Current Cardiothoracic Research Projects
Anne Holland, Linda Denehy, John Wilson
Chest physiotherapy in cystic fibrosis - Effects of flow limitation and assisted ventilation.
This research investigates chest physiotherapy assisted with non-invasive ventilation compared with standard airway clearance techniques in adults with cystic fibrosis (CF). The prevalence and characteristics of EFL in 102 adults with CF is also examined, including effects of body positions used during chest physiotherapy on EFL. Implications of EFL for titration of positive pressure during chest physiotherapy are explored.
Catherine Hill, Linda Denehy, Christine McDonald
Development of an outcome measure for upper limb function in patients with COPD.
Upper limb exercises are commonly included in a pulmonary rehabilitation program for patients with COPD. The aim of this series of studies is to establish the reliability of a newly developed outcome measure of upper limb function called the grocery shelving task (GST). In addition, the validity of the GST will be assessed by comparing it with the incremental unsupported upper limb exercise test (IUULXT) and to compare the responsiveness of both tests to pulmonary rehabilitation (PR) in patients with COPD.
Rebecca Scholes, Linda Denehy
Assessment of pre-operative risk factors in patients following upper abdominal surgery.
The aim of this study is to develop and prospectively trial a risk factor model which predicts patients who are at risk of developing postoperative pulmonary complications following abdominal surgery.
Katherine McCann, Linda Denehy, Don Campbell, Graeme Hawthorn
Is a community based pulmonary rehabilitation program effective in improving health economic, physiological & psychological outcomes.
This randomised controlled study examines the physical, psychological and health economic outcomes of a community based PR program. Subjects with COPD are randomly allocated into either a 6 week PR group or a control group. They are assessed four times throughout a 12 month period using tools to measure exercise capacity, quality of life and health care utilisation.
Rosemary Moore, Christine McDonald,
The effects of exertional oxygen in Chronic Obstructive Pulmonary Disease (COPD).
A prospective, double blinded, randomised controlled trial to compare the longer term use of portable supplemental oxygen therapy with air, used during exertion, in individuals with COPD who experience reduced exercise tolerance due to breathlessness, but do not have resting hypoxaemia.
Laura Romano, Linda Denehy
Development of a quantitative measure of recovery of mobility following upper abdominal surgery.
This research aims to assess mobility in patients following abdominal surgery using the personal activity logger (PAL1) as a means of quantifying the amount of time spent upright and the number of occasions the patient stands upright in the four days following surgery.
Elizabeth Skinner, Susan Berney, Linda Denehy
Development of an outcome measures to assess the effectiveness of physiotherapy exercise intervention for patients in intensive care
This project aims to develop an outcome measure that can be used for assessment and exercise prescription in patients who are on a ventilator in the Intensive Care Unit.
Susan Berney, Linda Denehy, Helen Opdam
Airway management of patients with acute quadriplegia from spinal cord injury in intensive care
This study aims to describe current practice across Australia in airway management in acute quadriplegic patients using a prospective audit over a 12 month period. Information regarding decisionmaking on whether to proceed directly to tracheostomy or a trial of extubation will be determined and once the factors are identified a model will be developed that will help guide clinicians in the decision making process. The second phase of this project will involve a prospective evaluation of this model
Julie Reeve, Linda Denehy, Kathy Stiller
Physiotherapy management of patients undergoing thoracic surgery.
This project aims to asses the role of physiotherapy management in patients undergoing open thoracotomy for lung resection using a randomised controlled trial.
Ash C and Button BM.
The relationship between gastro-oesophageal reflux (GOR) and tube feeding in Cystic Fibrosis.
This study will measure the effects of percutaneous enteral gastrostomy (PEG) feeds on gastro-oesophageal function in adults with CF. We hypothesize that there will be increased GOR when patients receive PEG feeds while recumbent. This has not been studied before in adults with CF. Dr Button is continuing to study the prevalence and significance of GOR in adults with CF using 24 hour oesophageal pH monitoring. In this randomized cross-over study patients will be randomized to PEG feed or no PEG feed regimen on the first of two consecutive nights. They will cross over and receive the alternative regimen on the second night. Two 24 hour pH monitoring probes will be used during this two day study. The funding will pay for the probes.
Wilson JW, Button BM.
The effect of ezomeprazole (Nexium) on gastro-oesophageal reflux – intervention trial.
Gastro-oesophageal reflux is common in adults with CF before and after lung transplantation. This pre- /post- intervention trial is designed to measure baseline gastro-oesophageal function without anti-reflux medication followed by at least two months on the proton pump inhibitor, ezomeprazole, to determine the effect of this anti-reflux medication on gastric acid production and gastro-oesophageal reflux.
Munro P, Snell G, Button BM.
A prospective three month randomised controlled trial comparing two chest physiotherapy protocols in lung transplant recipients.
It is not known whether patients should undertake preventative airway clearance therapy after lung transplantation as the allograft is not innervated by the vagal nerve. Many patients post lung transplantation have significant problems with infection, rejection and obliterative bronchiolitis. It would be unethical to prescribe unsubstantiated preventative airway clearance therapy to patients already requiring significant daily treatment with immunosuppressive and other medication. We are currently undertaking a randomized controlled trial comparing current practice (control) with a PEP therapy intervention. The control treatment consists of reactive positive expiratory pressure (PEP) airway clearance therapy when patients are diagnosed with a pulmonary infection for the duration of the course of anti-biotics. The intervention consists of proactive / preventative twice daily PEP therapy from the time of the first bronchoscopy post discharge after surgery for three months. The outcome measures will be pulmonary function, clinical score of infection and inflammation based on findings using broncho-alveolar lavage, quality of life, patient treatment satisfaction and exercise tolerance.
Button B, Sherburn S, Chase J
Urinary Incontinence in Women with Cystic Fibrosis and Chronic Obstructive Pulmonary Disease
Urinary incontinence is frequently reported by women with lung disease. Our objective is to understand the mechanisms behind urinary incontinence in young nulliparous women with CF compared to older women with COPD, many who have had vaginal deliveries, compared to healthy age matched controls. This two-phase study consisted firstly of a questionnaire mailed to women with CF and COPD at the Alfred Hospital and other Pulmonary Rehab. Programs and to control women in the community. This was followed by an assessment and treatment study to establish mechanisms and optimal physiotherapy management. The study is currently being completed and conclusions drawn. Numerous oral and poster presentations have been made at national and international conferences in Australia, the UK and Europe. The next phase will be to develop a written and illustrated information brochure for physiotherapists and their patients to use in conjunction with clinical treatment.
Button BM, Roberts S, Kotsimbos T, Wilson J, Snell G, Williams T
Gastro-oesophageal reflux in adults with CF before and after transplantation
Gastro-oesophageal reflux (GOR) has been known in children with CF for three decades, but has received little attention until relatively recently. Little is known about GOR in adults with CF. The objectives of this ongoing study is: (1) To establish the prevalence and significance of GOR in adults with CF before and after lung transplantation at one of the largest CF Clinics worldwide with a population of approximately 250 adults; (2) To establish the effects of airway clearance therapy including positioning, forced expirations and coughing on gastro-oesophageal function. A number of oral presentations have been made at national and international CF conferences in Australia, Ireland, the UK and the USA. A number of abstracts have been published internationally and three manuscripts are currently being prepared for publication.
Multicentre trial: “Twelve month trial of hypertonic saline versus placebo in patients with cystic fibrosis”
This multi-centre trial in Australia and New Zealand compared the effects of hypertonic saline with isontonic saline (control) over a twelve month period in 166 patients aged ten and over. Broadly speaking, the outcome measures will be pulmonary function, bacteriology, sputum amount, quality of life, adherence, number of acute exacerbations and hospitalizations for pulmonary infections. The trial results will be analyzed late in 2004 with presentations and publications to follow.