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  • Book chapter
    Anderson KM, McGregor AH, Masouros SD, Wilken JMet al., 2023,

    Orthotics

    , Blast Injury Science and Engineering A Guide for Clinicians and Researchers Second Edition, Pages: 437-446

    Continued advances are required to address mobility limitations caused by lower extremity blast injury. Individuals who experience persistent deficits following trauma may benefit from external support and/or offloading provided by ankle foot orthoses (AFOs). Currently available AFOs vary widely in their design and potential benefit. Carbon fibre custom dynamic ankle foot orthoses (CDOs) have been increasingly used to improve mobility after traumatic injury. CDOs are made predominantly from carbon fibre and are intended to restore function across a range of daily and high-energy activities. Patient-reported outcomes, physical performance measures, and biomechanics data from studies focusing on CDO use have demonstrated positive outcomes. CDOs consist of a proximal cuff, posterior carbon fibre strut, and footplate, which can be tuned to meet the needs of the patient. Available literature provides guidance related to key design considerations during the fitting process. Further, intensive training when combined with the CDO has been found to enhance clinical outcomes and facilitate successful return to high-energy activity. A majority of available data related to CDO use following limb trauma is focused on a subset of military personnel, and available civilian data is limited.
  • Book chapter
    Kaufmann JJ, McMenemy L, Phillips ATM, McGregor AHet al., 2023,

    Bone Health in Lower-Limb Amputees

    , Blast Injury Science and Engineering A Guide for Clinicians and Researchers Second Edition, Pages: 479-488

    Bone mineral density (BMD) loss in lower-limb amputees has in the past been referred to as either osteopenia or osteoporosis. However, evidence and hypotheses in emerging literature are beginning to challenge this, suggesting that the use of these terms could be inappropriate due to key differences in the aetiology and mechanisms underpinning the bone loss in the younger amputee population. Computational and clinical analysis carried out within the Centre for Blast Injury Studies at Imperial College London and the ADVANCE Study has provided strong evidence to support this stance. Investigating BMD discordance in the spine and femur of 153 lower-limb amputees and a frequency-matched control population has shown that bone loss in amputees is localised to the amputated limb rather than systemic (as it manifests in age-related osteoporosis). Combined musculoskeletal and finite element modelling goes some way to explaining the cause of this. Weight bearing through a prosthetic socket offloads the distal femur, and consequently large areas of the femoral shaft and neck experience significantly reduced levels of stimulation when compared to weight bearing on a healthy limb. The long-term result of this is a phenomenon that we refer to as unloading osteopenia.
  • Book chapter
    Hopkins M, McMenemy L, Turner S, McGregor AHet al., 2023,

    Sockets and Residuum Health

    , Blast Injury Science and Engineering A Guide for Clinicians and Researchers Second Edition, Pages: 447-478

    Major limb amputation affects millions of people worldwide and became a common procedure in the latter years of the conflicts in Afghanistan and Iraq. Prosthetic devices are commonly introduced to lower-limb amputees to assist with mobility and functionality. Despite vast leaps in the technology of lower-limb prostheses, acceptance of a prosthesis is limited by the quality of interfacing between the residuum and the device. No single design fits all, and production of a socket is a complex task, requiring significant skill and expertise from the prosthetist. The fit and pressure distribution of the socket can significantly impact the health of the soft tissue, leading to conditions such as pressure sores if not properly managed. The residuum-socket interface is further complicated by natural volume fluctuations of the limb, issues with thermoregulation, infections and musculoskeletal pathologies. Researchers, clinicians and industry have attempted to better understand and inform optimal socket fit through computational and hardware methods, and surgical techniques such as direct skeletal fixation have been proposed to bypass the socket altogether. This chapter explores the nature of the prosthetic socket, common issues users present and methods to improve the interface between the residual limb and the prosthesis.
  • Book chapter
    McGregor AH, 2023,

    Section Overview

    , Blast Injury Science and Engineering A Guide for Clinicians and Researchers Second Edition

    This section builds on the journey of blast injury and the success of work to prevent and mitigate injury and the success of our clinical management of blast injuries. This short overview describes some of the factors that are discussed in the following chapters relating to long-term quality of life for survivors of blast injuries.
  • Book chapter
    Silverman AK, Hendershot BD, McGregor AH, 2023,

    Musculoskeletal Health After Blast Injury

    , Blast Injury Science and Engineering A Guide for Clinicians and Researchers Second Edition, Pages: 489-497

    Rehabilitation after blast injury is critical for regaining mobility and functional independence. In addition to immediate rehabilitation goals to facilitate activities of daily living, rehabilitation should address movement patterns and prosthetic interventions that mitigate long-term secondary (musculoskeletal) conditions. For example, after limb loss, which is a common result of blast trauma, people experience disproportionately high rates of osteoarthritis and low back pain relative to the general population. These conditions often develop and/or deteriorate over time and can have detrimental effects on mobility and quality of life. In this chapter, we describe and summarise existing knowledge of these musculoskeletal conditions secondary to blast injuries that include limb loss. Relationships between movement strategies and biomechanical outcomes are also discussed. While many musculoskeletal health conditions are multifactorial in onset and progression, these conditions are strongly related to movement biomechanics, and thus can be mitigated through rehabilitation approaches. Specifically, rehabilitation strategies that balance immediate goals of clinical outcomes and community engagement with long-term goals of healthy joint mechanics are critical for this population. In addition, rehabilitation and prosthetic interventions should be continually monitored and delivered so that they appropriately account for movement adaptations and changing mobility needs of the individual.
  • Journal article
    Barrie A, Kent B, Supra Man Collaborative, 2023,

    Supracondylar elbow fracture management (Supra Man) : a national trainee collaborative evaluation of practice.

    , Bone Joint J, Vol: 105-B, Pages: 82-87

    AIMS: Management of displaced paediatric supracondylar elbow fractures remains widely debated and actual practice is unclear. This national trainee collaboration aimed to evaluate surgical and postoperative management of these injuries across the UK. METHODS: This study was led by the South West Orthopaedic Research Division (SWORD) and performed by the Supra Man Collaborative. Displaced paediatric supracondylar elbow fractures undergoing surgery between 1 January 2019 and 31 December 2019 were retrospectively identified and their anonymized data were collected via Research Electronic Data Capture (REDCap). RESULTS: A total of 972 patients were identified across 41 hospitals. Mean age at injury was 6.3 years (1 to 15), 504 were male (52%), 583 involved the left side (60%), and 538 were Gartland type 3 fractures (55%). Median time from injury to theatre was 16 hours (interquartile range (IQR) 6.6 to 22), 300 patients (31%) underwent surgery on the day of injury, and 91 (9%) underwent surgery between 10:00 pm and 8:00 am. Overall, 910 patients (94%) had Kirschner (K)-wire) fixation and these were left percutaneous in 869 (95%), while 62 patients (6%) had manipulation under anaesthetic (MUA) and casting. Crossed K-wire configuration was used as fixation in 544 cases (59.5%). Overall, 208 of the fixation cases (61%) performed or supervised by a paediatric orthopaedic consultant underwent lateral-only fixation, whereas 153 (27%) of the fixation cases performed or supervised by a non-paediatric orthopaedic consultant used lateral-only fixation. In total, 129 percutaneous wires (16%) were removed in theatre. Of the 341 percutaneous wire fixations performed or supervised by a paediatric orthopaedic consultant, 11 (3%) underwent wire removal in theatre, whereas 118 (22%) of the 528 percutaneous wire fixation cases performed or supervised by a non-paediatric orthopaedic consultant underwent wire removal in theatre. Four MUA patients (6%) and seven K-wire fixation patients (0.
  • Journal article
    Newington L, Alexander C, Kirby P, Saggu R, Wells Met al., 2022,

    Reflections on contributing to health research: A qualitative interview study with research participants and patient advisors

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

    Objectives:The aims of this study were to explore individuals’ experiences of contributing to health research and to identify the types of impact that are perceived as important by participants or patient and public advisors. Specifically, research led by NMAHPP clinicians (Nursing, Midwifery, Allied health professions, Healthcare science, Psychology and Pharmacy).Methods:Semi-structured one-to-one interviews were conducted with health research participants and patient or public advisors. Interviewees were recruited from five UK sites and via social media. Interview transcripts were analysed using Thematic Analysis to identify key themes and areas of disagreement.Results:Twenty-one interviews were completed, and four main themes were identified. The first, optimising research experiences, included personal reflections and broader recommendations to improve participant experiences. The second, connecting health research with healthcare, described research as key for the continued development of healthcare, but illustrated that communication between research teams, participants, and clinicians could be improved. The third theme explored the personal impacts of contributing to research, with interviewees recalling common positive experiences. The final theme discussed capturing research impacts. Interviewees highlighted potential priorities for different stakeholders, but emphasised that financial impacts should not be the sole factor.Conclusion:Individuals who were involved in NMAHPP health research recalled positive experiences and reported good relationships with their research teams. They felt that their contributions were valued. Suggested strategies to optimise the research experience focused on simplifying documentation, clear signposting of the research activities involved, and feedback on the research findings. Routine sharing of relevant research data with clinicians was also recommended. Personal impacts included a deeper understanding of their health
  • Journal article
    Bottle A, Liddle A, 2022,

    Hip fracture in the COVID-19 era: what can we say about care and patient outcomes?

    , BMJ Quality & Safety, Vol: 32, Pages: 244-246, ISSN: 2044-5423
  • 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
    Behforootan S, Thorniley M, Minonzio J-G, Boughton O, Karia M, Bhattacharya R, Hansen U, Cobb J, Abel Ret al., 2022,

    Can guided wave ultrasound predict bone mechanical properties at the femoral neck in patients undergoing hip arthroplasty?

    , Journal of the Mechanical Behavior of Biomedical Materials, Vol: 136, ISSN: 1751-6161

    The bone quality of patients undergoing hip replacement surgery is poorly predicted by radiographs alone. With better bone quality information available to a surgeon, the operation can be performed more safely. The aim of this study was to investigate whether ultrasound signals of cortical bone at peripheral sites such as the tibia and radius can be used to predict the compressive mechanical properties of cortical bone at the femoral neck.We recruited 19 patients undergoing elective hip arthroplasty and assessed the radius and tibia of these patients with the Azalée guided wave ultrasound to estimate the porosity and thickness of the cortex. Excess bone tissues were collected from the femoral neck and the compressive mechanical properties of the cortex were characterised under a mechanical loading rig to determine stiffness, ultimate strength, and density. The correlations between the ultrasound measurements and mechanical properties were analysed using linear regression, Pearson correlation statistics, and multiple regression analysis.Cortical mechanical properties were weakly to moderately correlated with the ultrasound measurements at various sites (R2 = 0.00–0.36). The significant correlations found were not consistent across all 4 peripheral measurement sites. Additionally, weak to moderate ability of the ultrasound to predict mechanical properties at the neck of femur with multiple regression analysis was found (R2 = 0.00–0.48). Again, this was inconsistent across the different anatomical sites. Overall, the results demonstrate the need for ultrasound scans to be collected directly from clinically relevant sites such as the femoral neck due to the inconsistency of mechanical properties across various sites.
  • 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
    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
    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

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