The problem
Research Problem 1
The importance of nutrition in major burn recovery is well established. However, clinicians often rely on estimated equations to guide nutritional provision for patients, despite their poor correlation with measured energy expenditure (EE). This discrepancy can lead to underfeeding or overfeeding of patients, both of which may negatively impact patient outcomes.
Research Problem 2
Indirect Calorimetry (IC) is commonly used in Burn Units in Australia, and internationally, to measure resting EE (REE) of patients with major burns. However, IC only provides a brief snapshot of information and does not capture a patient’s total EE (TEE). Therefore, in practice clinicians compensate for this by applying a theoretical activity factor onto the REE measurement to estimate a patient’s TEE
Research Problem 3
Wearable devices provide an opportunity to measure and monitor a patient with burn injury’s TEE while also providing other clinically relevant information, such as physical activity levels and vital sign monitoring. However, the literature indicates current wearable devices likely over or underestimated EE among individuals with or without medical conditions. Additionally, there is limited evidence about the use of wearable technology to monitor EE within a hospitalised setting, and none within an acute burns setting.
Summary of the research
Study 1 – Systematic Literature Review
Title: Measuring energy expenditure with wearable technology in a hospital setting: A systematic review
Aim: Examine the available evidence in the use of wearable devices to measure EE in a hospital setting and how these devices compare with the gold standard methods for measuring EE. Methodology: In accordance with the PRISMA 2020 statement
Status: In progress
Study 2 – Feasibility Study
Title: Feasibility and acceptability of wearable sensors in patients with burn injury to measure energy expenditure
Aim: Explore the feasibility of using wearable devices to measure EE of inpatients recovering from burn injury.
Methodology: Mixed-method feasibility trial (compare wearable device resting energy expenditure estimates to indirect calorimetry)
Status: Recruitment complete (n = 13), data analysis in progress
Study 3 – Pilot Validation Trial
Title: To be determined
Aim: To build upon of the findings from the feasibility trial to validate the use of wearable devices to monitor TEE and other clinically relevant observations.
Methodology: Phase One Validation Trial (compare wearable device total energy expenditure estimates to doubly labelled water)
Status: Ethics approval complete, aiming to recruit in 2026
The impact
This study represents a significant advancement in clinical nutrition research by introducing the use of doubly labelled water (DLW), the gold standard for measuring TEE, into the burn care setting. This will be the first study globally to compare wearable device estimates with DLW in a hospital setting, and the first in Australia to apply DLW in a burns context. It also marks only the second time DLW has been used in hospital inpatients nationally.
The outcomes have the potential to directly improve care for burn patients and may facilitate further clinical areas to utilise more precise, personalised nutritional support. Continuous data from wearables may also inform rehabilitation strategies and support early detection of clinical deterioration.
Our researchers
Bronwyn Segon (Monash, CSIRO, RBWH), Dr Merrilyn Banks (RBWH), Dr Judy Bauer MONASH), Dr David Silvera-Tawil (CSIRO), Dr Jason Brown (RBWH), Dr Wei Lu (CSIRO), Andrea McKittrick (Occupational Therapy, RBWH), Anita Plaza (Physiotherapist, RBWH ), Dale Trevor (consumer), Dr Marlien Varnfield (CSIRO)