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  • Journal article
    Panhelleux B, Shalhoub J, Silverman A, McGregor Aet al., 2022,

    A review of through-knee amputation

    , Vascular, Vol: 30, Pages: 1149-1159, ISSN: 0967-2109

    Objectives: Through knee amputation (TKA) is an umbrella term for several different surgical techniques, which may affect clinical and functional outcomes. This makes it hard to evaluate the benefits and need for a TKA approach. This paper seeks to: (1) Determine the number of TKAs performed compared with other major lower limb amputations (MLLA) in England over the past decade; (2) identify the theoretical concepts behind TKA surgical approaches and their potential effect on functional and clinical outcomes; and (3) provide a platform for discussion and research on TKA and surgical outcomes.Methods: National Health Service Hospital Episodes Statistics were used to obtain recent numbers of MLLAs in England. EMBASE and MEDLINE were searched using a systematic approach with predefined criteria for relevant literature on TKA surgery.Results: In the past decade, 4.6% of MLLA in England were TKAs. Twenty-six articles presenting TKA surgical techniques met our criteria. These articles detailed three TKA surgical techniques; the classical approach, which keeps the femur intact and retains the patella; the Mazet technique, which shaves the femoral condyles into a box shape; and the Gritti-Stokes technique, which divides the femur proximal to the level of the condyles and attaches the patella at the distal cut femur.Conclusions: TKA has persisted as a surgical approach over the past decade, with three core approaches identified. Studies reporting clinical, functional, and biomechanical outcomes of TKA frequently fail to distinguish between the 3 distinct and differing approaches, making direct comparisons difficult. Future studies that compare TKA approaches to one another and to other amputation levels are needed.
  • Journal article
    van Helden JFL, Martinez-Valdes E, Strutton PH, Falla D, Chiou SYet al., 2022,

    Reliability of high-density surface electromyography for assessing characteristics of the thoracic erector spinae during static and dynamic tasks

    , Journal of Electromyography and Kinesiology, Vol: 67, ISSN: 1050-6411

    PURPOSE: To establish intra- and inter-session reliability of high-density surface electromyography (HDEMG)-derived parameters from the thoracic erector spinae (ES) during static and dynamic goal-directed voluntary movements of the trunk, and during functional reaching tasks. METHODS: Twenty participants performed: 1) static trunk extension, 2) dynamic trunk forward and lateral flexion, and 3) multidirectional functional reaching tasks on two occasions separated by 7.5 ± 1.2 days. Muscle activity was recorded bilaterally from the thoracic ES. Root mean square (RMS), coordinates of the barycentre, mean frequency (MNF), and entropy were derived from the HDEMG signals. Reliability was determined with intraclass correlation coefficient (ICC), coefficient of variation, and standard error of measurement. RESULTS: Good-to-excellent intra-session reliability was found for all parameters and tasks (ICC: 0.79-0.99), whereas inter-session reliability varied across tasks. Static tasks demonstrated higher reliability in most parameters compared to functional and dynamic tasks. Absolute RMS and MNF showed the highest overall reliability across tasks (ICC: 0.66-0.98), while reliability of the barycentre was influenced by the direction of the movements. CONCLUSION: RMS and MNF derived from HDEMG show consistent inter-session reliability in goal-directed voluntary movements of the trunk and reaching tasks, whereas the measures of the barycentre and entropy demonstrate task-dependent reliability.
  • Journal article
    Miles A, McRae J, Clunie G, Gillivan-Murphy P, Inamoto Y, Kalf H, Pillay M, Pownall S, Ratcliffe P, Richard T, Robinson U, Wallace S, Brodsky MBet al., 2022,

    An international commentary on dysphagia and dysphonia during the COVID-19 pandemic

    , Dysphagia, Vol: 37, Pages: 1349-1374, ISSN: 0179-051X

    COVID-19 has had an impact globally with millions infected, high mortality, significant economic ramifications, travel restrictions, national lockdowns, overloaded healthcare systems, effects on healthcare workers’ health and well-being, and large amounts of funding diverted into rapid vaccine development and implementation. Patients with COVID-19, especially those who become severely ill, have frequently developed dysphagia and dysphonia. Health professionals working in the field have needed to learn about this new disease while managing these patients with enhanced personal protective equipment. Emerging research suggests differences in the clinical symptoms and journey to recovery for patients with COVID-19 in comparison to other intensive care populations. New insights from outpatient clinics also suggest distinct presentations of dysphagia and dysphonia in people after COVID-19 who were not hospitalized or severely ill. This international expert panel provides commentary on the impact of the pandemic on speech pathologists and our current understanding of dysphagia and dysphonia in patients with COVID-19, from acute illness to long-term recovery. This narrative review provides a unique, comprehensive critical appraisal of published peer-reviewed primary data as well as emerging previously unpublished, original primary data from across the globe, including clinical symptoms, trajectory, and prognosis. We conclude with our international expert opinion on what we have learnt and where we need to go next as this pandemic continues across the globe.
  • Journal article
    Allen JE, Clunie G, Ma JK-Y, Coffey M, Winiker K, Richmond S, Lowell SY, Volkmer Aet al., 2022,

    Translating ultrasound into clinical practice for the assessment of swallowing and laryngeal function: a speech and language pathology-led consensus study

    , Dysphagia, Vol: 37, Pages: 1586-1598, ISSN: 0179-051X

    Ultrasound (US) has an emerging evidence base for the assessment of swallowing and laryngeal function. Accessibility and technological advances support the use of US as a clinical assessment tool; however, there is insufficient evidence to support its translation into clinical practice. This study aimed to establish consensus on the priorities for translation of US into clinical practice for the assessment of swallowing and laryngeal function. Nominal Group Technique (NGT) was used as a formal method of consensus development. Clinicians and academics, all members of an international US working group, were invited to participate in the study. Two NGT meetings were held, where participants silently generated and then shared ideas. Participants anonymously ranked items. Rankings were aggregated before participants re-ranked items in order of priority. Discussions regarding rankings were recorded and transcribed to inform analysis. Member-checking with participants informed the final analysis. Participants (n = 15) were speech and language pathologists, physiotherapists and sonographers representing six countries. Fifteen items were identified and prioritised 1–13 (including two equally ranked items). Reliability, validity and normative data emerged as key areas for research while development of training protocols and engagement with stakeholders were considered vital to progressing US into practice. Analysis revealed common themes that might be addressed together in research, in addition to the ranked priority. A measured approach to the translation of US into clinical practice will enable effective implementation of this tool. Priorities may evolve as clinical and professional contexts shift, but this study provides a framework to advance research and clinical practice in this field.
  • Journal article
    Ruparell K, Barve R, Tas RN, Chen S, Mclaughlin R, Ravendren A, Gupte CMet al., 2022,

    Motivators and deterrents for early career female doctors applying to surgical training programmes in the UK National Health Service: a mixed-methods study

    , BMJ OPEN, Vol: 12, ISSN: 2044-6055
  • Journal article
    Newman H, Clunie G, Wallace S, Smith C, Martin D, Pattison Net al., 2022,

    What matters most to adults with a tracheostomy in ICU and the implications for clinical practice: a qualitative systematic review and metasynthesis

    , Journal of Critical Care, Vol: 72, Pages: 1-16, ISSN: 0883-9441

    Purpose: Tracheostomy is a common surgical procedure in ICU. Whilst often life-saving, it can have important impacts on patients. Much of the literature on tracheostomy focuses on timing and technique of insertion, risk factors and complications. More knowledge of patient experience of tracheostomy in ICU is needed to support person-centred care.Materials and Methods: Qualitative systematic review and metasynthesis of the literature on adult experience of tracheostomy in ICU. Comprehensive search of four bibliographic databases and grey literature. Title and abstract screening and full text eligibility was completed independently by two reviewers. Metasynthesis was achieved using thematic synthesis, supported by a conceptual framework of humanised care.Results: 2971 search returns were screened on title and abstract and 127 full texts assessed for eligibility. Thirteen articles were included for analysis. Five descriptive and three analytical themes were revealed. The over-arching theme was ‘To be seen and heard as a whole person’. Patients wanted to be treated as a human, and having a voice made this easier.Conclusions: Voice restoration should be given high priority in the management of adults with a tracheostomy in ICU. Staff training should focus on both technical skills and compassionate care to improve person-centred outcomes.
  • Journal article
    Hall AJ, Clement ND, Ojeda-Thies C, MacLullich AM, Toro G, Johansen A, White TO, Duckworth ADet al., 2022,

    IMPACT-Global Hip Fracture Audit: Nosocomial infection, risk prediction and prognostication, minimum reporting standards and global collaborative audit Lessons from an international multicentre study of 7,090 patients conducted in 14 nations during the COVID-19 pandemic

    , SURGEON-JOURNAL OF THE ROYAL COLLEGES OF SURGEONS OF EDINBURGH AND IRELAND, Vol: 20, Pages: E429-E446, ISSN: 1479-666X
  • Journal article
    van der Feltz-Cornelis CM, Sweetman J, Allsopp G, Attree E, Crooks MG, Cuthbertson DJ, Forshaw D, Gabbay M, Green A, Heightman M, Hillman T, Hishmeh L, Khunti K, Lip GYH, Lorgelly P, Montgomery H, Strain WD, Wall E, Watkins C, Williams N, Wootton DG, Banerjee A, STIMULATE-ICP Cet al., 2022,

    STIMULATE-ICP-Delphi (Symptoms, Trajectory, Inequalities and Management: Understanding Long-COVID to Address and Transform Existing Integrated Care Pathways Delphi): study protocol

    , PLoS One, Vol: 17, ISSN: 1932-6203

    IntroductionAs mortality rates from COVID-19 disease fall, the high prevalence of long-term sequelae (Long COVID) is becoming increasingly widespread, challenging healthcare systems globally. Traditional pathways of care for Long Term Conditions (LTCs) have tended to be managed by disease-specific specialties, an approach that has been ineffective in delivering care for patients with multi-morbidity. The multi-system nature of Long COVID and its impact on physical and psychological health demands a more effective model of holistic, integrated care. The evolution of integrated care systems (ICSs) in the UK presents an important opportunity to explore areas of mutual benefit to LTC, multi-morbidity and Long COVID care. There may be benefits in comparing and contrasting ICPs for Long COVID with ICPs for other LTCs.Methods and analysisThis study aims to evaluate health services requirements for ICPs for Long COVID and their applicability to other LTCs including multi-morbidity and the overlap with medically not yet explained symptoms (MNYES). The study will follow a Delphi design and involve an expert panel of stakeholders including people with lived experience, as well as clinicians with expertise in Long COVID and other LTCs. Study processes will include expert panel and moderator panel meetings, surveys, and interviews. The Delphi process is part of the overall STIMULATE-ICP programme, aimed at improving integrated care for people with Long COVID.Ethics and disseminationEthical approval for this Delphi study has been obtained (Research Governance Board of the University of York) as have approvals for the other STIMULATE-ICP studies. Study outcomes are likely to inform policy for ICPs across LTCs. Results will be disseminated through scientific publication, conference presentation and communications with patients and stakeholders involved in care of other LTCs and Long COVID.
  • Journal article
    Bicer M, Phillips ATM, Melis A, McGregor AH, Modenese Let al., 2022,

    Generative deep learning applied to biomechanics: A new augmentation technique for motion capture datasets

    , JOURNAL OF BIOMECHANICS, Vol: 144, ISSN: 0021-9290
  • Journal article
    Rowland S, Fitzgerald EJ, Lungren M, Elizabeth HL, Harned Z, McGregor Aet al., 2022,

    Digital health technology-specific risks for medical malpractice liability

    , npj Digital Medicine, Vol: 5, Pages: 1-6, ISSN: 2398-6352

    The global digital health market is worth approximately 300 billion USD1 and is predicted to grow by up to 25% this year. Consequently, medical professionals are increasingly required to use digital technologies such as telehealth platforms, AI-driven clinical decision-making tools, digitally enabled surgical tools, mHealth technologies, or electronic health care records (EHR), as part of care delivery. These technologies hold clear benefits for enabling more efficient, modern care delivery however there are significant challenges to implementation, including when and how to use them, how to enable an accurate medical diagnosis in a virtual environment, interpretation and relevance of novel data points from digital devices, the potential for automation bias, appropriate utilisation of and engagement with digital disease management platforms and continuity of care in a digital world. Several of these issues have become apparent through the pandemic due to the hasty deployment of novel technologies as ‘bolt-on’ solutions to address standalone challenges in healthcare delivery, without consideration of the broader healthcare architecture. The majority of practicing clinicians are not sufficiently trained in how to safely integrate digital health technologies into the clinical workflow before encountering such technologies in practice. The introduction of digital health technologies may therefore represent a risk for medical error and subsequent malpractice liability. Medical malpractice is frequently defined as a physician’s failure to comply with customary medical practice,2 however the application of this standard in the context of digital health is challenging. What are the accepted norms for history and examination during a telehealth consult? How should these be documented on electronic systems? When is it safe to offer digital first solutions for disease management? What is the custom for clinicians to ensure continuity of care? If there is a me
  • Journal article
    Burge T, Jones G, Jordan C, Jeffers J, Myant Cet al., 2022,

    A computational tool for automatic selection of total knee replacementimplant size using x-ray images

    , Frontiers in Bioengineering and Biotechnology, Vol: 10, Pages: 1-11, ISSN: 2296-4185

    Purpose: The aim of this study was to outline a fully automatic tool capable of reliably predicting the most suitable total kneereplacement implant sizes for patients, using bi-planar X-ray images. By eliminating the need for manual templating or guidingsoftware tools via the adoption of convolutional neural networks, time and resource requirements for pre-operative assessmentand surgery could be reduced, the risk of human error minimized, and patients could see improved outcomes.Methods: The tool utilizes a machine learning-based 2D – 3D pipeline to generate accurate predictions of subjects’ distal femur andproximal tibia bones from X-ray images. It then virtually fits different implant models and sizes to the 3D predictions, calculatesthe implant to bone root-mean-squared error and maximum over/under hang for each, and advises the best option for thepatient. The tool was tested on 78, predominantly White subjects (45 female/33 male), using generic femur component and tibiaplate designs scaled to sizes obtained for five commercially available products. The predictions were then compared to the groundtruth best options, determined using subjects’ MRI data.Results: The tool achieved average femur component size prediction accuracies across the five implant models of 77.95% in termsof global fit (root-mean-squared error), and 71.79% for minimizing over/underhang. These increased to 99.74% and 99.49% with ±1size permitted. For tibia plates, the average prediction accuracies were 80.51% and 72.82% respectively. These increased to99.74% and 98.98% for ±1 size. Better prediction accuracies were obtained for implant models with fewer size options, howeversuch models more frequently resulted in a poor fit.Conclusion: A fully automatic tool was developed and found to enable higher prediction accuracies than generally reported formanual templating techniques, as well as similar computational methods.
  • Journal article
    van der Kruk E, Strutton P, Koizia LJ, Fertleman M, Reilly P, Bull AMJet al., 2022,

    Why do older adults stand-up differently to young adults?: investigation of compensatory movement strategies in sit-to-walk

    , npj Aging, Vol: 8, ISSN: 2731-6068

    Functional motor redundancy enables humans to move with distinct muscle activation patterns while achieving a similar outcome. Since humans select similar strategies, there seems to be an optimal control. However, older adults move differently to young adults. The question is whether this is this due to an altered reinforcement scheme, altered sensory inputs, or due to alterations in the neuromusculoskeletal systems, so that it is no longer optimal or possible to execute the same movement strategies. The aim of this study was to analyse natural compensation strategies in the vital daily-life-task, sit-to-walk, in relation to neuromuscular capacity and movement objectives in younger (27.2 ± 4.6 years, N = 27, 14♀) and elderly (75.9 ± 6.3 years, N = 23, 12♀) adults. Aspects of the neuromuscular system that are prone to age-related decline and feasible to quantify were assessed (i.e. strength, nerve conductivity, fear of falling). Kinematics and muscle activity were recorded and joint kinetics were estimated using biomechanical models. Elderly men consistently used their arms when standing up. This strategy was not associated with a lack of or a reduction in strength, but with a reduction, but no lack of, ankle joint range of motion, and with increased fear of falling. The results show that humans preferentially maintain a minimum threshold of neuromuscular reserve to cope with uncertainties which results in compensation prior to coming up against physical limitations. Smaller base of support while standing up, a compensatory strategy with possibly greater risk of falls, was associated with muscular weakness, and longer nerve conduction latencies.
  • Journal article
    Clunie G, Anderson C, Hughes C, Savage M, Roe J, Sandhu G, McGregor A, Alexander Cet al., 2022,

    “A major quality of life issue”: A survey-based analysis of the experiences of adults with laryngotracheal stenosis with mucus and cough

    , Annals of Otology, Rhinology and Laryngology, Vol: 131, Pages: 962-970, ISSN: 0003-4894

    Objectives:To investigate how the symptoms of mucus and cough impact adults living with laryngotracheal stenosis, and to use this information to guide future research and treatment plans.Methods:A survey was developed with the support of patient advisors and distributed to people suffering with laryngotracheal stenosis. The survey comprised 15 closed and open questions relating to mucus and cough and included the Leicester Cough Questionnaire (LCQ). Descriptive statistics, X2 and thematic analyses were completed.Results:In total, 641 participants completed the survey, with 83.62% (n = 536) reporting problems with mucus; 79% having daily issues of varying severity that led to difficulties with cough (46.18%) and breathing (20.90%). Mucus affected voice and swallowing to a lesser degree. Respondents described a range of triggers; they identified smoky air as the worst environmental trigger. Strategies to manage mucus varied widely with drinking water (72.26%), increasing liquid intake in general (49.35%) and avoiding or reducing dairy (45.32%) the most common approaches to control symptoms. The LCQ showed a median total score of 14 (interquartile range 11-17) indicative of cough negatively affecting quality of life. Thematic analysis of free text responses identified 4 key themes—the Mucus Cycle, Social impact, Psychological impact, and Physical impact.Conclusion:This study shows the relevance of research focusing on mucus and cough and its negative impact on quality of life, among adults with laryngotracheal stenosis. It demonstrates the inconsistent advice and management strategies provided by clinicians for this issue. Further research is required to identify clearer treatment options and pathways.
  • Journal article
    Chidambaram S, Maheswaran Y, Patel K, Sounderajah V, Hashimoto DA, Seastedt KP, McGregor AH, Markar SR, Darzi Aet al., 2022,

    Using Artificial Intelligence-Enhanced Sensing and Wearable Technology in Sports Medicine and Performance Optimisation

    , SENSORS, Vol: 22
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  • Journal article
    Preston B, Harris S, Villet L, Mattathil C, Cobb J, Riviere Cet al., 2022,

    The medial condylar wall is a reliable landmark to kinematically align the femoral component in medial UKA: an in-silico study

    , KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY, Vol: 30, Pages: 3220-3227, ISSN: 0942-2056
  • Journal article
    Nowinka Z, Alagha MA, Mahmoud K, Jones GGet al., 2022,

    Predicting Depression in Patients With Knee Osteoarthritis Using Machine Learning: Model Development and Validation Study

    , JMIR FORMATIVE RESEARCH, Vol: 6
  • Conference paper
    Edwards T, Gupta S, Soussi D, Patel A, Khan S, Liddle A, Cobb J, Logishetty Ket al., 2022,

    1019 Collaborative Surgical Team Training in Virtual Reality Is Superior to Individual Learning: A Randomised Controlled Trial

    , ASiT Surgical Conference, Publisher: OXFORD UNIV PRESS, ISSN: 0007-1323
  • Conference paper
    Lu V, Zhang J, Logishetty K, Khanduja Vet al., 2022,

    109 The Impact of Extended Reality on Surgery: A Scoping Review

    , ASiT Surgical Conference, Publisher: OXFORD UNIV PRESS, ISSN: 0007-1323
  • Conference paper
    Woodbridge H, Alexander C, Jones M, Gordon Aet al., 2022,

    Exploring the barriers to early physical rehabilitation and investigating its safety in critically ill patients receiving vasoactive drugs. Rising Star - ICS Gold Medal.

    , Intensive Care Society State of the Art 2021 Congress, Publisher: SAGE Publications
  • Journal article
    Sanz-Pena I, Arachchi S, Curtis-Woodcock N, Silva P, McGregor A, Newell Net al., 2022,

    Obtaining patient torso geometry for the design of scoliosis braces. A study of the accuracy and repeatability of handheld 3D scanners

    , Prosthetics and Orthotics International, Vol: 46, Pages: e374-e382, ISSN: 0309-3646

    Objective: Obtaining patient geometry is crucial in scoliosis brace design for patients with adolescent idiopathic scoliosis. Advances in 3D scanning technologies provide the opportunity to obtain patient geometries quickly with fewer resources during the design process compared with the plaster-cast method. This study assesses the accuracy and repeatability of such technologies for this application.Methods: The accuracy and repeatability of three different handheld scanners and phone-photogrammetry was assessed using different mesh generation software. Twenty-four scans of a single subject's torso were analyzed for accuracy and repeatability based on anatomical landmark distances and surface deviation maps.Results: Mark II and Structure ST01 scanners showed maximum mean surface deviations of 1.74 ± 3.63 mm and 1.64 ± 3.06 mm, respectively. Deviations were lower for the Peel 1 scanner (maximum of −0.35 ± 2.8 mm) but higher with the use of phone-photogrammetry (maximum of −5.1 ± 4.8 mm). The mean absolute errors of anatomical landmark distance measurements from torso meshes obtained with the Peel 1, Mark II, and ST01 scanners were all within 9.3 mm (3.6%), whereas phone-photogrammetry errors were as high as 18 mm (7%).Conclusions: Low-cost Mark II and ST01 scanners are recommended for obtaining torso geometries because of their accuracy and repeatability. Subject’s breathing/movement affects the resultant geometry around the abdominal and anterolateral regions.

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