Melbourne School of Health Sciences Collected Works - Research Publications

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    Survey of neurodevelopmental allied health teams in Australian and New Zealand neonatal nurseries: Staff profile and standardised neurobehavioural/neurological assessment
    Allinson, LG ; Doyle, LW ; Denehy, L ; Spittle, AJ (WILEY, 2017-06)
    AIMS: The primary aim of this study was to establish how many neonatal nurseries in Australia and New Zealand had a neurodevelopmental allied health team, to ascertain the disciplines involved, their qualifications and experience. The secondary aim was to evaluate which standardised neurobehavioural/neurological assessments were currently being implemented, and the existing practice in relation to their use. METHODS: A descriptive cross-sectional survey, sampling 179 eligible public and private hospital neonatal intensive care units (NICUs) and special care nurseries (SCNs) throughout Australia and New Zealand, was purpose-developed and administered electronically from the 5th April to 23rd July 2013. RESULTS: A total of 117 units (65%) overall, and 26 of 26 (100%) NICUs responded to the survey. NICUs had more neurodevelopmental allied health staff than SCNs, with physiotherapists and speech pathologists the most common disciplines. Physiotherapists were more likely to administer standardised neurobehavioural/neurological assessments in NICUs, while medical staff were more likely to do so in SCNs. A wide variety of standardised neurobehavioural/neurological assessment tools were used, with Prechtl's General Movements Assessment the most common in the NICUs (50%) and the Hammersmith Neonatal Neurological Examination the most common in the special care units (25%). Standardised neurobehavioural assessments were not administered in 22% of SCNs. CONCLUSIONS: Although neurodevelopmental allied health teams and standardised neurobehavioural/neurological assessments are valued by many, there was little consistency across Australian and New Zealand neonatal nurseries.
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    How is physical activity measured in lung cancer? A systematic review of outcome measures and their psychometric properties
    Edbrooke, L ; Denehy, L ; Parry, SM ; Astin, R ; Jack, S ; Granger, CL (WILEY, 2017-02)
    Physical activity (PA) levels are low in patients with lung cancer. Emerging evidence supports the use of interventions to increase PA in this population. We aimed to (1) identify and synthesize outcome measures which assess PA levels in patients with lung cancer and (2) to evaluate, synthesize and compare the psychometric properties of these measures. A systematic review of articles from searches was conducted of five electronic databases and personal records. Eligible studies were those which assessed PA using either performance-based or patient-reported measures. For aim 2, studies identified in aim 1 reporting on at least one psychometric property (validity, reliability, responsiveness or measurement error) were included. Two independent reviewers assessed eligibility and risk of bias with the COnsensus-based Standards for the selection of health status Measurement INstruments. Thirty-four studies using 21 different measures of PA were identified. Seventeen studies used performance-based measures. The Godin Leisure Time Exercise Questionnaire (GLTEQ) was the most frequently used patient-reported measure. Psychometric properties were reported for 13 of these measures and most frequently for movement sensors. Two studies reported on properties of the GLTEQ. Quality ratings for risk of bias were low. There is significant heterogeneity amongst studies regarding method of PA measurement along the lung cancer continuum. Greater consensus could be achieved by using a consensus approach such as a Delphi process. Future studies should include assessment of psychometric properties of the measurement tool being used. Currently, it is recommended where feasible, both performance-based and patient-reported measurements of PA should be undertaken.
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    The Australian Pelvic Floor Questionnaire is a valid measure of pelvic floor symptoms in patients following surgery for colorectal cancer
    Lin, K-Y ; Frawley, HC ; Granger, CL ; Denehy, L (WILEY, 2017-06)
    AIMS: This study evaluated the construct validity of the Australian Pelvic Floor Questionnaire against two alternative measures of the severity of bladder and bowel symptoms. METHODS: This was an exploratory analysis of data from two prospective studies. Patients who had undergone surgery for colorectal cancer were analysed. Bladder and bowel symptoms were measured using three validated questionnaires: the Australian Pelvic Floor Questionnaire, the International Consultation on Incontinence Questionnaire Short Form Questionnaire for urinary incontinence and the International Consultation on Incontinence Questionnaire-Bowel Module post-cancer treatment. RESULTS: The study sample consisted of 44 participants, including 25 men and 19 women. The Australian Pelvic Floor Questionnaire bladder and bowel domain scores demonstrated moderate positive correlations with the International Consultation on Incontinence Questionnaire Short Form Questionnaire for urinary incontinence (r = 0.74, P < 0.01) and the International Consultation on Incontinence Questionnaire-Bowel Module (r = 0.69-0.78, P < 0.01). Similar results were obtained in each gender subgroup. CONCLUSIONS: This study suggested that the Australian Pelvic Floor Questionnaire may be a valid measurement tool for use in colorectal cancer populations in clinical trials and practice. Future research using larger cohorts is warranted.
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    Associations between nutritional energy delivery, bioimpedance spectroscopy and functional outcomes in survivors of critical illness
    Fetterplace, K ; Beach, LJ ; MacIsaac, C ; Presneill, J ; Edbrooke, L ; Parry, SM ; Rechnitzer, T ; Curtis, R ; Berney, S ; Deane, AM ; Denehy, L (WILEY, 2019-12)
    BACKGROUND: Patients who survive critical illness frequently develop muscle weakness that can impact on quality of life; nutrition is potentially a modifiable risk factor. The present study aimed to explore the associations between cumulative energy deficits (using indirect calorimetry and estimated requirements), nutritional and functional outcomes. METHODS: A prospective single-centre observational study of 60 intensive care unit (ICU) patients, who were mechanically ventilated for at least 48 h, was conducted. Cumulative energy deficit was determined from artificial nutrition delivery compared to targets. Measurements included: (i) at recruitment and ICU discharge, weight, fat-free mass (bioimpedance spectroscopy) and malnutrition (Subjective Global Assessment score B/C); (ii) at awakening and ICU discharge, physical function (Physical Function in Intensive Care Test-scored) and muscle strength (Medical Research Council sum-score (MRC-SS). ICU-acquired weakness was defined as a MRC-SS score of less than 48/60. RESULTS: The median (interquartile range) cumulative energy deficit compared to the estimated targets up to ICU day 12 was 3648 (2514-5650) kcal. Adjusting for body mass index, age and severity of illness, cumulative energy deficit (per 1000 kcal) was independently associated with greater odds of ICU-acquired weakness [odds ratio (OR) = 2.1, 95% confidence interval (CI) = 1.4-3.3, P = 0.001] and malnutrition (OR = 1.9, 95% CI = 1.1-3.2, P = 0.02). In similar multivariable linear models, cumulative energy deficit was associated with reductions in fat-free mass (-1.3 kg; 95% CI = -2.4 to -0.2, P = 0.02) and physical function scores (-0.6 points; 95% CI = -0.9 to -0.3, P = 0.001). CONCLUSIONS: Cumulative energy deficit from artificial nutrition support was associated with reduced functional outcomes and greater loss of fat-free mass in ventilated ICU patients.
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    Improving the delivery of physical activity services in lung cancer: A qualitative representation of the patient's perspective
    Granger, CL ; Parry, SM ; Edbrooke, L ; Abo, S ; Leggett, N ; Dwyer, M ; Denehy, L (WILEY, 2019-01)
    OBJECTIVE: To explore patient experiences of, and preferences for, physical activity after a lung cancer diagnosis. METHODS: This was a qualitative study involving seven patients who had been treated for lung cancer within the previous 2 years. Participants attended a focus group interview. Conventional content analysis methodology was used to analyse the text by two independent researchers. RESULTS: Eight major themes emerged from the data. These were as follows: the influence of past lifestyle and chronic disease; the perceived benefits of physical activity; using physical activity to facilitate return to activities of daily living; the impact of symptoms, capacity and motivation; family and peer support; access to services; health professionals; and enjoyment of different types of physical activity. Patients suggested several factors that could improve their healthcare experience. These include access to exercise professionals particularly after cancer treatment; access to information about physical activity in different formats; supervision from health professionals and peer support; and use of behaviour change strategies to achieve sustainable increases in physical activity. CONCLUSION: Our results should be considered in the improvement of lung cancer care pathways as we strive to implement physical activity services into routine clinical care.
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    How Can Clinicians Use Outcome Measures in Routine Care? Knowledge Translation Strategies
    Haines, KJ ; Skinner, EH ; Pastva, A ; Berney, S ; Denehy, L (Springer Science and Business Media LLC, 2015-12-01)
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    Measuring physical function after ICU: one step at a time
    Hodgson, CL ; Denehy, L (SPRINGER, 2017-12)
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    Symptoms of Posttraumatic Stress Disorder and Associated Risk Factors in Patients With Lung Cancer: A Longitudinal Observational Study
    Ni, J ; Feng, J ; Denehy, L ; Wu, Y ; Xu, L ; Granger, CL (SAGE PUBLICATIONS INC, 2018-12)
    PURPOSE: This study aimed to measure symptoms of posttraumatic stress disorder (PTSD) in Chinese patients following a new diagnosis of lung cancer. Secondary aims were to explore factors at diagnosis that may predict PTSD symptoms at 6 months. METHODS: This was a prospective longitudinal observational study that included 93 patients with newly diagnosed lung cancer. PTSD symptomology was assessed using the PTSD Checklist Civilian Version (PCL-C) and health-related quality of life (HRQoL) was assessed with the European Organisation for the Research and Treatment of Cancer questionnaire. Measures were completed at diagnosis and 6 months. RESULTS: No patient had PTSD at baseline or 6 months as measured by a score of ⩾50 in the PCL-C. However, at diagnosis, 44% of patients had "mild" symptoms of PTSD. At 6 months, 64% of patients had "mild" and 8% had "moderate" PTSD symptoms. PTSD symptom scores significantly worsened over 6 months (mean difference [95% CI] = 7.2 [5.4 to 9.0]). Six months after diagnosis, higher PTSD scores were seen in people who at diagnosis were younger ( P = .003), had a lower smoking pack history ( P = .012), displayed less sedentary behavior ( P < .005), or initially had worse cancer symptoms, including fatigue ( P = .001) and poorer HRQoL ( P = .004). CONCLUSIONS: Mild PTSD symptoms are common in patients with lung cancer 6 months after treatment; however, a full diagnosis of PTSD is uncommon. Screening for PTSD symptoms may be considered for at-risk patients with newly diagnosed lung cancer.
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    Exercise rehabilitation following hospital discharge in survivors of critical illness: an integrative review
    Connolly, B ; Denehy, L ; Brett, S ; Elliott, D ; Hart, N (BIOMED CENTRAL LTD, 2012)
    Although clinical trials have shown benefit from early rehabilitation within the ICU, rehabilitation of patients following critical illness is increasingly acknowledged as an area of clinical importance. However, despite recommendations from published guidelines for rehabilitation to continue following hospital discharge, there is limited evidence to underpin practice during this intermediate stage of recovery. Those patients with ICU-acquired weakness on discharge from the ICU are most likely to benefit from ongoing rehabilitation. Despite this, screening based on strength alone may fail to account for the associated level of physical functioning, which may not correlate with muscle strength, nor address non-physical complications of critical illness. The aim of this review was to consider which patients are likely to require rehabilitation following critical illness and to perform an integrative review of the available evidence of content and nature of exercise rehabilitation programmes for survivors of critical illness following hospital discharge. Literature databases and clinical trials registries were searched using appropriate terms and groups of terms. Inclusion criteria specified the reporting of rehabilitation programmes for patients following critical illness post-hospital discharge. Ten items, including data from published studies and protocols from trial registries, were included. Because of the variability in study methodology and inadequate level of detail of reported exercise prescription, at present there can be no clear recommendations for clinical practice from this review. As this area of clinical practice remains in its relative infancy, further evidence is required both to identify which patients are most likely to benefit and to determine the optimum content and format of exercise rehabilitation programmes for patients following critical illness post-hospital discharge.
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    Early rehabilitation in critical care (eRiCC): functional electrical stimulation with cycling protocol for a randomised controlled trial
    Parry, SM ; Berney, S ; Koopman, R ; Bryant, A ; El-Ansary, D ; Puthucheary, Z ; Hart, N ; Warrillow, S ; Denehy, L (BMJ PUBLISHING GROUP, 2012)
    INTRODUCTION: Intensive care-acquired weakness is a common problem, leads to significant impairment in physical functioning and muscle strength, and is prevalent in individuals with sepsis. Early rehabilitation has been shown to be safe and feasible; however, commencement is often delayed due to a patient's inability to co-operate. An intervention that begins early in an intensive care unit (ICU) admission without the need for patient volition may be beneficial in attenuating muscle wasting. The eRiCC (early rehabilitation in critical care) trial will investigate the effectiveness of functional electrical stimulation-assisted cycling and cycling alone, compared to standard care, in individuals with sepsis. METHODS AND ANALYSIS: This is a single centre randomised controlled trial. Participants (n=80) aged ≥18 years, with a diagnosis of sepsis or severe sepsis, who are expected to be mechanically ventilated for ≥48 h and remain in the intensive care ≥4 days will be randomised within 72 h of admission to (1) standard care or (2) intervention where participants will receive functional electrical muscle stimulation-assisted supine cycling on one leg while the other leg undergoes cycling alone. Primary outcome measures include: muscle mass (quadriceps ultrasonography; bioelectrical impedance spectroscopy); muscle strength (Medical Research Council Scale; hand-held dynamometry) and physical function (Physical Function in Intensive Care Test; Functional Status Score in intensive care; 6 min walk test). Blinded outcome assessors will assess measures at baseline, weekly, at ICU discharge and acute hospital discharge. Secondary measures will be evaluated in a nested subgroup (n=20) and will consist of biochemical/histological analyses of collected muscle, urine and blood samples at baseline and at ICU discharge. ETHICS AND DISSEMINATION: Ethics approval has been obtained from the relevant institution, and results will be published to inform clinical practice in the care of patients with sepsis to optimise rehabilitation and physical function outcomes. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry ACTRN12612000528853.