Whole Arm Water Displacement Volumetry Is a Reliable and Sensitive Measure: A Pilot to Assess Acute Postburn Volume Change.

Water displacement volumetry (WDV) is a reliable method for measurement of wrist and hand volume in lymphedema patients. However, within session WDV reliability for the whole upper limb (UL) lacks comprehensive investigation, particularly in acute edema populations. This study aimed to confirm the reliability and investigate the impact of time between repeated trials on the sensitivity of WDV as a measure of whole UL volume change in an uninjured cohort and a burn injured pilot group. Within session, duplicate measures of whole UL WDV were recorded in two groups of noninjured volunteers and a group of burn patients. Each noninjured group differed only in the time between WDV repeats. The reliability trials were performed <10 minutes apart (T10) and 20 to 30 minutes apart (T20). The time between repetitions for burn patients was 20 to 30 minutes, based on the results of the noninjured participant trials. All trial groups demonstrated excellent correlation between trials (ICCT10 = 0.999, ICCT20 = 0.997). The minimum detectable difference calculated for WDV when measuring whole UL volume change of >50 ml for noninjured and >100 ml for burn patients. Despite this, a systematic bias was demonstrated between the T10 group means. The T20 group trials did not indicate such error on statistical testing (P = .297). The study confirms that WDV measurement of whole ULs is reliable and sensitive, if used at least 20 minutes apart. However, a significant and clinically relevant subject-by-method interaction was demonstrated. Researchers and clinicians are reminded to be aware of the performance of the technique when designing investigations in patient populations.

Evaluation of a disease specific rheumatoid arthritis self-management education program, a single group repeated measures study.

BACKGROUND: Rheumatoid Arthritis is a progressive and disabling disease, predicted to increase in prevalence over the next 50 years. Self-management is acknowledged as an integral part in the management of chronic disease. The rheumatoid arthritis specific self-management program delivered by health professionals was developed by Arthritis Western Australia in 2006. The purpose of this study was to determine whether this program would achieve early benefits in health related outcomes, and whether these improvements would be maintained for 12 months. METHODS: Individuals with rheumatoid arthritis were referred from rheumatologists. Participants with co-existing inflammatory musculoskeletal conditions were excluded. All participants completed a 6-week program. Assessments occurred at baseline (8 weeks prior to intervention), pre-intervention, post-intervention, and 6 and 12 month follow ups. Outcomes measured included pain and fatigue (numerical rating scale, 0-10), depression and anxiety (hospital anxiety and depression questionnaire), health distress, and quality of life (SF-36 version 2). RESULTS: There were significant improvements in mean [SD] fatigue (5.7 [2.4] to 5.1 [2.6]), depression (6.3 [4.3] to 5.6 [3.9]) and SF-36 mental health (44.5 [11.1] to 46.5 [9.5]) immediately following intervention, with long term benefits for depression (6.3 [4.3] to 4.9 [3.9]), and SF-36 subscales mental health (44.5 [11.1] to 47.8 [10.9]), role emotional (41.5 [13.2] to 46.5 [11.8]), role physical (35.0 [11.0] to 40.2 [12.1]) and physical function (34.8 [11.5] to 38.6 [10.7]). CONCLUSION: Participants in the program recorded significant improvements in depression and mental health post-intervention, which were maintained to 12 months follow up.

Measurement of acute edema shifts in human burn survivors--the reliability and sensitivity of bioimpedence spectroscopy as an objective clinical measure.

Improvements in treatment for acute burn edema have stalled in comparison with other areas of burn care. Designing acute edema treatment studies in humans is hindered by the lack of objective, sensitive methods of measurement in the burn population. Bioimpedence spectroscopy (BIS) is a noninvasive method of measuring fluid volumes in the body. The aim of this study was to examine the reliability and sensitivity of BIS in the measurement of acute edema shifts in burn survivors, including assessment across different wound conditions. BIS measurements were collected in triplicate from 21 burn patients in total. Phase I (n = 13) examined BIS under three different dressing conditions. Phase II (n = 8) considered only patients with dressings intact. Sensitivity (minimum detectable difference [MDD]) was examined with total body water, extracellular fluid (ECF), and intracellular fluid volume measurements. BIS demonstrated excellent reliability across all dressings conditions, including when open wounds were present (intraclass correlation coefficient = 0.975-1.00, 95% confidence intervals = 0.938-1.00). Clinically useful levels of sensitivity, or MDD, were calculated. BIS MDD for total body water (open wounds) = 360 ml, ECF (open wounds) = < or = 10 ml, ECF (new dressings) = 540 ml, and intracellular fluid (open wounds) = 310 ml. BIS analysis is clinically applicable for real-time, noninvasive monitoring of whole-body fluid shifts in acute burn survivors with < or = 30% TBSA.

Volume measurement using the Polhemus FastSCAN 3D laser scanning: a novel application for burns clinical research.

UNLABELLED: The Polhemus FastSCAN system offers a noncontact method of quantifying limb edema volume by combining laser scanning with 3D spatial orientation. The aim of this study was to investigate the reliability, validity and clinical utility of this assessment technique in the burn environment. Pilot Studies: Completed in order to develop a standardised scanning procedure. Intertester Reliability: Two testers each scanned 30 uninjured upper limbs. Intratester Reliability: One tester conducted repeated scans for burn survivors (n = 6). VALIDITY: The scan volumes were compared with water displacement measures for all volunteers (n = 36). Intertester reliability was moderate for whole arm scans (R = .59; 95% confidence intervals [CI] = 0.28-0.78) and excellent with hand truncated (R = .95; 95% CI = 0.90-0.98; minimum detectable difference = 242.1 cm3). Intratester reliability was inconclusive (R = .72; 95% CI = -0.07-0.96) but qualitative assessment confirmed poorer quality scans. The FastSCAN system overstated the arm volume by 49.3 cm3 on average, but 95% limits of agreement when compared with water displacement demonstrated the limitations as a clinical or research tool in the burn environment. The Polhemus FastSCAN system provides a noncontact method of limb volume measurement. The reliability was good only with the hand removed from calculations. The accuracy of the system compared poorly with water displacement measures in the burn clinical environment. Using the currently available software and method, the change detectable by this technique was too large for monitoring the efficacy of acute burn edema interventions.

Variations in torsion of the lower limb in Japanese and Caucasians with and without knee osteoarthritis.

OBJECTIVE: Associations between torsion of the lower limb and knee osteoarthritis (OA) appear to be inconsistent across populations. We examined whether femoral and tibiofibular torsion differed between people with and without knee OA (main effect), and whether the differences were consistent across Japanese and Australian Caucasian persons, and between women and men (interaction effect). METHODS: Data collection was conducted in Japan and Australia. Subjects with knee OA included 100 Japanese and 102 Australian Caucasians, and healthy subjects included 52 Japanese and 34 Australian Caucasians. Femoral and tibiofibular torsion were measured using reliable clinical techniques. Three-way analysis of variance was conducted to examine the main and interaction effects. RESULTS: While there were no significant differences in femoral and tibiofibular torsion between the subjects with and without knee OA as a whole (main effect), there were significant interactions (p < 0.05). Femoral antetorsion was lower only in the female subjects with knee OA compared with their healthy counterparts (p < 0.05). Tibiofibular torsion was lower only in the Japanese subjects with knee OA compared with their healthy counterparts (p < 0.01). CONCLUSION: There may be ethnic and sex variations in the relationship between torsion of the lower limb and knee OA; and lower tibiofibular torsion can be a characteristic in a Japanese population with the disease. Longitudinal study is warranted to examine relationships between these variables and knee OA in a population-specific manner to determine whether the observed relationships express cause or effect.

Osteoporotic fracture: missed opportunity for intervention.

As prior fracture is consistently associated with increased risk of subsequent fracture, subjects with a history of prior fracture represent a high risk group which should be targeted for intervention to reduce future fracture rates. The aim of this study was to investigate whether prior osteoporotic fracture affected treatment patterns among subjects admitted with hip fractures. All hip fracture admissions to two major teaching hospitals of the University of New South Wales, Sydney, Australia, over the 12-month period between July 1997 and June 1998 were identified retrospectively from medical records. Patient demographics, frequency and location of prior fractures, and treatment status on admission were recorded. There were a total of 348 atraumatic hip fracture admissions over this 12-month period. Forty five percent of 251 women and 30% of 97 men with an osteoporotic hip fracture had a known prior fracture, including prior hip fracture in 19% of the women and 8% of the men. Among subjects with prior fractures, only 18% of women and 7% of men were on any specific anti-osteoporosis therapy. Even among those with a prior hip fracture, only 21% of women and none of the men were taking optimal appropriate therapy. A high proportion of individuals suffering hip fractures had sustained prior "signal" fractures. Although more subjects with prior fracture received treatment than those without prior fracture, total treatment levels were low, and the majority of high-risk subjects did not receive therapy shown to reduce the risk of further fractures.