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

220 results found

Deane JA, Pavlova A, Lim A, Gregory J, Aspden R, McGregor Aet al., 2020, Is intrinsic lumbar spine shape associated with Lumbar Disc Degeneration? An exploratory study, BMC Musculoskeletal Disorders, Vol: 21, Pages: 1-10, ISSN: 1471-2474

Background: Lumbar disc degeneration (LDD) is a condition associated with recurrentlow back pain (LBP). Knowledge regarding effective management is limited. As a steptowards the identification of risk, prognostic or potentially modifiable factors in LDDpatients, the aim of this study was to explore the hypothesis that intrinsic lumbar spineshape is associated with LDD and clinical outcomes in symptomatic adults. Methods: 3T MRI was used to acquire T2-weighted sagittal images (L1-S1) from 70healthy controls and LDD patients (mean age 49 years, SD 11, range 31-71years). Statistical Shape Modelling (SSM) was used to describe lumbar spine shape.SSM identified variations in lumbar shape as ‘modes’ of variation and quantifieddeviation from the mean. Intrinsic shape differences were determined between LDDgroups using analysis of variance with post-hoc comparisons. The relationshipbetween intrinsic shape and self-reported function, mental health and quality of lifewere also examined.Results: The first 7 modes of variation explained 91% of variance in lumbarshape. Higher LDD sum scores correlated with a larger lumbar lordosis (Mode 1 (55%variance), P=0.02), even lumbar curve distribution (Mode 2 (12% variance), P=0.05),larger anterior-posterior (A-P) vertebral diameter (Mode 3 (10% variance), P=0.007)and smaller L4-S1 disc spaces (Mode 7 (2% variance), P≤0.001). In the presence ofrecurrent LBP, LDD was associated with a larger A-P vertebral diameter (Mode 3) anda more even lumbar curvature with smaller L5/S1 disc spaces (Mode 4), which wassignificantly associated with patient quality of life (P=0.002-0.04, r p =0.43-0.61)).Conclusions: This exploratory study provides new evidence that intrinsic shapephenotypes are associated with LDD and quality of life in patients. Longitudinalstudies are required to establish the potential role of these risk or prognostic shapephenotypes.

Journal article

Turner S, McGregor A, 2020, Perceived impact of socket fit on major lower limb prosthetic rehabilitation: a clinician and amputee perspective, Archives of Rehabilitation Research and Clinical Translation, ISSN: 2590-1095

ObjectiveTo determine amputees’ and rehabilitation clinicians’ perspectives on the impact of socket fit and issues caused by ill-fitting sockets throughout lower limb prosthetic rehabilitation.DesignA survey was developed to identify rehabilitation factors and issues for prosthesis wearers and rehabilitation clinicians. Participants opted to participate in a further telephone interview.SettingOnline and across the United Kingdom.ParticipantsLower limb prosthetic wearers and clinicians that are part of a lower limb prosthetic rehabilitation team.InterventionsNot applicable.Main Outcome Measure(s)A survey and an interview to measure the perceived impact of socket fit on lower limb rehabilitation.Results48.0% of amputees and 65.7% of clinicians identified socket fit related issues as the biggest factor impacting rehabilitation. Amputee interviewees focused on the impact of fit on quality of life and the ability to complete daily tasks, whilst clinicians focused on the lack of widespread ability to adjust the socket and gait re-education.ConclusionsSocket fit has a large impact on and is a large source of frustration to amputees and their clinical teams throughout rehabilitation. From the interviews, it became clear that the interpretation of socket fit is different for each person; thus “socket fit” does not mean the same for all.

Journal article

Clunie G, Belsi A, Roe J, Alexander C, Sandhu G, McGregor Aet al., 2020, Not Just Dyspnoea – Swallowing as a Concern for Adults with Laryngotracheal Stenosis Who Undergo Reconstructive Surgery?, UK Swallowing Research Group 2020 Conference

Conference paper

Aldera M, Alexander C, McGregor A, 2020, Prevalence and incidence of low back pain in the Kingdom of Saudi Arabia: a systematic review, Journal of Epidemiology and Global Health, ISSN: 2210-6006

Study Design: A systematic review.Objective: To identify published studies that assess the prevalence and incidence of Low Back Pain (LBP) in the Saudi Arabian population.Methods: Six electronic databases were searched for articles published between January 1995 and December 2018. Crosssectional or cohort studies were included if they were conducted in the KSA and focused on the prevalence or incidence of LBP in adults. Case–control and retrospective studies were excluded. Studies were also excluded if they did not meet the quality criteria set out by the Joanna Briggs Institute (JBI) assessment or had a high or medium risk of bias according to the criteria proposed by Hoy et al. One independent reviewer (MAA) verified that the studies met the inclusion criteria, and three independent reviewers (MAA, AHM, CMA) assessed the quality of the studies and extracted their relevant characteristics. All the studies were assessed for quality using the JBI assessment and were assessed for risk of bias according to the Hoy et al. approach.Results: The initial search identified 158 papers; five studies met the inclusion criteria. The nature of the findings meant no meta-analysis could be performed; therefore, a narrative summary was generated to discuss the findings. The prevalence of LBP in different professional groups within a working-age group ranged between 64% and 89%.Discussion: The prevalence of LBP in the KSA has only been examined within specific professional groups, which limits the ability to generalize the finding. The review clarifies the need for further quality epidemiological studies to identify the prevalence of LBP in the general population. Many of the issues identified are problems related to occupational risk of LBP. The implication therefore is that these occupational factors need to be assessed so that risk factors for LBP among employees in KSA can be modified.

Journal article

Hopkins M, Vaidyanathan R, McGregor AH, 2020, Examination of the performance characteristics of velostat as an in-socket pressure sensor, IEEE Sensors Journal, Vol: 20, Pages: 6992-7000, ISSN: 1530-437X

Velostat is a low-cost, low-profile electrical bagging material with piezoresistive properties, making it an attractive option for in-socket pressure sensing. The focus of this research was to explore the suitability of a Velostat-based system for providing real-time socket pressure profiles. The prototype system performance was explored through a series of bench tests to determine properties including accuracy, repeatability and hysteresis responses, and through participant testing with a single subject. The fabricated sensors demonstrated mean accuracy errors of 110 kPa and significant cyclical and thermal drift effects of up to 0.00715 V/cycle and leading to up to a 67% difference in voltage range respectively. Despite these errors the system was able to capture data within a prosthetic socket, aligning to expected contact and loading patterns for the socket and amputation type. Distinct pressure maps were obtained for standing and walking tasks displaying loading patterns indicative of posture and gait phase. The system demonstrated utility for assessing contact and movement patterns within a prosthetic socket, potentially useful for improvement of socket fit, in a low cost, low profile and adaptable format. However, Velostat requires significant improvement in its electrical properties before proving suitable for accurate pressure measurement tools in lower limb prosthetics.

Journal article

Tukanova K, Papi E, Jamel S, Hanna GB, McGregor AH, Markar SRet al., 2020, Assessment of chest wall movement following thoracotomy: a systematic review, JOURNAL OF THORACIC DISEASE, Vol: 12, Pages: 1031-+, ISSN: 2072-1439

Journal article

Papi E, Bull AMJ, McGregor AH, 2020, Alteration of movement patterns in low back pain assessed by Statistical Parametric Mapping, Journal of Biomechanics, Vol: 100, 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

Clunie G, Roe J, Alexander C, Sandhu G, McGregor Aet al., 2020, 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., 2020, What is the clinical value of mHealth for patients?, npj Digital Medicine, Vol: 3, Pages: 1-6, 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

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., 2019, 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

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

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

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, 2019, 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, 2019, 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, 2019, 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, 2019, 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

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