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  • Journal article
    Tukanova K, Chidambaram S, Guidozzi N, Hanna GB, McGregor AH, Markar SRet al., 2021,

    ASO author reflections: the role of physiotherapy regimens in esophagectomy and gastrectomy for cancer

    , Annals of Surgical Oncology, Vol: 29, Pages: 3168-3169, ISSN: 1068-9265

    PASTDespite advancements in surgical management, esophageal and gastric cancer surgery is still associated with a significant morbidity. Traditionally, esophagectomy and gastrectomy via an open surgical approach has been the treatment of choice for esophageal and gastric cancer, respectively.1,2 Enhanced recovery after surgery (ERAS) protocols commonly include physiotherapy regimens or early mobilization intervention. These programs are well-established in colorectal cancer surgery and have shown to reduce postoperative complication rates and shortened the length of hospital stay (LOS).3Only a small number of studies have assessed the role of respiratory physiotherapy in gastrointestinal cancer surgery, while this patient group commonly present with pre-existing respiratory disease and is particularly at risk for malnutrition and loss of muscle mass.4 Although there is growing evidence of the benefits of physiotherapy implementation in decreasing the risk for postoperative morbidity, there is currently insufficient strong evidence for routine implementation of standardized respiratory physiotherapy in esophageal and gastric cancer surgery.PRESENTThis is the first meta-analysis assessing the effect of prehabilitation and peri- or postoperative physiotherapy regimens on postoperative mortality and morbidity in esophageal and gastric cancer surgery.5 A lower incidence of pneumonia was observed following both prehabilitation and peri- or postoperative rehabilitation. Furthermore, a lower incidence of postoperative morbidity was seen in patients undergoing prehabilitation, while peri- or postoperative rehabilitation resulted in a shorter LOS and better health-related quality-of-life scores for dyspnea and physical functioning. These results suggest that implementation of a physiotherapy regimen in both the pre- and peri- or postoperative setting may be beneficial. This meta-analysis is however limited by the lack of a standardized physiotherapy protocol for patients unde
  • Journal article
    Dandridge O, Garner A, Jeffers JRT, Amis AA, Cobb JP, van Arkel RJet al., 2021,

    Validity of repeated-measures analyses of in vitro arthroplasty kinematics and kinetics

    , Journal of Biomechanics, Vol: 129, Pages: 1-5, ISSN: 0021-9290

    In vitro models of arthroplasty enable pre-clinical testing and inform clinical decision making. Repeated-measures comparisons maximise resource efficiency, but their validity without testing order randomisation is not known. This study aimed to identify if there were any large testing order effects for cadaveric models of knee and hip arthroplasty. First, the effect of testing order on total knee arthroplasty (TKA) biomechanics was assessed. Extension moments for TKAs (N=3) implanted into the native knee (TKA-only) were compared to a dataset of TKAs (N=24) tested after different combinations of partial knee arthroplasty (TKA-last). The effect of repeatedly testing the same knee five times over 36 hours on patellofemoral and tibiofemoral kinematics was also quantified. Second, the effect of testing order on capsular ligament function after total hip arthroplasty (THA) was assessed. Randomisation was removed from a previously published dataset to create increasing and decreasing head size groups, which were compared with t-tests.All three TKA-only extension moments fell within the 95% CI of the TKA-last knees across the full range of knee flexion/extension. Repeated testing resulted in root-mean-squared kinematics errors within 1 mm, 1°, or < 5 % of total range of motion. Following THA, smaller head-size resulted in greater laxity in both the increasing (p=0.01) and decreasing (p<0.001) groups. Testing order did not have large effects on either knee or hip arthroplasty biomechanics measured with in vitro cadaveric models.
  • Journal article
    Bates A, McGregor A, Alexander C, 2021,

    Prolonged standing behaviour in people with Joint Hypermobility Syndrome

    , BMC Musculoskeletal Disorders, Vol: 22, ISSN: 1471-2474

    Background: Joint Hypermobility Syndrome (JHS) is a rare Heritable Disorder of Connective tissue characterised by generalised joint laxity and chronic widespread pain. Joint Hypermobility Syndrome has a large impact on patients’ day to day activities, and many complain of symptoms when standing for prolonged periods. This study investigates whether people with JHS exhibit the same behaviours to deal with the effects of prolonged standing as people with equal hypermobility and no pain, and people with normal flexibility and no pain.Methods: 23 people with JHS, 22 people with Generalised Joint Hypermobility (GJH), and 22 people with normal flexibility (NF) were asked to stand for a maximum of 15 minutes across two force-plates. Fidgets were counted and quantified using a cumulative sum algorithm and sway parameters of the quiet standing periods between fidgets were calculated. Results: Average standing time for participants with JHS was 7.35 minutes and none stood for the full 15 minutes. All participants with GJH and NF completed 15 minutes of standing. There were no differences in fidgeting behaviour between any groups. There was a difference in anteroposterior sway (p=.029) during the quiet standing periods.Conclusion: There is no evidence to suggest people with JHS exhibit different fidgeting behaviour. Increased anteroposterior-sway may suggest a muscle weakness and strengthening muscles around the ankle may reduce postural sway and potentially improve the ability to stand for prolonged periods.
  • Journal article
    Kennedy DL, Vollert J, Ridout D, Alexander CM, Rice ASet al., 2021,

    The responsiveness of quantitative sensory testing-derived sensory phenotype to disease-modifying intervention in patients with entrapment neuropathy: a longitudinal study

    , Pain, Vol: 162, Pages: 2881-2893, ISSN: 0304-3959

    ABSTRACT: The German Research Network on Neuropathic Pain (DFNS) quantitative sensory testing (QST) method for sensory phenotyping is used to stratify patients by mechanism associated sensory phenotype, theorised to be predictive of intervention efficacy. We hypothesised that change in pain and sensory dysfunction would relate to change in sensory phenotype. We investigated the responsiveness of sensory phenotype to surgery in patients with an entrapment neuropathy.With ethical approval and consent, this observational study recruited patients with neurophysiologically confirmed carpal tunnel syndrome. Symptom and pain severity parameters and DFNS QST were evaluated prior to and after carpal tunnel surgery. Surgical outcome was evaluated by patient-rated change. Symptom severity score of the Boston Carpal Tunnel Questionnaire and associated pain and paraesthesia subgroups were comparators for clinically relevant change.QST results (n=76) were compared to healthy controls (n=54). At 6 months post-surgery 92% participants reported a good surgical outcome and large decrease in pain and symptom severity (p<.001). Change in QST parameters occurred for thermal detection, thermal pain and mechanical detection thresholds with a moderate to large effect size. Change in mechanical pain measures were not statistically significant. Change occurred in sensory phenotype post-surgery (p<.001); sensory phenotype was associated with symptom subgroup (p=.03) and patient-rated surgical outcome (p =.02).QST derived sensory phenotype is sensitive to clinically important change. In an entrapment neuropathy model, sensory phenotype was associated with patient-reported symptoms and demonstrated statistically significant, clinically relevant change after disease modifying intervention. Sensory phenotype was independent of disease severity and may reflect underlying neuropathophysiology.
  • Journal article
    Arnold M, Zhao S, Doyle R, Jeffers J, Boughton Oet al., 2021,

    Power tool use in orthopaedic surgery: iatrogenic injury, its detection and technological advances

    , JBJS Open Access, Vol: 6, Pages: 1-16, ISSN: 2472-7245

    Background: Power tools are an integral part to orthopaedic surgery but have the capacity to cause iatrogenic injury. This systematic review aimed to investigate the prevalence of iatrogenic injury due to power tools in orthopaedic surgery and discuss the current methods 9that can be used to reduce this. Methods: A systematic review of all English language articles using a keyword search was undertaken in Medline, Embase, PubMed and Scopus databases. Exclusion criteria included injuries related to cast saw, temperature induced damage and complications not clearly related to power tool use. Results: 3694 abstracts were retrieved, and 88studies were included in the final analysis. Only a few studies and individual case reports directly looked at prevalence of injury due to power tools. This included 2 studies looking at frequency of vascular injury during femoral fracture fixation (0.49% and 0.2%),2 studies investigating frequency of vertebral artery injury during spinal surgery (0.5% and 0.08%)and 3 studies investigating vascular injury during total joint arthroplasty (124 vascular injuries involving 138 blood vessels,0.13% and 0.1% incidence)in addition to 1 questionnaire sent electronically to surgeons. There are multiple methods to prevent damage during the use of power tools. These include robotics, Revised Manuscript (Maximum 3000 Words)simulation, specific drill settings and real-time feedback techniques such as spectroscopy and electromyography. Conclusion: Power tools have the potential to cause iatrogenic injury to surrounding structures during orthopaedic surgery. Fortunately, the published literature suggests the frequency of iatrogenic injury using orthopaedic power tools is low. There are multiple technologies available to reduce damage using power tools. In high-risk operations the use of advanced technologies to reduce the chance of iatrogenic injury should be considered. Clinical Relevance: Power tools used during orthopaedic surgery have the potentia
  • Journal article
    Urbanczyk CA, Bonfiglio A, McGregor AH, Bull AMJet al., 2021,

    Comparing optical and electromagnetic tracking systems to facilitate compatibility in sports kinematics data.

    , International Biomechanics, Vol: 8, Pages: 75-84, ISSN: 2333-5432

    Electromagnetic (EM) tracking has been used to quantify biomechanical parameters of the lower limb and lumbar spine during ergometer rowing to improve performance and reduce injury. Optical motion capture (OMC) is potentially better suited to measure comprehensive whole-body dynamics in rowing. This study compared accuracy and precision of EM and OMC displacements by simultaneously recording kinematics during rowing trials at low, middle, and high rates on an instrumented ergometer (n=12). Trajectories calculated from OMC and EM sensors attached to the pelvis, lumbar spine, and right leg were highly correlated, but EM tracking lagged behind ergometer and OMC tracking by approximately 6%, yielding large RMS errors. When this phase-lag was corrected by least squares minimization, agreement between systems improved. Both systems demonstrated an ability to adequately track large dynamic compound movements in the sagittal plane but struggled at times to precisely track small displacements and narrow angular ranges in medial/lateral and superior/inferior directions. An OMC based tracking methodology can obtain equivalence with a previously validated EM system, for spine and lower limb metrics. Improvements in speed and consistency of data acquisition with OMC are beneficial for dynamic motion studies. Compatibility ensures continuity by maintaining the ability to compare to prior work.
  • Journal article
    Federer SJ, Jones GG, 2021,

    Artificial intelligence in orthopaedics: A scoping review

    , PLOS ONE, Vol: 16, ISSN: 1932-6203
  • Journal article
    Turner S, Jain S, Patel A, Hopkins M, McGregor Aet al., 2021,

    Visual biofeedback tool for quantitative pressure monitoring in lower-limb prosthetic sockets

    , Prosthesis, Vol: 3, Pages: 394-405, ISSN: 2673-1592

    Obtaining a good socket fit is an iterative process dependent on the skill and experience of the prosthetist creating it and requires individualisation based on the size and shape. There is no standard measurement system used to aid prosthetic socket creation despite the severe impacts on physical health and quality of life if one is ill fitting. Pressure sensors embedded in a prosthetic socket were used to collect data at the socket–residuum interface. To choose an interpolation method, the sensor array was simplified to a 2D grid with a border for extrapolation and tested using previously collected walking test pressure data. Four multivariable interpolation methods were evaluated to create a colour map of the pressure data. Radial basis function interpolation was chosen, as it produced a clear image with a graduated interpolation between data points, and was used to create a colour map across the surface of a 3D prosthetic socket model. For the model to be accessible to clinical audiences, a desktop application was created using PyQt to view the model. The application allowed for connection to the sensors via Bluetooth, with the pressure data updating on the 3D model in real time. Clinician feedback on the application showed the potential for a clinical product; however, further development informed by feedback from rehabilitation clinicians and prosthesis users is required.
  • Journal article
    Kennedy DL, Ridout D, Lysakova L, Vollert J, Alexander CM, Rice ASCet al., 2021,

    The association of sensory phenotype and concomitant mood, sleep and functional impairment with the outcome of carpal tunnel surgery

    , BMC Musculoskeletal Disorders, Vol: 22, Pages: 1-19, ISSN: 1471-2474

    BackgroundUp to 25% of people who have had carpal tunnel release surgery (CTR) fail to report improvement; however, evidence for prognostic indicators in this surgical cohort is limited. To identify candidate prognostic factors, this study investigated the association of quantitative sensory testing (QST) derived sensory phenotype and attendant impairment with patient-reported surgical outcome.MethodsWith ethical approval and informed consent, this prospective observational longitudinal study recruited patients from two London hospitals. Multimodal phenotyping measures including quantitative sensory testing (QST), pain parameters, insomnia, pain-related worry, mood and function, were evaluated prior to; and at 3- and 6-months post-surgery. Pain in median nerve distribution with electrophysiologically confirmed conduction delay and DN4 score ≥ 4 was defined as neuropathic. Primary outcome was patient-rated change at 6 months, dichotomised as poor outcome; “worse” or “no change” and good outcome; “slightly better”, “much better” or “completely cured”.ResultsSeventy-six patients participated. Prior to surgery, substantial heterogeneity in established categories of somatosensory function was observed with 21% of participants categorised as having a healthy sensory phenotype; 29% with thermal hyperalgesia; 32% mechanical hyperalgesia and 18% sensory loss. Seventy six percent of participants were classified as having neuropathic pain, 33% with high levels of pain related worry and 64% with clinical insomnia. Observed differences in pain, sleep impairment, psychological factors and function, between sensory phenotypic groups, was not significant. At 3- and 6-months post-surgery there was significant improvement in all phenotyping measures with a moderate to large effect size. Thermal and mechanical measures of somatosensation improved (p < 0.001), as did functional ability
  • Journal article
    Garner A, Dandridge O, Amis A, Cobb J, van Arkel RJet al., 2021,

    Bi-unicondylar arthroplasty: a biomechanics and clinical outcomes study

    , Bone & Joint Research, Vol: 10, Pages: 723-733, ISSN: 2046-3758

    Aims Bi-Unicondylar Arthroplasty (Bi-UKA) is a bone and anterior cruciate ligament (ACL) preserving alternative to Total Knee Arthroplasty (TKA) when the patellofemoral joint is preserved. The aim of this study is to investigate the clinical outcomes and biomechanics of Bi-UKA. Methods Bi-UKA subjects (N = 22) were measured on an instrumented treadmill, using standard gait metrics, at top walking speeds. Age, sex and BMI-matched healthy (N = 24) and primary TKA (N = 22) subjects formed control groups. TKA subjects with pre-operative patellofemoral or tricompartmental arthritis or ACL dysfunction were excluded. The Oxford Knee Score (OKS) and EuroQol-5D (EQ-5D) were compared. Bi-UKA then TKA were performed on eight fresh frozen cadaveric knees, to investigate knee extensor efficiency under controlled laboratory conditions, using a repeated measures study design. Results Bi-UKA walked 20% faster than TKA (Bi-UKA 6.70.9km/h, TKA 5.60.7km/h p<0.001), exhibiting nearer-normal vertical Ground Reaction Forces in maximum weight-acceptance and mid-stance, with longer step and stride lengths compared to TKA (p<0.05). Bi-UKAsubjects reported higher OKS (p=0.004) and EQ-5D (p<0.001). In vitro, Bi-UKA generated the same extensor moment as native knees at low flexion angles, whilst reduced extensor moment was measured following TKA (p<0.003). Conversely, at higher flexion angles, the extensor moment of TKA was normal. Over the full range, the extensor mechanism was more efficient following Bi-UKA than TKA (p<0.05). Conclusion Bi-UKA had more normal gait characteristics and improved patient reported outcomes, compared to matched TKA subjects. This can, in part, be explained by differences in extensor efficiency.
  • Journal article
    Edwards TC, Coombs AW, Szyszka B, Logishetty K, Cobb JPet al., 2021,

    Cognitive task analysis-based training in surgery: a meta-analysis

    , BJS OPEN, Vol: 5, ISSN: 2474-9842
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  • Journal article
    Wedatilake T, Palmer A, Fernquest S, Redgrave A, Arnold L, Kluzek S, McGregor A, Teh J, Newton J, Glyn-Jones Set al., 2021,

    Association between hip joint impingement and lumbar disc disease in elite rowers

    , BMJ Open Sport and Exercise Medicine, Vol: 7, Pages: 1-7, ISSN: 2055-7647

    Objectives Lumbar disc disease is a known cause of back pain. Increasingly it is thought that cam morphology of the hip may have a causal role in development of lumbar disc disease. The aim of this study was to describe the morphology of the hip and investigate the association of cam morphology with lumbar disc disease observed on MRI in elite rowers.Methods Cross-sectional observational study of 20 elite rowers (12 male, 8 female, mean age 24.45, SD 2.1). Assessment included clinical examination, questionnaires, 3T MRI scans of the hips and lumbar spine. Alpha angle of the hips and Pfirrmann score of lumbar discs were measured.Results 85% of rowers had a cam morphology in at least one hip. Alpha angle was greatest at the 1 o’clock position ((bone 70.9 (SD 16.9), cartilage 71.4 (16.3)). 95% of the group were noted to have labral tears, but only 50% of the group had history of groin pain. 85% of rowers had at least one disc with a Pfirrmann score of 3 or more and 95% had a history of back pain. A positive correlation was observed between the alpha angle and radiological degenerative disc disease (correlation coefficient=3.13, p=0.012). A negative correlation was observed between hip joint internal rotation and radiological degenerative disc disease (correlation coefficient=−2.60, p=0.018).Conclusions Rowers have a high prevalence of labral tears, cam morphology and lumbar disc disease. There is a possible association between cam morphology and radiological lumbar degenerative disc disease, however, further investigation is required.
  • Journal article
    Khatri C, Ward AE, Nepogodiev D, Ahmed I, Chaudhry D, Dhaif F, Bankhad-Kendall B, Kaafarani H, Bretherton C, Mahmood A, Marais L, Parsons N, Bhangu A, Metcalfe A, Parsons N, Khatri C, Siaw-Acheampong K, Chaudhry D, Dawson BE, Evans JP, Glasbey JC, Gujjuri RR, Heritage E, Jones CS, Kamarajah SK, Khatri C, Keatley JM, Lawday S, Li E, Mckay SC, Nepogodiev D, Pellino G, Tiwari A, Simoes JFF, Trout IM, Venn ML, Wilkin RJW, Bhangu A, Ademuyiwa AO, Agarwal A, Al Ameer E, Alderson D, Alser O, Arnaud AP, Augestad KM, Bankhead-Kendall B, Benson RA, Chakrabortee S, Blanco-Colino R, Brar A, Bravo AM, Breen KA, Buarque IL, Caruana E, Cunha MF, Davidson GH, Desai A, Di Saverio S, Edwards J, Elhadi M, Farik S, Fiore M, Fitzgerald JE, Ford S, Gallo G, Ghosh D, Gomes GMA, Griffiths E, Halkias C, Harrison EM, Hutchinson P, Isik A, Kaafarani H, Kolias A, Lawani I, Lederhuber H, Leventoglu S, Loffler MW, Martin J, Mashbari H, Mazingi D, Mohan H, Moore R, Moszkowicz D, Ng-Kamstra JS, Metallidis S, Moug S, Niquen M, Ntirenganya F, Outani O, Pata F, Pinkney TD, Pockney P, Radenkovic D, Ramos-De la Medina A, Roberts K, Santos I, Schache A, Schnitzbauer A, Stewart GD, Shaw R, Shu S, Soreide K, Spinelli A, Sundar S, Tabiri S, Townend P, Tsoulfas G, van Ramshorst G, Vidya R, Vimalachandran D, Wright N, Simoes JFF, Mak JKC, Kulkarni R, Sharma N, Nankivell P, Tirotta F, Parente A, Breik O, Kisiel A, Cato LD, Saeed S, Bhangu A, Griffiths E, Pathanki AM, Ford S, Desai A, Almond M, Kamal M, Chebaro A, Lecolle K, Truant S, El Amrani M, Zerbib P, Pruvot FR, Mathieu D, Surmei E, Mattei L, Marin H, Dudek J, Singhal T, El-Hasani S, Nehra D, Walters A, Cuschieri J, Davidson GH, Ho M, Wade RG, Johnstone J, Bourke G, Brunelli A, Elkadi H, Otify M, Pompili C, Burke JR, Bagouri E, Chowdhury M, Abual-Rub Z, Kaufmann A, Munot S, Lo T, Young A, Kowal M, Wall J, Peckham-Cooper A, Winter SC, Belcher E, Stavroulias D, Di Chiara F, Wallwork K, Qureishi A, Lami M, Sravanam S, Mastoridis S, Shah K, Chidambaram S, Smet al., 2021,

    Outcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures: an international cohort study

    , BMJ Open, Vol: 11, Pages: 1-10, ISSN: 2044-6055

    Objectives Studies have demonstrated high rates of mortality in people with proximal femoral fracture and SARS-CoV-2, but there is limited published data on the factors that influence mortality for clinicians to make informed treatment decisions. This study aims to report the 30-day mortality associated with perioperative infection of patients undergoing surgery for proximal femoral fractures and to examine the factors that influence mortality in a multivariate analysis.Setting Prospective, international, multicentre, observational cohort study.Participants Patients undergoing any operation for a proximal femoral fracture from 1 February to 30 April 2020 and with perioperative SARS-CoV-2 infection (either 7 days prior or 30-day postoperative).Primary outcome 30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality.Results This study reports included 1063 patients from 174 hospitals in 19 countries. Overall 30-day mortality was 29.4% (313/1063). In an adjusted model, 30-day mortality was associated with male gender (OR 2.29, 95% CI 1.68 to 3.13, p<0.001), age >80 years (OR 1.60, 95% CI 1.1 to 2.31, p=0.013), preoperative diagnosis of dementia (OR 1.57, 95% CI 1.15 to 2.16, p=0.005), kidney disease (OR 1.73, 95% CI 1.18 to 2.55, p=0.005) and congestive heart failure (OR 1.62, 95% CI 1.06 to 2.48, p=0.025). Mortality at 30 days was lower in patients with a preoperative diagnosis of SARS-CoV-2 (OR 0.6, 95% CI 0.6 (0.42 to 0.85), p=0.004). There was no difference in mortality in patients with an increase to delay in surgery (p=0.220) or type of anaesthetic given (p=0.787).Conclusions Patients undergoing surgery for a proximal femoral fracture with a perioperative infection of SARS-CoV-2 have a high rate of mortality. This study would support the need for providing these patients with individualised medical and anaesthetic care, including medical optimisation before t
  • Journal article
    Garner A, Dandridge O, Amis A, Cobb J, van Arkel Ret al., 2021,

    Partial and combined partial knee arthroplasty: greater anterior-posterior stability than posterior-cruciate retaining total knee arthroplasty

    , The Journal of Arthroplasty, Vol: 36, Pages: 3765-3772.e4, ISSN: 0883-5403

    BackgroundLittle is known regarding anterior-posterior stability after anterior cruciate ligament–preserving partial (PKA) and combined partial knee arthroplasty (CPKA) compared to standard posterior cruciate–retaining total knee arthroplasty (TKA).MethodsThe anterior-posterior tibial translation of twenty-four cadaveric knees was measured, with optical tracking, while under 90N drawer with the knee flexed 0-90°. Knees were tested before and after PKA, CPKA (medial and lateral bicompartmental and bi-unicondylar), and then posterior cruciate–retaining TKA. The anterior-posterior tibial translations of the arthroplasty states, at each flexion angle, were compared to the native knee and each other with repeated measures analyses of variance and post-hoc t-tests.ResultsUnicompartmental and bicompartmental arthroplasty states had similar laxities to the native knee and to each other, with ≤1-mm differences throughout the flexion range (P ≥ .199). Bi-unicondylar arthroplasty resulted in 6- to 8-mm increase of anterior tibial translation at high flexion angles compared to the native knee (P ≤ .023 at 80-90°). Meanwhile, TKA exhibited increased laxity across all flexion angles, with increased anterior tibial translation of up to 18 ± 6 mm (P < .001) and increased posterior translation of up to 4 ± 2 mm (P < .001).ConclusionsIn a cadaveric study, anterior-posterior tibial translation did not differ from native laxity after PKA and CPKA. Posterior cruciate ligament–preserving TKA demonstrated increased laxity, particularly in anterior tibial translation.
  • Journal article
    Bhattacharyya R, Al-Obaidi B, Sugand K, Bhattacharya R, Gupte CMet al., 2021,

    Evaluating the effectiveness of the Imperial Femoral Intramedullary Nailing Cognitive Task Analysis (IFINCTA) tool in a real-time simulation setting (Distributed Interactive Simulation): a randomized controlled trial

    , INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED, Vol: 52, Pages: 3420-3426, ISSN: 0020-1383
  • Journal article
    Udeh-Momoh C, Watermeyer T, Sindi S, Giannakopoulou P, Robb C, Ahmadi Abhari S, Zheng B, Waheed A, McKeand E, Salman D, Beaney T, Loots C, Price G, Atchison C, Car J, Majeed A, McGregor A, Kivipelto M, Ward H, Middleton Let al., 2021,

    Health, lifestyle and psycho-social determinants of poor sleep quality during the Early Phase of the COVID-19 pandemic: a focus on UK older adults deemed clinically extremely vulnerable

    , Frontiers in Public Health, Vol: 9, Pages: 1-11, ISSN: 2296-2565

    Background: Several studies have assessed the impact of COVID-19-relatedlockdownson sleep quality across global populations. However, no study to date has specifically assessed at-riskpopulations, particularly those at highest risk of complications from coronavirus infection deemed “clinically-extremely-vulnerable-(COVID-19CEV)” [as defined by Public Health England, 2020].Methods: In this cross-sectional study, we surveyed 5,558 adults aged ≥50 years (of whom 523 met criteria for COVID-19CEV) during the first pandemic wave that resulted in a nationwide-lockdown (April-June 2020) with assessments of sleep quality (an adapted sleep scale that captured multiple sleep indices before and during the lockdown), health/medical, lifestyle, psychosocial and socio demographic factors. We examined associations between these variablesand sleep quality;and explored interactions of COVID-19CEV status with significant predictors of poor sleep,to identify potential moderating factors. Results: 37% of participants reported poor sleep quality which was associated with younger age, female sex and multimorbidity. Significant associations with poor sleep included health/medical factors: COVID-19 CEV status, higher BMI, arthritis, pulmonary disease, and mental health disorders; and the following lifestyle and psychosocial factors: living alone, higher alcohol consumption, an unhealthy diet and higher depressive and anxiety symptoms. Moderators of the negative relationship between COVID-19 CEV status and good sleep quality were marital status, loneliness, anxiety and diet. Within this subgroup, less anxious and less lonely males, as well as females with healthier diets, reported better sleep. Conclusions: Sleep quality in older adults was compromised during the sudden unprecedented nation-wide lockdown due to distinct modifiable factors. An important contribution of our study is the assessment of a &ldquo
  • Journal article
    Braeuninger-Weimer K, Anjarwalla N, McGregor A, Roberts L, Sell P, Pincus Tet al., 2021,

    Improving consultations for persistent musculoskeletal low back pain in orthopaedic spine settings: an intervention development

    , BMC Musculoskeletal Disorders, Vol: 22, Pages: 1-11, ISSN: 1471-2474

    BackgroundThere is a need to improve consultations between patients with persistent musculoskeletal low back pain and orthopaedic spine clinicians when surgery is not indicated. Poor communication and lack of education about self- management in these consultations have been shown to be associated with increased distress and higher subsequent health care seeking.AimTo develop a standardised intervention to improve spine care consultations for patients for whom surgery is not beneficial.MethodThe intervention was developed in six stages. The first three stages included: interviews with patients, an interactive workshop with clinicians from a mix of disciplines, and interviews with spine clinicians about their perspective of the recommendations, their perceived difficulties and potential improvements. Information from these stages was synthesised by an expert panel, creating a draft intervention structure and content. The main features of the intervention and the materials developed were then reviewed by patients and spine clinicians. Finally, the research team incorporated the recommended amendments to produce the intervention.ResultsIn total, 36 patients and 79 clinicians contributed to the development of the intervention. The final intervention includes three components: a pre-consultation letter with information suggesting that surgery is one possible intervention amongst many, introducing the staff, and alerting patients to bring with them a potted history of interventions tried previously. The intervention includes short online training sessions to improve clinicians’ communication skills, during the consultation, in reference to listening skills, validation of patients’ pain, and use of appropriate language. Clinicians are also supplied with a list of evidence-based sources for advice and further information to share with patients. Finally, post consultation, a follow up letter includes a short summary of the patients’ clinical journey, the res
  • Journal article
    Cowell I, McGregor A, O'Sullivan P, O'Sullivan K, Poyton R, Schoeb V, Murtagh Get al., 2021,

    Physiotherapists' approaches to patients' concerns in back pain consultations following a psychologically informed training program

    , Qualitative Health Research, Vol: 13, Pages: 1-16, ISSN: 1049-7323

    Guidelines advocate a combined physical and psychological approach to managing non-specific chronic low back pain (NSCLBP), referred to as psychologically informed practice (PIP). PIP is underpinned by patient-centered principles and skilled communication. Evidence suggests that a physiotherapist-focused style of communication prevails in physiotherapy. There is a recognized need for observational research to identify specific communication practices in physiotherapy interactions. This observational study explored the interactional negotiation of agenda setting following a PIP training intervention, by identifying and describing how physiotherapists solicit and respond to the agenda of concerns that patients with NSCLBP bring to primary care initial encounters. The research setting was primary care. Nineteen initial physiotherapy consultations were video-recorded, transcribed, and analyzed using conversation analysis, a qualitative observational method. These data revealed a patient-focused style of communication where trained physiotherapists demonstrated a collaborative and responsive style of verbal and nonverbal communication to solicit, explore, and validate patients’ concerns.
  • Journal article
    McGregor A, 2021,

    Commentary: "Vowel Quality and Direction of Stress Shift in a Predictive Model Explaining the Varying Impact of Misplaced Word Stress: Evidence From English" and "Exploring the Complexity of the L2 Intonation System: An Acoustic and Eye-Tracking Study"

    , FRONTIERS IN COMMUNICATION, Vol: 6
  • Journal article
    Newington L, Alexander CM, Wells M, 2021,

    The impacts of clinical academic activity: Qualitative interviews with healthcare managers and research-active nurses, midwives, allied health professionals and pharmacists

    , BMJ Open, Vol: 11, ISSN: 2044-6055

    Objectives: To explore the perceived impacts of clinical academic activity among the professions outside medicine.Design: Qualitative semistructured interviews.Setting and participants: There were two groups of interviewees: Research-active nurses, midwives, allied health professionals, healthcare scientists, psychologists and pharmacists (NMAHPPs) and managers of these professions. All participants were employed in a single, multisite healthcare organisation in the UK.Analysis: Interview transcripts were analysed using the framework method to identify key themes, subthemes and areas of divergence.Results: Four themes were identified. The first, cultural shifts, described the perceived improvements in the approach to patient care and research culture that were associated with clinical academic activity. The second theme explored visibility and included the positive reputation that clinical academics were identified as bringing to the organisation in contrast with perceived levels of invisibility and inaccessibility of these roles. The third theme identified the impacts of the clinical academic pathways, including the precarity of these roles. The final theme explored making impact tangible, and described interviewees’ suggestions of possible methods to record and demonstrate impact.Conclusions: Perceived positive impacts of NMAHPP clinical academic activity focused on interlinked positive changes for patients and clinical teams. This included delivery of evidence-based healthcare, patient involvement in clinical decision making and improved staff recruitment and retention. However, the positive impacts of clinical academic activity often centred around individual clinicians and did not necessarily translate throughout the organisation. The current clinical academic pathway was identified as causing tension between the perceived value of clinical academic activity and the need to find sufficient staffing to cover clinical services.

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