Selina Parry | University of Melbourne (original) (raw)

Papers by Selina Parry

Research paper thumbnail of The impact of extended bed rest on the musculoskeletal system in the critical care environment

Extreme Physiology & Medicine, 2015

Prolonged immobility is harmful with rapid reductions in muscle mass, bone mineral density and im... more Prolonged immobility is harmful with rapid reductions in muscle mass, bone mineral density and impairment in other body systems evident within the first week of bed rest which is further exacerbated in individuals with critical illness. Our understanding of the aetiology and secondary consequences of prolonged immobilization in the critically ill is improving with recent and ongoing research to establish the cause, effect, and best treatment options. This review aims to describe the current literature on bed rest models for examining immobilization-induced changes in the musculoskeletal system and pathophysiology of immobilisation in critical illness including examination of intracellular signalling processes involved. Finally, the review examines the current barriers to early activity and mobilization and potential rehabilitation strategies, which are being, investigated which may reverse the effects of prolonged bed rest. Addressing the deleterious effects of immobilization is a major step in treatment and prevention of the public health issue, that is, critical illness survivorship.

Research paper thumbnail of Low physical activity levels and poorer muscle strength are associated with reduced physical function at intensive care unit discharge: An observational study

Australian Critical Care, 2015

Research paper thumbnail of Functional Electrical Stimulation-Cycling In Acute Traumatic Tetraplegia Within Four Days Post Injury: A Case Report

Research paper thumbnail of Manual Muscle Strength Testing In Critically Ill Patients

Research paper thumbnail of Interobserver Reliability of Quantitative Muscle Sonographic Analysis in the Critically Ill Population

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2015

There is growing interest in the use of quantitative high-resolution neuromuscular sonography to ... more There is growing interest in the use of quantitative high-resolution neuromuscular sonography to evaluate skeletal muscles in patients with critical illness. There is currently considerable methodological variability in the measurement technique of quantitative muscle analysis. The reliability of muscle parameters using different measurement techniques and assessor expertise levels has not been examined in patients with critical illness. The primary objective of this study was to determine the interobserver reliability of quantitative sonographic measurement analyses (thickness and echogenicity) between assessors of different expertise levels and using different techniques for selecting the region of interest. We conducted a cross-sectional observational study in neurocritical care and mixed surgical-medical intensive care units from 2 tertiary referral hospitals. Twenty diaphragm and 20 quadriceps images were evaluated. Images were obtained by using standardized imaging acquisition...

Research paper thumbnail of Ultrasonography in the intensive care setting can be used to detect changes in the quality and quantity of muscle and is related to muscle strength and function

Journal of Critical Care, 2015

Objectives: A rapid and early loss of skeletal muscle mass underlies the physical disability comm... more Objectives: A rapid and early loss of skeletal muscle mass underlies the physical disability common amongst survivors of critical illness. However, skeletal muscle function depends not only on its quantity but its quality, which may be adversely affected. We set out to characterise the changes in macroscopic muscle echogenicity and fascial characteristics that occur early in critical illness, and to relate these to microscopic histologically defined myofibre necrosis and fascial pathology. Design and Setting: Prospective two center observational study. Patients: Thirty subjects comprising a subgroup of patients recruited to the Musculoskeletal Ultrasound in Critical Illness: Longitudinal Evaluation (MUSCLE) study. Measurements and Main Results: Comparisons were made between sequential Vastus Lateralis histological specimens and ultrasound assessment of Rectus Femoris echogenicity. Change in muscle echogenicity was greater in patients who developed muscle necrosis (n = 15) than in those who did not (8.2% [95% CI, -5.3 to 21.7] vs -15.0% [95% CI, -28.9 to -1.09]; p = 0.016). The area under receiver operator curve for ultrasound echogenicity's prediction of myofiber necrosis was 0.74 (95% CI, 0.565 to 0.919; p = 0.024) increasing to 0.85 (95% CI, 0.703 to -0.995; p = 0.003) with the removal of those with potential iatrogenic muscle damage. Fasciitis was observed in 18 of 30 biopsies (60%). Conclusions: Myofiber necrosis and fascial inflammation can be detected noninvasively using ultrasound in the critically ill. Fasciitis precedes and frequently accompanies muscle necrosis. These findings may have functional implications for survivors of critical illness. (Crit Care Med 2015; XX:00-00)

Research paper thumbnail of PP028-SUN: Associations between Cumulative Calorie Debt (CCD) in Intensive Care (ICU), The Diagnosis of Intensive Care Unit Acquired Weakness (ICUAW) and Length of Stay (LOS)

Research paper thumbnail of PP038-SUN: Measured Energy Expenditure Compared with Estimated Energy Requirments and Accelerometry in Intensive Care

Research paper thumbnail of The self-reported Physical Activity Scale for the Elderly (PASE) is a valid and clinically applicable measure in lung cancer

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, Jan 26, 2015

Physical activity (PA) is an important outcome in lung cancer; however, there is lack of consensu... more Physical activity (PA) is an important outcome in lung cancer; however, there is lack of consensus as to the best method for assessment. The Physical Activity Scale for the Elderly (PASE) is a commonly used questionnaire. The aim of this study was to assess the clinimetric properties of the PASE in lung cancer, specifically validity, predictive utility and clinical applicability (floor/ceiling effects, responsiveness and minimal important difference [MID]). This is a prospective observational study. Sixty-nine participants (62 % male, median [IQR] age 68 years [61-74]) with lung cancer completed the PASE at diagnosis at 2, 4 and 6 months. Additional measures included movement sensors (steps/day), physical function, health-related quality of life, functional capacity (6-min walk distance [6MWD]), and muscle strength. Spearman's rank correlation coefficient was used to assess relationships. Linear regression analyses were conducted to determine predictive utility of the PASE for h...

Research paper thumbnail of Functional outcomes in ICU – what should we be using? - an observational study

Critical Care, 2015

Introduction: With growing awareness of the importance of rehabilitation, new measures are being ... more Introduction: With growing awareness of the importance of rehabilitation, new measures are being developed specifically for use in the intensive care unit (ICU). There are currently 26 measures reported to assess function in ICU survivors. The Physical Function in Intensive care Test scored (PFIT-s) has established clinimetric properties. It is unknown how other functional measures perform in comparison to the PFIT-s or which functional measure may be the most clinically applicable for use within the ICU. The aims of this study were to determine (1) the criterion validity of the Functional Status Score for the ICU (FSS-ICU), ICU Mobility Scale (IMS) and Short Physical Performance Battery (SPPB) against the PFIT-s; (2) the construct validity of these tests against muscle strength; (3) predictive utility of these tests to predict discharge to home; and (4) the clinical applicability. This was a nested study within an ongoing controlled study and an observational study.

Research paper thumbnail of TITLE: Functional electrical stimulation with cycling in the critically ill: a pilot case-matched control study

Research paper thumbnail of A new two-tier strength assessment approach to the diagnosis of weakness in intensive care: an observational study

Critical Care, 2015

Introduction: Intensive care unit-acquired weakness (ICU-AW) is a significant problem. There is c... more Introduction: Intensive care unit-acquired weakness (ICU-AW) is a significant problem. There is currently widespread variability in the methods used for manual muscle testing and handgrip dynamometry (HGD) to diagnose ICU-AW. This study was conducted in two parts. The aims of this study were: to determine the inter-rater reliability and agreement of manual muscle strength testing using both isometric and through-range techniques using the Medical Research Council sum score and a new four-point scale, and to examine the validity of HGD and determine a cutoff score for the diagnosis of ICU-AW for the new four-point scale. Methods: Part one involved evaluation of muscle strength by two physical therapists in 29 patients ventilated >48 hours. Manual strength testing was performed by both physical therapists using two techniques: isometric and through range; and two scoring systems: traditional six-point Medical Research Council scale and a new collapsed four-point scale. Part two involved assessment of handgrip strength conducted on 60 patients. A cutoff score for ICU-AW was identified for the new four-point scoring system. Results: The incidence of ICU-AW was 42% (n = 25/60) in this study (based on HGD). In part one the highest reliability and agreement was observed for the isometric technique using the four-point scale (intraclass correlation coefficient = 0.90: kappa = 0.72 respectively). Differences existed between isometric and through-range scores (mean difference = 1.76 points, P = 0.005). In part two, HGD had a sensitivity of 0.88 and specificity of 0.80 for diagnosing ICU-AW. A cutoff score of 24 out of 36 points was identified for the four-point scale.

Research paper thumbnail of Early rehabilitation in critical care (eRiCC): functional electrical stimulation with cycling protocol for a randomised controlled trial

Research paper thumbnail of Assessment of impairment and activity limitations in the critically ill: a systematic review of measurement instruments and their clinimetric properties

Intensive Care Medicine

Purpose To identify measures used to evaluate the broad constructs of functional impairment and l... more Purpose To identify measures used to evaluate the broad constructs of functional impairment and limitations in the critically ill across the continuum of recovery, and to evaluate, synthesise and compare the clinimetric properties of the measures identified. Methods A systematic review of articles was carried out using the databases Medline (1950-2014), CINAHL (1982-2014), EMBASE (1980-2014), Cochrane Library (2014) and Scopus (1960-2014). Additional studies were identified by searching personal files. Eligibility criteria for selection: Search 1: studies which assessed muscle mass, strength or function using objective non-laboratory measures; Search 2: studies which evaluated a clinimetric property (reliability, measurement error, validity or responsiveness) for one of the measures identified in search one. Two independent reviewers assessed articles for inclusion and assessed risk of bias using the consensus-based standards for selection of health status measurement instruments ch...

Research paper thumbnail of Clinical application of the Melbourne risk prediction tool in a high-risk upper abdominal surgical population: an observational cohort study

Physiotherapy, 2014

(1) To determine the ability of the Melbourne risk prediction tool to predict a pulmonary complic... more (1) To determine the ability of the Melbourne risk prediction tool to predict a pulmonary complication as defined by the Melbourne Group Scale in a medically defined high-risk upper abdominal surgery population during the postoperative period; (2) to identify the incidence of postoperative pulmonary complications; and (3) to examine the risk factors for postoperative pulmonary complications in this high-risk population. Design Observational cohort study. Setting Tertiary Australian referral centre. Participants and methods 50 individuals who underwent medically defined high-risk upper abdominal surgery. Presence of postoperative pulmonary complications was screened daily for seven days using the Melbourne Group Scale (Version 2). Postoperative pulmonary risk prediction was calculated according to the Melbourne risk prediction tool. Outcome measures (1) Melbourne risk prediction tool; and (2) the incidence of postoperative pulmonary complications. Results Sixty-six percent (33/50) underwent hepatobiliary or upper gastrointestinal surgery. Mean (SD) anaesthetic duration was 377.8 (165.5) minutes. The risk prediction tool classified 84% (42/50) as high risk. Overall postoperative pulmonary complication incidence was 42% (21/50). The tool was 91% sensitive and 21% specific with a 50% chance of correct classification. Conclusion This is the first study to externally validate the Melbourne risk prediction tool in an independent medically defined highrisk population. There was a higher incidence of pulmonary complications postoperatively observed compared to that previously reported. Results demonstrated poor validity of the tool in a population already defined medically as high risk and when applied postoperatively. This observational study has identified several important points to consider in future trials.

Research paper thumbnail of Functional electrical stimulation with cycling in the critically ill: A pilot case-matched control study

Journal of Critical Care, 2014

To determine (a) safety and feasibility of functional electrical stimulation (FES)cycling and (b)... more To determine (a) safety and feasibility of functional electrical stimulation (FES)cycling and (b) compare FES-cycling to case-matched controls in functional recovery and delirium outcomes.

Research paper thumbnail of Electrical Muscle Stimulation in the Intensive Care Setting

Critical Care Medicine, 2013

The role of electrical muscle stimulation in intensive care has not previously been systematicall... more The role of electrical muscle stimulation in intensive care has not previously been systematically reviewed. To identify, evaluate, and synthesize the evidence examining the effectiveness and the safety of electrical muscle stimulation in the intensive care, and the optimal intervention variables. A systematic review of articles using eight electronic databases (Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Excerpta Medica Database, Expanded Academic ASAP, MEDLINE, Physiotherapy Evidence Database, PubMed, and Scopus) personal files were searched, and cross-referencing was undertaken. Quantitative studies published in English, assessing electrical muscle stimulation in intensive care, were included. One reviewer extracted data using a standardized form, which were cross-checked by a second reviewer. Quality appraisal was undertaken by two independent reviewers using the Physiotherapy Evidence Database and Newcastle-Ottawa scales, and the National Health and Medical Research Council Hierarchy of Evidence Scale. Preferred Reporting Items for Systematic Reviews guidelines were followed. Nine studies on six individual patient groups of 136 participants were included. Eight were randomized controlled trials, with four studies reporting on the same cohort of participants. Electrical muscle stimulation appears to preserve muscle mass and strength in long-stay participants and in those with less acuity. No such benefits were observed when commenced prior to 7 days or in patients with high acuity. One adverse event was reported. Optimal training variables and safety of the intervention require further investigation. Electrical muscle stimulation is a promising intervention; however, there is conflicting evidence for its effectiveness when administered acutely. Outcomes measured are heterogeneous with small sample sizes.

Research paper thumbnail of Functional capacity, physical activity and muscle strength assessment of individuals with non-small cell lung cancer: a systematic review of instruments and their measurement properties

BMC Cancer, 2013

The measurement properties of instruments used to assess functional capacity, physical activity a... more The measurement properties of instruments used to assess functional capacity, physical activity and muscle strength in participants with non-small cell lung cancer (NSCLC) have not been systematically reviewed. Method: Objectives: To identify outcome measures used to assess these outcomes in participants with NSCLC; and to evaluate, synthesise and compare the measurement properties of the outcome measures identified. Data Sources: A systematic review of articles using electronic databases MEDLINE Additional studies were identified by searching personal files and cross referencing. Eligibility Criteria for Study Selection: Search one: studies which assessed functional capacity, physical activity or muscle strength in participants with NSCLC using non-laboratory objective tests were included. Search two: studies which evaluated a measurement property (inter-or intra-rater reliability; measurement error; criterion or construct validity; or responsiveness) in NSCLC for one of the outcome measures identified in search one. Studies published in English from 1980 were eligible. Data Extraction and Methodological Quality Assessment: data collection form was developed and data extracted. Methodological quality of studies was assessed by two independent reviewers using the 4-point COSMIN checklist.

Research paper thumbnail of Which field walking test should be used to assess functional exercise capacity in lung cancer? an observational study

BMC Pulmonary Medicine, 2015

There is emerging evidence regarding the efficacy of exercise training to improve exercise capaci... more There is emerging evidence regarding the efficacy of exercise training to improve exercise capacity for individuals with non-small cell lung cancer (NSCLC). Cardiopulmonary exercise testing (CPET) is the gold standard measure of exercise capacity; however this laboratory test has limitations for use in research and clinical practice. Alternative field walking tests are the six-minute walk test (6MWT), incremental-shuttle walk test (ISWT) and endurance-shuttle walk test (ESWT); however there is limited information about their clinimetric properties in NSCLC. In NSCLC to determine the 1) criterion validity of the 6MWT, ISWT and ESWT against CPET; 2) construct validity of the 6MWT, ISWT and ESWT against measures of function, strength, respiratory function and health-related quality of life (HRQoL); and 3) clinical applicability of the tests. Twenty participants (40 % male, mean ± SD age 66.1 ± 6.5 years) with stage I-IIIb NSCLC completed the 6MWT, ISWT, ESWT and CPET within six months of treatment. Testing order was randomised. Additional measures included Eastern Cooperative Oncology Group Performance-Status (ECOG-PS, function), respiratory function, hand-grip dynamometry and HRQoL. Correlations and regression analyses were used to assess relationships. The ISWT demonstrated criterion validity with a moderate relationship between ISWT distance and CPET peak oxygen consumption (r = 0.61, p = 0.007). Relationships between CPET and six minute walk distance (6MWD) (r = 0.24, p = 0.329) or ESWT time (r = 0.02, p = 0.942) were poor. Moderate construct validity existed for the 6MWD and respiratory function (forced vital capacity % predicted r = 0.53, p = 0.019; forced expiratory volume in the first second % predicted r = 0.55, p = 0.015). There were no relationships between the walking tests and measures of function, strength or HRQoL. The ESWT had a ceiling effect with 18 % reaching maximum time. No floor effects were seen in the tests. The mean ± SD time required to perform the individual 6MWT, ISWT and ESWT was 12.8 ± 2.5, 14.7 ± 3.7 and 16.3 ± 5.0 min respectively; in comparison to CPET which was 51.2 ± 12.7 min. Only one assessor was required to perform all field walking tests and no adverse events occurred. The ISWT is a promising measure of functional exercise capacity in lung cancer. Findings need to be confirmed in a larger sample prior to translation into practice.

Research paper thumbnail of The impact of extended bed rest on the musculoskeletal system in the critical care environment

Extreme Physiology & Medicine, 2015

Prolonged immobility is harmful with rapid reductions in muscle mass, bone mineral density and im... more Prolonged immobility is harmful with rapid reductions in muscle mass, bone mineral density and impairment in other body systems evident within the first week of bed rest which is further exacerbated in individuals with critical illness. Our understanding of the aetiology and secondary consequences of prolonged immobilization in the critically ill is improving with recent and ongoing research to establish the cause, effect, and best treatment options. This review aims to describe the current literature on bed rest models for examining immobilization-induced changes in the musculoskeletal system and pathophysiology of immobilisation in critical illness including examination of intracellular signalling processes involved. Finally, the review examines the current barriers to early activity and mobilization and potential rehabilitation strategies, which are being, investigated which may reverse the effects of prolonged bed rest. Addressing the deleterious effects of immobilization is a major step in treatment and prevention of the public health issue, that is, critical illness survivorship.

Research paper thumbnail of Low physical activity levels and poorer muscle strength are associated with reduced physical function at intensive care unit discharge: An observational study

Australian Critical Care, 2015

Research paper thumbnail of Functional Electrical Stimulation-Cycling In Acute Traumatic Tetraplegia Within Four Days Post Injury: A Case Report

Research paper thumbnail of Manual Muscle Strength Testing In Critically Ill Patients

Research paper thumbnail of Interobserver Reliability of Quantitative Muscle Sonographic Analysis in the Critically Ill Population

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2015

There is growing interest in the use of quantitative high-resolution neuromuscular sonography to ... more There is growing interest in the use of quantitative high-resolution neuromuscular sonography to evaluate skeletal muscles in patients with critical illness. There is currently considerable methodological variability in the measurement technique of quantitative muscle analysis. The reliability of muscle parameters using different measurement techniques and assessor expertise levels has not been examined in patients with critical illness. The primary objective of this study was to determine the interobserver reliability of quantitative sonographic measurement analyses (thickness and echogenicity) between assessors of different expertise levels and using different techniques for selecting the region of interest. We conducted a cross-sectional observational study in neurocritical care and mixed surgical-medical intensive care units from 2 tertiary referral hospitals. Twenty diaphragm and 20 quadriceps images were evaluated. Images were obtained by using standardized imaging acquisition...

Research paper thumbnail of Ultrasonography in the intensive care setting can be used to detect changes in the quality and quantity of muscle and is related to muscle strength and function

Journal of Critical Care, 2015

Objectives: A rapid and early loss of skeletal muscle mass underlies the physical disability comm... more Objectives: A rapid and early loss of skeletal muscle mass underlies the physical disability common amongst survivors of critical illness. However, skeletal muscle function depends not only on its quantity but its quality, which may be adversely affected. We set out to characterise the changes in macroscopic muscle echogenicity and fascial characteristics that occur early in critical illness, and to relate these to microscopic histologically defined myofibre necrosis and fascial pathology. Design and Setting: Prospective two center observational study. Patients: Thirty subjects comprising a subgroup of patients recruited to the Musculoskeletal Ultrasound in Critical Illness: Longitudinal Evaluation (MUSCLE) study. Measurements and Main Results: Comparisons were made between sequential Vastus Lateralis histological specimens and ultrasound assessment of Rectus Femoris echogenicity. Change in muscle echogenicity was greater in patients who developed muscle necrosis (n = 15) than in those who did not (8.2% [95% CI, -5.3 to 21.7] vs -15.0% [95% CI, -28.9 to -1.09]; p = 0.016). The area under receiver operator curve for ultrasound echogenicity's prediction of myofiber necrosis was 0.74 (95% CI, 0.565 to 0.919; p = 0.024) increasing to 0.85 (95% CI, 0.703 to -0.995; p = 0.003) with the removal of those with potential iatrogenic muscle damage. Fasciitis was observed in 18 of 30 biopsies (60%). Conclusions: Myofiber necrosis and fascial inflammation can be detected noninvasively using ultrasound in the critically ill. Fasciitis precedes and frequently accompanies muscle necrosis. These findings may have functional implications for survivors of critical illness. (Crit Care Med 2015; XX:00-00)

Research paper thumbnail of PP028-SUN: Associations between Cumulative Calorie Debt (CCD) in Intensive Care (ICU), The Diagnosis of Intensive Care Unit Acquired Weakness (ICUAW) and Length of Stay (LOS)

Research paper thumbnail of PP038-SUN: Measured Energy Expenditure Compared with Estimated Energy Requirments and Accelerometry in Intensive Care

Research paper thumbnail of The self-reported Physical Activity Scale for the Elderly (PASE) is a valid and clinically applicable measure in lung cancer

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, Jan 26, 2015

Physical activity (PA) is an important outcome in lung cancer; however, there is lack of consensu... more Physical activity (PA) is an important outcome in lung cancer; however, there is lack of consensus as to the best method for assessment. The Physical Activity Scale for the Elderly (PASE) is a commonly used questionnaire. The aim of this study was to assess the clinimetric properties of the PASE in lung cancer, specifically validity, predictive utility and clinical applicability (floor/ceiling effects, responsiveness and minimal important difference [MID]). This is a prospective observational study. Sixty-nine participants (62 % male, median [IQR] age 68 years [61-74]) with lung cancer completed the PASE at diagnosis at 2, 4 and 6 months. Additional measures included movement sensors (steps/day), physical function, health-related quality of life, functional capacity (6-min walk distance [6MWD]), and muscle strength. Spearman's rank correlation coefficient was used to assess relationships. Linear regression analyses were conducted to determine predictive utility of the PASE for h...

Research paper thumbnail of Functional outcomes in ICU – what should we be using? - an observational study

Critical Care, 2015

Introduction: With growing awareness of the importance of rehabilitation, new measures are being ... more Introduction: With growing awareness of the importance of rehabilitation, new measures are being developed specifically for use in the intensive care unit (ICU). There are currently 26 measures reported to assess function in ICU survivors. The Physical Function in Intensive care Test scored (PFIT-s) has established clinimetric properties. It is unknown how other functional measures perform in comparison to the PFIT-s or which functional measure may be the most clinically applicable for use within the ICU. The aims of this study were to determine (1) the criterion validity of the Functional Status Score for the ICU (FSS-ICU), ICU Mobility Scale (IMS) and Short Physical Performance Battery (SPPB) against the PFIT-s; (2) the construct validity of these tests against muscle strength; (3) predictive utility of these tests to predict discharge to home; and (4) the clinical applicability. This was a nested study within an ongoing controlled study and an observational study.

Research paper thumbnail of TITLE: Functional electrical stimulation with cycling in the critically ill: a pilot case-matched control study

Research paper thumbnail of A new two-tier strength assessment approach to the diagnosis of weakness in intensive care: an observational study

Critical Care, 2015

Introduction: Intensive care unit-acquired weakness (ICU-AW) is a significant problem. There is c... more Introduction: Intensive care unit-acquired weakness (ICU-AW) is a significant problem. There is currently widespread variability in the methods used for manual muscle testing and handgrip dynamometry (HGD) to diagnose ICU-AW. This study was conducted in two parts. The aims of this study were: to determine the inter-rater reliability and agreement of manual muscle strength testing using both isometric and through-range techniques using the Medical Research Council sum score and a new four-point scale, and to examine the validity of HGD and determine a cutoff score for the diagnosis of ICU-AW for the new four-point scale. Methods: Part one involved evaluation of muscle strength by two physical therapists in 29 patients ventilated >48 hours. Manual strength testing was performed by both physical therapists using two techniques: isometric and through range; and two scoring systems: traditional six-point Medical Research Council scale and a new collapsed four-point scale. Part two involved assessment of handgrip strength conducted on 60 patients. A cutoff score for ICU-AW was identified for the new four-point scoring system. Results: The incidence of ICU-AW was 42% (n = 25/60) in this study (based on HGD). In part one the highest reliability and agreement was observed for the isometric technique using the four-point scale (intraclass correlation coefficient = 0.90: kappa = 0.72 respectively). Differences existed between isometric and through-range scores (mean difference = 1.76 points, P = 0.005). In part two, HGD had a sensitivity of 0.88 and specificity of 0.80 for diagnosing ICU-AW. A cutoff score of 24 out of 36 points was identified for the four-point scale.

Research paper thumbnail of Early rehabilitation in critical care (eRiCC): functional electrical stimulation with cycling protocol for a randomised controlled trial

Research paper thumbnail of Assessment of impairment and activity limitations in the critically ill: a systematic review of measurement instruments and their clinimetric properties

Intensive Care Medicine

Purpose To identify measures used to evaluate the broad constructs of functional impairment and l... more Purpose To identify measures used to evaluate the broad constructs of functional impairment and limitations in the critically ill across the continuum of recovery, and to evaluate, synthesise and compare the clinimetric properties of the measures identified. Methods A systematic review of articles was carried out using the databases Medline (1950-2014), CINAHL (1982-2014), EMBASE (1980-2014), Cochrane Library (2014) and Scopus (1960-2014). Additional studies were identified by searching personal files. Eligibility criteria for selection: Search 1: studies which assessed muscle mass, strength or function using objective non-laboratory measures; Search 2: studies which evaluated a clinimetric property (reliability, measurement error, validity or responsiveness) for one of the measures identified in search one. Two independent reviewers assessed articles for inclusion and assessed risk of bias using the consensus-based standards for selection of health status measurement instruments ch...

Research paper thumbnail of Clinical application of the Melbourne risk prediction tool in a high-risk upper abdominal surgical population: an observational cohort study

Physiotherapy, 2014

(1) To determine the ability of the Melbourne risk prediction tool to predict a pulmonary complic... more (1) To determine the ability of the Melbourne risk prediction tool to predict a pulmonary complication as defined by the Melbourne Group Scale in a medically defined high-risk upper abdominal surgery population during the postoperative period; (2) to identify the incidence of postoperative pulmonary complications; and (3) to examine the risk factors for postoperative pulmonary complications in this high-risk population. Design Observational cohort study. Setting Tertiary Australian referral centre. Participants and methods 50 individuals who underwent medically defined high-risk upper abdominal surgery. Presence of postoperative pulmonary complications was screened daily for seven days using the Melbourne Group Scale (Version 2). Postoperative pulmonary risk prediction was calculated according to the Melbourne risk prediction tool. Outcome measures (1) Melbourne risk prediction tool; and (2) the incidence of postoperative pulmonary complications. Results Sixty-six percent (33/50) underwent hepatobiliary or upper gastrointestinal surgery. Mean (SD) anaesthetic duration was 377.8 (165.5) minutes. The risk prediction tool classified 84% (42/50) as high risk. Overall postoperative pulmonary complication incidence was 42% (21/50). The tool was 91% sensitive and 21% specific with a 50% chance of correct classification. Conclusion This is the first study to externally validate the Melbourne risk prediction tool in an independent medically defined highrisk population. There was a higher incidence of pulmonary complications postoperatively observed compared to that previously reported. Results demonstrated poor validity of the tool in a population already defined medically as high risk and when applied postoperatively. This observational study has identified several important points to consider in future trials.

Research paper thumbnail of Functional electrical stimulation with cycling in the critically ill: A pilot case-matched control study

Journal of Critical Care, 2014

To determine (a) safety and feasibility of functional electrical stimulation (FES)cycling and (b)... more To determine (a) safety and feasibility of functional electrical stimulation (FES)cycling and (b) compare FES-cycling to case-matched controls in functional recovery and delirium outcomes.

Research paper thumbnail of Electrical Muscle Stimulation in the Intensive Care Setting

Critical Care Medicine, 2013

The role of electrical muscle stimulation in intensive care has not previously been systematicall... more The role of electrical muscle stimulation in intensive care has not previously been systematically reviewed. To identify, evaluate, and synthesize the evidence examining the effectiveness and the safety of electrical muscle stimulation in the intensive care, and the optimal intervention variables. A systematic review of articles using eight electronic databases (Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Excerpta Medica Database, Expanded Academic ASAP, MEDLINE, Physiotherapy Evidence Database, PubMed, and Scopus) personal files were searched, and cross-referencing was undertaken. Quantitative studies published in English, assessing electrical muscle stimulation in intensive care, were included. One reviewer extracted data using a standardized form, which were cross-checked by a second reviewer. Quality appraisal was undertaken by two independent reviewers using the Physiotherapy Evidence Database and Newcastle-Ottawa scales, and the National Health and Medical Research Council Hierarchy of Evidence Scale. Preferred Reporting Items for Systematic Reviews guidelines were followed. Nine studies on six individual patient groups of 136 participants were included. Eight were randomized controlled trials, with four studies reporting on the same cohort of participants. Electrical muscle stimulation appears to preserve muscle mass and strength in long-stay participants and in those with less acuity. No such benefits were observed when commenced prior to 7 days or in patients with high acuity. One adverse event was reported. Optimal training variables and safety of the intervention require further investigation. Electrical muscle stimulation is a promising intervention; however, there is conflicting evidence for its effectiveness when administered acutely. Outcomes measured are heterogeneous with small sample sizes.

Research paper thumbnail of Functional capacity, physical activity and muscle strength assessment of individuals with non-small cell lung cancer: a systematic review of instruments and their measurement properties

BMC Cancer, 2013

The measurement properties of instruments used to assess functional capacity, physical activity a... more The measurement properties of instruments used to assess functional capacity, physical activity and muscle strength in participants with non-small cell lung cancer (NSCLC) have not been systematically reviewed. Method: Objectives: To identify outcome measures used to assess these outcomes in participants with NSCLC; and to evaluate, synthesise and compare the measurement properties of the outcome measures identified. Data Sources: A systematic review of articles using electronic databases MEDLINE Additional studies were identified by searching personal files and cross referencing. Eligibility Criteria for Study Selection: Search one: studies which assessed functional capacity, physical activity or muscle strength in participants with NSCLC using non-laboratory objective tests were included. Search two: studies which evaluated a measurement property (inter-or intra-rater reliability; measurement error; criterion or construct validity; or responsiveness) in NSCLC for one of the outcome measures identified in search one. Studies published in English from 1980 were eligible. Data Extraction and Methodological Quality Assessment: data collection form was developed and data extracted. Methodological quality of studies was assessed by two independent reviewers using the 4-point COSMIN checklist.

Research paper thumbnail of Which field walking test should be used to assess functional exercise capacity in lung cancer? an observational study

BMC Pulmonary Medicine, 2015

There is emerging evidence regarding the efficacy of exercise training to improve exercise capaci... more There is emerging evidence regarding the efficacy of exercise training to improve exercise capacity for individuals with non-small cell lung cancer (NSCLC). Cardiopulmonary exercise testing (CPET) is the gold standard measure of exercise capacity; however this laboratory test has limitations for use in research and clinical practice. Alternative field walking tests are the six-minute walk test (6MWT), incremental-shuttle walk test (ISWT) and endurance-shuttle walk test (ESWT); however there is limited information about their clinimetric properties in NSCLC. In NSCLC to determine the 1) criterion validity of the 6MWT, ISWT and ESWT against CPET; 2) construct validity of the 6MWT, ISWT and ESWT against measures of function, strength, respiratory function and health-related quality of life (HRQoL); and 3) clinical applicability of the tests. Twenty participants (40 % male, mean ± SD age 66.1 ± 6.5 years) with stage I-IIIb NSCLC completed the 6MWT, ISWT, ESWT and CPET within six months of treatment. Testing order was randomised. Additional measures included Eastern Cooperative Oncology Group Performance-Status (ECOG-PS, function), respiratory function, hand-grip dynamometry and HRQoL. Correlations and regression analyses were used to assess relationships. The ISWT demonstrated criterion validity with a moderate relationship between ISWT distance and CPET peak oxygen consumption (r = 0.61, p = 0.007). Relationships between CPET and six minute walk distance (6MWD) (r = 0.24, p = 0.329) or ESWT time (r = 0.02, p = 0.942) were poor. Moderate construct validity existed for the 6MWD and respiratory function (forced vital capacity % predicted r = 0.53, p = 0.019; forced expiratory volume in the first second % predicted r = 0.55, p = 0.015). There were no relationships between the walking tests and measures of function, strength or HRQoL. The ESWT had a ceiling effect with 18 % reaching maximum time. No floor effects were seen in the tests. The mean ± SD time required to perform the individual 6MWT, ISWT and ESWT was 12.8 ± 2.5, 14.7 ± 3.7 and 16.3 ± 5.0 min respectively; in comparison to CPET which was 51.2 ± 12.7 min. Only one assessor was required to perform all field walking tests and no adverse events occurred. The ISWT is a promising measure of functional exercise capacity in lung cancer. Findings need to be confirmed in a larger sample prior to translation into practice.