Imperial College London

ProfessorAlisonMcGregor

Faculty of MedicineDepartment of Surgery & Cancer

Professor of Musculoskeletal Biodynamics
 
 
 
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Contact

 

+44 (0)20 7594 2972a.mcgregor

 
 
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Location

 

Room 202ABuilding E - Sir Michael UrenWhite City Campus

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Summary

 

Publications

Publication Type
Year
to

214 results found

Clunie G, Roe J, Alexander C, Sandhu G, McGregor Aet al., Voice and swallowing outcomes following airway reconstruction in adults: a systematic review, The Laryngoscope, ISSN: 0023-852X

Objectives: Laryngotracheal stenosis is a rare condition characterized by upper airway narrowing. Reconstructive surgical treatment aims to manage the area of stenosis to improve dyspnea and can impact on voice and swallowing function. This article critically evaluates the literature about voice and swallowing outcomes in adults with laryngotracheal stenosis who undergo reconstructive surgery.Study Design: Systematic review.Methods: Six databases were searched for articles referring to voice and swallowing outcome measures following reconstruction procedures in adults with laryngotracheal stenosis. Screening was completed using predefined inclusion/exclusion criteria. Results: A total of 143 abstracts were reviewed, with 67 articles selected for full text review. 20 studies met the inclusion criteria. Data extraction was completed with The Strengthening Reporting of Observational Studies in Epidemiology checklist with Oxford Centre for Evidence-Based Medicine Level of Evidence used to indicate quality. Risk of bias was assessed using the Risk of Bias Assessment Tool for Non-Randomized Studies. All studies scored a high risk of bias in at least one of the domains. Selection and timing of outcome measures was heterogenous and there was limited information provided about rationale or reliability.Conclusion: The literature acknowledges the importance of voice and swallowing outcomes following airway reconstruction. Studies show correlation between reconstructive surgery and deterioration in vocal function; there is no consistent data about swallowing outcomes. The lack of a core outcome measures set for adults with laryngotracheal stenosis limits the findings of this review. Further research is needed to establish clear criteria for robust and clinically relevant outcome measurement.

Journal article

Rowland S, Fitzgerald JE, Holme T, Powell J, McGregor Aet al., What is the clinical value of mHealth for patients?, npj Digital Medicine, ISSN: 2398-6352

Despite growing interest from both patients and healthcare providers there is little clinical guidance on how mobile apps should be utilised to add value to patient care. We categorize apps according to their functionality (e.g. preventative behavior change, digital self-management of a specific condition, diagnostic) and discuss evidence for effectiveness from published systematic reviews and meta-analyses and the relevance to patient care. We discuss the limitations of the current literature describing clinical outcomes from mHealth apps, what FDA clearance means now (510(k) / de novo FDA clearance) and in the future. We discuss data security and privacy as a major concern for patients when using mHealth apps. Patients are often not involved in the development of mobile health guidelines, and professionals’ views regarding high quality health apps may not reflect patients’ views. We discuss efforts to develop guidelines for the development of safe and effective mHealth apps in the US and elsewhere and the role of independent app reviews sites in identifying mHealth apps for patient care. There are only a small number of clinical scenarios where published evidence suggests that mHealth apps may improve patient outcomes.

Journal article

Papi E, Bull AMJ, McGregor AH, 2019, Alteration of movement patterns in low back pain assessed by Statistical Parametric Mapping, Journal of Biomechanics, Pages: 109597-109597, ISSN: 0021-9290

Changes in movement pattern in low back pain (LBP) groups have been analysed by reporting predefined discrete variables. However, this approach does not consider the full kinematic data waveform and its dynamic information, potentially exposing the analysis to bias. Statistical Parametric Mapping (SPM) has been introduced and applied to 1 dimensional (D) kinematic variables allowing the assessment of data over time. The aims of this study were to assess differences in 3D kinematics patterns in people with and without LBP during functional tasks by using SPM and to investigate if SPM analysis was consistent with standard 3D range of motion (RoM) assessments. 3D joints kinematics of the spine and lower limbs were compared between 20 healthy controls and 20 participants with non-specific LBP during walking, sit-to-stand and lifting. SPM analysis showed significant differences in the 3Dkinematics of the lower thoracic segment, upper and lower lumbar segment and knee joint during walking and lifting mostly observed at the beginning and/or towards the end of the tasks. ROMs differed between groups in the lower thoracic segment (walking/sit-to-stand), upper and lower lumbar segments (walking/sit-to-stand/lifting), hip and knee (sit-to-stand/lifting). Based on these results, the two approaches can yield different data interpretations. SPM analysis allows the identification of differences in movement that occur over time. This adds value to LBP movement analysis as it allows an understanding of the LBP strategies adopted during motion that may not be conveyed by simple discrete parameters such as ROMs.

Journal article

Favier C, Deane J, McGregor A, Phillips Aet al., 2019, Design and preliminary testing of a low-cost balance perturbation system for the evaluation of real life postural adjustment on public transport, Journal of Medical Engineering and Technology, Vol: 43, Pages: 356-362, ISSN: 0309-1902

Balance recovery mechanisms are of paramount importance in situations like public transport where sudden loss of equilibrium can occur. These mechanisms can be altered by aging or pathological disorders. However it is almost impossible to investigate these phenomena in real-life conditions, and the safe environment of a laboratory is needed. This paper investigates how jerk perturbations in the transverse plane similar to those experienced on public transport can be simulated in a controlled manner. A platform capable of producing horizontal perturbations with a person standing on it was developed. Accuracy, repeatability, and load sensitivity of the system were assessed with repeated trials in all four directions of movement. Comparison between the destabilising effect experienced on public transport and the postural response to perturbations from the platform was also made by tracking acceleration of the centre of mass of four subjects in these two situations. Results show that balance perturbations representative of real-life situations, such as standing on public transport, can accurately and repeatedly be produced in a safe and controlled environment with a low-cost and low-maintenance system. Coupled to motion capture technology, the system can be used for pathology assessment and rehabilitation treatments.

Journal article

Wilson S, Eberle H, Hayashi Y, Madgwick SOH, McGregor A, Jing X, Vaidyanathan Ret al., 2019, Formulation of a new gradient descent MARG orientation algorithm: Case study on robot teleoperation, Mechanical Systems and Signal Processing, Vol: 130, Pages: 183-200, ISSN: 0888-3270

We introduce a novel magnetic angular rate gravity (MARG) sensor fusion algorithm for inertial measurement. The new algorithm improves the popular gradient descent (ʻMadgwick’) algorithm increasing accuracy and robustness while preserving computational efficiency. Analytic and experimental results demonstrate faster convergence for multiple variations of the algorithm through changing magnetic inclination. Furthermore, decoupling of magnetic field variance from roll and pitch estimation is proven for enhanced robustness. The algorithm is validated in a human-machine interface (HMI) case study. The case study involves hardware implementation for wearable robot teleoperation in both Virtual Reality (VR) and in real-time on a 14 degree-of-freedom (DoF) humanoid robot. The experiment fuses inertial (movement) and mechanomyography (MMG) muscle sensing to control robot arm movement and grasp simultaneously, demonstrating algorithm efficacy and capacity to interface with other physiological sensors. To our knowledge, this is the first such formulation and the first fusion of inertial measurement and MMG in HMI. We believe the new algorithm holds the potential to impact a very wide range of inertial measurement applications where full orientation necessary. Physiological sensor synthesis and hardware interface further provides a foundation for robotic teleoperation systems with necessary robustness for use in the field.

Journal article

Kent P, O'Sullivan P, Smith A, Haines T, Campbell A, McGregor AH, Hartvigsen J, O'Sullivan K, Vickery A, Caneiro JP, Schütze R, Laird RA, Attwell S, Hancock Met al., 2019, RESTORE-Cognitive functional therapy with or without movement sensor biofeedback versus usual care for chronic, disabling low back pain: study protocol for a randomised controlled trial., BMJ Open, Vol: 9, Pages: 1-11, ISSN: 2044-6055

INTRODUCTION: Low back pain (LBP) is the leading cause of disability globally and its costs exceed those of cancer and diabetes combined. Recent evidence suggests that individualised cognitive and movement rehabilitation combined with lifestyle advice (cognitive functional therapy (CFT)) may produce larger and more sustained effects than traditional approaches, and movement sensor biofeedback may enhance outcomes. Therefore, this three-arm randomised controlled trial (RCT) aims to compare the clinical effectiveness and economic efficiency of individualised CFT delivered with or without movement sensor biofeedback, with usual care for patients with chronic, disabling LBP. METHODS AND ANALYSIS: Pragmatic, three-arm, randomised, parallel group, superiority RCT comparing usual care (n=164) with CFT (n=164) and CFT-plus-movement-sensor-biofeedback (n=164). Inclusion criteria include: adults with a current episode of LBP >3 months; sought primary care ≥6 weeks ago for this episode of LBP; average LBP intensity of ≥4 (0-10 scale); at least moderate pain-related interference with work or daily activities. The CFT-only and CFT-plus-movement-sensor-biofeedback participants will receive seven treatment sessions over 12 weeks plus a 'booster' session at 26 weeks. All participants will be assessed at baseline, 3, 6, 13, 26, 40 and 52 weeks. The primary outcome is pain-related physical activity limitation (Roland Morris Disability Questionnaire). Linear mixed models will be used to assess the effect of treatment on physical activity limitation across all time points, with the primary comparison being a formal test of adjusted mean differences between groups at 13 weeks. For the economic (cost-utility) analysis, the primary outcome of clinical effect will be quality-adjusted life years measured across the 12-month follow-up using the EuroQol EQ-5D-5L . ETHICS AND DISSEMINATION: Approved by Curtin University Human Research Ethics Committee (HRE2018-0062, 6 Feb 2018). Study

Journal article

Cowell I, McGregor A, O'Sullivan P, O'Sullivan K, Poyton R, Murtagh GMet al., How do physiotherapists solicit and explore patients' concerns in back pain consultations: a conversation analytic approach, Physiotherapy Theory and Practice, ISSN: 1532-5040

Background: Guidelines advocate that non-specific chronic low back pain (NSCLBP) be considered within a multi-dimensional bio-psychosocial (BPS) framework. This BPS approach advocates incorporating the patient’s perspective as part of the treatment process. ‘Agenda setting’ has been introduced as the key to understanding patients’ concerns in medical encounters; however, this has received little attention in physiotherapy. This study explored how physiotherapists solicit and respond to the agenda of concerns that patients’ with NSCLBP bring to initial encounters. Method: The research setting was primary care. Twenty initial physiotherapy consultations were video-recorded, transcribed and analysed using conversation analysis, a qualitative observational method. Both verbal and non-verbal features of the interaction were considered. Results: This data highlights a spectrum of communication styles ranging from more physiotherapist-focused, where the physiotherapists did not attend to patients’ concerns, to a more patient-focused style, which provided greater opportunities for patients to voice their concerns. On occasions patients were willing to pursue their own agenda when their concern was initially overlooked. Conclusion: This study provides empirical evidence on communication patterns in physiotherapy practice. A more collaborative style of communication with a shared conversational agenda provided patients with the conversational space to describe their concerns more fully.

Journal article

Favier C, McGregor A, Phillips A, 2019, Subject specific multiscale modelling for the study of lumbar pathologies, 17th International symposium on computer simulation in biomechanics, Publisher: International Society of Biomechanics

Conference paper

Sivapuratharasu B, Bull AMJ, McGregor AH, 2019, Understanding low back pain in traumatic lower limb amputees: a systematic review, Archives of Rehabilitation Research and Clinical Translation, Vol: 1, ISSN: 2590-1095

Objective: This systematic review aims to evaluate current literature for the prevalence, causes and effect of low back pain (LBP) in traumatic lower limb amputees, specifically its association with the kinematics and kinetics of the lumbar spine and lower extremities. Data Sources: Databases (EMBASE, MEDLINE, Scopus, CINAHL, and PsycINFO) were searched systematically for eligible studies from inception to January 2018. Study Selection: The inclusion terms were synonyms of ‘low back pain’, ‘lower limb amputation’, and ‘trauma’, whilst studies involving non-traumatic amputee populations, single cases or reviews were excluded. 1822 studies were initially identified, of which 44 progressed to full-text reading, and 11 studies were included in the review.Data Extraction: Two independent reviewers reviewed the included studies, which were evaluated using a quality assessment tool and the GRADE system for risk of bias, prior to analysing results and conclusions. Data Synthesis: There was a LBP prevalence of 52–64% in traumatic amputees, compared to the 48–77% in the general amputee population (predominantly vascular, tumour and trauma), attributed to a mixture of biomechanical, psycho-social and personal factors. These factors determined the presence, frequency and severity of the pain in the amputees, significantly impacting on their quality of life. However, little evidence was available on causality. Conclusion: The high prevalence of LBP in traumatic amputees highlights the necessity to advance research into the underlying mechanics behind LBP, specifically the spinal kinematics and kinetics. This may facilitate improvements in rehabilitation, with the potential to improve quality of life in traumatic amputees.

Journal article

Salman D, Farooqi M, McGregor A, Majeed Aet al., 2019, Time spent being sedentary: an emerging risk factor for poor health, British Journal of General Practice, Vol: 69, Pages: 278-279, ISSN: 0960-1643

Journal article

Lin D, Papi E, McGregor A, 2019, Exploring the clinical context of adopting an instrumented insole: a qualitative study of clinicians’ preferences in England, BMJ Open, Vol: 9, Pages: 1-8, ISSN: 2044-6055

Objectives: This study explores clinicians’ views of the clinical uptake of a smart pressure-sensing insole, named Flexifoot, to enhance the care and management of patients with osteoarthritis (OA). Clinicians are key users of wearable technologies, and can provide appropriate feedback for a specific device for successful clinical implementation.Design: Qualitative study with in-depth, semi-structured interviews, analysed using inductive analysis to generate key themes.Setting: Conducted in a University setting.Participants: 30 clinicians were interviewed (11 physiotherapists, 11 orthopaedic surgeons, 5 general practitioners, 3 podiatrists).Results: All clinicians regarded Flexifoot to be useful for the care and management of patients in adjunction to current methods. Responses revealed four main themes: use, data presentation, barriers to use, and future development. Flexifoot data was recognised as capable of enhancing information exchange between clinicians and patients, and also between clinicians themselves. Participants supported the use of feedback for rehabilitation, screening and evaluation of treatment progress/success purposes. Flexifoot use by patients was encouraged as a self-management tool that may motivate them by setting attainment goals. The data interface should be secure, concise and visually appealing. The measured parameters of Flexifoot, its duration of wear and frequency of data output would all depend on the rationale for its use. The clinicians and patients must collaborate to optimise the use of Flexifoot for long-term monitoring of disease for patient care in clinical practice. Many identified potential other uses for Flexifoot.Conclusions: Clinicians thought that Flexifoot may complement and improve current methods of long-term patient management for OA or other conditions in clinical settings. Flexifoot was recognised to be useful for objective measures and should be tailored carefully for each person and condition to maximise com

Journal article

Favier C, McGregor A, Phillips A, Full body subject specific musculoskeletal model for complex spine movements, XXVII Congress of the International Society of Biomechanics

Conference paper

Kaufmann J, Phillips A, McGregor A, Investigating bone health in lower-limb amputees, 2019 Blast Injury Conference

Conference paper

Adesida Y, Papi E, McGregor A, 2019, Exploring the role of wearable technology in sport kinematics and kinetics: a systematic review, Sensors, Vol: 19, ISSN: 1424-2818

The aim of this review was to understand the use of wearable technology in sport in order to enhance performance and prevent injury. Understanding sports biomechanics is important for injury prevention and performance enhancement and is traditionally assessed using optical motion capture. However, such approaches are limited by capture volume restricting assessment to a laboratory environment, a factor that can be overcome by wearable technology. A systematic search was carried out across seven databases where wearable technology was employed to assess kinetic and kinematic variables in sport. Articles were excluded if they focused on sensor design and did not measure kinetic or kinematic variables or apply the technology on targeted participants. A total of 33 articles were included for full-text analysis where participants took part in a sport and performed dynamic movements relating to performance monitored by wearable technologies. Inertial measurement units, flex sensors and magnetic field and angular rate sensors were among the devices used in over 15 sports to quantify motion. Wearable technology usage is still in an exploratory phase, but there is potential for this technology to positively influence coaching practice and athletes’ technique.

Journal article

Greenwood J, McGregor A, Jones F, Hurley Met al., 2019, Rehabilitation following lumbar fusion surgery (REFS) a randomised controlled feasibility study, European Spine Journal, Vol: 28, Pages: 735-744, ISSN: 0940-6719

PURPOSE: Following lumbar fusion surgery (LFS), 40% of patients are unsure/dissatisfied with their outcome. A prospective, single-centre, randomised, controlled trial was conducted to evaluate the feasibility (including clinical and economic impact) of a theoretically informed rehabilitation programme following LFS (REFS). METHODS: REFS was informed by an explicit theoretical framework and consisted of 10 consecutive weekly group rehabilitation sessions (education, low-tech cardiovascular, limb and spine strengthening exercises, and peer support). Participants were randomised to REFS or 'usual care.' Primary feasibility outcomes included recruitment and engagement. Secondary outcomes, collected preoperatively and 3, 6, and 12  months postoperatively, comprised the Oswestry disability index, European Quality of Life 5 dimensions score, pain self-efficacy questionnaire, hospital anxiety and depression scale and the aggregated functional performance time. Economic impact was evaluated with the Client Services Receipt Inventory. RESULTS: Fifty-two of 58 eligible participants were recruited, and engagement with REFS was > 95%. REFS participants achieved a clinically meaningful reduction in unadjusted mean short-term disability (- 13.27 ± 13.46), which was not observed in the 'usual care' group (- 2.42 ± 12.33). This was maintained in the longer term (- 14.72% ± 13.34 vs - 7.57 ± 13.91). Multilevel regression analyses, adjusted for body mass index, baseline depression, and smoking status reported a statistically significant short-term improvement in disability (p = 0.014) and pain self-efficacy (p = 0.007). REFS costs £275 per participant. CONCLUSIONS: Results suggest that REFS is feasible and potentially affordable for delivery in the National Health Service. It is associated with a clinically meaningful i

Journal article

Kaufmann J, Phillips A, McGregor A, Investigating bone health in lower-limb amputees, TGCS 2019 - 17th International Symposium on Computer Simulation in Biomechanics

Conference paper

Formstone L, Pucek M, Wilson S, Bentley P, McGregor A, Vaidyanathan Ret al., 2019, Myographic Information Enables Hand Function Classification in Automated Fugl-Meyer Assessment, 9th IEEE/EMBS International Conference on Neural Engineering (NER), Publisher: IEEE, Pages: 239-242, ISSN: 1948-3546

Conference paper

Cowell I, O'Sullivan P, O'Sullivan K, Poyton R, McGregor A, Murtagh Get al., 2019, The Perspectives of physiotherapists on managing non-specific low back pain following a training programme in Cognitive Functional Therapy: a qualitative study, Musculoskeletal Care, Vol: 17, Pages: 79-90, ISSN: 1478-2189

Background: It has long been acknowledged that nonspecific chronic low back pain (NSCLBP) is associated with a complex combination of biopsychosocial (BPS) factors, and recent guidelines advocate that the management of back pain should reflect this multidimensional complexity. Cognitive functional therapy (CFT) is a behaviourally oriented intervention that targets patients' individual BPS profiles. Although the efficacy of CFT has been demonstrated in primary care, little evidence exists about the training requirements of this approach.Methods: Qualitative semistructured interviews were conducted with 10 physiotherapists working in primary care, who had undergone a formal training programme in CFT. A purposive sampling method was employed to seek the broadest perspectives. Thematic analysis was used to analyse the interview transcripts and capture the emergent themes.Results: Five main themes emerged: (i) the learning challenge; (ii) self‐reported changes in confidence; (iii) self‐reported changes in communication practice; (iv) self‐reported changes in attitudes and understanding; (v) the physiotherapists felt that CFT was more effective than their usual approach for NSCLBP but identified barriers to successful implementation, which included a lack of time and difficulties in engaging patients with strong biomedical beliefs.Conclusions: The study suggested that training in CFT has the capacity to produce self‐reported changes in physiotherapists' attitudes, confidence and practice. The provision of such training has implications in terms of time and costs; however, this this may be warranted, given the physiotherapists' strong allegiance to the approach compared with their usual practice.

Journal article

Rane L, Ding Z, McGregor AH, Bull AMJet al., 2019, Deep learning for musculoskeletal force prediction, Annals of Biomedical Engineering, Vol: 47, Pages: 778-789, ISSN: 0090-6964

Musculoskeletal models permit the determination of internal forces acting during dynamic movement, which is clinically useful, but traditional methods may suffer from slowness and a need for extensive input data. Recently, there has been interest in the use of supervised learning to build approximate models for computationally demanding processes, with benefits in speed and flexibility. Here, we use a deep neural network to learn the mapping from movement space to muscle space. Trained on a set of kinematic, kinetic and electromyographic measurements from 156 subjects during gait, the network’s predictions of internal force magnitudes show good concordance with those derived by musculoskeletal modelling. In a separate set of experiments, training on data from the most widely known benchmarks of modelling performance, the international Grand Challenge competitions, generates predictions that better those of the winning submissions in four of the six competitions. Computational speedup facilitates incorporation into a lab-based system permitting real-time estimation of forces, and interrogation of the trained neural networks provides novel insights into population-level relationships between kinematic and kinetic factors.

Journal article

Kaufmann J, Phillips A, McGregor A, Investigating bone health in lower-limb amputees, ISB/ASB 2019

Conference paper

Sperry MM, Phillips ATM, McGregor AH, 2019, Lower back pain and healthy subjects exhibit distinct lower limb perturbation response strategies: a preliminary study, Journal of Back and Musculoskeletal Rehabilitation, Vol: 32, Pages: 27-35, ISSN: 1053-8127

BACKGROUND: It is hypothesized that inherent differences in movement strategies exist between control subjects and those with a history of lower back pain (LBP). Previous motion analysis studies focus primarily on tracking spinal movements, neglecting the connection between the lower limbs and spinal function. Lack of knowledge surrounding the functional implications of LBP may explain the diversity in success from general treatments currently offered to LBP patients. OBJECTIVE: This pilot study evaluated the response of healthy controls and individuals with a history of LBP (hLBP) to a postural disturbance. METHODS: Volunteers (n= 26) were asked to maintain standing balance in response to repeated balance disturbances delivered via a perturbation platform while both kinematic and electromyographic data were recorded from the trunk, pelvis, and lower limb. RESULTS: The healthy cohort utilized an upper body-focused strategy for balance control, with substantial activation of the external oblique muscles. The hLBP cohort implemented a lower limb-focused strategy, relying on activation of the semitendinosus and soleus muscles. No significant differences in joint range of motion were identified. CONCLUSIONS: These findings suggest that particular reactive movement patterns may indicate muscular deficits in subjects with hLBP. Identification of these deficits may aid in developing specific rehabilitation programs to prevent future LBP recurrence.

Journal article

Papi E, Bull A, McGregor A, 2019, Spinal segments do not move together predictably during daily activities, Gait and Posture, Vol: 67, Pages: 277-283, ISSN: 0966-6362

Background: Considering the thoracic, lumbar spine or whole spine as rigid segments has been the norm until recent studies highlighted the importance of more detailed modelling. A better understanding of the requirement for spine multi-segmental analysis could guide planning of future studies and avoid missing clinically-relevant information.Research question: This study aims to assess the correlation between adjacent spine segments movement thereby evaluating segmental redundancy in both healthy and participants with low back pain (LBP).Methods: A 3D motion capture system tracked the movement of upper and lower thoracic and lumbar spine segments in twenty healthy and twenty participants with LBP. Tasks performed included walking, sit-to-stand and lifting, repeated 3 times. 3D angular kinematics were calculated for each spine segment. Segmental redundancy was evaluated through cross-correlation (Rxy) analysis of kinematics time series and correlation of range of motion (RROM) of adjacent spine segments.Results: The upper/lower lumbar pairing showed weak correlations in the LBP group for all tasks and anatomical planes (Rxyrange:0.02–0.36) but moderate and strong correlations during walking (Rxy _frontalplane:0.4) and lifting (Rxy _sagittalplane:0.64) in the healthy group. The lower thoracic/upper lumbar pairing had weak correlations for both groups during lifting and sit-to-stand in the frontal plane and for walking (Rxy:0.01) in the sagittal plane only. The upper/lower thoracic pairing had moderate correlations during sit-to-stand in sagittal and transverse plane in patients with LBP (Rxy _sagittalplane:0.41; Rxy _transverse plane:−0.42) but weak in healthy (Rxy _sagittalplane:0.23; Rxy _transverseplane:−0.34); the contrary was observed during lifting.The majority of RROM values (55/72) demonstrated weak correlations.Significance:The results suggest that multi-segmental analysis of the spine is necessary if spine movement characteristics are to be

Journal article

Cowell I, O'Sullivan P, O'Sullivan K, Poyton R, McGregor A, Murtagh Get al., 2018, Perceptions of physiotherapists towards the management of non-specific chronic low back pain from a biopsychosocial perspective: a qualitative study, Musculoskeletal Science and Practice, Vol: 38, Pages: 113-119, ISSN: 2468-8630

BackgroundPhysiotherapists have been urged to embrace a patient-oriented biopsychosocial (BPS) framework for the management of non-specific chronic low back pain (NSCLBP). However, recent evidence suggests that providing broader BPS interventions demonstrates small differences in pain or disability compared to usual care. Little is known about how to integrate a BPS model into physiotherapy practice and the challenges it presents.ObjectiveTo explore the perceptions of physiotherapists' in primary care in England adopting a BPS approach to managing NSCLBP patients.MethodQualitative semi-structured interviews were conducted with ten physiotherapists working in primary care. A purposive sampling method was employed to seek the broadest perspectives. Thematic analysis was used to analyse the interview transcripts and capture the emergent themes.ResultsThree main themes emerged: (1) physiotherapists recognised the multi-dimensional nature of NSCLBP and the need to manage the condition from a BPS perspective, (2) addressing psychological factors was viewed as challenging due to a lack of training and guidance, (3) engaging patients to self-manage their NSCLBP was seen as a key objective.ConclusionAlthough employing a BPS approach is recognised by physiotherapists in the management of NSCLBP, this study highlights the problems of implementing evidence based guidelines recommending that psychological factors be addressed but providing limited support for this. It also supports the need to allocate more time to explore these domains in distressed individuals. Engaging patients to self-manage was seen as a key objective, which was not a straightforward process, requiring careful negotiation.

Journal article

Wong JKL, McGregor AH, 2018, Spatiotemporal gait changes in healthy pregnant women and women with pelvic girdle pain: a systematic review, Journal of Back and Musculoskeletal Rehabilitation, Vol: 31, Pages: 821-838, ISSN: 1053-8127

INTRODUCTION: Gait is affected in women with pelvic girdle pain (PGP), a musculoskeletal condition affecting 20% of pregnant women. Whilst there is evidence of spatiotemporal changes in gait during healthy pregnancy, less is known in relation to women with PGP. Appreciating gait characteristics during healthy pregnancy could inform our understanding of the role of gait in PGP. PURPOSE: The purpose of this review was to systematically analyse differences in the spatiotemporal parameters of gait in healthy pregnant women and those with PGP, and to make recommendations to improve research methods in investigating gait in PGP women. METHODS: The review was undertaken following the PRISMA guidelines. Three databases and pre-existing literature were electronically and manually searched. Study selection and data extraction were conducted by two reviewers. Quality assessment was performed using the NHLBI tool for Observational Cohort and Cross-sectional Studies. RESULTS: The search returned 2925 results. Fourteen studies were selected for data extraction. Twelve studies investigated gait in healthy pregnant women and two in PGP women. Studies employed either a cohort or cross-sectional design and used various methods to assess gait. Three, nine and two studies were high, medium and low in quality, respectively. Direct comparisons between studies were impeded due to incomparable gestational time-points investigated, in addition to variations in gait parameters and definitions used. CONCLUSION: Evidence from studies on healthy pregnant women could inform future research on PGP women, for which current evidence is scarce. We recommend the standardisation of critical factors to allow inter-study comparisons for a meta-analysis.

Journal article

Kaufmann J, Phillips A, McGregor A, Investigating bone health in lower-limb amputees, 2018 Blast Injury Conference

Conference paper

Favier C, McGregor A, Phillips A, 2018, Subject specific multiscale modelling of the lumbar spine, 14th Annual Bath Biomechanics Symposium

Conference paper

Kaufmann J, Phillips A, McGregor A, Investigating bone health in lower-limb amputees, 14th Bath Biomechanics Symposium

Conference paper

Rawson T, Sivakumaran P, Lobo R, Mahir G, Rossiter A, Levy J, McGregor A, Lupton M, Easton G, Gill Det al., 2018, Development of a web-based tool for undergraduate engagement in medical research; the ProjectPal experience, BMC Medical Education, Vol: 18, ISSN: 1472-6920

BackgroundWe report the development and evaluation of a web-based tool designed to facilitate student extra-curricular engagement in medical research through project matching students with academic supervisors.UK based university students were surveyed to explore their perceptions of undergraduate research, barriers and facilitators to current engagement. Following this, an online web-based intervention (www.ProjectPal.org) was developed to support access of students to research projects and supervisors. A pilot intervention was undertaken across a London-based university in January 2013 to February 2016. In March 2016, anonymised data were extracted from the prospective data log for analysis of website engagement and usage. Supervisors were surveyed to evaluate the website and student outputs.ResultsFifty-one students responded to the electronic survey. Twenty-four (47%) reported frustration at a perceived lack of opportunities to carry out extra-curricular academic projects. Major barriers to engaging in undergraduate research reported were difficulties in identifying suitable supervisors (33/51; 65%) and time pressures (36/51; 71%) associated with this. Students reported being opportunistic in their engagement with undergraduate research. Following implementation of the website, 438 students signed up to ProjectPal and the website was accessed 1357 times. Access increased on a yearly basis. Overall, 70 projects were advertised by 35 supervisors. There were 86 applications made by students for these projects. By February 2016, the 70 projects had generated 5 peer-review publications with a further 7 manuscripts under peer-review, 14 national presentations, and 1 national prize.ConclusionThe use of an online platform to promote undergraduate engagement with extra-curricular research appears to facilitate extra-curricular engagement with research. Further work to understand the impact compared to normal opportunistic practices in enhancing student engagement is now

Journal article

Favier C, McGregor A, Phillips A, 2018, Combined musculoskeletal and structural finite element modelling of the lumbar spine, 8th World Congress of Biomechanics

Conference paper

Papi E, Bull A, McGregor A, 2018, Is there evidence to use kinematic/kinetic measures clinically in low back pain patients? A systematic review, Clinical Biomechanics, Vol: 55, Pages: 53-64, ISSN: 0268-0033

BackgroundCurrently, there is a widespread reliance on self-reported questionnaires to assess low back pain patients. However, it has been suggested that objective measures of low back pain patients' functional status should be used to aid clinical assessment. The aim of this study is to systematically review which kinematic /kinetic parameters have been used to assess low back pain patients against healthy controls and to propose clinical kinematic/kinetic measures.MethodsPubMed, Embase and Scopus databases were searched for relevant studies. Reference lists of selected studies and hand searches were performed. Studies had to compare people with and without non-specific low back pain while performing functional tasks and report body segment/joint kinematic and/or kinetic data. Two reviewers independently identified relevant papers.FindingsSixty-two studies were included. Common biases identified were lack of assessor blinding and sample size calculation, use of samples of convenience, and poor experimental protocol standardization. Studies had small sample sizes. Range of motion maneuvers were the main task performed (33/62). Kinematic/kinetic data of different individual or combination of body segments/joints were reported among the studies, commonest was to assess the hip joint and lumbar segment motion (13/62). Only one study described full body movement. The most commonly reported outcome was range of motion. Statistically significant differences between controls and low back pain groups were reported for different outcomes among the studies. Moreover, when the same outcome was reported disagreements were noted.InterpretationThe literature to date offers limited and inconsistent evidence of kinematic/kinetic measures in low back pain patients that could be used clinically.

Journal article

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