Belinda J Gabbe

Swansea University, Swansea, Wales, United Kingdom

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Publications (218)888.49 Total impact

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    ABSTRACT: Most studies about burn injury focus on admitted cases. To compare outpatient and inpatient presentations at burn centers in Australia to inform the establishment of a repository for outpatient burn injury. Data for sequential outpatient presentations were collected at seven burn centers in Australia between December 2010 and May 2011 and compared with inpatient admissions from these centers recorded by the Burns Registry of Australia and New Zealand for the corresponding period. There were 788 outpatient and 360 inpatient presentations. Pediatric outpatients included more children <3 years of age (64% vs 33%), scald (52% vs 35%) and contact burns (39% vs 24%). Adult outpatients included fewer males (58% vs 73%) and intentional injuries (3.3% vs 10%), and more scald (46% vs 30%) and contact burns (24% vs 13%). All pediatric, and 98% of adult, outpatient presentations involved a %TBSA<10. The pattern of outpatient presentations was consistent between centers. Outpatient presentations outnumbered inpatient admissions by 2.2:1. The pattern of outpatient burns presenting to burn centers differed to inpatient admission data, particularly with respect to etiology and burn severity, highlighting the importance of the need for outpatient data to enhance burn injury surveillance and inform prevention. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.
    Burns: journal of the International Society for Burn Injuries 12/2014; DOI:10.1016/j.burns.2014.11.013 · 1.84 Impact Factor
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    ABSTRACT: To determine associations between the number of injuries sustained and three measures of disability 12-months post-injury for hospitalised patients. Data from 27,840 adult (18+ years) participants, hospitalised for injury, were extracted for analysis from the Validating and Improving injury Burden Estimates (Injury-VIBES) Study. Modified Poisson and linear regression analyses were used to estimate relative risks and mean differences, respectively, for a range of outcomes (Glasgow Outcome Scale-Extended, GOS-E; EQ-5D and 12-item Short Form health survey physical and mental component summary scores, PCS-12 and MCS-12) according to the number of injuries sustained, adjusted for age, sex and contributing study. More than half (54%) of patients had an injury to more than one ICD-10 body region and 62% had sustained more than one Global Burden of Disease injury type. The adjusted relative risk of a poor functional recovery (GOS-E<7) and of reporting problems on each of the items of the EQ-5D increased by 5-10% for each additional injury type, or body region, injured. Adjusted mean PCS-12 and MCS-12 scores worsened with each additional injury type, or body region, injured by 1.3-1.5 points and 0.5 points, respectively. Consistent and strong relationships exist between the number of injury types and body regions injured and 12-month functional and health status outcomes. Existing composite measures of anatomical injury severity such as the NISS or ISS, which use up to three diagnoses only, may be insufficient for characterising or accounting for multiple injuries in disability studies. Future studies should consider the impact of multiple injuries to avoid under-estimation of injury burden.
    PLoS ONE 12/2014; 9(12):e113467. DOI:10.1371/journal.pone.0113467 · 3.53 Impact Factor
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    be active 2014: National Sports Injury Prevention Conference. Canberra, Pages e139–e140; 12/2014
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    ABSTRACT: Far fewer injury surveillance systems exist within community sport than elite sport. As a result, most epidemiological data on sports injuries have limited relevance to community-level sporting populations. There is potential for data from community club-based injury surveillance systems to provide a better understanding of community sports injuries. This study aimed to describe the incidence and profile of community-level Australian football injuries reported using a club-based injury surveillance system.DesignProspective, epidemiological study.Methods Sports trainers from five community-level Australian football leagues recorded injury data during two football seasons using the club-based system. An online surveillance tool developed by Sports Medicine Australia (‘Sports Injury Tracker’) was used for data collection. The injury incidence, profile and match injury rate were reported.ResultsInjury data for 1205 players were recorded in season one and for 823 players in season two. There was significant variability in injury incidence across clubs. However, aggregated data were consistent across football seasons, with an average of 0.7 injuries per player per season and 38–39 match injuries per 1000 h match exposure. A large proportion of injuries occurred during matches, involved the lower limb and resulted from contact.Conclusions Data from the club-based system provided a profile of injuries consistent with previous studies in community-level Australian football. Moreover, injury incidence was consistent with other studies using similar personnel to record data. However, injury incidence was lower than that reported in studies using player self-report or healthcare professionals and may be an underestimate of true values.KeywordsSportsEpidemiologyDatabaseSports Injury TrackerSports trainers
    Journal of Science and Medicine in Sport 11/2014; DOI:10.1016/j.jsams.2014.11.390 · 3.08 Impact Factor
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    ABSTRACT: residential aged care facility (RACF) resident numbers are increasing. Residents are frequently frail with substantial co-morbidity, functional and cognitive impairment with high susceptibility to acute illness. Despite living in facilities staffed by health professionals, a considerable proportion of residents are transferred to hospital for management of acute deteriorations in health. This model of emergency care may have unintended consequences for patients and the healthcare system. This review describes available evidence about the consequences of transfers from RACF to hospital.
    Age and Ageing 10/2014; 43(6). DOI:10.1093/ageing/afu117 · 3.11 Impact Factor
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    ABSTRACT: The global burden of injury is enormous, especially in developing countries. Trauma systems in highincome countries have reduced mortality and disability. An important component of trauma quality improvement programmes is the trauma registry which monitors the epidemiology, processes and outcomes of trauma care. There is a severe deficit of trauma registries in developing countries and there are few resources to support the development of trauma registries. Specifically, publicly available information of trauma registry methodology in developed trauma registries is sparse. The aim of this study was to describe and compare trauma registries globally.
    Injury 09/2014; 46(2). DOI:10.1016/j.injury.2014.09.010 · 2.46 Impact Factor
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    ABSTRACT: Objectives To explore the financial and employment impacts following serious injury. Design Semi-structured telephone administered qualitative interviews with purposive sampling and thematic qualitative analysis. Participants: 118 patients (18-81 years) registered by the Victorian State Trauma Registry or Victorian Orthopaedic Trauma Outcomes Registry 12-24 months post-injury. Results Key findings of the study were that although out-of-pocket treatment costs were generally low, financial hardship was prevalent after hospitalisation for serious injury, and was predominantly experienced by working age patients due to prolonged absences from paid employment. Where participants were financially pressured prior to injury, injury further exacerbated these financial concerns. Reliance on savings and loans and the need to budget carefully to limit financial burden were discussed. Financial implications of loss of income were generally less for those covered by compensation schemes, with non-compensable participants requiring welfare payments due to an inability to earn an income. Most participants reported that the injury had a negative impact on work. Loss of earnings payments from injury compensation schemes and income protection policies, supportive employers, and return to work programs were perceived as key factors in reducing the financial burden of injured participants. Employer-related barriers to return to work included the employer not listening to the needs of the injured participant, not understanding their physical limitations, and placing unrealistic expectations on the injured person. While the financial benefits of compensation schemes were acknowledged, issues accessing entitlements and delays in receiving benefits were commonly reported by participants, suggesting that improvements in scheme processes could have substantial benefits for injured patients. Conclusions Seriously injured patients commonly experienced substantial financial and work-related impacts of injury. Participants of working age who were unemployed prior to injury, did not have extensive leave accrual at their pre-injury employment, and those not covered by injury compensation schemes or income protection insurance clearly represent participants “at risk” for substantial financial hardship post-injury. Early identification of these patients, and improved provision of information about financial support services, budgeting and work retraining could assist in alleviating financial stress after injury
    Injury 09/2014; 45(9). DOI:10.1016/j.injury.2014.01.019 · 2.46 Impact Factor
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    ABSTRACT: Objectives: To compare 6 month and 12 month health status and functional outcomes between regional major trauma registries in Hong Kong and Victoria, Australia. Summary Background Data: Multicentres from trauma registries in Hong Kong and the Victorian State Trauma Registry (VSTR). Methods: Multicentre, prospective cohort study. Major trauma patients and aged >= 18 years were included. The main outcome measures were Extended Glasgow Outcome Scale (GOSE) functional outcome and risk-adjusted Short-Form 12 (SF-12) health status at 6 and 12 months after injury. Results: 261 cases from Hong Kong and 1955 cases from VSTR were included. Adjusting for age, sex, ISS, comorbid status, injury mechanism and GCS group, the odds of a better functional outcome for Hong Kong patients relative to Victorian patients at six months was 0.88 (95% CI: 0.66, 1.17), and at 12 months was 0.83 (95% CI: 0.60, 1.12). Adjusting for age, gender, ISS, GCS, injury mechanism and comorbid status, Hong Kong patients demonstrated comparable mean PCS-12 scores at 6-months (adjusted mean difference: 1.2, 95% CI: -1.2, 3.6) and 12-months (adjusted mean difference: -0.4, 95% CI: -3.2, 2.4) compared to Victorian patients. Keeping age, gender, ISS, GCS, injury mechanism and comorbid status, there was no difference in the MCS-12 scores of Hong Kong patients compared to Victorian patients at 6-months (adjusted mean difference: 0.4, 95% CI: -2.1, 2.8) or 12-months (adjusted mean difference: 1.8, 95% CI: -0.8, 4.5). Conclusion: The unadjusted analyses showed better outcomes for Victorian cases compared to Hong Kong but after adjusting for key confounders, there was no difference in 6-month or 12-month functional outcomes between the jurisdictions.
    PLoS ONE 08/2014; 9(8):e103396. DOI:10.1371/journal.pone.0103396 · 3.53 Impact Factor
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    ABSTRACT: Traumatic injury is a leading contributor to the overall global burden of disease. However, there is a worldwide shortage of population data to inform understanding of non-fatal injury burden. An improved understanding of the pattern of recovery following trauma is needed to better estimate the burden of injury, guide provision of rehabilitation services and care to injured people, and inform guidelines for the monitoring and evaluation of disability outcomes.
    Injury Prevention 08/2014; DOI:10.1136/injuryprev-2014-041336 · 1.94 Impact Factor
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    ABSTRACT: Background Previous research aimed at improving injury surveillance standards has focused mainly on issues of data quality rather than upon the implementation of surveillance systems. There are numerous settings where injury surveillance is not mandatory and having a better understanding of the barriers to conducting injury surveillance would lead to improved implementation strategies. One such setting is community sport, where a lack of available epidemiological data has impaired efforts to reduce injury. This study aimed to i) evaluate use of an injury surveillance system following delivery of an implementation strategy; and ii) investigate factors influencing the implementation of the system in community sports clubs. Methods A total of 78 clubs were targeted for implementation of an online injury surveillance system (approximately 4000 athletes) in five community Australian football leagues concurrently enrolled in a pragmatic trial of an injury prevention program called FootyFirst. System implementation was evaluated quantitatively, using the RE-AIM framework, and qualitatively, via semi-structured interviews with targeted-users. Results Across the 78 clubs, there was 69% reach, 44% adoption, 23% implementation and 9% maintenance. Reach and adoption were highest in those leagues receiving concurrent support for the delivery of FootyFirst. Targeted-users identified several barriers and facilitators to implementation including personal (e.g. belief in the importance of injury surveillance), socio-contextual (e.g. understaffing and athlete underreporting) and systems factors (e.g. the time taken to upload injury data into the online system). Conclusions The injury surveillance system was implemented and maintained by a small proportion of clubs. Outcomes were best in those leagues receiving concurrent support for the delivery of FootyFirst, suggesting that engagement with personnel at all levels can enhance uptake of surveillance systems. Interview findings suggest that increased uptake could also be achieved by educating club personnel on the importance of recording injuries, developing clearer injury surveillance guidelines, increasing club staffing and better remunerating those who conduct surveillance, as well as offering flexible surveillance systems in a range of accessible formats. By increasing the usage of surveillance systems, data will better represent the target population and increase our understanding of the injury problem, and how to prevent it, in specific settings.
    07/2014; 1(19). DOI:10.1186/s40621-014-0019-y
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    ABSTRACT: In recent reports, Australian football has outranked other team sports in the frequency of hospitalizations and emergency department (ED) presentations. Understanding the profile of these and other "medical-attention" injuries is vital for developing preventive strategies that can reduce health costs. The objective of this review was to describe the frequency and profile of Australian football injuries presenting for medical attention.
    Clinical journal of sport medicine: official journal of the Canadian Academy of Sport Medicine 07/2014; DOI:10.1097/JSM.0000000000000108 · 2.01 Impact Factor
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    ABSTRACT: Background Plating is commonly used in surgical fixation of mid-shaft humeral fractures. The literature lacks detail regarding plating complications or screw-plate fixation factors that may impact upon plating outcomes. This study aims to evaluate the outcomes of humeral shaft fractures treated by plating in two major trauma centres and to examine screw-plate fixation factors that may impact upon clinical outcome. Materials and methods Patients enrolled in the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) between 2003 and 2008 were identified. X-rays were reviewed independently by three orthopaedic surgeons to determine radiological union and fixation. Screw-plate implant details and post-operative clinical outcomes including loss of fixation and re-operation rate were evaluated. Health-related quality of life measures (SF-12) were assessed at 6 and 12-months post-injury. Results 103 patients (male n=72, female n=31; mean age 36.9 years) were identified. There were 25 complications in 22 patients with loss of fixation (n=7), superficial infection (n=5), deep infection (n=4) and non-union (n=4) being the most common. 13 patients required further surgical interventions. Screw placements on both sides of the fracture were evaluated; when at least 4 screws were placed on both sides of the fracture, there was no loss of fixation (p= 0.04). Median time to union was 22 weeks. At 12 months post injury, SF-12 scores were significantly below population norms. Conclusions There was a high incidence of post-operative complications following plating of humeral shaft fractures in this multi-trauma patient population. Our results indicate reduced rates of loss of fixation for having ≥4 screws on both sides of the fracture.
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    ABSTRACT: To achieve expert consensus on the content of an exercise training program (known as FootyFirst) to prevent lower-limb injuries.
    Clinical journal of sport medicine: official journal of the Canadian Academy of Sport Medicine 07/2014; DOI:10.1097/JSM.0000000000000124 · 2.01 Impact Factor
  • P A Cameron, B J Gabbe, K Smith, B Mitra
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    ABSTRACT: Trauma systems have been successful in saving lives and preventing disability. Making sure that the right patient gets the right treatment in the shortest possible time is integral to this success. Most trauma systems have not fully developed trauma triage to optimize outcomes. For trauma triage to be effective, there must be a well-developed pre-hospital system with an efficient dispatch system and adequately resourced ambulance system. Hospitals must have clear designations of the level of service provided and agreed protocols for reception of patients. The response within the hospital must be targeted to ensure the sickest patients get an immediate response. To enable the most appropriate response to trauma patients across the system, a well-developed monitoring programme must be in place to ensure constant refinement of the clinical response. This article gives a brief overview of the current approach to triaging trauma from time of dispatch to definitive treatment.
    BJA British Journal of Anaesthesia 06/2014; 113(2). DOI:10.1093/bja/aeu231 · 4.35 Impact Factor
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    ABSTRACT: Resuscitation of patients presenting with hemorrhagic shock after major trauma has evolved to incorporate multiple strategies to maintain tissue perfusion and oxygenation while managing coagulation disorders. We aimed to study changes across time in long-term outcomes in patients with major trauma. A retrospective observational study in a single major trauma center in Australia was conducted. We included all patients with major trauma and massive blood transfusion within the first 24 h during a 6-year period (from 2006 to 2011). The main outcome measures were Glasgow Outcome Score-Extended (GOSE) and work capacity at 6 and 12 months. There were 5,915 patients with major trauma of which 365 (6.2%; 95% confidence interval [95% CI], 5.6 - 6.8) received a massive transfusion. The proportion of major trauma patients receiving a massive transfusion decreased across time from 8.2% to 4.4% (P < 0.01). There were statistically significant trends toward lower volumes of red blood cell transfusion and higher ratios of fresh-frozen plasma to red blood cells (P G 0.01). Among massively transfused patients, there was no significant change in measured outcomes during the study period, with a persistent 23% mortality in hospital, 52% unfavorable GOSE at 6 months, and 44% unfavorable GOSE at 12 months. Massive transfusion was independently associated with unfavorable outcomes at 6 months after injury (adjusted odds ratio, 1.56; 95% CI, 1.05 - 2.31) but not at 12 months (adjusted odds ratio, 0.85; 95% CI, 0.72 - 1.01). A significant reduction in massive transfusion rates was observed. Unfavorable long-term outcomes among patients receiving a massive transfusion after trauma were frequent with a substantial proportion of survivors experiencing poor functional status 1 year after injury.
    Shock (Augusta, Ga.) 06/2014; 42(4). DOI:10.1097/SHK.0000000000000219 · 2.73 Impact Factor
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    UKCRC Public Health Research Centres of Excellence Conference 2014 (Leeds); 06/2014
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    ABSTRACT: Introduction Sustaining a moderate to severe burn injury is associated with the potential for substantial impairments to long-term physical and psychosocial health, including health related quality of life (HRQoL). The objective of this study was to identify clinical and patient characteristics which predict HRQoL 12-months after injury. Methods A total of 125 patients were recruited over the study period, although only 99 were included in the final analysis representing all those who completed both the pre-burn and 12-months after burn injury Short Form 36 Medical Outcomes Survey (SF-36v2). These patients also completed the Burn Specific Health Scale-Brief (BSHS-B). Patient demographics and burn injury characteristics and treatment factors were collected to identify which factors predict 12-month health status outcomes. Multiple linear regression analyses were conducted to identify important predictors of outcomes. The SF36v2 models were adjusted for pre-injury measurements. Results Older age (regression coefficient −0.26, 95% confidence interval (95% CI) −0.38, −0.13), female gender (−8.08, 95% CI −12.8, −3.34) and increased percentage of full-thickness burns per body surface area (−0.51; 95% CI −0.88, −0.13) were important predictors of poorer physical health status at 12 months. Older age (−0.15, 95% CI −0.26, −0.04) and increased percentage of full-thickness burns per body surface area (−0.36, 95% CI −0.69, −0.03) were important predictors of poorer mental health status at 12 months. Older age (−0.38; 95%CI −0.66, −0.11) and female gender (−12.17; 95% CI −22.76, −1.57) were important predictors of poorer BSHS-B total score at 12 months after injury. Conclusions Given the complexity of burn care rehabilitation, physical and psychosocial screening and assessment within the first weeks after a burn injury along with adequate monitoring after discharge should be undertaken in burn injured patients. In this context, patients of specific demographics, such as female patients and older patients, and patients with a higher percentage of full thickness surface area burns are of greater risk for poorer physical and psychological outcomes and may benefit from additional monitoring and rehabilitation.
    Burns: journal of the International Society for Burn Injuries 06/2014; 40(4). DOI:10.1016/j.burns.2014.01.021 · 1.84 Impact Factor
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    ABSTRACT: There is limited evidence describing the long-term outcomes of severe pelvic ring fractures. The aim of this study was to describe the longer term independent living and return to work outcomes following severe pelvic ring fracture.
    ANZ Journal of Surgery 05/2014; DOI:10.1111/ans.12700 · 1.12 Impact Factor
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    ABSTRACT: Objectives To obtain benefits from sports injury prevention programs, players are instructed to perform the exercises as prescribed. We developed an observational checklist to measure the quality of exercise performance by players participating in FootyFirst, a coach-led, exercise-based, lower-limb injury prevention program in community Australian football (AF). Design Observational Method The essential performance criteria for each FootyFirst exercise were described in terms of the technique, volume and intensity required to perform each exercise. An observational checklist was developed to evaluate each criterion through direct visual observation of players at training. The checklist was trialled by two independent raters who observed the same 70 players completing the exercises at eight clubs. Agreement between observers was assessed by Kappa-statistics. Exercise fidelity was defined as the proportion of observed players who performed all aspects of their exercises correctly. Results The raters agreed on 61/70 observations (87%) (Kappa = 0.72, 95% CI:0.55;0.89). Of the observations with agreed ratings, 41 (67%) players were judged as performing the exercises as prescribed. Conclusions The observational checklist demonstrated high inter-rater reliability. Many players observed did not perform the exercises as prescribed, raising concern as to whether they would be receiving anticipated program benefits. Where quality of exercise performance is important, evaluation and reporting of program fidelity should include direct observations of participants.
    Journal of Science and Medicine in Sport 05/2014; DOI:10.1016/j.jsams.2014.05.001 · 3.08 Impact Factor
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    ABSTRACT: Background Early, accurate prediction of discharge destination from the acute hospital assists individual patients and the wider hospital system. The Trauma Rehabilitation and Prediction Tool (TRaPT), developed using registry data, determines probability of inpatient rehabilitation discharge for patients with isolated lower limb fractures.Objective Aims of this study include prospective validation of the TRaPT, assessing whether its performance could be improved by adding additional demographic data, and simplifying it for use as a bedside tool.DesignCohort, measurement focused study.Methods Patients admitted to a major trauma centre in Melbourne, Australia, with isolated lower limb fractures were included. Individual's TRaPT scores were calculated from admission data. Performance of the TRaPT score alone, and in combination with frailty, weight bearing status and home supports, was assessed using measures of discrimination and calibration. Simplified TRaPT was developed by rounding the coefficients of variables in the original model and grouping age into eight categories. Simplified TRaPT performance measures including specificity, sensitivity, and positive and negative predictive values were evaluated.ResultsOne hundred and fourteen patients were included. Prospective validation of the TRaPT showed excellent discrimination [C-statistic 0.90 (95% CI 0.82, 0.97)], a sensitivity of 80% and specificity of 94%. All patients able to weight bear were discharged directly home. Simplified TRaPT scores had a sensitivity of 80% and a specificity of 88%.LimitationsGeneralizability may be limited given the compensation system that exists in Australia but the methods used will assist in designing a similar tool in any population.ConclusionsTRaPT accurately predicted discharge destination for 80% of patients and may form a useful aid for discharge decision making, with the simplified version facilitating its use as a bedside tool.
    Physical Therapy 04/2014; 94(7). DOI:10.2522/ptj.20130413 · 3.25 Impact Factor

Publication Stats

4k Citations
888.49 Total Impact Points

Institutions

  • 2012–2014
    • Swansea University
      • College of Medicine
      Swansea, Wales, United Kingdom
  • 2008–2014
    • University of Vic
      Vic, Catalonia, Spain
  • 2004–2014
    • Alfred Hospital
      • • Department of Department of Epidemiology and Preventive Medicine (DEPM)
      • • Department of Emergency and Trauma Centre
      Melbourne, Victoria, Australia
  • 2002–2014
    • Monash University (Australia)
      • Department of Epidemiology and Preventive Medicine
      Melbourne, Victoria, Australia
    • University of Melbourne
      • Department of Physiotherapy
      Melbourne, Victoria, Australia
    • Victoria University Melbourne
      Melbourne, Victoria, Australia
  • 2012–2013
    • University of Washington Seattle
      Seattle, Washington, United States
  • 2006–2008
    • Royal Melbourne Hospital
      Melbourne, Victoria, Australia
    • La Trobe University
      • Department of Physiotherapy
      Melbourne, Victoria, Australia
  • 2003
    • The Chinese University of Hong Kong
      • Prince of Wales Hospital
      Hong Kong, Hong Kong
  • 1999–2000
    • University of Victoria
      Victoria, British Columbia, Canada
    • Deakin University
      Geelong, Victoria, Australia