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Background: Conservative sharp wound debridement (CSWD) is fundamental to wound bed preparation. Evidence-based practice guidelines strongly recommend frequent CSWD of diabetes-related foot ulcers (DFU) based on expert opinion and observational studies which suggest that more frequent debridement is associated with better healing outcomes. Aim: To document current practice with regards to CSWD of DFU and whether this is performed at every visit, how often and what factors determine debridement frequency. Method: Survey data were collected and managed using REDCap electronic data tools, a secure, web-based application. The survey was distributed through podiatry managers and relevant clinical networks between October 2017 and February 2018. Results: One hundred clinicians opened the survey and seventy-five surveys were completed by n = 53 NSW Health (Australia) employed podiatrists (representing 41% of all NSW Health podiatrists), 11 privately practicing podiatrists, and 11 nurses. Most (n = 47) worked in metropolitan areas versus regional/remote (n = 28). CSWD was the most frequently used debridement method, performed at every visit by most (84%) of podiatrists. Callus, slough and infection presence were the top 3 most important determinants of frequency, with staff time (a limiting factor) ranking 4th. Regional/remote podiatrists practiced less frequent debridement compared with those in metropolitan areas (debridement every 2 weeks or less = 71% regional podiatrists versus 45% metropolitan podiatrists) (p = 0.024). Conclusion and clinical implications: CSWD was the predominant form of debridement used with debridement occurring at every treatment visit for most of the clinicians surveyed. Debridement frequency was determined by clinical wound indications and staffing resources, with regional/remote podiatrists providing debridement less often than their metropolitan colleagues. [ABSTRACT FROM AUTHOR]

• SpO 2 was commonly monitored during exercise testing • Oxygen was available during exercise testing and training in most programs • The rationale for prescribing oxygen during exercise varied between programs The aims of this study were to determine, in Australian pulmonary rehabilitation programs for people with COPD: (1) whether oxygen saturation (SpO 2) was monitored during exercise testing; (2) whether supplemental oxygen was available during exercise testing and/or training; (3) whether oxygen was prescribed during exercise training; and the reason for providing oxygen; (4) whether a protocol was available for supplemental oxygen prescription during exercise training. This was a cross-sectional multi-center study using a purposed-designed survey. De-identified survey data were analyzed and the absolute number and percentage of responses were recorded for each question. The survey was sent to 261 pulmonary rehabilitation programs and 142 surveys (54%) were available for analysis. Oxygen saturation was monitored during exercise testing in 92% of programs. Supplemental oxygen was available in the majority of programs during exercise testing (82%) and training (84%). The rationale cited by 87 programs (73%) for prescribing oxygen during exercise training was maintaining SpO 2 above a threshold ranging from SpO 2 80–88%. Forty-five (32%) programs had a protocol for oxygen prescription during exercise training. While monitoring of SpO 2 during exercise testing and using supplemental oxygen during testing and training is common in Australian pulmonary rehabilitation programs, few programs had a protocol in place for the prescription of supplemental oxygen for people with COPD who were not on long-term oxygen therapy. This may be due to lack of strong evidence to support the use of supplemental oxygen during exercise training. [ABSTRACT FROM AUTHOR]

Background: Group allied health interventions for people with chronic conditions may be a solution to increasing access to allied health in primary care. This umbrella review aimed to determine the effectiveness of allied health group interventions to improve health-related outcomes for adults with chronic conditions and the applicability of the findings to the Australian primary health care context. Methods: An umbrella review of systematic reviews conducted April-July 2022, searching eight databases. Systematic reviews were eligible if they included randomised controlled trials (RCT) or quasi-RCTs, community dwelling adults aged ≥ 18, at least one chronic condition, group intervention in scope for allied health professionals, and published in English after 2000. Studies were excluded if interventions were conducted in hospital or aged care facilities, out of scope for allied health, or unsupervised. Results: Two thousand three hundred eighty-five systematic reviews were identified: after screening and full text review 154 were included and data extracted from 90. The chronic conditions included: cancer (n = 15), cardiovascular disease (n = 6), mixed chronic conditions (n = 3), kidney disease (n = 1), low back pain (n = 12), respiratory disease (n = 8), diabetes (n = 14), heart failure (n = 9), risk of falls (n = 5), hypertension (n = 4, osteoarthritis (n = 6) and stroke (n = 8). Most group interventions included prescribed exercise and were in scope for physiotherapists and exercise physiologists. Overall, allied health group exercise programs for community dwelling adults improved health outcomes for most chronic conditions. Aggregated data from the systematic reviews suggests programs of 45–60 min per session, 2–3 times per week for 12 weeks. Lifestyle education and support for people with type-2 diabetes improved glycaemic control. Conclusions: Prescribed group exercise delivered by allied health professionals, predominantly by exercise physiologists and physiotherapists, significantly improved health outcomes for community dwelling adults with a broad range of chronic conditions. [ABSTRACT FROM AUTHOR]

Few studies have used 24-hour accelerometery to characterise posture and movement patterns in people with chronic obstructive pulmonary disease (COPD). This study aimed to quantify sedentary behaviour (SB), patterns of SB accumulation and physical activity (PA) in people with COPD, and to examine physiological and functional capacity correlates of total SB and patterns of SB accumulation. SB and PA were assessed continuously over seven days using thigh-worn accelerometery in people with COPD. Participants were regarded as "sedentary" if combined sitting/reclining time accounted for ≥70% of waking wear time. Differences in patterns of SB accumulation and PA were compared between "sedentary" and "non-sedentary" participants. Physiological and functional capacity correlates of SB were explored using univariate analysis. Sixty-nine people with COPD (mean (SD) age 74 (9) years, FEV1 55% (19) predicted) had sufficient wear data for analysis. Mean sedentary time was 643 (105) minutes/day (71% (11) of waking wear time), of which 374 (142) minutes/day were accumulated in prolonged bouts of ≥30 min. "Sedentary" participants had a more unfavourable pattern of SB accumulation and spent less time in PA of any intensity. Sedentary time, expressed as a proportion of waking wear time, was inversely correlated with light (r = −0.97, p <.01) and moderate-to-vigorous intensity PA (r = −0.55, p <.01) and exercise capacity (r = −0.33, p <.01), but not with age, body mass index or lung function. People with COPD had high total SB and accumulated the majority of SB in prolonged bouts. High total SB was correlated with low physical activity and exercise tolerance. [ABSTRACT FROM AUTHOR]

Objective: To investigate the inter-rater and intra-rater reliability of the Brief Balance Evaluation System Test (Brief-BESTest) in people with chronic obstructive pulmonary disease and its correlation between the Brief-BESTest score and lung function, functional exercise capacity, functional lower limb strength, and fear of falling. Design: Prospective, single-group, observational study. Setting: Outpatient pulmonary rehabilitation program. Subjects: People with chronic obstructive pulmonary disease who were attending a pulmonary rehabilitation program. Intervention: Participants performed three Brief-BESTests on two separate days, assessed by two independent physiotherapists. Participants also performed a lung function test, two 6-minute walk tests, the five sit-to-stand test and completed the Fall Efficacy Scale International questionnaire. Results: Thirty participants (mean (SD) age was 72 (7), forced expiratory volume in 1 second % predicted was 47 (16%), and baseline 6-minute walk distance was 427 (90) meters) completed the study. The interclass coefficients of the inter-rater and intra-rater reliability were 0.86 and 0.96, respectively. The Brief-BESTest score was moderately correlated with the 6-minute walk distance (r = 0.49, P < 0.01) and the five sit-to-stand test time (r =−0.54, P < 0.01). No adverse events were reported after the completion of 90 tests in this study. Conclusion: The Brief-BESTest was shown to have good inter- and intra-rater reliability for measuring balance in people with chronic obstructive pulmonary disease. A moderate correlation was demonstrated between the Brief-BESTest balance score with functional exercise capacity and functional lower limb strength in this population. [ABSTRACT FROM AUTHOR]

ABSTRACT Background and objective The aim of the Pulmonary Rehabilitation Guidelines (Guidelines) is to provide evidence-based recommendations for the practice of pulmonary rehabilitation ( PR) specific to Australian and New Zealand healthcare contexts. Methods The Guideline methodology adhered to the Appraisal of Guidelines for Research and Evaluation ( AGREE) II criteria. Nine key questions were constructed in accordance with the PICO (Population, Intervention, Comparator, Outcome) format and reviewed by a COPD consumer group for appropriateness. Systematic reviews were undertaken for each question and recommendations made with the strength of each recommendation based on the GRADE (Gradings of Recommendations, Assessment, Development and Evaluation) criteria. The Guidelines were externally reviewed by a panel of experts. Results The Guideline panel recommended that patients with mild-to-severe COPD should undergo PR to improve quality of life and exercise capacity and to reduce hospital admissions; that PR could be offered in hospital gyms, community centres or at home and could be provided irrespective of the availability of a structured education programme; that PR should be offered to patients with bronchiectasis, interstitial lung disease and pulmonary hypertension, with the latter in specialized centres. The Guideline panel was unable to make recommendations relating to PR programme length beyond 8 weeks, the optimal model for maintenance after PR, or the use of supplemental oxygen during exercise training. The strength of each recommendation and the quality of the evidence are presented in the summary. Conclusion The Australian and New Zealand Pulmonary Rehabilitation Guidelines present an evaluation of the evidence for nine PICO questions, with recommendations to provide guidance for clinicians and policymakers. [ABSTRACT FROM AUTHOR]

Background and objective Studies in children with cystic fibrosis ( CF) suggest greater physical activity ( PA) is associated with a slower rate of decline in respiratory function. In adults with CF, objectively measured PA time and its relationship to long-term clinical outcomes of respiratory function and need for hospitalization are unknown. Methods PA measured objectively ( Sense Wear armband), pulmonary function, exercise capacity ( Modified Shuttle Test-25) and CF-related quality of life ( CFQ-R) were assessed in 65 adults (34 male; mean age 28 years) with CF during a stable phase. A sub-group of these participants undertook additional measurement of PA at hospital discharge for a respiratory exacerbation. Results Median daily habitual moderate-vigorous PA ( MVPA) time was 31-min ( IQR:15-53). Participants who accumulated ≥30-min MPVA daily experienced fewer hospital days ( P = 0.04), better exercise capacity and higher FEV1 at 12 months ( P ≤ 0.001). Daily, fewer females than males accrued ≥30-min MVPA ( P = 0.02). Compared with those who did not, participants who accumulated 30-min MVPA in bouts ≥10-min ( n = 21) recorded better FEV1 ( P = 0.02) and exercise capacity ( P = 0.006), and reduced hospital admissions ( P = 0.04) and hospital days ( P = 0.04) at 12 months. MVPA participation declined significantly 1 month post-hospital discharge (median 12 min (4-34); P = 0.04). Conclusion Adults with CF are able to achieve recommended MVPA targets of 30mins/day; however, a significant gender difference in activity time is apparent. Greater time in MVPA is related to more positive clinical outcomes over 12 months. Whether increasing PA levels can improve clinical outcomes in adults with CF warrants further investigation. [ABSTRACT FROM AUTHOR]

Abstract: Background: The SenseWear Armband (SWA) provides simple and non-invasive measures of energy expenditure (EE) during physical activity, however its accuracy in adults with cystic fibrosis (CF) during free living physical activities has not been established. Methods: 26 CF adults (mean FEV1 63% predicted; 11 males) completed a series of standardised static and active tasks with simultaneous analysis of EE via the SWA and indirect calorimetry (IC). Results: Mean difference and limits of agreement between EE values from the SWA and IC across all activities were −0.02METs (95% CI −1.1 to 1.1). There was moderate agreement between the two measures (ICC 0.4; 95% CI: 0 to 0.7; p=0.03). For individual activity tasks ICC ranged from 0.1 to 0.6. Conclusion: Overall, the SWA demonstrated good agreement with IC for EE estimates in CF adults during a series of free-living activities, however accuracy was variable when assessing EE for specific activities of shorter duration. [Copyright &y& Elsevier]

Objective The use of digital health is a novel way to improve access to comprehensive pulmonary rehabilitation for people with chronic obstructive pulmonary disease (COPD). This study aims to determine if a home-based pulmonary rehabilitation program supported by mobile health (mHealth) technology is equivalent to center-based pulmonary rehabilitation in terms of improvements in exercise capacity and health status in people with COPD. Methods This study is a prospective, multicenter, equivalence randomized controlled trial (RCT) with intention-to-treat analysis. A hundred participants with COPD will be recruited from 5 pulmonary rehabilitation programs. Following randomization, participants will be assigned in a concealed manner to receive either home-based pulmonary rehabilitation supported by mHealth or center-based pulmonary rehabilitation. Both programs will be 8 weeks and will include progressive exercise training, disease management education, self-management support, and supervision by a physical therapist. Co-primary outcome measures will be the 6-Minute Walk Test and the COPD Assessment Test. Secondary outcome measures will include the St George's Respiratory Questionnaire, the EuroQol 5 Dimension 5 Level, the modified Medical Research Council dyspnea scale, the 1-minute sit-to-stand test, the 5 times sit-to-stand test, the Hospital Anxiety and Depression Scale, daily physical activity levels, health care utilization, and costs. Outcomes will be measured at baseline and at the end of the intervention. Participant experience will be assessed through semi-structured interviews at the end of the intervention. Utilization of health care and costs will be measured again after 12 months. Impact This study will be the first rigorous RCT to examine the effects of a home-based pulmonary rehabilitation program supported by mHealth technology that includes comprehensive clinical outcome evaluation, assessment of daily physical activity, a health economic analysis, and qualitative analysis. If findings demonstrate that there is equivalence in clinical outcomes, that the mHealth program costs the least amount (and is thus cost-effective), and that the mHealth program is acceptable to participants, such programs should be widely implemented to improve access to pulmonary rehabilitation. [ABSTRACT FROM AUTHOR]

Background. The Six-Minute Walk Test (6MWT) is widely used as an outcome measure in exercise rehabilitation. However, the repeatability of the 6MWT performed at home in survivors of a critical illness has not been evaluated. Objective. The purpose of this study was to evaluate, in survivors of a critical illness: (1) the repeatability of the 6MWT performed at home, (2) the effect on estimates of change in functional exercise capacity if only one 6MWT was performed at follow-up assessments, and (3) the relationship between the physical functioning (PF) score of the 36-Item Short-Form Health Survey questionnaire (SF-36) and the 6MWT. Design. Repeated measures of the 6MWT and SF-36 were obtained. Methods. Eligible participants had an intensive care unit (ICU) length of stay of 48 hours and were mechanically ventilated for 24 hours. Two 6MWTs and the SF-36 were conducted in participants’ homes at weeks 1, 8, and 26 after hospital discharge. Results. One hundred seventy-three participants completed the study. The participants had a mean age of 57 years (SD16), a mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score on admission of 19 (SD10), a mean ICU length of stay of 9 days (SD8), and a mean mechanical ventilation time of 140 hours (SD137). Of the 173 participants, 110 performed two 6MWTs at weeks 1, 8, and 26. There were significant mean increases in 6-minute walk distance in the second test of 15 m (P.0001) at week 1, 13 m (P.0001) at week 8, and 9 m (P.04) at week 26. If only one 6MWT was performed at weeks 8 and 26, the estimate of change in 6-minute walk distance from week 1 was 19 m less (P.001) at both weeks 8 and 26. There was a moderate to strong correlation between SF-36 PF score and 6-minute walk distance at each assessment (week 1: r.62, P.001; week 8: r.55, P.001; and week 26: r.47, P.001). Limitations. Some study participants were unable to perform a second 6MWT,and these participants may have differed in important aspects of function compared with those individuals who completed two 6MWTs. Conclusions. In survivors of a critical illness, the 6MWT in the home environment should be performed twice at each assessment to give an accurate reflection of change in exercise capacity over time. The SF-36 PF score was a strong indicator of 6-minute walk distance in early recovery from a critical illness. [ABSTRACT FROM AUTHOR]

We conducted a systematic review of the use of telehealth in people with Cystic Fibrosis (CF). The studies reviewed were of adults and children with CF, and incorporated telehealth for monitoring symptoms, assessing adherence to prescribed therapies or providing a therapeutic intervention. Searches of four electronic databases returned 293 references. Eight studies met the inclusion criteria. Variability in study design and outcome measures precluded meta-analysis. Seven studies assessed telemonitoring feasibility for patient usability and acceptance, or for physiological monitoring. Two studies were randomised controlled trials, although only one showed differences in outcome between the intervention and usual care with improved spirometry stability and significantly increased antibiotic use in the intervention group. In four studies participants were asked to transmit data on spirometry (FEV(1)) or symptoms. Participant non-compliance with data reporting ranged from 43-63%. Generally, participants reported being able to use the required technology. There is insufficient evidence to reach a firm conclusion about the benefits of telehealth in people with CF, but it remains a promising area for future investigation. [ABSTRACT FROM AUTHOR]

We conducted a systematic review of the use of telehealth in people with Cystic Fibrosis (CF). The studies reviewed were of adults and children with CF, and incorporated telehealth for monitoring symptoms, assessing adherence to prescribed therapies or providing a therapeutic intervention. Searches of four electronic databases returned 293 references. Eight studies met the inclusion criteria. Variability in study design and outcome measures precluded meta-analysis. Seven studies assessed telemonitoring feasibility for patient usability and acceptance, or for physiological monitoring. Two studies were randomised controlled trials, although only one showed differences in outcome between the intervention and usual care with improved spirometry stability and significantly increased antibiotic use in the intervention group. In four studies participants were asked to transmit data on spirometry (FEV1) or symptoms. Participant non-compliance with data reporting ranged from 43-63%. Generally, participants reported being able to use the required technology. There is insufficient evidence to reach a firm conclusion about the benefits of telehealth in people with CF, but it remains a promising area for future investigation. [ABSTRACT FROM AUTHOR]

The article compares ventilation, respiratory flow and sputum properties following treadmill and cycle exercise with resting breathing or control to determine the physiologic mechanisms by which exercise may clear secretions in cystic fibrosis (CF) patients. Fourteen adult subjects with CF underwent 20 minutes of resting breathing, treadmill and cycle exercise in a three-day crossover study. Ease of expectoration and reductions in sputum mechanical impedance were found to be experienced by the subjects following exercise.