Health Sciences Conference Papers

Predicting a student’s success in Health Sciences based on their academic writing skills

Gerard F. Hoyne et al. — Tue, 10 Jul 2012 21:26:55 PDT

Writing skills underpin academic success in any tertiary course, irrespective of the discipline. Anecdotal evidence suggested that first year undergraduates in the Health Sciences frequently underestimate the importance of writing skills. This study explored the relationship between a student’s academic writing in their first semester of academic study, as assessed through a Post Entrance Literacy Assessment (PELA), and their performance in a core academic literacy unit, and an anatomy unit at the end of semester. The PELA was useful in identifying students with deficient writing skills, but did not reliably predict overall performance in the literacy unit. Students identified as “at risk” by PELA testing failed to engage with optional academic support programs. This led to increased collaboration between colleagues in the Academic Enabling Support Centre and Health Sciences to instigate a School wide policy change making it compulsory for any “at risk” student to attend support workshops.

Improving fitness and motor skills in adolescents with DCD: Preliminary results from the AMPitup program

Beth Hands et al. — Thu, 12 Apr 2012 23:18:58 PDT

Adolescents with DCD need developmentally appropriate exercise programs that are meaningful and enjoyable, and also enable them to develop the skills, fitness and confidence to participate in community exercise settings as adults.

T cell homeostasis is regulated by a program of mRNA alternative splicing mediated by heterogeneous nuclear ribonuclear protein L-like (hnRNPLL)

Gerard F. Hoyne — Tue, 18 Jan 2011 19:36:41 PST

It is essential that the immune system maintains stable numbers of a diverse range of lymphocytes since they play important roles in both innate and adaptive immune responses. T lymphocytes are critical for generating cellular immunity and memory following infections (e.g. CD4+ and CD8+ TCR ab + cells), they are also involved in immune regulation (e.g. CD4+ foxp3+ regulatory T cells), as well as immune surveillance at mucosal surfaces and controlling responses to tumors (e.g. TCR gd + cells, NKT cells). Each cell lineage must be contained within a defined cellular compartment and the size of each compartment is physically constrained due to limitations of nutrients and space. Growth factors that belong to the common gamma chain family of cytokines (e.g. IL-7, IL-15 and IL-2) are particularly important for T cell survival but the molecular regulation of lymphocyte survival remains poorly understood. However our understanding of the molecular mechanisms that control T cell homeostasis remains poorly defined. We have recently identified a novel role for the nuclear protein heterogeneous nuclear ribonuclear protein L-like (hnRNPLL) for the homeostasis of CD4+ and CD8+ T cells in the peripheral immune system through the characterization of a mouse strain derived from an ENU mutagenesis screen (1). The thunder mouse strain was identified on the basis of reduced numbers of peripheral T cells and we have gone onto to show that the cellular phenotype is caused by a hypomorphic mutation in the Hrnpll gene which controls mRNA alternative splicing. We have used a genomic approach to study the target genes in naïve and memory T cells whose splicing is dependent on hnRNPLL. This revealed that the transition from the naïve to memory phenotype involves a program of mRNA alternative splicing that involves hundreds of genes. The thunder mutation does not affect T cell development but it has a non redundant role in regulating the persistence of T cells in the peripheral immune system. These studies have uncovered that temporal changes in mRNA alternative splicing underpins the control T cell homeostasis in vivo that occurs in response to growth factor and antigen receptor signalling.

(1) 1. Wu, Z et al 2008. Memory T cell RNA rearrangement programmed by heterogeneous nuclear ribonucleoprotein hnRNPLL. Immunity 29: 863-875.

Physical Wellness: The relationship between motor skill, fitness and physical activity in young children

Beth P. Hands et al. — Mon, 29 Nov 2010 16:37:23 PST

The health benefits of adequate physical activity levels for children are well reported. However, we cannot assume that children will choose to be sufficiently active of their own accord. Motor competence and fitness are increasingly highlighted as key co-determinants of physical activity in young children (Hands, Parker, & Larkin, 2001) and where possible strategies to enhance these factors should be included in early childhood settings. However few studies have adopted an integrated view of the collective effects of these three factors on developing healthy children. This presentation explores interrelationships between measures of motor skill competence, fitness, and weekly physical activity level in 44 children aged between 5 and 10 years. These are derived from parent completed questionnaire and physical assessments. In particular the emphasis was on comparing low active and high active children and drawing implications for parents, caregivers and teachers on ways to facilitate children’s physical well being.

Critical periods for the development of adolescent obesity

Paola Chivers et al. — Tue, 26 Oct 2010 18:44:26 PDT

Numerous individual, behavioural, and environmental factors contribute to the development of obesity in adolescence. It is likely that some factors may be more influential during specific developmental phases in childhood. In this paper, we use data from the Western Australian Pregnancy Cohort (Raine) Study to identify these critical periods and their respective contributing factors.

A sample of 1403 participants (674 females and 729 males) was available for analysis over eight time points (birth, ages 1, 2, 3, 6, 8, 10, and 14 years). Cross sectional (ANOVA, Chi square) and longitudinal (linear mixed model) analysis was used to identify key factors related to BMI weight status at 14 years, along with the period of importance. Over 100 factors were assessed.

We identified three critical developmental periods between birth and age 8 years; perinatal, between ages 1 to 3 years and 6 and 8 years. During the perinatal period, a key factor was maternal smoking (χ2 = 12.6, p = .002). Between ages 1 to 3 years, some indicators included early feeding behaviours (exclusive breast feeding for longer than 4 months χ2 = 15.2, p < .001); abnormal motor development, and early physical activity behaviours (e.g. visits to park age 1 year χ2 = 17.0, p = .030). Between ages 6 and 8 years physical activity, socioeconomic status, and sedentary behaviours were most influential (e.g. television watching age 6 years χ2 = 42.3, p < .001).

Early childhood contains several critical developmental periods in which individual, behavioural and environmental factors may increase the likelihood of adolescent obesity. Further research is needed to identify effective age-specific interventions, particularly in the preschool years.

Paola Chivers, Beth Hands, Helen Parker and Max Bulsara, 'Critical periods for the development of adolescent obesity', Obesity Research and Clinical Practice, Vol. 4 (S1), 2010, S50.

ISSN: 1871-403X

doi: 10.1016/j.orcp.2010.09.100

The influence of individual, behavioural and environmental factors on BMI at 6, 8, 10 and 14 years

Paola Chivers et al. — Tue, 26 Oct 2010 18:32:13 PDT

As a child matures from birth to adolescence, the relative influence of individual, behavioural and environmental obesogenic factors varies. In this paper, we report four structural equation models that identify possible causal pathways and interrelationships between key obesogenic factors in the Western Australian Pregnancy Cohort (Raine) Study at age 6, 8, 10 and 14 years.

A sample of 1403 participants (674 females and 729 males) was available for analysis. Data for BMI, physical fitness and activity, sedentary behaviour, socioeconomic status, motor competence, diet, self concept, and the school environment were used to develop exploratory structural equation models (AMOS, SPSS) at 6, 8, 10 and 14 years.

The interrelationships between physical activity and sedentary behaviours changed across models at 6 years (χ2 (df = 22) = 25.036, p = .295), 8 years (χ2 (df = 32) = 33.326, p = .403), 10 years (χ2 (df = 40) = 47.820, p = .185) and 14 years (χ2 (df = 57) = 59.487, p = .385), with motor competence becoming important at adolescence.

The relationship between screen time and physical activity as predictors of BMI was complex, and changed between 6, 8, and 10 years. By 14 years of age motor competency, aerobic fitness and physical activity were highly interrelated and together predicted BMI. These exploratory analyses also identified that diet, the school environment, self-concept, and the valuing of physical activity were not important for BMI. Significant differences in pathways were also found between males and females. For example, the pathway between income and screen time was significant for males, but not females at age 14 years.

Interrelationships among obesogenic factors are complex, dynamic and individualised. Their influence on BMI operates in both direct and indirect ways and changes with age between 6 and 14 years. Interventions for obesity must consider age and gender specific differences in pathways and mechanisms.

Chivers, P., Hands, B., Parker, H., & Bulsara, M. (2010). The influence of individual, behavioural and environmental factors on BMI at 6, 8, 10 and 14 years. Obesity Research and Clinical Practice, 4(S1), S41. doi: 10.1016/j.orcp.2010.09.084

Novel lifecourse childhood adiposity trajectories and the prediction of adolescent cardiovascular risk factors

R C Huang et al. — Tue, 26 Oct 2010 18:17:53 PDT

Objectives: In the light of the obesity epidemic we aimed to characterise novel childhood adiposity trajectories and to determine their relation to adolescent cardiovascular risk.

Research design and methods: 2868 Australian children were studied serially from birth to age 14 years. Semi-parametric mixture modelling was applied to anthropometric data over 8 time points to generate adiposity trajectories of z-scores (weight-for-height and body mass index (BMI)). Cardiovascular and related metabolic risk factors assessed in 1106 children at age 14 were compared between adiposity trajectories.

Results: Seven adiposity trajectories were identified. Three (2 rising and 1 chronic high adiposity) comprised 29% of the population and were associated with higher fasting insulin, homeostasis model of insulin resistance (HOMA) and prevalence of the metabolic risk cluster (all p-value ≤ 0.003 in males) compared to a reference trajectory group (with longitudinal adiposity z-scores of approximately zero). In boys, trajectories with rising slopes had greater HOMA, insulin and metabolic syndrome cluster compared with a falling or stable trajectory reaching the same final adiposity. Birth weight was not an independent predictor of HOMA, insulin or metabolic syndrome.

Conclusion: A rising trajectory with accelerated adiposity gain had a greater influence than birth weight on cardiovascular/metabolic risk factors. With world-wide increases in maternal obesity and infant birth weight we speculate that “rising” and “stable high” adiposity trajectories will become more common, resulting in a positive relationship between birth weight and cardiovascular risk. Public health should urgently target excessive weight gain in early childhood across all birth weights.

Huang, R. C., de Klerk, N., Smith, A., Kendall, G., Mori, T., Newnham, J., et al. (2010). Novel lifecourse childhood adiposity trajectories and the prediction of adolescent cardiovascular risk factors. Obesity Research and Clinical Practice, 4(S1), S75. doi: 10.1016/j.orcp.2010.09.146

Physiotherapy and non-invasive ventilation (NIV) at Royal Perth Hospital — a unique service delivery model?

Shane Patman et al. — Mon, 22 Mar 2010 22:31:19 PDT

In 1998, the RPH Physiotherapy Department commenced an acute NIV service, in conjunction with the Respiratory Medicine Department, for patients external to the intensive care unit (ICU). From treating nine patients in its foundation year, the service has grown consistently to 180 episodes provided in 2002, and currently averages 13 patients per month, with many more patients assessed but NIV deemed inappropriate. The NIV service is provided within RPH Physiotherapy Department’s existing rostered 24-hour, seven-day cover. The initial service delivery and subsequent growth in NIV has resulted in many challenges within physiotherapy. The NIV service has not received dedicated funding or staffing from the onset and has subsequently been provided from within existing services. Consequently the Physiotherapy Department has pursued a unique service delivery model in which the understanding and application of NIV has been considered and deemed a core element for those physiotherapists working in the medical, surgical or critical care environments, as opposed to being considered an advanced practitioner skill the domain of select senior staff. In a department that historically has a significant turn-over of staff and sixmonthly rotational posts, a significant degree of ongoing education, training and support has been required to achieve this NIV service delivery model. A significant cultural shift and change to work practices, particularly among non-fulltime physiotherapy staff, has been required to enable the implementation of NIV services within current physiotherapy services. The future visions and expectations of the physiotherapy NIV service is presently tempered by the expansion of NIV services provided from the ICU and the possible commencement of a dedicated sleep unit at RPH.

Patman, S., Winship, P., & Harrold, M. (2004). Physiotherapy and non-invasive ventilation (NIV) at Royal Perth Hospital — a unique service delivery model?Australian Journal of Physiotherapy, 50(3), 83.

ISSN: 0004-9514

Respiratory physiotherapy in the acute tetraplegic patient - is the use of non-invasive ventilation (NIV) a useful adjunct?

Shane Patman et al. — Mon, 22 Mar 2010 21:06:03 PDT

This prospective randomised clinical trial aimed to establish if out-of-hours physiotherapy using intermittent non-invasive ventilation is more beneficial than traditional intermittent positive pressure breathing (IPPB) in maintenance of lung function and prevention of nosocomial pneumonia (NP) in acute tetraplegics, and explore if continuous nocturnal NIV is a viable and effective alternative to intermittent IPPB or NIV. Patients admitted with acute tetraplegia (involving from C5 to T1) were eligible for inclusion. Patients requiring prolonged invasive mechanical ventilation or with significant head injury requiring neurosurgical involvement were excluded. Randomisation of 23 subjects (17 male, mean age 36.8 yrs, SD17.4) was to either Group 1 (n = 6) receiving standard historical physiotherapy care using IPPB, Group 2 (n = 10) receiving standard physiotherapy but substituting intermittent NIV for IPPB, or Group 3 receiving continuous nocturnal NIV. Ethical constraints prevented the use of a control group. Dependent variables were vital capacity (VC), arterial-to-inspired oxygen ratio (PaO2/FiO2), NP incidence, length of stay at the acute facility, and utilisation of out-of-hours physiotherapy service. Groups were similar with demographic variables. One-way analysis of variance and Chi Square tests performed, with an intention to treat philosophy, unearthed no significant differences with daily PaO2/FiO2, NP incidence, length of ICU stay (p = 0.24), or out-of-hours physiotherapy requirements. Significant differences with mean length of acute facility stay [502.2 hrs (SD 363.5) vs 163.3 (116.0) vs 220.6 (165.1); p = 0.036], VC on day 2 [1.30l (0.24) vs 1.50 (0.37) vs 0.86 (0.46); p = 0.026] and day 3 [0.90l (0.37) vs 1.53 (0.37) vs 0.91 (0.28); p = 0.005] were apparent, the clinical significance of which is unclear.

Patman, S., & Cooling, C. (2004). Respiratory physiotherapy in the acute tetraplegic patient - is the use of non-invasive ventilation (NIV) a useful adjunct? Australian Journal of Physiotherapy, 50(3), 110.

ISSN: 0004-9514

The influence of physiotherapy on ventilator-associated pneumonia in acquired brain injury patients

Shane Patman et al. — Mon, 22 Mar 2010 20:56:03 PDT

This prospective randomised controlled trial investigated the effect of respiratory physiotherapy on the incidence of ventilator-associated pneumonia (VAP) in adults with acquired brain injury (ABI). Subjects admitted with a Glasgow Coma Scale nine, requiring intracranial pressure monitoring, and invasive ventilatory support for > 24 hours, were randomly allocated to a treatment group (six respiratory physiotherapy interventions in each 24-hour period while ventilated), or a control group (routine nursing care only). Incidence of VAP, duration of ventilatory support, and length of ICU stay were the dependent variables. Consent was obtained from 128 subjects with 65 randomised to the treatment group. Twenty-seven subjects were excluded due to unstable neurological, cardiac or respiratory status, five due to early limiting of active management, and consent was declined in five patients. Results are presented as mean (SD) for the treatment vs control groups. Groups were similar with respect to demographic variables. Fifteen subjects were withdrawn from the study (five from the treatment group): seven due to cessation of active management, five became medically unstable and three received physiotherapy beyond that described in the treatment protocol. Using multivariate analysis of variance with intention to treat philosophy, there were no significant differences for VAP incidence [14/65 vs 17/63; p = 0.47], length of ventilation (hr) [180.9 (123.3) vs 210.2 (169.9); p = 0.27], or length of ICU stay (hr) [228.6 (122.7) vs 251.7 (173.2); p = 0.38]. Respiratory physiotherapy, in addition to routine nursing care, does not appear to prevent VAP, reduce length of ventilation or ICU stay in adult patients with ABI.

This study was supported by a 2001 Physiotherapy Research Foundation Seeding Grant.

Patman, S., Stiller, K., Blackmore, M., & Jenkins, S. (2004). The influence of physiotherapy on ventilator-associated pneumonia in acquired brain injury patients. Australian Journal of Physiotherapy, 50(3), 109.

ISSN: 0004-9514

The effect of chest physiotherapy on the prevention and treatment of nosocomial pneumonia for intensive care patients with acquired brain injury - preliminary results

Shane Patman et al. — Mon, 22 Mar 2010 20:14:08 PDT

This randomised controlled trial investigated the effects of respiratory physiotherapy on adult acquired brain injury (ABI) patients admitted to the intensive care unit (ICU). Subjects admitted with a Glasgow Coma Scale of < 9, requiring intracranial pressure monitoring, and invasive ventilatory support for > 24 hours, were randomised to a treatment group receiving six respiratory physiotherapy interventions in 24 hours, or to a control group. The incidence of nosocomial pneumonia (NP), duration of ventilatory support, and length of ICU stay were the dependent variables. Of 141 patients fulfilling inclusion criteria, consent was obtained for 105 subjects, with 53 randomised to the treatment group. Presence of exclusion criteria (eg unstable neurological, cardiac or respiratory status) accounted for 25 of those excluded and consent was declined in four patients. Groups were similar with respect to demographic variables except for age[treatment group 46.5 (19.7) vs control 38.2 (19.2); p = 0.03] and body mass index [28.1 (5.6) vs 24.5 (5.2); p = 0.02]. Thirteen subjects were withdrawn (four from treatment group) - five due to cessation of active management, four because they became medically unstable and four received physiotherapy services outside of those provided by group randomisation. Seven withdrawn subjects died. Using multivariate analysis of variance with intention-to-treat philosophy, there were no significant differences for NP incidence [treatment group 11/53 vs control 15/52; p = 0.365], length of ventilation [190.2 hr (124.9) vs 224.3 (171.6); p = 0.248], or length of ICU stay [240.5 hr (120.9) vs 256.4 (169.4); p = 0.584]. Despite a trend favouring the treatment group, there appears to be no benefit from respiratory physiotherapy in preventing NP or reducing length of ventilation or ICU stay in adult ABI patients.

Patman, S., Stiller, K., Blackmore, M., & Jenkins, S. (2003). The effect of chest physiotherapy on the prevention and treatment of nosocomial pneumonia for intensive care patients with acquired brain injury - preliminary results. Australian Journal of Physiotherapy, 49(3), 12.

ISSN: 0004-9514

The Proceedings of the Australian Physiotherapy Association's 8th National Cardiothoracic Special Group Conference, 'Inspiring Innovation, Expiring Tradition' may be accessed at: http://ajp.physiotherapy.asn.au/AJP/vol_49/3/volume49_number3.cfm

The use of non-invasive ventilation (NIV) as an adjunct to physiotherapy in the treatment of the acute tetraplegic patient – preliminary results

Shane Patman et al. — Mon, 22 Mar 2010 20:04:07 PDT

This randomised clinical trial investigated if out-of-hours physiotherapy using intermittent non-invasive ventilation (NIV) is more beneficial than traditional intermittent positive pressure breathing (IPPB) in maintenance of lung function and prevention of nosocomial pneumonia (NP) in acute tetraplegics, and explored if continuous nocturnal NIV is a viable and effective alternative to intermittent IPPB or NIV. Patients admitted with acute tetraplegia (involving spinal levels from C5 to T1) were eligible for inclusion. Patients requiring prolonged invasive mechanical ventilation or who had significant head injury requiring neurosurgical involvement were excluded. Randomisation was to: Group 1 receiving historical standard physiotherapy care using IPPB; Group 2 receiving standard physiotherapy but using intermittent NIV as a substitute for IPPB; or Group 3 receiving continuous nocturnal NIV. Ethical constraints prevented the use of a control group. Dependent variables were vital capacity (VC), arterial to inspired oxygen ratio (PaO2/FiO2), NP incidence, length of stay at the acute facility, and utilisation of out-of-hours physiotherapy service. Groups were similar with respect to demographic variables. One-way analysis of variance and chi squared tests performed on the dependent variables of 21 subjects (Group 1 = 7, Group 2 = 8), with an intention-to-treat philosophy, found no significant differences with daily PaO2/FiO2, NP incidence, length of ICU stay (p = 0.403), or out-of-hours physiotherapy requirements. Significant differences with length of acute facility stay [502.2 hours (363.5) vs 163.3 (116.0) vs 228.6 (183.3); p = 0.046], VC on Day 2 [1.30l (0.24) vs 1.58 (0.32) vs 0.85 (0.53); p = 0.021] and Day 3 only [1.01l (0.29) vs 1.60 (0.35) vs 0.88 (0.36); p = 0.009] were evident but the clinical significance of this is unclear.

Patman, S., & Cooling, C. (2003). The use of non-invasive ventilation (NIV) as an adjunct to physiotherapy in the treatment of the acute tetraplegic patient – preliminary results. Australian Journal of Physiotherapy, 49(3), 11.

ISSN: 0004-9514

The Royal Perth Hospital (RPH) Physiotherapy experience with non-invasive ventilation (NIV) – a unique service delivery model?

Shane Patman et al. — Mon, 22 Mar 2010 19:39:58 PDT

In 1998, the Royal Perth Hospital (RPH) physiotherapy department, in conjunction with the respiratory medicine department, commenced an acute non-invasive ventilation (NIV) service for patients external to the intensive care unit (ICU). From its foundation year in which nine patients were treated, the service has grown consistently to 180 episodes provided in 2002, with many more patients assessed but NIV deemed inappropriate. The RPH physiotherapy department provides the NIV service within its rostered 24 hour, 7 day cover. The initial service delivery and subsequent growth in NIV has resulted in many challenges within physiotherapy. From the outset, the NIV service has not received dedicated funding or staffing and has subsequently been provided from within existing services. Consequently, the physiotherapy department has pursued a unique service delivery model in which the understanding and application of NIV has been considered and deemed a core element for those physiotherapists working in the medical, surgical or critical care environments, as opposed to being considered an advanced practitioner skill that is the domain of select senior staff. Achieving this NIV service delivery model has required a significant degree of ongoing education, training and support in a department that historically has a significant turnover of staff and six-monthly rotational posts. A significant cultural shift and change to work practices, particularly amongst non-fulltime physiotherapy staff, has been required to enable the implementation of NIV services within current physiotherapy services. The future visions and expectations of the physiotherapy NIV service is presently tempered by the expansion of NIV services provided from the ICU and the possible commencement of a dedicated sleep unit at RPH.

Patman, S., Winship, P., & Harrold, M. (2003). The Royal Perth Hospital (RPH) Physiotherapy experience with non-invasive ventilation (NIV) – a unique service delivery model? Australian Journal of Physiotherapy, 49(3), 16.

ISSN: 0004-9514

The Bali bombings – the Royal Perth Hospital Intensive Care Unit Physiotherapy experiences

Shane Patman et al. — Mon, 22 Mar 2010 19:28:02 PDT

The events of October 12, 2002 in Bali had significant implications for the intensive care unit (ICU) and burns unit (BU) at Royal Perth Hospital (RPH), with 28 casualties transferred to RPH, 11 of whom required intensive care. Significant implications and repercussions for ICU physiotherapy services resulted. Historically, the RPH ICU averages approximately 10 major burns patients per year. Traditionally at RPH, the multidisciplinary philosophy is that rehabilitation commences at the time of injury. Individual ICU burns admissions are very labour intensive from a physiotherapy perspective, with customised splinting, positioning, stretching and rehabilitation programs in conjunction with any specific respiratory physiotherapy interventions provided. From the outset, the focus of physiotherapy services was to provide this same individualised and holistic care to each Bali bombing patient. In contrast, literature suggests that the traditional response in a major trauma situation by medical services is one of “best for the most”. Apart from obvious challenges in these 11 patients being admitted within a 48 hour timeframe was the scope of traumas and management complexity encountered. From October 14 until December 9, 2002, 707 occasions of service and 28,485 minutes of physiotherapy treatment were provided to 11 Bali victims in ICU, representing 64.5% of their total inpatient physiotherapy services. This was achieved successfully with unheralded degrees of co-operation, communication, dedication and commitment not just from the ICU and BU physiotherapy and nursing teams but also in conjunction with all members of the health care team. Three Bali bombing patients died in ICU, but all others were discharged home, the last one on January 6, 2003.

Patman, S., & Edgar, D. (2003). The Bali bombings – the Royal Perth Hospital Intensive Care Unit Physiotherapy experiences. Australian Journal of Physiotherapy, 49(3), 19.

ISSN: 0004-9514

Beyond the Bali Bombings – the Royal Perth Hospital Intensive Care Unit Physiotherapy 2002 burns experiences

Shane Patman et al. — Mon, 22 Mar 2010 19:17:52 PDT

Historically, the Royal Perth Hospital (RPH) intensive care unit (ICU) averages approximately 10 major adult burns patients per year. Following the multidisciplinary philosophy that rehabilitation commences at the time of injury, individual ICU burns admissions are very labour intensive from a physiotherapy perspective, with customised splinting, positioning, stretching and rehabilitation programs provided in conjunction with any specific respiratory physiotherapy interventions. Prior to October 12, ICU burns admissions for 2002 numbered 13 and required 215 occasions of service and 1,458 minutes of physiotherapy, representing 15.6% of their total inpatient physiotherapy services. The October 12 Bali bombings resulted in 11 ICU admissions within a 48 hour timeframe, necessitating unique management and co-ordination strategies for ICU physiotherapy services. From October 14 until December 9, 707 occasions of service and 28,485 minutes of physiotherapy were provided to 11 Bali bombing victims in ICU, representing 64.5% of their total inpatient physiotherapy services. Many lessons and skills were developed from strategies instigated to manage ICU physiotherapy services during the treatment of Bali victims. Post-Bali, RPH ICU received 10 further major burns patients with 550 occasions of service and 23570 minutes of physiotherapy treatment provided in ICU, representing 63% of their total inpatient physiotherapy services. Interestingly, these data mirror the workload data from ICU Bali bombing patients and underline the success of providing an individual treatment focus with Bali bombing patients, which has been sustained and repeated with subsequent admissions. In summary, 34 burns patients received 1,472 occasions of service and 53513 minutes of physiotherapy treatment in ICU during 2002, which represents an unheralded and unrivalled period of RPH ICU physiotherapy experiences in the field of burns management.

Patman, S., & Edgar, D. (2003). Beyond the Bali Bombings – the Royal Perth Hospital Intensive Care Unit Physiotherapy 2002 burns experiences. Australian Journal of Physiotherapy, 49(3), 20.

ISSN: 0004-9514

Incidence of adverse physiological changes in intensive care – a multi-centre audit

Litsa Zeppos et al. — Tue, 09 Mar 2010 19:54:53 PST

There has been some concern in the literature as to whether physiotherapy causes adverse physiological changes (APC) that could be harmful to intensive care patients. A multicentre audit was performed to: investigate the incidence of APC during physiotherapy in critically ill patients over a three-month period; benchmark this against studies which have recorded spontaneous APC; and to investigate whether there were any trends in patient category, demographic characteristics, type of intervention, or seniority of physiotherapist. There were 12 800 physiotherapy treatments completed with 29 treatments resulting in adverse physiological changes (0.22%). This incidence was significantly lower than a previous study of APC (663 events/247 patients over a 24-hour period), that is, the incidence during physiotherapy was lower than during general ICU care. Significant trends in the 29 patients who had an APC during physiotherapy were apparent, with a deterioration in cardiovascular status the major APC noted (i.e. decrease in blood pressure or arrhythmia) in patients on medium to high doses of inotropes/vasopressors, having unstable baseline hemodynamic values, previous cardiac co-morbidities, receiving intervention consisting of positive pressure, and/or with junior physiotherapists completing the intervention. Combinations of incidents in these 29 patients demonstrated that a decrease in blood pressure commonly occurred if a patient on inotropes with unstable baseline values was either turned to right side lying (2 sided Fishers exact test, p = 0.006) or received positive pressure (2-sided Fishers exact test, p = 0.07). This audit has demonstrated that the overwhelming majority of physiotherapy treatments in intensive care are safe.

Zeppos, L., Paratz, J., Adsett, J., Berney, S., Bridson, J., & Patman, S. (2006). Incidence of adverse physiological changes in intensive care – a multi-centre audit. Australian Journal of Physiotherapy, 52(1), S35.

ISSN: 0004-9514

Changes in triceps surae muscle length and stiffness during intensive care admission: an observational study

G Nielsen et al. — Tue, 09 Mar 2010 19:45:56 PST

This prospective descriptive study aimed to determine if changes in triceps surae muscle length and stiffness occur in ICU following acquired brain injury (ABI). Adult patients admitted to ICU for invasive ventilation and sedation for greater than 48 hours were studied. Twelve subjects met inclusion criteria over the six-week audit, five with ABI and seven with other diagnoses. Muscle stiffness was quantified by measuring ankle joint angles achieved from the application of three standardised torques (5, 10 and 15 Nm) via a modified Lidcombe template. Maximum dorsiflexion was used to indicate muscle length changes. Measurements were performed in knee flexion and extension to selectively bias soleus and gastrocnemius. Serial measurements were undertaken three times per week from admission to ICU until subjects were able to actively achieve ankle dorsiflexion, or were discharged from ICU. Subject comparisons were made between first and final day measurements, with comparison also made between subjects with ABI and those with other diagnoses. No significant differences were found between groups and neither group showed a significant change between admission and pre discharge measures. Analyses of all subjects showed a significant decrease in one of the measures of muscle stiffness. One subject developed extensor tone as sedation was withdrawn, which was reflected in all measures as decreased ankle dorsiflexion. Changes associated with contracture were evident only in one subject, and were related to the presence of extensor muscle tone. Some subjects exhibited increased ankle extensibility. The trend towards increased extensibility may have been related to muscle atrophy.

Nielsen, G., Gardner, P., & Patman, S. (2006). Changes in triceps surae muscle length and stiffness during intensive care admission: an observational study. Australian Journal of Physiotherapy, 52(1), S22.

ISSN: 0004-9514

Cardiothoracic physiotherapists wanted – must be committed, motivated and competent in this specialty area

M Williams et al. — Tue, 09 Mar 2010 19:37:22 PST

Eligibility to join the physiotherapy profession is achieved through successful completion of a recognised tertiary program and registration with an appropriate state or territory board. After this point, opportunities to formally demonstrate focused clinical expertise both within the physiotherapy profession and to the broader health, tertiary and government communities have been associated with the completion of postgraduate coursework or research degrees. While opportunities to pursue postgraduate education exist throughout Australia, advanced professional clinical competencies might also be demonstrated by behaviours and attributes other than holding a postgraduate qualification. The majority of physiotherapists are likely to be able to name cardiothoracic physiotherapists who demonstrate admirable assessment and treatment skills underpinned by a contemporary body of knowledge and enviable communication, critical thinking and problem– solving skills. The Clinical Standards Committee of the National Cardiothoracic Group (NCG) is responsible for developing and assessing the competencies in order to be eligible for the title of ‘cardiothoracic physiotherapist’. The development of advanced cardiothoracic skills may occur through a variety of formal and informal educational experiences which may not always include the completion of a postgraduate degree. Titled membership should be attainable by cardiothoracic physiotherapists committed to working in the area. This presentation will clarify the aim and role of the titling process, the application and assessment procedures and the breadth of evidence which could be used to support each of the clinical standards competencies. In short: cardiothoracic physiotherapists wanted — must be committed, motivated and competent in this speciality area.

Williams, M., Patman, S., Smith, M., Paratz, J., & Alison, J. (2006). Cardiothoracic physiotherapists wanted – must be committed, motivated and competent in this specialty area. Australian Journal of Physiotherapy, 52(1), S23.

ISSN: 0004-9514

The financial costs associated with respiratory physiotherapy for ventilator-associated pneumonia in patients with acquired brain injury

Shane Patman et al. — Tue, 09 Mar 2010 18:43:46 PST

This study provides the first description of the financial costs of respiratory physiotherapy for patients with acquired brain injury (ABI) in the intensive care unit (ICU) aimed at decreasing the incidence of ventilator-associated pneumonia (VAP), duration of mechanical ventilation (MV) and length of ICU stay. Consent was obtained for 144 adult ABI patients admitted with a Glasgow Coma Scale ≤ 9, requiring intracranial pressure monitoring, and invasive MV for > 24 hours, with randomisation to a treatment group (six respiratory physiotherapy treatments in each 24-hour period whilst ventilated, n = 72), or a control group (routine medical and nursing care only, n = 72). Respiratory physiotherapy comprised positioning, manual hyperinflation and suctioning. For subjects with ABI receiving prophylactic physiotherapy, the respiratory physiotherapy cost was $487.00 per subject. In comparison, ICU bed-days cost for the period of MV was $33 380.00 per subject. Thirty-three subjects (23%) developed VAP (14 from the prophylactic treatment group) and were re-randomised eto a treatment group (n = 17), or a control group (n = 16). For subjects with VAP, the total respiratory physiotherapy cost was $1029.00 per subject, compared to $510.00 for subjects without VAP. The respective ICU bed-days cost for the period of MV per subject was $61 092.00 and $25 142.00, giving an incremental health cost of $35 950.00 per episode of VAP. The cost of respiratory physiotherapy as a percent of their ICU bed-days cost for the period of MV was 1.4 % in those with VAP and 1.1 % in those without VAP.

Patman, S., Stiller, K., & Jenkins, S. (2006). The financial costs associated with respiratory physiotherapy for ventilator-associated pneumonia in patients with acquired brain injury. Australian Journal of Physiotherapy, 52(1), S23.

ISSN: 0004-9514

Physiotherapy for ventilator associated pneumonia in patients with acquired brain injury

Shane Patman et al. — Tue, 09 Mar 2010 18:34:20 PST

Respiratory physiotherapy is often provided to treat ventilator-associated pneumonia (VAP) in patients with acquired brain injury (ABI) due to the morbidity and mortality associated with VAP. However there are limited data on the efficacy of physiotherapy in ICU and no data on the effect of respiratory physiotherapy on outcomes in patients with ABI. This prospective randomised controlled trial investigated the effect of respiratory physiotherapy on the resolution of VAP, the duration of ventilatory support, and length of ICU stay in adults with ABI and VAP. Subjects admitted with a Glasgow Coma Scale ≤ 9, requiring intracranial pressure monitoring, and invasive ventilatory support for >24 hours, and who developed VAP, were randomised to a treatment group (six treatments in each 24-hour period whilst ventilated; n = 17), or a control group (routine medical and nursing care only; n = 16). Respiratory physiotherapy comprised positioning, manual hyperinflation and suctioning. Groups were comparable on baseline demographic variables. Four subjects (two from each group) were withdrawn as three became medically unstable and one was incorrectly randomised. Using multivariate analysis of variance with intention to treat philosophy and analysis by treatment principle, there were no significant differences for daily mean clinical pulmonary infection scores or measures of arterial to inspired oxygenation, duration of ventilatory support (mean hours ± SD) [342.0 ± 185.3 vs. 351.0 ± 174.7; p = 0.89], or ICU stay (mean hours ± SD) [384.7 ± 179.6 vs. 397.9 ± 190.7; p = 0.84]. In this sample, respiratory physiotherapy for ABI patients with VAP did not expedite recovery by reducing duration of ventilation or length of ICU stay.

Patman, S., Stiller, K., & Jenkins, S. (2006). Physiotherapy for ventilator-associated pneumonia in patients with acquired brain injury. Australian Journal of Physiotherapy, 52(1), S23.

ISSN: 0004-9514