Objective To determine the feasibility of designing and conducting a definitive trial to evaluate... more Objective To determine the feasibility of designing and conducting a definitive trial to evaluate the effectiveness of sacral fracture fixation compared with non-surgical management among older people admitted with a lateral compression pelvic fragility fracture (PFF). Design Single-site, parallel, two-arm randomised controlled feasibility trial. Setting A UK tertiary centre hospital. Participants Patients aged ≥70 years who were ambulating pre-injury requiring hospital admission (within 28 days of injury) with a type 1 lateral compression PFF. Interventions The intervention group received sacral fracture fixation (cement augmentation±screw fixation) within 7 days of randomisation. Routine preoperative and postoperative care followed each surgical intervention. The control group received usual care consisting of analgesia, and regular input from the medical and therapy team. Primary and secondary outcome measures The feasibility outcomes were the number of eligible patients, willingness to be randomised, adherence to allocated treatment, retention, data on the completeness and variability of the proposed definitive trial outcome measures, and reported adverse events. Results 241 patients were screened. 13 (5.4%) were deemed eligible to participate. Among the eligible participants, nine (69.2%) were willing to participate. Five participants were randomised to the intervention group and four to the control group. The clinicians involved were willing to allow their patients to be randomised and adhere to the allocated treatment. One participant in the intervention group and two participants in the control group received their allocated treatment. All participants were followed up until 12 weeks post-randomisation, and had an additional safety follow-up assessment at 12 months. Overall, the proportion of completeness of outcome measures was at least 75%. No adverse events were directly related to the trial. Conclusions There were significant challenges in recruiting sufficient participants which will need to be addressed prior to a definitive trial. Trial registration number ISRCTN16719542.
Background: Patellofemoral pain (PFP) is one of the most common forms of knee pain in adults unde... more Background: Patellofemoral pain (PFP) is one of the most common forms of knee pain in adults under the age of 40, with a prevalence of 23% in the general population. The long-term prognosis is poor, with only one third of people pain-free 1 year after diagnosis. The biomedical model of pain in relation to persistent PFP has recently been called into question. It has been suggested that interventions for chronic musculoskeletal conditions should consider alternative mechanisms of action, beyond muscles and joints. Modern treatment therapies should consider desensitising strategies, with exercises that target movements and activities patients find fearful and painful. High-quality research on exercise prescription in relation to pain mechanisms, not directed at specific tissue pathology, and dose response clearly warrants further investigation. Our primary aim is to establish the feasibility and acceptability of conducting a definitive RCT which will evaluate the clinical and cost-effectiveness of a loaded self-managed exercise programme for people with patellofemoral pain. Method: This is a single-centred, multiphase, sequential, mixed-methods trial that will evaluate the feasibility of running a definitive large-scale randomised controlled trial of a loaded self-managed exercise programme versus usual physiotherapy. Initially, 8-10 participants with a minimum 3-month history of PFP will be recruited from an NHS physiotherapy waiting list and interviewed. Participants will be invited to discuss perceived barriers and facilitators to exercise engagement, and the meaning and impact of PFP. Then, 60 participants will be recruited in the same manner for the main phase of the feasibility trial. A web-based service will randomise patients to a loaded self-managed exercise programme or usual physiotherapy. The loaded self-managed exercise programme is aimed at addressing lower limb knee and hip weakness and is positioned within a framework of reducing fear/avoidance with an emphasis on self-management. Baseline assessment will include demographic data, average pain within the last week (VAS), fear avoidance behaviours, catastrophising, self-efficacy, sport and leisure activity participation, and general quality of life. Follow-up will be 3 and 6 months. The analysis will focus on descriptive statistics and confidence intervals. The qualitative components will follow a thematic analysis approach.
Annals of the Royal College of Surgeons of England, 2016
Introduction Spinal orthopaedic triage aims to reduce unnecessary referrals to surgical consultan... more Introduction Spinal orthopaedic triage aims to reduce unnecessary referrals to surgical consultants, thereby reducing waiting times to be seen by a surgeon and to surgical intervention. This paper presents an evaluation of a spinal orthopaedic triage service in the third largest spinal unit in the UK. Methods A retrospective service evaluation spanning 2012 to 2014 was undertaken by members of the extended scope practitioner (ESP) team to evaluate the ESPs' ability to manage patient care independently and triage surgical referrals appropriately. Data collected included rates of independent management, referral rates for surgical consideration and conversion to surgery. Patient satisfaction rates were evaluated retrospectively from questionnaires given to 5% of discharged patients. Results A total of 2,651 patients were seen. The vast majority (92%) of all referrals seen by ESPs were managed independently. Only 8% required either a discussion with a surgeon to confirm management ...
ii Lower limb overuse injuries are common in the military, and their causes are multifactorial. B... more ii Lower limb overuse injuries are common in the military, and their causes are multifactorial. Both internal factors such as anthropometrics and body mass index, and external factors such as equipment use and weapons carriage, have been implicated in the development of such injuries because of their potential detriment to efficient gait biomechanics. Visual assessments of function have been used as a method of assessing such injurious biomechanics, and are commonplace in the clinical environment. Despite the prevalence of their use, the psychometric properties of such tests have not been investigated extensively. This is an issue, as a minimum level of reliability and validity needs to be reached to ensure practises are justified. A recently developed visual assessment of function, FootFAST, had not been investigated in such a way. FootFAST was designed to be used with populations such as the military, and specifically aims to predict lower limb overuse injury risk. FootFAST compri...
Background: Diabetic peripheral neuropathy (DPN) not only produces severe pain, tingling, and num... more Background: Diabetic peripheral neuropathy (DPN) not only produces severe pain, tingling, and numbness sensation in the involved limbs, but also limits physical function due to loss of sensation. There are no recommended methods for clinical situations to measure these signs and symptoms. Studies with high methodological quality use the modified Brief Pain Inventory for Diabetic Peripheral Neuropathic pain (mBPI-DPN) scale and the short form Screening of Activity Limitations and Safety Awareness (sSALSA) scale for measuring these symptoms in DPN population. In order to capture a real change in the variables of interest, the psychometric properties of that measure should be within acceptable limits. As these two measures were not assessed for all of the psychometric properties, there was a need for further evaluation. Methods: Data were collected (n ¼ 38 patients) in a longitudinal cohort study. Test-retest reliability (0-4 weeks) and Responsiveness-Minimal Clinically Important Difference (MCID) (0-12 weeks) were calculated between two sessions. Convergent validity was assessed (between mBPI-DPN pain interference and sSALSA scale). Results: Both measures demonstrated acceptable test-retest reliability (mBPI-DPN scale: ICC ¼ 0.61, SEM ¼ 12.92; the sSALSA scale: ICC ¼ 0.81, SEM ¼ 4.88) and convergent validity (Spearman's correlation coefficient r ¼ 0.62). The computational methods used in different methodologies to calculate MCID for the mBPI-DPN and the sSALSA scale were varied, hence the magnitude of derived MCID scores also varied. Conclusions: Our study have provided evidence to add to the scientific basis surrounding the use of mBPI-DPN and sSALSA scales in DPN population, but standardization of these measures in a larger population is required
Background: A novel loaded self-managed exercise programme that includes pain education and self-... more Background: A novel loaded self-managed exercise programme that includes pain education and self-management strategies may result in better outcomes for people with patellofemoral pain (PFP). However, establishing program feasibility is an essential first step before testing efficacy. The purpose of this study was to evaluate the feasibility and acceptability of conducting a definitive RCT which will evaluate the clinical and cost-effectiveness of a loaded selfmanaged exercise programme for people with PFP compared with usual physiotherapy. Methods: In a mixed methods, pragmatic, randomised controlled feasibility study, 60 participants with PFP (57% female; mean age 29 years) were recruited from a physiotherapy clinic within a large UK teaching hospital. They were randomly allocated to receive either a loaded self-managed exercise programme (n = 30) or usual physiotherapy (n = 30). Feasibility indicators of process, resources, and management were collected through follow-up of standardised questionnaires six months after recruitment and semi-structured interviews with 20 participants and physiotherapists. Results: Recruitment rate was 5 participants per month; consent rate was 99%; adherence to intervention appointments was 87%; completeness of questionnaire data was 100%; and adherence to intervention delivery was 95%. Three exercise diaries were returned at six months (5%). At six months, 25 questionnaire booklets were returned (9 in the loaded self-managed group, 16 in the usual physiotherapy group), with a total retention rate of 42%. At six months, 56% (5/9) of respondents in the loaded self-managed group and 56% (9/16) in the usual physiotherapy group were classified as 'recovered'. Both groups demonstrated improvements in average pain (VAS), kinesiophobia, pain catastrophizing, general self-efficacy and EQ-5D-5 L from baseline to six months. Conclusion: The results of this feasibility study confirm that it is feasible and acceptable to deliver a loaded self-managed exercise programme to adults with PFP in an NHS physiotherapy outpatient setting. However, between group differences in lost to follow up and poor exercise diary completion mean we are uncertain on some feasibility aspects. These methodological issues need addressing prior to conducting a definitive RCT.
Background: Activity advice and prescription are commonly used in the management of low back pain... more Background: Activity advice and prescription are commonly used in the management of low back pain (LBP). However, no research has assessed whether objective measurements of physical activity predict outcome, recovery and course of LBP. Methods: One hundred and one patients with acute LBP were recruited into a longitudinal cohort study. Each participant completed the Roland Morris Disability Questionnaire (RMDQ), Visual Analogue Scale and a “simple” activity question, detailing whether they had resumed full “normal” activities (Y/N), at baseline (T0) and 3 months (T1); Baecke Physical Activity Questionnaire, Fear-Avoidance Beliefs Questionnaire and the 12-item General Health Questionnaire at T0. Physical activity was measured for 7 days at T0 and T1 with an RT3 accelerometer and the seven day physical activity recall questionnaire (7d-PAR). Results: The only significant predictor of RMDQ change was RMDQ score at T0 (p Conclusions: These results question the role of physical activity in LBP recovery and the assumption that activity levels change as LBP symptoms resolve. Conflicts of Interest: None Sources of Funding: This research was supported by a University of Otago Establishment Grant
A systematic review and meta-analysis of pain neuroscience education for chronic low back pain: s... more A systematic review and meta-analysis of pain neuroscience education for chronic low back pain: short-and long-term outcomes of pain and disability.
Supplemental Digital Content is Available in the Text. Indices of centrally facilitated pain, col... more Supplemental Digital Content is Available in the Text. Indices of centrally facilitated pain, collected early in rehabilitation pathways, are associated with worse pain severity at follow-up. Appropriate early reduction of pain hypersensitivity might improve such outcomes. Abstract Introduction: Central pain facilitation can hinder recovery in people with chronic low back pain (CLBP). Objectives: The objective of this observational study was to investigate whether indices of centrally facilitated pain are associated with pain outcomes in a hospital-based cohort of individuals with CLBP undertaking a pain management programme. Methods: Participants provided self-report and pain sensitivity data at baseline (n = 97) and again 3 months (n = 87) after a cognitive behavioural therapy–based group intervention including physiotherapy. Indices of centrally facilitated pain were pressure pain detection threshold, temporal summation and conditioned pain modulation at the forearm, Widespread Pain Index (WPI) classified using a body manikin, and a Central Mechanisms Trait (CMT) factor derived from 8 self-reported characteristics of anxiety, depression, neuropathic pain, fatigue, cognitive dysfunction, pain distribution, catastrophizing, and sleep. Pain severity was a composite factor derived from Numerical Rating Scales. Cross-sectional and longitudinal regression models were adjusted for age and sex. Results: Baseline CMT and WPI each was associated with higher pain severity (CMT: r = 0.50, P < 0.001; WPI: r = 0.21, P = 0.04) at baseline and at 3 months (CMT: r = 0.38, P < 0.001; WPI: r = 0.24, P = 0.02). High baseline CMT remained significantly associated with pain at 3 months after additional adjustment for baseline pain (β = 2.45, P = 0.04, R2 = 0.25, P < 0.0001). Quantitative sensory testing indices of pain hypersensitivity were not significantly associated with pain outcomes at baseline or at 3 months. Conclusion: Central mechanisms beyond those captured by quantitative sensory testing are associated with poor CLBP outcome and might be targets for improved therapy.
Supplemental Material, sj-pdf-1-gos-10.1177_21514593211026794 for ASSERT (Acute Sacral inSufficiE... more Supplemental Material, sj-pdf-1-gos-10.1177_21514593211026794 for ASSERT (Acute Sacral inSufficiEncy fractuRe augmenTation): Perceptions in the Assessment and Treatment of Pubic Rami and Sacral Fragility Fractures Amongst Healthcare Professionals in Geriatric Medicine and Surgery—A Qualitative Study by Opinder Sahota, Paul Leighton, Maribel Cameron, Rachael Taylor, Terence Ong, Avril Drummond, Paul Hendrick, Nasir Quraishi, Khalid Salem and On Behalf of the ASSERT Research Team in Geriatric Orthopaedic Surgery & Rehabilitation
Supplemental Material, sj-pdf-2-gos-10.1177_21514593211026794 for ASSERT (Acute Sacral inSufficiE... more Supplemental Material, sj-pdf-2-gos-10.1177_21514593211026794 for ASSERT (Acute Sacral inSufficiEncy fractuRe augmenTation): Perceptions in the Assessment and Treatment of Pubic Rami and Sacral Fragility Fractures Amongst Healthcare Professionals in Geriatric Medicine and Surgery—A Qualitative Study by Opinder Sahota, Paul Leighton, Maribel Cameron, Rachael Taylor, Terence Ong, Avril Drummond, Paul Hendrick, Nasir Quraishi, Khalid Salem and On Behalf of the ASSERT Research Team in Geriatric Orthopaedic Surgery & Rehabilitation
Abstract Background Low back pain (LBP) is a common musculoskeletal disorder affecting population... more Abstract Background Low back pain (LBP) is a common musculoskeletal disorder affecting populations from both low- and middle-income, and high-income countries. Global prevalence of LBP is estimated at 9.4% with prevalence rates substantially higher in low- and middle-income countries notably in Africa (39%). The recommended biopsychosocial model of managing patients with LBP, has been predominantly applied and evaluated in high-income countries, therefore, it is essential to ascertain the feasibility of implementing this approach in low- and middle-income countries including Ghana. Aim To investigate the feasibility of implementing a biopsychosocial physiotherapy management approach (exercise and patient education) for the management of patients with chronic LBP in Ghana. Methods Context: Komfo Anokye Teaching Hospital, Ghana. Design Mixed-methods, sequential, feasibility, pretest-posttest quasi-experimental study. Physiotherapists will be recruited and trained to deliver the biopsychosocial intervention, followed by recruitment of patients with CLBP. Assessment of outcome measures will be conducted at baseline, post-intervention, and 3-months, focusing on feasibility outcomes including recruitment rate, retention rate, and acceptability of the intervention. Patient demographics and secondary outcomes measures will also be collected. Descriptive statistics will be used to summarize the outcomes data and assess feasibility against a priori feasibility criteria. Finally, qualitative interviews will be conducted to explore participants’ experiences and acceptance through thematic analysis. Discussion This study will investigate the feasibility of implementing a biopsychosocial physiotherapy management approach for patients with CLBP in Ghana. The outcomes will assess the feasibility of the intervention, the appropriateness of outcome measures and inform a future clinical trial.
Aims: To systematically review the evidence for the effectiveness of combining cognitive behaviou... more Aims: To systematically review the evidence for the effectiveness of combining cognitive behavioural therapy (CBT) and exercise versus exercise alone in the management of patients with non-specific chronic low back pain (NSCLBP). Methods: Electronic search of CINAHL, PUBMED, Sports Discuss, SCOPUS, AMED, MEDLINE, Cochrane Central Register of Controlled Trials, and EMBASE, between 1990 – July 2017; complemented by hand searching of citation lists and citation tracking. Two independent reviewers screened titles and abstracts from the retrieved search results. Studies were considered based on PRISMA guidelines. Data was extracted based on Cochrane the Handbook of Systematic Reviews guidelines; the Cochrane Data Collection Form for Intervention Reviews (RCTs only), was Paapa Kwesi Ampiah1, Paul Hendrick2, Erika Gonzalez Macias3 Affiliations: 1Senior physiotherapist, Department of Physiotherapy, Ga South Municipal Hospital, Ghana Health Service, P. O. BOX 361 Mallam, Accra, Ghana; 2Divis...
ObjectivesIn response to demographic and health system pressures, the development of non-medical ... more ObjectivesIn response to demographic and health system pressures, the development of non-medical advanced clinical practice (ACP) roles is a key component of National Health Service workforce transformation policy in the UK. This review was undertaken to establish a baseline of evidence on ACP roles and their outcomes, impacts and implementation challenges across the UK.DesignA scoping review was undertaken following JBI methodological guidance.Methods13 online databases (Medline, CINAHL, ASSIA, Embase, HMIC, AMED, Amber, OT seeker, PsycINFO, PEDro, SportDiscus, Osteopathic Research and PenNutrition) and grey literature sources were searched from 2005 to 2020. Data extraction, charting and summary was guided by the PEPPA-Plus framework. The review was undertaken by a multi-professional team that included an expert lay representative.Results191 papers met the inclusion criteria (any type of UK evidence, any sector/setting and any profession meeting the Health Education England defini...
IntroductionA global health workforce crisis, coupled with ageing populations, wars and the rise ... more IntroductionA global health workforce crisis, coupled with ageing populations, wars and the rise of non-communicable diseases is prompting all countries to consider the optimal skill mix within their health workforce. The development of advanced clinical practice (ACP) roles for existing non-medical cadres is one potential strategy that is being pursued. In the UK, National Health Service (NHS) workforce transformation programmes are actively promoting the development of ACP roles across a wide range of non-medical professions. These efforts are currently hampered by a high level of variation in ACP role development, deployment, nomenclature, definition, governance and educational preparation across the professions and across different settings. This scoping review aims to support a more consistent approach to workforce development in the UK, by identifying and mapping the current evidence base underpinning multiprofessional advanced level practice in the UK from a workforce, clinic...
Objective To determine the feasibility of designing and conducting a definitive trial to evaluate... more Objective To determine the feasibility of designing and conducting a definitive trial to evaluate the effectiveness of sacral fracture fixation compared with non-surgical management among older people admitted with a lateral compression pelvic fragility fracture (PFF). Design Single-site, parallel, two-arm randomised controlled feasibility trial. Setting A UK tertiary centre hospital. Participants Patients aged ≥70 years who were ambulating pre-injury requiring hospital admission (within 28 days of injury) with a type 1 lateral compression PFF. Interventions The intervention group received sacral fracture fixation (cement augmentation±screw fixation) within 7 days of randomisation. Routine preoperative and postoperative care followed each surgical intervention. The control group received usual care consisting of analgesia, and regular input from the medical and therapy team. Primary and secondary outcome measures The feasibility outcomes were the number of eligible patients, willingness to be randomised, adherence to allocated treatment, retention, data on the completeness and variability of the proposed definitive trial outcome measures, and reported adverse events. Results 241 patients were screened. 13 (5.4%) were deemed eligible to participate. Among the eligible participants, nine (69.2%) were willing to participate. Five participants were randomised to the intervention group and four to the control group. The clinicians involved were willing to allow their patients to be randomised and adhere to the allocated treatment. One participant in the intervention group and two participants in the control group received their allocated treatment. All participants were followed up until 12 weeks post-randomisation, and had an additional safety follow-up assessment at 12 months. Overall, the proportion of completeness of outcome measures was at least 75%. No adverse events were directly related to the trial. Conclusions There were significant challenges in recruiting sufficient participants which will need to be addressed prior to a definitive trial. Trial registration number ISRCTN16719542.
Background: Patellofemoral pain (PFP) is one of the most common forms of knee pain in adults unde... more Background: Patellofemoral pain (PFP) is one of the most common forms of knee pain in adults under the age of 40, with a prevalence of 23% in the general population. The long-term prognosis is poor, with only one third of people pain-free 1 year after diagnosis. The biomedical model of pain in relation to persistent PFP has recently been called into question. It has been suggested that interventions for chronic musculoskeletal conditions should consider alternative mechanisms of action, beyond muscles and joints. Modern treatment therapies should consider desensitising strategies, with exercises that target movements and activities patients find fearful and painful. High-quality research on exercise prescription in relation to pain mechanisms, not directed at specific tissue pathology, and dose response clearly warrants further investigation. Our primary aim is to establish the feasibility and acceptability of conducting a definitive RCT which will evaluate the clinical and cost-effectiveness of a loaded self-managed exercise programme for people with patellofemoral pain. Method: This is a single-centred, multiphase, sequential, mixed-methods trial that will evaluate the feasibility of running a definitive large-scale randomised controlled trial of a loaded self-managed exercise programme versus usual physiotherapy. Initially, 8-10 participants with a minimum 3-month history of PFP will be recruited from an NHS physiotherapy waiting list and interviewed. Participants will be invited to discuss perceived barriers and facilitators to exercise engagement, and the meaning and impact of PFP. Then, 60 participants will be recruited in the same manner for the main phase of the feasibility trial. A web-based service will randomise patients to a loaded self-managed exercise programme or usual physiotherapy. The loaded self-managed exercise programme is aimed at addressing lower limb knee and hip weakness and is positioned within a framework of reducing fear/avoidance with an emphasis on self-management. Baseline assessment will include demographic data, average pain within the last week (VAS), fear avoidance behaviours, catastrophising, self-efficacy, sport and leisure activity participation, and general quality of life. Follow-up will be 3 and 6 months. The analysis will focus on descriptive statistics and confidence intervals. The qualitative components will follow a thematic analysis approach.
Annals of the Royal College of Surgeons of England, 2016
Introduction Spinal orthopaedic triage aims to reduce unnecessary referrals to surgical consultan... more Introduction Spinal orthopaedic triage aims to reduce unnecessary referrals to surgical consultants, thereby reducing waiting times to be seen by a surgeon and to surgical intervention. This paper presents an evaluation of a spinal orthopaedic triage service in the third largest spinal unit in the UK. Methods A retrospective service evaluation spanning 2012 to 2014 was undertaken by members of the extended scope practitioner (ESP) team to evaluate the ESPs' ability to manage patient care independently and triage surgical referrals appropriately. Data collected included rates of independent management, referral rates for surgical consideration and conversion to surgery. Patient satisfaction rates were evaluated retrospectively from questionnaires given to 5% of discharged patients. Results A total of 2,651 patients were seen. The vast majority (92%) of all referrals seen by ESPs were managed independently. Only 8% required either a discussion with a surgeon to confirm management ...
ii Lower limb overuse injuries are common in the military, and their causes are multifactorial. B... more ii Lower limb overuse injuries are common in the military, and their causes are multifactorial. Both internal factors such as anthropometrics and body mass index, and external factors such as equipment use and weapons carriage, have been implicated in the development of such injuries because of their potential detriment to efficient gait biomechanics. Visual assessments of function have been used as a method of assessing such injurious biomechanics, and are commonplace in the clinical environment. Despite the prevalence of their use, the psychometric properties of such tests have not been investigated extensively. This is an issue, as a minimum level of reliability and validity needs to be reached to ensure practises are justified. A recently developed visual assessment of function, FootFAST, had not been investigated in such a way. FootFAST was designed to be used with populations such as the military, and specifically aims to predict lower limb overuse injury risk. FootFAST compri...
Background: Diabetic peripheral neuropathy (DPN) not only produces severe pain, tingling, and num... more Background: Diabetic peripheral neuropathy (DPN) not only produces severe pain, tingling, and numbness sensation in the involved limbs, but also limits physical function due to loss of sensation. There are no recommended methods for clinical situations to measure these signs and symptoms. Studies with high methodological quality use the modified Brief Pain Inventory for Diabetic Peripheral Neuropathic pain (mBPI-DPN) scale and the short form Screening of Activity Limitations and Safety Awareness (sSALSA) scale for measuring these symptoms in DPN population. In order to capture a real change in the variables of interest, the psychometric properties of that measure should be within acceptable limits. As these two measures were not assessed for all of the psychometric properties, there was a need for further evaluation. Methods: Data were collected (n ¼ 38 patients) in a longitudinal cohort study. Test-retest reliability (0-4 weeks) and Responsiveness-Minimal Clinically Important Difference (MCID) (0-12 weeks) were calculated between two sessions. Convergent validity was assessed (between mBPI-DPN pain interference and sSALSA scale). Results: Both measures demonstrated acceptable test-retest reliability (mBPI-DPN scale: ICC ¼ 0.61, SEM ¼ 12.92; the sSALSA scale: ICC ¼ 0.81, SEM ¼ 4.88) and convergent validity (Spearman's correlation coefficient r ¼ 0.62). The computational methods used in different methodologies to calculate MCID for the mBPI-DPN and the sSALSA scale were varied, hence the magnitude of derived MCID scores also varied. Conclusions: Our study have provided evidence to add to the scientific basis surrounding the use of mBPI-DPN and sSALSA scales in DPN population, but standardization of these measures in a larger population is required
Background: A novel loaded self-managed exercise programme that includes pain education and self-... more Background: A novel loaded self-managed exercise programme that includes pain education and self-management strategies may result in better outcomes for people with patellofemoral pain (PFP). However, establishing program feasibility is an essential first step before testing efficacy. The purpose of this study was to evaluate the feasibility and acceptability of conducting a definitive RCT which will evaluate the clinical and cost-effectiveness of a loaded selfmanaged exercise programme for people with PFP compared with usual physiotherapy. Methods: In a mixed methods, pragmatic, randomised controlled feasibility study, 60 participants with PFP (57% female; mean age 29 years) were recruited from a physiotherapy clinic within a large UK teaching hospital. They were randomly allocated to receive either a loaded self-managed exercise programme (n = 30) or usual physiotherapy (n = 30). Feasibility indicators of process, resources, and management were collected through follow-up of standardised questionnaires six months after recruitment and semi-structured interviews with 20 participants and physiotherapists. Results: Recruitment rate was 5 participants per month; consent rate was 99%; adherence to intervention appointments was 87%; completeness of questionnaire data was 100%; and adherence to intervention delivery was 95%. Three exercise diaries were returned at six months (5%). At six months, 25 questionnaire booklets were returned (9 in the loaded self-managed group, 16 in the usual physiotherapy group), with a total retention rate of 42%. At six months, 56% (5/9) of respondents in the loaded self-managed group and 56% (9/16) in the usual physiotherapy group were classified as 'recovered'. Both groups demonstrated improvements in average pain (VAS), kinesiophobia, pain catastrophizing, general self-efficacy and EQ-5D-5 L from baseline to six months. Conclusion: The results of this feasibility study confirm that it is feasible and acceptable to deliver a loaded self-managed exercise programme to adults with PFP in an NHS physiotherapy outpatient setting. However, between group differences in lost to follow up and poor exercise diary completion mean we are uncertain on some feasibility aspects. These methodological issues need addressing prior to conducting a definitive RCT.
Background: Activity advice and prescription are commonly used in the management of low back pain... more Background: Activity advice and prescription are commonly used in the management of low back pain (LBP). However, no research has assessed whether objective measurements of physical activity predict outcome, recovery and course of LBP. Methods: One hundred and one patients with acute LBP were recruited into a longitudinal cohort study. Each participant completed the Roland Morris Disability Questionnaire (RMDQ), Visual Analogue Scale and a “simple” activity question, detailing whether they had resumed full “normal” activities (Y/N), at baseline (T0) and 3 months (T1); Baecke Physical Activity Questionnaire, Fear-Avoidance Beliefs Questionnaire and the 12-item General Health Questionnaire at T0. Physical activity was measured for 7 days at T0 and T1 with an RT3 accelerometer and the seven day physical activity recall questionnaire (7d-PAR). Results: The only significant predictor of RMDQ change was RMDQ score at T0 (p Conclusions: These results question the role of physical activity in LBP recovery and the assumption that activity levels change as LBP symptoms resolve. Conflicts of Interest: None Sources of Funding: This research was supported by a University of Otago Establishment Grant
A systematic review and meta-analysis of pain neuroscience education for chronic low back pain: s... more A systematic review and meta-analysis of pain neuroscience education for chronic low back pain: short-and long-term outcomes of pain and disability.
Supplemental Digital Content is Available in the Text. Indices of centrally facilitated pain, col... more Supplemental Digital Content is Available in the Text. Indices of centrally facilitated pain, collected early in rehabilitation pathways, are associated with worse pain severity at follow-up. Appropriate early reduction of pain hypersensitivity might improve such outcomes. Abstract Introduction: Central pain facilitation can hinder recovery in people with chronic low back pain (CLBP). Objectives: The objective of this observational study was to investigate whether indices of centrally facilitated pain are associated with pain outcomes in a hospital-based cohort of individuals with CLBP undertaking a pain management programme. Methods: Participants provided self-report and pain sensitivity data at baseline (n = 97) and again 3 months (n = 87) after a cognitive behavioural therapy–based group intervention including physiotherapy. Indices of centrally facilitated pain were pressure pain detection threshold, temporal summation and conditioned pain modulation at the forearm, Widespread Pain Index (WPI) classified using a body manikin, and a Central Mechanisms Trait (CMT) factor derived from 8 self-reported characteristics of anxiety, depression, neuropathic pain, fatigue, cognitive dysfunction, pain distribution, catastrophizing, and sleep. Pain severity was a composite factor derived from Numerical Rating Scales. Cross-sectional and longitudinal regression models were adjusted for age and sex. Results: Baseline CMT and WPI each was associated with higher pain severity (CMT: r = 0.50, P < 0.001; WPI: r = 0.21, P = 0.04) at baseline and at 3 months (CMT: r = 0.38, P < 0.001; WPI: r = 0.24, P = 0.02). High baseline CMT remained significantly associated with pain at 3 months after additional adjustment for baseline pain (β = 2.45, P = 0.04, R2 = 0.25, P < 0.0001). Quantitative sensory testing indices of pain hypersensitivity were not significantly associated with pain outcomes at baseline or at 3 months. Conclusion: Central mechanisms beyond those captured by quantitative sensory testing are associated with poor CLBP outcome and might be targets for improved therapy.
Supplemental Material, sj-pdf-1-gos-10.1177_21514593211026794 for ASSERT (Acute Sacral inSufficiE... more Supplemental Material, sj-pdf-1-gos-10.1177_21514593211026794 for ASSERT (Acute Sacral inSufficiEncy fractuRe augmenTation): Perceptions in the Assessment and Treatment of Pubic Rami and Sacral Fragility Fractures Amongst Healthcare Professionals in Geriatric Medicine and Surgery—A Qualitative Study by Opinder Sahota, Paul Leighton, Maribel Cameron, Rachael Taylor, Terence Ong, Avril Drummond, Paul Hendrick, Nasir Quraishi, Khalid Salem and On Behalf of the ASSERT Research Team in Geriatric Orthopaedic Surgery & Rehabilitation
Supplemental Material, sj-pdf-2-gos-10.1177_21514593211026794 for ASSERT (Acute Sacral inSufficiE... more Supplemental Material, sj-pdf-2-gos-10.1177_21514593211026794 for ASSERT (Acute Sacral inSufficiEncy fractuRe augmenTation): Perceptions in the Assessment and Treatment of Pubic Rami and Sacral Fragility Fractures Amongst Healthcare Professionals in Geriatric Medicine and Surgery—A Qualitative Study by Opinder Sahota, Paul Leighton, Maribel Cameron, Rachael Taylor, Terence Ong, Avril Drummond, Paul Hendrick, Nasir Quraishi, Khalid Salem and On Behalf of the ASSERT Research Team in Geriatric Orthopaedic Surgery & Rehabilitation
Abstract Background Low back pain (LBP) is a common musculoskeletal disorder affecting population... more Abstract Background Low back pain (LBP) is a common musculoskeletal disorder affecting populations from both low- and middle-income, and high-income countries. Global prevalence of LBP is estimated at 9.4% with prevalence rates substantially higher in low- and middle-income countries notably in Africa (39%). The recommended biopsychosocial model of managing patients with LBP, has been predominantly applied and evaluated in high-income countries, therefore, it is essential to ascertain the feasibility of implementing this approach in low- and middle-income countries including Ghana. Aim To investigate the feasibility of implementing a biopsychosocial physiotherapy management approach (exercise and patient education) for the management of patients with chronic LBP in Ghana. Methods Context: Komfo Anokye Teaching Hospital, Ghana. Design Mixed-methods, sequential, feasibility, pretest-posttest quasi-experimental study. Physiotherapists will be recruited and trained to deliver the biopsychosocial intervention, followed by recruitment of patients with CLBP. Assessment of outcome measures will be conducted at baseline, post-intervention, and 3-months, focusing on feasibility outcomes including recruitment rate, retention rate, and acceptability of the intervention. Patient demographics and secondary outcomes measures will also be collected. Descriptive statistics will be used to summarize the outcomes data and assess feasibility against a priori feasibility criteria. Finally, qualitative interviews will be conducted to explore participants’ experiences and acceptance through thematic analysis. Discussion This study will investigate the feasibility of implementing a biopsychosocial physiotherapy management approach for patients with CLBP in Ghana. The outcomes will assess the feasibility of the intervention, the appropriateness of outcome measures and inform a future clinical trial.
Aims: To systematically review the evidence for the effectiveness of combining cognitive behaviou... more Aims: To systematically review the evidence for the effectiveness of combining cognitive behavioural therapy (CBT) and exercise versus exercise alone in the management of patients with non-specific chronic low back pain (NSCLBP). Methods: Electronic search of CINAHL, PUBMED, Sports Discuss, SCOPUS, AMED, MEDLINE, Cochrane Central Register of Controlled Trials, and EMBASE, between 1990 – July 2017; complemented by hand searching of citation lists and citation tracking. Two independent reviewers screened titles and abstracts from the retrieved search results. Studies were considered based on PRISMA guidelines. Data was extracted based on Cochrane the Handbook of Systematic Reviews guidelines; the Cochrane Data Collection Form for Intervention Reviews (RCTs only), was Paapa Kwesi Ampiah1, Paul Hendrick2, Erika Gonzalez Macias3 Affiliations: 1Senior physiotherapist, Department of Physiotherapy, Ga South Municipal Hospital, Ghana Health Service, P. O. BOX 361 Mallam, Accra, Ghana; 2Divis...
ObjectivesIn response to demographic and health system pressures, the development of non-medical ... more ObjectivesIn response to demographic and health system pressures, the development of non-medical advanced clinical practice (ACP) roles is a key component of National Health Service workforce transformation policy in the UK. This review was undertaken to establish a baseline of evidence on ACP roles and their outcomes, impacts and implementation challenges across the UK.DesignA scoping review was undertaken following JBI methodological guidance.Methods13 online databases (Medline, CINAHL, ASSIA, Embase, HMIC, AMED, Amber, OT seeker, PsycINFO, PEDro, SportDiscus, Osteopathic Research and PenNutrition) and grey literature sources were searched from 2005 to 2020. Data extraction, charting and summary was guided by the PEPPA-Plus framework. The review was undertaken by a multi-professional team that included an expert lay representative.Results191 papers met the inclusion criteria (any type of UK evidence, any sector/setting and any profession meeting the Health Education England defini...
IntroductionA global health workforce crisis, coupled with ageing populations, wars and the rise ... more IntroductionA global health workforce crisis, coupled with ageing populations, wars and the rise of non-communicable diseases is prompting all countries to consider the optimal skill mix within their health workforce. The development of advanced clinical practice (ACP) roles for existing non-medical cadres is one potential strategy that is being pursued. In the UK, National Health Service (NHS) workforce transformation programmes are actively promoting the development of ACP roles across a wide range of non-medical professions. These efforts are currently hampered by a high level of variation in ACP role development, deployment, nomenclature, definition, governance and educational preparation across the professions and across different settings. This scoping review aims to support a more consistent approach to workforce development in the UK, by identifying and mapping the current evidence base underpinning multiprofessional advanced level practice in the UK from a workforce, clinic...
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Papers by Paul Hendrick