Effectiveness of interventions to prevent or reverse pre-frailty and frailty in middle-aged community dwelling adults: A systematic review.

INTRODUCTION: Frailty, marked by diminished physiological capacity and higher health risks, is less understood in middle-aged individuals (40-65 years) than older adults. This review synthesises intervention studies for pre-frailty and frailty in this demographic, assessing effectiveness, feasibility, and implementation factors including participant experience and cost-effectiveness. METHOD: Registered on the Open Science Framework and adhering to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and the template for intervention description and replication (TIDieR) guidelines, this review searched six databases for interventions targeting middle-aged adults. Dual screening, data extraction, risk assessment, and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) certainty evaluation were conducted. Findings were narratively synthesized due to heterogeneity. RESULTS: Eight studies (2018-2023) with 2838 participants were included. Resistance training and multicomponent exercise reduced frailty; though, not always significantly. Low-intensity exercises and education-based interventions yielded mixed results, suggesting a need for further research. Positive participant experiences and cost-effectiveness of interventions such as resistance training and educational interventions supports their feasibility. Varying quality, methodologies and levels of bias indicated a need for more rigorous future research. DISCUSSION: This review reveals an evidence gap in middle-aged frailty interventions. Multicomponent interventions and resistance training showed promise, but their comparative effectiveness remains uncertain. Educational and low-intensity interventions need further research to establish their effectiveness. The findings diverge from those in older adults, emphasising the need for age-specific approaches. Future studies should employ higher-quality methods and explore emerging technologies to enhance intervention effectiveness for pre-frailty and frailty in middle-aged adults.

The quality of care delivered to residents in long-term care in Australia: an indicator-based review of resident records (CareTrack Aged study).

BACKGROUND: This study estimated the prevalence of evidence-based care received by a population-based sample of Australian residents in long-term care (LTC) aged ≥ 65 years in 2021, measured by adherence to clinical practice guideline (CPG) recommendations. METHODS: Sixteen conditions/processes of care amendable to estimating evidence-based care at a population level were identified from prevalence data and CPGs. Candidate recommendations (n = 5609) were extracted from 139 CPGs which were converted to indicators. National experts in each condition rated the indicators via the RAND-UCLA Delphi process. For the 16 conditions, 236 evidence-based care indicators were ratified. A multi-stage sampling of LTC facilities and residents was undertaken. Trained aged-care nurses then undertook manual structured record reviews of care delivered between 1 March and 31 May 2021 (our record review period) to assess adherence with the indicators. RESULTS: Care received by 294 residents with 27,585 care encounters in 25 LTC facilities was evaluated. Residents received care for one to thirteen separate clinical conditions/processes of care (median = 10, mean = 9.7). Adherence to evidence-based care indicators was estimated at 53.2% (95% CI: 48.6, 57.7) ranging from a high of 81.3% (95% CI: 75.6, 86.3) for Bladder and Bowel to a low of 12.2% (95% CI: 1.6, 36.8) for Depression. Six conditions (skin integrity, end-of-life care, infection, sleep, medication, and depression) had less than 50% adherence with indicators. CONCLUSIONS: This is the first study of adherence to evidence-based care for people in LTC using multiple conditions and a standardised method. Vulnerable older people are not receiving evidence-based care for many physical problems, nor care to support their mental health nor for end-of-life care. The six conditions in which adherence with indicators was less than 50% could be the focus of improvement efforts.

Dispersal mediates trophic interactions and habitat connectivity to alter metacommunity composition.

Dispersal contributes vitally to metacommunity structure. However, interactions between dispersal and other key processes have rarely been explored, particularly in the context of multitrophic metacommunities. We investigated such a metacommunity in naturally fragmented habitats populated by butterfly species (whose dispersal capacities were previously assessed), flowering plants, and butterfly predators. Using data on butterfly species abundance, floral abundance, and predation (on experimentally placed clay butterfly models), we asked how dispersal ability mediates interactions with predators, mutualists, and the landscape matrix. In contrast to expectations, high densities of strong dispersers were found in more isolated sites and sites with low floral resource density, while intermediate dispersers maintained similar densities across isolation and floral gradients, and higher densities of poor dispersers were found in more connected sites and sites with higher floral density. These findings raise questions about how strong dispersers experience the landscape matrix and the quality of isolated and low-resource sites. Strong dispersers were able to escape habitat patches with high predation, while intermediate dispersers maintained similar densities along a predation gradient, and poor dispersers occurred at high densities in these patches, exposing them to interactions with predators. This work demonstrates that species that vary in dispersal capacities interact differently with predators and mutualist partners in a landscape context, shaping metacommunity composition.

Seasonal Variation in Upper Limb Size, Volume, Fluid Distribution, and Lymphedema Diagnosis, Following Breast Cancer Treatment.

Background: Breast cancer-related lymphedema (BCRL) is a common complication of breast cancer treatment. Anecdotal and qualitative research suggests that heat and hot weather cause an exacerbation of BCRL; however, there is little quantitative evidence to support this. The aim of this article is to investigate the relationship between seasonal climate variation and limb size, volume, fluid distribution, and diagnosis in women following breast cancer treatment. Methods and Results: Women older than the age of 35 years who had undergone treatment for breast cancer were invited to participate. Twenty-five women aged between 38 and 82 years were recruited. Seventy-two percent received surgery, radiation therapy, and chemotherapy as part of their breast cancer treatment. Participants completed anthropometric, circumferential, and bioimpedance measures and a survey on three occasions: November (spring), February (summer), and June (winter). Diagnostic criteria of >2 cm and >200 mL difference between the affected and unaffected arm, and a positive bioimpedance ratio of >1.139 for a dominant arm and >1.066 for nondominant arm was applied across the three measurement occasions. No significant correlation between seasonal variation in climate and upper limb size, volume, or fluid distribution were found in women diagnosed with or at risk of developing BCRL. Lymphedema diagnosis depends on the season and diagnostic measurement tool utilized. Conclusion: There was no statistically significant variation in limb size, volume, or fluid distribution in this population across spring, summer, and winter, although there were linked trends in these values. The diagnosis of lymphedema, however, varied between individual participants throughout the year. This has important implications for the implementation/commencement of treatment and management. Further research with a larger population in different climates is required to explore the status of women with respect to BCRL. The use of common clinical diagnostic criteria did not result in consistent diagnostic classification of BCRL for the women involved in this study.

Outcomes of a trial of an age-friendly dining initiative: Dining Co.

OBJECTIVES: With the rise of age-friendly cities and communities, increasing attention is being paid to coproducing age-friendly guidelines with older people and community stakeholders. Little is known however about age-friendly guidelines for dining establishments. METHODS: A three-stage study to develop general and contextualised requirements for an age-friendly dining experience was conducted in the City of Onkaparinga, South Australia. The first stage involved older people in co-designing aspects of an age-friendly dining experience. Subsequently, the second and third stage coproduced, trialed and evaluated age-friendly initiatives with two dining venues. RESULTS: Through co-design, seven domains of an age-friendly dining experience were identified (Menu, Affordability, Dementia Awareness, Venue, Feeling Welcome, Special Offerings and Assistance), alongside an overarching desire for a 'meaningful' dining experience. Differences in health and socioeconomic status of diners underpinned the differences needed to ensure an age-friendly dining experience and highlight the importance of contextualisation for the local population. The trial demonstrated positive outcomes for both older diners and venues. DISCUSSION: The environment, value and logistics of dining out are important to older people when making choices about dining in the community. The elements of an age-friendly dining experience presented in this study are a useful starting point for contextualisation to other local settings.

Machine learning models for identifying pre-frailty in community dwelling older adults.

BACKGROUND: There is increasing evidence that pre-frailty manifests as early as middle age. Understanding the factors contributing to an early trajectory from good health to pre-frailty in middle aged and older adults is needed to inform timely preventive primary care interventions to mitigate early decline and future frailty. METHODS: A cohort of 656 independent community dwelling adults, aged 40-75 years, living in South Australia, undertook a comprehensive health assessment as part of the Inspiring Health cross-sectional observational study. Secondary analysis was completed using machine learning models to identify factors common amongst participants identified as not frail or pre-frail using the Clinical Frailty Scale (CFS) and Fried Frailty Phenotype (FFP). A correlation-based feature selection was used to identify factors associated with pre-frailty classification. Four machine learning models were used to derive the prediction models for classification of not frail and pre-frail. The class discrimination capability of the machine learning algorithms was evaluated using area under the receiver operating characteristic curve (AUC), sensitivity, specificity, precision, F1-score and accuracy. RESULTS: Two stages of feature selection were performed. The first stage included 78 physiologic, anthropometric, environmental, social and lifestyle variables. A follow-up analysis with a narrower set of 63 variables was then conducted with physiologic factors associated with the FFP associated features removed, to uncover indirect indicators connected with pre-frailty. In addition to the expected physiologic measures, a range of anthropometric, environmental, social and lifestyle variables were found to be associated with pre-frailty outcomes for the cohort. With FFP variables removed, machine learning (ML) models found higher BMI and lower muscle mass, poorer grip strength and balance, higher levels of distress, poor quality sleep, shortness of breath and incontinence were associated with being classified as pre-frail. The machine learning models achieved an AUC score up to 0.817 and 0.722 for FFP and CFS respectively for predicting pre-frailty. With feature selection, the performance of ML models improved by up to + 7.4% for FFP and up to + 7.9% for CFS. CONCLUSIONS: The results of this study indicate that machine learning methods are well suited for predicting pre-frailty and indicate a range of factors that may be useful to include in targeted health assessments to identify pre-frailty in middle aged and older adults.

Appropriate and acceptable health assessments for people experiencing homelessness.

BACKGROUND: Appropriate and acceptable recruitment strategies and assessment tools are essential to determine the health needs for people experiencing homelessness. Based on a systematic review and known feasible community-based health assessments for people who are not homeless, a set of health assessments were trialled with people experiencing homelessness. METHODS: Participants were recruited via support agencies. They completed a health risk assessment, demographic and self-report health questionnaires, and objective assessments across 17 domains of health. RESULTS: Fifty-three participants (43.3% female, mean age 49.1 years) consented and completed 83-96% of assessments. Consent was reversed for assessments of grip, foot sensation, body measures (11%), and walking (30%), and initially refused for stress, sleep, cognition (6%); balance, walk test (9%) and oral examination (11%). There was one adverse event. Most assessments were both appropriate and acceptable. Some required modification for the context of homelessness, in particular the K10 was over-familiar to participants resulting in memorised responses. Recruitment strategies and practices must increase trust and ensure participants feel safe. CONCLUSIONS: This set of health assessments are appropriate and acceptable for administration with people experiencing homelessness. Outcomes of these assessments are essential to inform public and primary health service priorities to improve the health of people experiencing homelessness.

Mycoprotein as novel functional ingredient: Mapping of functionality, composition and structure throughout the Quorn fermentation process.

This study provides the first mapping of mycoprotein functionality, composition and structure throughout the Quorn fermentation process. The fermentation broth, RNA-reduced broth (RNA-broth), centrate and their centrifugation deposits and supernatants were characterised. The broth, RNA-broth and their deposits displayed high concentrations of fungal filaments, which contributed to their high gelling properties (with a 5,320 Pa elastic modulus reported for RNA-broth deposits gels). Foams prepared with RNA-broth and centrate supernatants via frothing exhibited high stability (380 min), with high concentrations of a foam-positive cerato-platanin reported in these samples. Emulsions prepared with the broth and broth supernatant showed high emulsifying activity and stability indexes (12.80 m2/g and 15.84 mins for the broth supernatant) and low oil droplet sizes (18.09 µm for the broth). This study identified previously unreported gelling, foaming and/or emulsifying properties for the different Quorn streams, highlighting opportunities to develop novel sustainable alternatives to animal-derived functional ingredients using mycoprotein material.

Effectiveness of a co-designed technology package on perceptions of safety in community-dwelling older adults.

OBJECTIVES: Increasing numbers of older people are living longer, often alone, in their own homes. Services and products that enable older people to remain safely in their own homes are required. The My Smart Home project recruited 30 community-dwelling people aged 65+ to co-design a package of technology to address their individual goals for safety and security at home. The technology package, up to the value of $4000, included installation of health monitoring, communication and entertainment devices, and security alarms, with 6 hours of technology coaching. METHODS: Participants completed the Personal Wellbeing Index (PWI), the Australian Quality of Life-8 Dimensions (AQoL-8D) and the Canadian Occupational Performance Measure (COPM) at baseline, and after 4 weeks' use of the technology package. Semi-structured interviews were also used to qualitatively understand the challenges, enablers and outcomes of the project with respect to safety and security in the home. RESULTS: Significant improvements in PWI (p < 0.01), AQoL-8D (p < 0.001) and COPM for goal performance (p < 0.001) and goal satisfaction (p < 0.001) were reported. Participants also reported feeling safer and more secure in their own homes. Common barriers to adoption of technology, cost, integration with already-owned technology and lack of confidence were overcome with this technology and coaching package. CONCLUSIONS: An individualised package of technology, with coaching, that supports older people to realise their personal goals with technology resulted in improved well-being, quality of life and sense of safety and security in community-dwelling older people. Ultimately, this should support a longer and better quality of life at home.

Floral diversity increases butterfly diversity in a multitrophic metacommunity.

The impact of multitrophic interactions on metacommunity structure, despite extensive theory and modeling/manipulative studies, has remained largely unexplored within naturally occurring metacommunities. We investigated the impacts of mutualistic partners and predators on a butterfly metacommunity, as well as the impacts that local and landscape characteristics have across three trophic levels: flowering plants, butterflies, and butterfly predators. Using data for butterfly diversity/richness, flowering plant diversity/richness, and butterfly predation (on clay butterfly models) across 15 grassland sites, we posed 3 questions. (1) How do mutualist metacommunity structure, predation pressure, and local and regional habitat characteristics affect butterfly metacommunity structure? (2) How do local and regional habitat characteristics affect flowering plant metacommunity structure? (3) How do local and regional habitat characteristics affect predation pressure? Floral diversity and richness had a positive effect on butterfly diversity and richness (Question 1). Site size positively affected floral diversity and richness (Question 2), and through this relationship site size had an indirect positive effect on butterfly diversity and richness (Question 1). In contrast to previous work, no other variables impacted butterfly diversity/richness. This result was particularly surprising for predation pressure: Our results suggest that within our study system, butterfly community diversity and richness are not strongly impacted by predation. Predator attacks occurred more in larger and more isolated sites (Question 3), suggesting that predators respond more strongly to landscape characteristics than abundance or diversity of butterfly prey species. This decoupling of predation pressure and butterfly communities suggests that conserving and restoring healthy predator populations may not negatively impact butterfly communities. If diverse plant communities are maintained, even small and isolated habitat patches can be valuable for butterfly conservation, which may influence reserve design and habitat restoration strategies.

Designing clinical indicators for common residential aged care conditions and processes of care: the CareTrack Aged development and validation study.

BACKGROUND: People who live in aged care homes have high rates of illness and frailty. Providing evidence-based care to this population is vital to ensure the highest possible quality of life. OBJECTIVE: In this study (CareTrack Aged, CT Aged), we aimed to develop a comprehensive set of clinical indicators for guideline-adherent, appropriate care of commonly managed conditions and processes in aged care. METHODS: Indicators were formulated from recommendations found through systematic searches of Australian and international clinical practice guidelines (CPGs). Experts reviewed the indicators using a multiround modified Delphi process to develop a consensus on what constitutes appropriate care. RESULTS: From 139 CPGs, 5609 recommendations were used to draft 630 indicators. Clinical experts (n = 41) reviewed the indicators over two rounds. A final set of 236 indicators resulted, mapped to 16 conditions and processes of care. The conditions and processes were admission assessment; bladder and bowel problems; cognitive impairment; depression; dysphagia and aspiration; end of life/palliative care; hearing and vision; infection; medication; mobility and falls; nutrition and hydration; oral and dental care; pain; restraint use; skin integrity and sleep. CONCLUSIONS: The suite of CT Aged clinical indicators can be used for research and assessment of the quality of care in individual facilities and across organizations to guide improvement and to supplement regulation or accreditation of the aged care sector. They are a step forward for Australian and international aged care sectors, helping to improve transparency so that the level of care delivered to aged care consumers can be rigorously monitored and continuously improved.

Effectiveness of an aged simulation training suit to support development of compassion and person-centred care in the aged-care workforce.

OBJECTIVES: The Australian aged-care sector employees are diverse, with a wide range of training backgrounds and work experience. Compassion and person-centred care (PCC) are essential for quality care. Effective training is required to facilitate compassion and PCC in the diverse workforce. METHODS: Eligible staff members (n = 732) participated in a 3-hour training activity using an aged simulation training suit. Training sessions were offered at eight ACH Group residential care sites. During the training, staff were required to complete functional daily tasks while wearing the suit. Pre- and post-training questionnaires were used to assess change in staff members' self-assessment of compassion and PCC. The Compassion Competence Scale and the Person-centred Care Assessment Tool were used to assess compassion and PCC. RESULTS: In total, 160 (22%) staff members participated in the evaluation of the training. Overall, participants reported significant improvements in self-reported compassion (p < 0.01) and PCC after the training (p < 0.001), compassionate communication (p < 0.001) and insight (p < 0.001), and ability to personalise care (p < 0.001) and in recognising patients' environmental accessibility (p < 0.01). CONCLUSIONS: The simulation activity improved aspects of compassion and person-centred care for the aged-care workforce. Further research is required to understand whether these changes are reflected in daily practice.

Chair design for older immobile people: Comparison of pressure mapping and manual handling outcomes.

The number of older adults unable to transfer or ambulate independently is increasing. High support chairs enable people experiencing loss of mobility to be mobile, but current chair designs are associated with global functional loss and pressure ulcers. This pilot study compared the functionality of a traditional design high support chair to a new design of motorised high support chair: 1) a motion laboratory study compared joint angles and pressure at the hip, knee, ankle, elbow and spine when pushing each chair, and 2) a pressure mapping study compared the interface pressure when older people with limited mobility used the chairs. Significant reduction in joint angles for the person pushing the chair (degree difference range -3.6 to 14.2) and decreased seated pressure (w/kg difference range -0.2 to 2.1) for the seated user were identified for the motorised chair. Longitudinal investigations are required to determine if the significant differences identified in this pilot study result in less manual handling injuries and pressure areas.

Compassion and person-centred care: Survey development for aged care workers.

OBJECTIVE: With a growing emphasis on personalised care, there is a need for effective workforce training to enable person-centred care (PCC) in aged care practice. The Australian aged care workforce is very diverse; thus, tools to evaluate compassion and PCC training need to reflect an understanding of these concepts relevant to the Australian context. There are currently no tools validated for use in aged care settings in Australia. METHODS: Two existing compassion and PCC questionnaires were modified for an Australian audience using cognitive interviews with aged care workers. The reliability of the modified questionnaires was assessed. RESULTS: The modified questionnaires were found to have acceptable inter-reliability and test-retest intra-class correlation for the subscales and overall. However, the investigation also found low Cohen's kappa values between the test and retest responses for the individual items, subscales and overall, and had low inter-class correlation for individual items, indicating poor inter-rater agreement. High inter-item correlation scores also suggest the questions encapsulate overly similar constructs. CONCLUSIONS: While further investigation of the psychometric properties of the new items is needed, these modified questionnaires may offer a method of assessing and re-assessing compassion and PCC using language that is understandable to the Australian aged care workforce. Tools to accurately measure Australian aged care staff perceptions of compassion and their ability to deliver PCC are important to improve the quality of care provided in aged care and facilitate the delivery of PCC in aged care settings.

Inertial Sensor Reliability and Validity for Static and Dynamic Balance in Healthy Adults: A Systematic Review.

Compared to laboratory equipment inertial sensors are inexpensive and portable, permitting the measurement of postural sway and balance to be conducted in any setting. This systematic review investigated the inter-sensor and test-retest reliability, and concurrent and discriminant validity to measure static and dynamic balance in healthy adults. Medline, PubMed, Embase, Scopus, CINAHL, and Web of Science were searched to January 2021. Nineteen studies met the inclusion criteria. Meta-analysis was possible for reliability studies only and it was found that inertial sensors are reliable to measure static standing eyes open. A synthesis of the included studies shows moderate to good reliability for dynamic balance. Concurrent validity is moderate for both static and dynamic balance. Sensors discriminate old from young adults by amplitude of mediolateral sway, gait velocity, step length, and turn speed. Fallers are discriminated from non-fallers by sensor measures during walking, stepping, and sit to stand. The accuracy of discrimination is unable to be determined conclusively. Using inertial sensors to measure postural sway in healthy adults provides real-time data collected in the natural environment and enables discrimination between fallers and non-fallers. The ability of inertial sensors to identify differences in postural sway components related to altered performance in clinical tests can inform targeted interventions for the prevention of falls and near falls.

Simulation and coaching to prevent aggressive events in aged care: A pilot study.

OBJECTIVES: Evaluation of simulation and coaching training to change the self-efficacy of aged care workers to prevent and manage workplace aggressive events. METHODS: Seventeen aged care workers from a community and residential aged care service provider completed education modules and two half-days of simulation using actors and real-life scenarios, with real-time coaching. Carer self-efficacy to identify, prevent and manage anxiety and aggression was measured before, following and six months after training. RESULTS: After training, participants reported significant improvements in preparedness to prevent and manage aggression, identify and manage triggers in their own behaviour, deflect and alter other triggers, and felt safer in the workplace. Six months after training, participants' self-efficacy remained above baseline for all measures and remained significantly improved for feeling safer in the workplace. CONCLUSION: This pilot study supports high-fidelity simulation and coaching to improve the self-efficacy of aged care workers to prevent and manage workplace aggressive events.

Older Adults' Experiences of Goals in Health: A Systematic Review and Metasynthesis.

Objective: To synthesize older adults' experiences and perceptions of goal setting and pursuit within health systems. Methods: Six databases were searched to May 2019 using a combination of MeSH and free text terms. Included papers were written in English and reported original qualitative research for participants aged 65 years and older. Participant quotes from the results sections of included studies were gathered for thematic analysis and synthesis. Results: Initial search yielded 9,845 articles, and 134 were identified for full-text review. Fifteen papers were included in the final synthesis. Two main themes were identified: enablers (intrinsic and extrinsic) and barriers (personal and system). Conclusion: Older adults' self-belief is the strongest enabler for goal activities, enhanced by a personalized coaching approach from health staff. Conversely, inconsistent goal terminology confuses patients and reduces engagement. Likewise, fatigue has profound physical and cognitive impact on patients' ability to engage and participate in goals.

Attaining and assessing the Australian interprofessional learning competencies.

Interprofessional collaboration is critical for optimal healthcare. Preparing for a collaborative, practice-ready workforce, the Interprofessional Learning Competencies (IPLCs) were adopted for accreditation of Australian entry-level health, nursing and medical tertiary training programs. In order to meet new accreditation standards, activities which facilitate and assess IPLC attainment must be identified. Interprofessional education programs have not evaluated student interprofessional learning activities using the Australian IPLCs. This project evaluates students' experiences of the IPLCs during 'Inspiring Health,' a community-based interprofessional placement, and determines whether reflections can effectively assess IPLC attainment. Forty-nine students from seven Flinders University health and social science programs completed written reflections about four self-selected IPLCs. The results indicated that students had opportunities to attain all the IPLCs. Their reflections were analyzed using thematic analysis. Three themes were identified: the processes by which students learned, the outcomes of their learning, and the factors that influenced their learning. Ultimately, these findings describe a beneficial community-based interprofessional learning activity for attainment of the Australian IPLCs and provide evidence that student reflections can be used to assess the Australian IPLCs.

Overuse injuries in runners of different abilities-a one-year prospective study.

The aim of this prospective study was to investigate differences in participant characteristics, previous injury, running dynamics during a long-distance run, and training between injured and uninjured runners in runners of different abilities. Center-of-mass acceleration data were collected during a long-distance overground run. Runners were then divided into four groups (elite, advanced, intermediate and slow) based on their finishing time. Participants completed training diaries and were monitored for 1 year. Seventy-six runners completed the prospective study with 39 (51.3%) sustaining a running injury (44% elite, 42% advanced, 54% intermediate, 59% slow). Differences between injured and uninjured runners within each group related to injury included: (1) elite injured runners ran with longer contact times and (2) more slow injured runners reported an injury in previous year, were heavier, had higher body mass and body mass index, ran with lower step frequencies, and ran a greater weekly distance. Advanced injured runners exhibited fatigue changes in step regularity and peak braking during the run that may be related to injury. These findings suggest that runners of different abilities may have different factors related to injury however due to the small sample sizes in the groups this needs to be explored further.

Dermal thickness and echogenicity using DermaScan C high frequency ultrasound: Methodology and reliability testing in people with and without primary lymphoedema.

BACKGROUND: DermaScan C high frequency ultrasound was investigated for image capture and analysis of dermal measures in people with and without primary lymphoedema. METHOD: Three repeated images were taken at six sites in people without lymphoedema (NLO). Intra-rater reliability was assessed by taking three sets of measures on images from 10 people and inter-session reliability by capturing three images, lifting the probe from the skin in between. Methods were adjusted, and repeated images from four sites were taken in people with primary lymphoedema (PLO) and reliability re-assessed. RESULTS: Intra-rater reliability in NLO and PLO for echogenicity measures were excellent (NLO ICC(3,1) : .989; PLO .997) across all sites and specific to each site (calf: ICC(3,1) : .989; and foot: ICC(3,1) : .999, respectively). Inter-session reliability was moderate for NLO (ICC(3,1) : .727), improving after method modifications for PLO (ICC(3,1) : .916). When investigated by site, inter-session reliability was good in the foot (ICC(3,1) : .811) and moderate in the calf (ICC(3,1) : .616). Mean thickness analysed by site resulted in good inter-session reliability only in the foot (ICC(3,1) .838). CONCLUSION: Intra-rater reliability was excellent using the DermaScan C for dermal measures in people with primary lymphoedema. Inter-session reliability required particular attention to method and gain settings.