Clinical Research - current projects
Developing better clinical interventions for burn patients
Development of novel therapeutic compounds for better scar outcomes
Through collaborations with both Industry and other departments at UWA we are currently running pre-clinical trials of drugs that target different aspects of scar formation and maintenance to determine whether they can improve long-term scarring. Formulation and the use of targeted nanoparticles to deliver drugs to the scar are part of this work as delivery is a critical aspect of successfully treating scar.
The use of laser therapy to improve poor scarring
We are examining the use of laser therapy to improve poor scarring and to treat troublesome scars. This is a patient study being conducted by the Burns Service of WA to identify how the laser is changing the scars. This study will also show when the best time is to treat a scar. The combined study is looking at clinical outcomes as well as the molecular and cellular biology following treatment.
Can patient surveys help us understand outcomes after lower limb burn injury?
The Lower Limb Functional Index (LLFI) has been proposed as a lower limb specific assessment tool which accurately determines the holistic status and quality of life of the individual. The questionnaire has been validated for assessment of people with musculoskeletal injuries, however its applicability for a burns population has not been evaluated. The aim of this research is to determine the reliability and validity of the LLFI within the lower limb burns injury population of Western Australia.
How should we measure muscle strength in patients with burn wounds?
Treatment of burns is aimed at returning patients to their pre-injury level of performance. To support clinicians and researchers in assessing the effects of interventions on individual patients, reliable and valid outcome measures are necessary. Despite the availability of many tools, clinicians lack a simple method of measuring the strength outcomes of patients with acute, open wounds. Further, during the acute phase after burn injury patients suffer from pain, edema, loss of muscle strength and fear avoidance which influences their performance in clinical tests. The aims of the study were to establish a protocol for use after burn and determine the level of reliability, validity and sensitivity of isometric strength measurements of major muscle groups.
Measuring swelling and fluid shifts after burns - are measure of body composition useful?
Acute burns cause significant swelling. The massive fluid shifts that occur as burn size increases necessitate fluid resuscitation to prevent the development of shock and potentially death. Adjustment of fluid requirements is dynamic and requires close monitoring in order to prevent under or over resuscitation in the first 24-48 hours post-burn. Current measures of fluid shifts are invasive. In 2009, for the first time investigators at the Royal Perth Hospital (RPH) burn unit quantified the reliability and sensitivity of a non-invasive technique, bioimpedance spectroscopy (BIS) in acute burn survivors. However, the use of BIS in acute burns is hindered by the presence of open wounds. As burn size increases, the degree of difficulty in achieving accurate measures also increases due to the lack of intact skin. Thus, the aim of this project is to devise methods to allow BIS to be used accurately irrespective of burn location or area. This project has the potential to provide the key to accurate, non-invasive monitoring of acute burn resuscitation and swelling management.
Measuring fitness levels after acute burn injury.
The modified Shuttle Walk Test (mSWT) is an externally paced, incremental, symptom-limited measurement of exercise capacity. A pilot trial conducted by the RPH research team showed that the mSWT was of limited value due to scale attenuation effects in burn patients with small burn injuries (< 10% TBSA). This study builds on the previous work in that we wish to examine if the test has value for larger (> 10% total body surface area, TBSA) burn patients. The aim of this study is to establish the reliability, validity and sensitivity of the mSWT.
Model of Care / Observational Studies
The following studies examine aspects of burn service delivery
Influence of transfer delay on post-burn mortality
In Australia and New Zealand (ANZ), health care is provided for ~26 million people dispersed across the eight million square kilometres of the two countries. Providing optimal care prior to and during transfer across such vast distances, is challenging. Lengthening the time taken to definitive burn care has a negative impact on post-burn outcome. The aims of this study were to determine if transfer time and admission pathway influenced post-burn mortality and to identify the factors predicting post-burn mortality in ANZ. A study based on data from the Burn Registry of Australia and New Zealand.
Can we predict post-burn outcome?
Like many burn centres worldwide, the Burn Service of Western Australia (BSWA) manages burn injuries across the spectrum of severity. The largest category, minor burns, defined here as 15% TBSA or less, comprise 90% of all burns managed at both our inpatient and outpatient facilities. Streamlining care to patient groups according to categories of estimated outcome can promote efficiency, quality results and sustainability of the burn service. Identifying the characteristics of patients that progress quickly to full recovery provides an increased level of certainty when designing fast-track programs for specific patient groups. This study examines the development and validation of a nomogram that predicts the likelihood of patients attaining good QoL at six months and beyond.
Defining post-burn outcomes
Mental Health and Itch in Burns Patients. Is there an association?
The purpose of this study was to investigate the relationship between mental health and self-reported itch in patients with burns. The Patient and Observer Scar Assessment Scale (POSAS) measured self-reported itch and the Short Form Health Survey (SF-36) provided an assessment of mental health across time. The hypothesis is that poorer mental health outcomes are associated with increased severity of itch. A longitudinal study is under way involving 232 participants who completed assessments at 1month, 3months, and 6months post burn injury.
Outcomes for Minor Burn Injuries
The study will focus on describing the pattern of recovery in minor burn patients and identifying the impact of severity variables (percentage of total body surface area (%TBSA) burned, burn depth, burn agent, burn location and surgical intervention) on functional outcomes, quality of life (QOL) and return to work (RTW). Early identification of patients who are at risk of poorer outcomes following a minor burn is important to aid the implementation of more informed, effective and targeted patient rehabilitation regimes.
Outcomes for Lower Limb Burn Injuries at Royal Perth Hospital
Currently, many outcome measures are used at Royal Perth Hospital (RPH) to assess burns patients at specific time-points in their recovery. Since 2006, data has been routinely collected at RPH from approximately 1500 burns patients at the time of their admission to hospital, discharge from hospital, and subsequently at one, three, six, 12 and 24 months post-burn injury. Of these patients, approximately 40% have sustained lower limb burn injuries. This longitudinal retrospective study will investigate the recovery of lower limb burns patients in regard to physical outcomes, functional outcomes, and quality of life. This data also enables the influence of individual burn characteristics on recovery patterns of lower limb burns patients to be analysed. Specifically, we aim to describe the influence of individual burn characteristics including burn location, depth and size which is described as the percentage of total body surface burnt (%TBSA) on patient outcomes and recovery following lower limb burn injury.
Influence of first aid on post-burn outcomes
Based essentially on animal studies, recommended first aid post-burn is water cooling for 20 minutes within three hours of injury. This was a prospective cohort study of Burn Registry of Australia and New Zealand data collected between 2009 and 2012. Information recorded included first aid (FA) applications prior and up to admission to a dedicated burn service. We will analyse four outcomes related to injury severity. These were hospital length of stay, admission to ICU, whether graft surgery occurred, and death.
Cortical Training Programme for Unilateral Hand Burns
The neural response to pain and acute trauma is a complex process of cortical re-organisation within the brain. Mal-adaptive re-organisation and maintenance of these brain changes is implicated in a number of chronic pain states such as phantom limb pain and chronic regional pain syndrome (CRPS). The maladaptive aspects of cortical plasticity are often observed in patients with burn injuries. However, growing research is being devoted towards treatment directed toward the brain for the management of chronic pain conditions. The aim of this study was to investigate cortical training and identify those patients most likely to benefit from this intervention.
Does exercise training improve muscle strength and function after burn injury?
As a direct result of the burn injury, patients lose muscle mass and strength. This can limit simple, daily function and subsequently, poorer quality of life. Resistance exercise is used to maintain and increase muscle mass and strength in healthy people. The aim of this study is to determine whether we can use gym exercise in acute burns to reduce the effects of post-burn muscle loss.
This intervention study will investigate the effect of weights training on muscle strength, muscle mass, physical activity and functional outcomes after burn injury. Adult patients admitted to the Fiona Stanley Hospital Burns Unit with a burn area of 5-40% of their total body, will be recruited into a control (CG) or exercise intervention group (EIG). In addition to usual physiotherapy, the EIG will receive an individualised resistance exercise training program.
Post-traumatic Growth after Burn Injury
Posttraumatic growth occurs as the result of reprioritising the important things in life after a trauma. It is not the opposite of posttraumatic stress. We do not know enough about whether it exists after a big burn injury, and if it exists, how it presents. The Gambit study explores these issues by gathering information from the experts in the subject - by asking the patients. We want to find out more about growth; what it is, if we can measure it, and whether we can find ways to improve it.