Imperial College London

ProfessorAlisonMcGregor

Faculty of MedicineDepartment of Surgery & Cancer

Professor of Musculoskeletal Biodynamics
 
 
 
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Contact

 

+44 (0)20 3313 8831a.mcgregor

 
 
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Location

 

Biodynamics LabCharing Cross HospitalCharing Cross Campus

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Summary

 

Publications

Publication Type
Year
to

199 results found

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.

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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

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Sivapuratharasu B, McGregor AH, Bull AMJ, Understanding low back pain in traumatic lower limb amputees: a systematic review, Archives of Rehabilitation Research and Clinical Translation, 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.

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Lin D, Papi E, McGregor A, Exploring the clinical context of adopting an instrumented insole: a qualitative study of clinicians’ preferences in England, BMJ Open, 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

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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.

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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.

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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

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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

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

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Rane L, Ding Z, McGregor AH, Bull AMJet al., Deep learning for musculoskeletal force prediction, Annals of Biomedical Engineering, 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.

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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.

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

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Sperry MM, Phillips ATM, McGregor AH, 2018, Lower back pain and healthy subjects exhibit distinct lower limb perturbation response strategies: a preliminary study, Journal of Back and Musculoskeletal Rehabilitation, 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.

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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

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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.

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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, 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.

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Papi E, Bo YN, McGregor A, 2018, A flexible wearable sensor for knee flexion assessment during gait, Gait and Posture, Vol: 62, Pages: 480-483, ISSN: 0966-6362

Background:Gait analysis plays an important role in the diagnosis and management of patients with movement disorders but it is usually performed within a laboratory. Recently interest has shifted towards the possibility of conducting gait assessments in everyday environments thus facilitating long-term monitoring. This is possible by using wearable technologies rather than laboratory based equipment.Research questionThis study aims to validate a novel wearable sensor system’s ability to measure peak knee sagittal angles during gait.Methods:The proposed system comprises a flexible conductive polymer unit interfaced with a wireless acquisition node attached over the knee on a pair of leggings. Sixteen healthy volunteers participated to two gait assessments on separate occasions. Data was simultaneously collected from the novel sensor and a gold standard 10 camera motion capture system. The relationship between sensor signal and reference knee flexion angles was defined for each subject to allow the transformation of sensor voltage outputs to angular measures (degrees). The knee peak flexion angle from the sensor and reference system were compared by means of root mean square error (RMSE), absolute error, Bland-Altman plots and intra-class correlation coefficients (ICCs) to assess test-retest reliability.Results:Comparisons of knee peak flexion angles calculated from the sensor and gold standard yielded an absolute error of 0.35(±2.9°) and RMSE of 1.2(±0.4)°. Good agreement was found between the two systems with the majority of data lying within the limits of agreement. The sensor demonstrated high test-retest reliability (ICCs>0.8).Significance:These results show the ability of the sensor to monitor knee peak sagittal angles with small margins of error and in agreement with the gold standard system. The sensor has potential to be used in clinical settings as a discreet, unobtrusive wearable device allowing for long-term gait analysis.

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Karia M, Masjedi M, Duffell L, Kotti M, McGregor Aet al., 2018, Comparison of gait biomechanics in patients with and without knee osteoarthritis during different phases of gait, Journal of Orthopaedics, Trauma and Rehabilitation, Vol: 25, Pages: 11-15, ISSN: 2210-4917

Background: This study aimed to characterise knee adduction angles (KAA) and knee adduction moments (KAM) and compare this with foot centre of pressure (COP) in volunteers with and without knee osteoarthritis (OA). Methods: A total of 108 participants were recruited; 84 had no known pathology, 18 had medial knee OA, and six had lateral knee OA. Linear regression was used to determine correlations between the normalised COP, KAM, and KAA during each phase of gait for all participants. Results: The first phase of gait demonstrated significant differences between groups for all measures: KAA in all phases, COP in phases one and two, and KAM in phase one only. Conclusion: The largest mechanical changes are seen in the first phase of gait in osteoarthritic patients. Although COP is an easy to measure tool, it is not as sensitive as KAA and did not demonstrate a significant difference between healthy and medial OA patients.

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Green A, Salman M, Yentis S, McGregor Aet al., 2018, Staff perceptions of activity on labour ward, Winter Scientific Meeting (WSM) of the Association-of-Anaesthetists-of-Great-Britain-and-Ireland (AAGBI), Publisher: WILEY, Pages: 73-73, ISSN: 0003-2409

CONFERENCE PAPER

Papi E, Koh WS, McGregor AH, 2017, Wearable technology for spine movement assessment: A systematic review, Journal of Biomechanics, Vol: 64, Pages: 186-197, ISSN: 0021-9290

Continuous monitoring of spine movement function could enhance our understanding of low back pain development. Wearable technologies have gained popularity as promising alternative to laboratory systems in allowing ambulatory movement analysis. This paper aims to review the state of art of current use of wearable technology to assess spine kinematics and kinetics.Four electronic databases and reference lists of relevant articles were searched to find studies employing wearable technologies to assess the spine in adults performing dynamic movements. Two reviewers independently identified relevant papers. Customised data extraction and quality appraisal form were developed to extrapolate key details and identify risk of biases of each study. Twenty-two articles were retrieved that met the inclusion criteria: 12 were deemed of medium quality (score 33.4-66.7%), and 10 of high quality (score> 66.8%). The majority of articles (19/22) reported validation type studies. Only 6 reported data collection in real-life environments. Multiple sensors type were used: electrogoniometers (3/22), strain gauges based sensors (3/22), textile piezoresistive sensor (1/22) and accelerometers often used with gyroscopes and magnetometers (15/22). Two sensors units were mainly used and placing was commonly reported on the spine lumbar and sacral regions. The sensors were often wired to data transmitter/logger resulting in cumbersome systems. Outcomes were mostly reported relative to the lumbar segment and in the sagittal plane, including angles, range of motion, angular velocity, joint moments and forces.This review demonstrates the applicability of wearable technology to assess the spine, although this technique is still at an early stage of development.

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Favier C, McGregor A, Phillips A, Development of a combined MSK and FEA model of the lower back, 13th Annual Bath Biomechanics Symposium

CONFERENCE PAPER

Green A, Salman M, Yentis S, McGregor Aet al., 2017, Trainer/trainee trainer training, Association-of-Anaesthetists-of-Great-Britain-and-Ireland (AAGBI) GAT Annual Scientific Meeting, Publisher: WILEY, Pages: 81-81, ISSN: 0003-2409

CONFERENCE PAPER

Duffell LD, Jordan SJ, Cobb JP, McGregor AHet al., 2017, Gait adaptations with aging in healthy participants and people with knee joint osteoarthritis, Gait and Posture, Vol: 57, Pages: 246-251, ISSN: 0966-6362

The relationship between age and gait characteristics in people with and without medial compartment osteoarthritis (OA) remains unclear. We aimed to characterize this relationship and to relate biomechanical and structural parameters in a subset of OA patients. Twenty five participants with diagnosed unilateral medial knee OA and 84 healthy participants, with no known knee pathology were recruited. 3D motion capture was used to analyse sagittal and coronal plane gait parameters while participants walked at a comfortable speed. Participants were categorized according to age (18–30, 31–59 and 60+ years), and those with and without OA were compared between and within age groups. In a subset of OA patients, clinically available Computed Tomography images were used to assess joint structure. Differences in coronal plane kinematics at the hip and knee were noted in participants with OA particularly those who were older compared with our healthy controls, as well as increased knee moments. Knee adduction moment correlated with structural parameters in the subset of OA patients. Increased knee moments and altered kinematics were observed in older participants presenting with OA only, which seem to be related to morphological changes in the joint due to OA, as opposed to being related to the initial cause of medial knee OA.

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Long MJ, Papi E, Duffell LD, McGregor AHet al., 2017, Predicting knee osteoarthritis risk in injured populations, Clinical Biomechanics, Vol: 47, Pages: 87-95, ISSN: 1879-1271

BackgroundIndividuals who suffered a lower limb injury have an increased risk of developing knee osteoarthritis. Early diagnosis of osteoarthritis and the ability to track its progression is challenging. This study aimed to explore links between self-reported knee osteoarthritis outcome scores and biomechanical gait parameters, whether self-reported outcome scores could predict gait abnormalities characteristic of knee osteoarthritis in injured populations and, whether scores and biomechanical outcomes were related to osteoarthritis severity via Spearman's correlation coefficient.MethodsA cross-sectional study was conducted with asymptomatic participants, participants with lower-limb injury and those with medial knee osteoarthritis. Spearman rank determined relationships between knee injury and outcome scores and hip and knee kinetic/kinematic gait parameters. K-Nearest Neighbour algorithm was used to determine which of the evaluated parameters created the strongest classifier model.FindingsDifferences in outcome scores were evident between groups, with knee quality of life correlated to first and second peak external knee adduction moment (0.47, 0.55). Combining hip and knee kinetics with quality of life outcome produced the strongest classifier (1.00) with the least prediction error (0.02), enabling classification of injured subjects gait as characteristic of either asymptomatic or knee osteoarthritis subjects. When correlating outcome scores and biomechanical outcomes with osteoarthritis severity only maximum external hip and knee abduction moment (0.62, 0.62) in addition to first peak hip adduction moment (0.47) displayed significant correlations.InterpretationThe use of predictive models could enable clinicians to identify individuals at risk of knee osteoarthritis and be a cost-effective method for osteoarthritis screening.

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McGregor AH, 2017, Injury prevention, performance and return to sport: How can science help?, Chinese Journal of Traumatology, Vol: 20, Pages: 63-66, ISSN: 1008-1275

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Kotti M, Duffell LD, Faisal AA, McGregor AHet al., 2017, Detecting knee osteoarthritis and its discriminating parameters using random forests, Medical Engineering and Physics, Vol: 43, Pages: 19-29, ISSN: 1350-4533

This papertackles the problem of automatic detection of knee osteoarthritis. A computer system is built that takes as input the body kinetics and produces as output not only an estimation of presence of the knee osteoarthritis,as previouslydone inthe literature, but alsothe most discriminating parameters along with a set of rules on how this decision was reached.This fills the gap of interpretability between the medical and the engineering approaches. We collected locomotion data from 47 subjects with knee osteoarthritis and 47 healthy subjects.Osteoarthritis subjects were recruited from hospital clinics and GP surgeries, and age and sex matched heathy subjects from the local community. Subjects walked on a walkway equippedwith two force plates with piezoelectric 3-component force sensors. Parameters of the vertical, anterior-posterior, and medio-lateral ground reaction forces, such asmean value, push-off time, and slope,were extracted. Then random forest regressors map thoseparameters via rule induction to the degree of knee osteoarthritis.To boost generalisation ability,a subject-independent protocol is employed.The 5-fold cross-validated accuracy is 72.61%±4.24%. We show that with 3 steps or lessa reliable clinical measure can be extractedin a rule-based approachwhen the dataset is analysed appropriately.

JOURNAL ARTICLE

Green A, Salman M, Yentis S, McGregor Aet al., 2017, Ergonomics and posture of midwives, obstetricians and anaesthetists on labour ward, Anaesthesia, Vol: 72, Pages: 82-82, ISSN: 0003-2409

Awkward body postures and the progressive accumulation of muscle fatigue are known risk factors for the development of injury, with most work-related musculoskeletal disorders developing over time [1]. Work-related disorders can develop while carrying out normal physical work activities and are associated with fixed or constrained body positions and continual repetition of movements [1]. Heavy workloads on the maternity unit often require staff to perform physically demanding activities under pressure and adopt suboptimal postures. Simple ergonomic intervention such as providing suitable adjustable seating and the appropriate layout of equipment can reduce injuries, reduce sickness absence and improve productivity [2].

JOURNAL ARTICLE

Green A, Salman M, Yentis S, McGregor Aet al., 2017, Musculoskeletal aches and pains reported by labour ward staff, Anaesthesia, Vol: 72, Pages: 82-82, ISSN: 0003-2409

Awkward body postures and the progressive accumulation of muscle fatigue are known risk factors for the development of injury, with most work-related musculoskeletal disorders developing over time [1]. Work-related disorders can develop while carrying out normal physical work activities and are associated with fixed or constrained body positions and continual repetition of movements [1]. Heavy workloads on the maternity unit often require staff to perform physically demanding activities under pressure and adopt suboptimal postures. Simple ergonomic intervention such as providing suitable adjustable seating and the appropriate layout of equipment can reduce injuries, reduce sickness absence and improve productivity [2].

JOURNAL ARTICLE

Deane JA, Mcgregor A, 2016, Current and Future Perspectives on Lumbar Degenerative Disc Disease: a UK survey exploring specialist multidisciplinary clinical opinion., BMJ Open, Vol: 6, ISSN: 2044-6055

Objectives: Despite lumbar degenerative disc disease (LDDD) being significantly associatedwith non-specific low back pain and effective treatment remaining elusive, specialistmultidisciplinary clinical stakeholder opinion remains unexplored. The present studyexamines the views of such experts.Design: A reliable and valid electronic survey was designed to establish trends usingtheoretical constructs relating to current assessment and management practices. Cliniciansfrom the Society of Back Pain Research (SBPR) U.K. were invited to take part. Quantitativedata was collated and coded using Bristol On-line Surveys (BOS) software, and contentanalysis used to systematically code and categorise qualitative data.Setting: Specialist multidisciplinary spinal interest group in the U.K.Participants: 38/141 clinically active, multidisciplinary SBPR members with specialistspinal interest participated. 84% had greater than 9 years postgraduate clinical experience.Interventions: NoneOutcome Measures: Frequency distributions were used to establish general trends inquantitative data. Qualitative responses were coded and categorised in relation to each themeand percentage responses calculated.Results: LDDD symptom recurrence, in the absence of psychosocial influence, wasassociated with physical signs of joint stiffness (26%), weakness (17%), joint hypermobility(6%), while physical factors (21%) and the ability to adapt (11%) were postulated as reasonswhy some experience pain and others do not. No one management strategy was supportedexclusively or with consensus. Regarding effective modalities, there was no significantdifference between AHP and Medic responses (p= 0.1-0.9). The future of LDDD care wasexpressed in terms of improvements in patient communication (35%), patient education(38%) and treatment stratification (24%).

JOURNAL ARTICLE

McGregor AH, 2016, Sports innovation in the journey towards rowing gold: Enhancement of performance and well being, Sports Innovation, Technology and Research, Pages: 31-38, ISBN: 9781786340412

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