot ulcers are presented with a dilemma, because whilst they are often advised to minimise standing and walking, there are also clear guidelines which encourage regular, sustained exercise for patients with diabetes. To overcome these apparently conflicting recommendations, we explored the feasibility, acceptability and safety of a tailored exercise program for adults admitted to hospital with diabetes-related foot ulcers. Methods: Patients with diabetes-related foot ulcers were recruited from an inpatient hospital setting. Baseline demographics and ulcer characteristics were collected, and participants undertook a supervised exercise training session comprising aerobic and resistance exercises followed by prescription of a home exercise programme. Exercises were tailored to ulcer location, which complied with podiatric recommendations for pressure offloading. Feasibility and safety were assessed via recruitment rate, retention rate, adherence to inpatient and outpatient follow up, adherence to home exercise completion, and recording of adverse events. Results: Twenty participants were recruited to the study. The retention rate (95%), adherence to inpatient and outpatient follow up (75%) and adherence to home exercise (50.0%) were all acceptable. No adverse events occurred. Conclusions: Targeted exercise appears safe to be undertaken by patients with diabetes-related foot ulcers during and after an acute hospital admission. Recruitment in this cohort may prove challenging, but adherence, retention and satisfaction with participation in exercise were high. Trial registration: The trial is registered in the Australian New Zealand Clinical Trials Registry (ACTRN12622001370796).
Publisher: Oxford University Press (OUP)
Date: 13-03-2018
DOI: 10.1093/JBCR/IRY010
Abstract: External stabilization is reported to improve reliability of hand-held dynamometry, yet this has not been tested in burns. We aimed to assess the reliability of dynamometry using an external system of stabilization in people with moderate burn injury and explore construct validity of strength assessment using dynamometry. Participants were assessed on muscle and grip strength three times on each side. Assessment occurred three times per week for up to 4 weeks. Within-session reliability was assessed using intraclass correlations calculated for within-session data grouped before surgery, immediately after surgery and in the subacute phase of injury. Minimum detectable differences were also calculated. In the same timeframe categories, construct validity was explored using regression analysis incorporating burn severity and demographic characteristics. Thirty-eight participants with total burn surface area 5% to 40% were recruited. Reliability was determined to be clinically applicable for the assessment method (intraclass correlation coefficient >0.75) at all phases after injury. Muscle strength was associated with sex and burn location during injury and wound healing. Burn size in the immediate period after surgery and age in the subacute phase of injury were also associated with muscle strength assessment results. Hand-held dynamometry is a reliable assessment tool for evaluating within-session muscle strength in the acute and subacute phase of injury in burns up to 40% total burn surface area. External stabilization may assist to eliminate reliability issues related to patient and assessor strength.
Publisher: IOP Publishing
Date: 14-09-2015
DOI: 10.1088/0967-3334/36/10/2189
Abstract: Bioimpedance spectroscopy (BIS) is frequently used to monitor body fluid and body composition in healthy and clinical populations. BIS guidelines state that there should be no skin lesions at the site of electrodes, and if lesions are present, electrode positions should be changed. However, alternate electrode positions are yet to be reported. This study aimed to determine if ventral electrode placements were suitable alternatives for whole body and segmental BIS measurements. Three alternate electrode placements were assessed for whole body BIS using a combination of ventral hand and foot electrode placements. An alternate position was assessed for upper and lower body segmental BIS. The results demonstrated that for whole body BIS, if drive and sense electrodes on the hand are moved to ventral positions, but foot electrodes remain in standard positions, then whole body BIS variables were comparable to standard electrode positioning (percentage difference range = 0.01 to 1.65%, p = 0.211-0.937). The alternate electrode placement for upper limb segmental BIS, results in BIS variables that are comparable to that of the standard positioning (percentage difference range = 0.24-3.51%, p = 0.393-0.604). The alternate lower limb electrode position significantly altered all resistance and predicted BIS variables for whole body and lower limb segmental BIS (percentage difference range = 1.06-12.09%, p < 0.001). If wounds are present on the hands and/or wrist, then the alternate electrode position described in this study is valid, for whole body and upper limb segmental BIS.
Publisher: Springer Science and Business Media LLC
Date: 28-03-2023
DOI: 10.1186/S13047-023-00616-0
Abstract: Diabetes-related foot ulcers result in significant mortality, morbidity and economic costs. Pressure offloading is important for ulcer healing, but patients with diabetes-related foot ulcers are presented with a dilemma, because whilst they are often advised to minimise standing and walking, there are also clear guidelines which encourage regular, sustained exercise for patients with diabetes. To overcome these apparently conflicting recommendations, we explored the feasibility, acceptability and safety of a tailored exercise program for adults admitted to hospital with diabetes-related foot ulcers. Patients with diabetes-related foot ulcers were recruited from an inpatient hospital setting. Baseline demographics and ulcer characteristics were collected, and participants undertook a supervised exercise training session comprising aerobic and resistance exercises followed by prescription of a home exercise programme. Exercises were tailored to ulcer location, which complied with podiatric recommendations for pressure offloading. Feasibility and safety were assessed via recruitment rate, retention rate, adherence to inpatient and outpatient follow up, adherence to home exercise completion, and recording of adverse events. Twenty participants were recruited to the study. The retention rate (95%), adherence to inpatient and outpatient follow up (75%) and adherence to home exercise (50.0%) were all acceptable. No adverse events occurred. Targeted exercise appears safe to be undertaken by patients with diabetes-related foot ulcers during and after an acute hospital admission. Recruitment in this cohort may prove challenging, but adherence, retention and satisfaction with participation in exercise were high. The trial is registered in the Australian New Zealand Clinical Trials Registry (ACTRN12622001370796).
Publisher: Elsevier BV
Date: 06-2018
DOI: 10.1016/J.BURNS.2017.08.009
Abstract: Resistance training is beneficial for rehabilitation in many clinical conditions, though this has not been systematically reviewed in burns. The objective was to determine the effectiveness of resistance training on muscle strength, lean mass, function, quality of life and pain, in children and adults after burn injury. Medline & EMBASE, PubMed, CINAHL and CENTRAL were searched from inception to October 2016. Studies were identified that implemented resistance training in rehabilitation. Data were combined and included in meta-analyses for muscle strength and lean mass. Otherwise, narrative analysis was completed. The quality of evidence for each outcome was summarised and rated using the GRADE framework. Eleven studies matched our inclusion criteria. Primary analysis did not demonstrate significant improvements for increasing muscle strength (SMD 0.74, 95% CI -0.02 to 1.50, p=0.06). Sensitivity analysis to correct an apparent anomaly in published data suggested a positive effect (SMD 0.37, 95% CI 0.08-0.65, p=0.01). Psychological quality of life demonstrated benefit from training (MD=25.3, 95% CI 3.94-49.7). All studies were rated as having high risk of bias. The quality of the evidence was rated as low or very low. Further research with robust methodology is recommended to assess the potential benefit suggested in this review.
No related grants have been discovered for Paul Michael Gittings.