Mr Dale Edwick1,2,3, Dr Dana Hince3, Mr Jeremy Rawlins1,5, Professor Fiona Wood1,2,4, A/Professor Dale Edgar1,2,3,4
1Fiona Stanley Hospital, Murdoch, Australia, 2Fiona Wood Foundation, Murdoch, Australia, 3The University of Notre Dame Australia, Fremantle, Australia, 4The University of Western Australia, Nedlands, Australia, 5Royal Perth Hospital, Perth, Australia
Introduction: The assessment of swelling following burn injury is complicated by the presence of wounds and dressings, and patients often experiencing significant pain, impaired movement, and requiring medications that modify behaviour. Traditional measures of volume, such as water displacement volumetry (WDV), lack sensitivity and are challengeable in the burn environment as validity is linked to patient cooperation. Additionally, these measures potentially increase pain and infection risk due to equipment contact with open wounds. Bioimpedance spectroscopy (BIS) is a measure of body composition with demonstrated reliability for measuring whole body and limb oedema, and sensitivity to measuring oedema (change) within healing wounds. This study was designed to determine the reliability and validity of BIS for measuring oedema following hand burn injury.
Methods: Patients presenting with hand burn injury were recruited to this trial. Repeated volume measures of the hand were recorded using a novel application of BIS, and repeated using WDV. The results were analysed using multi-level mixed effects regressions.
Results: One hundred patients were recruited (68 male) with a mean age of 40.1±13.8 years. The mean BSA per injured hand was 0.35±0.23%. Patients were recruited 2.81±1.69 days postinjury. Paired repeated measures were obtained for 195 hands, at admission to the service and the second 4.96 ± 1.80 days postinjury. Mean hand volume was 541.7±107.6mL. Comparison with WDV demonstrated a strong correlation (r=0.79; limits of agreement 198-460mL). Reliability of BIS was determined by ICC: 0.9978-0.9999 (CI 0.9967-0.9999).
Conclusion: BIS is a valid and reliable measure of oedema following acute hand burn injury.
Dale is a Senior Physiotherapist in the State Adult Burns Unit at Fiona Stanley Hospital in Western Australia. He is finalising his PhD studies through the School of Physiotherapy at The University of Notre Dame Australia. His research interests are the use of technology to measure wound healing and oedema, and the proactive management of oedema following hand and minor burn injury. When not at work, Dale is at home with his OT wife and 2 beautiful daughters, and likes to keep fit by running and bouldering.