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64
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Introduction
I am dedicated to finding the causes of why pain becomes persistent and how pain leads to disability, and also how analgesic physical interventions might work; their mechanisms of action. My research focuses on how physical actions (e.g. tissue injury, exercise, or hands-on interventions) interact with internal bio-physical and psychological processes, and how these are measured. My ultimate aim is to better match treatments to patients through the identification of active mechanistic pathways.
Additional affiliations
September 2008 - September 2009
September 2001 - May 2007
September 1999 - present
Publications
Publications (64)
Background:
Low back pain is a common health complaint resulting in substantial economic burden. Each year, upwards of 20 randomised controlled trials (RCTs) evaluating interventions for non-specific low back pain are published. Use of the term non-specific low back pain has been criticised on the grounds of encouraging heterogeneity and hampering...
Importance
Serious traumatic injury is a leading cause of death and disability globally, with most survivors known to develop chronic pain.
Objective
To describe early variables associated with poor long-term outcome for posttrauma pain and create a clinical screening tool for this purpose.
Design, Setting, and Participants
This was a prospective...
For manipulation, this paper addresses arguably the most fundamental question that can be asked about any therapeutic intervention: what is it ? In answering this question, this paper presents the prevailing model of joint manipulation (of Sandoz) and explains why this influential model is fundamentally flawed. The early research on ‘joint cracking...
Background
Definitions are important in healthcare. Unfortunately, problems can be found with all existing definitions of manipulation.
Methods
This paper derives a set of eligibility criteria from prior definitions of manipulation to inform what should (and should not) be incorporated within a valid definition. These criteria were then used to...
Background
Disability is an important multifaceted construct. A brief, generic self-reported disability questionnaire that promises a broader and more comparable measure of disability than disease-specific instruments does not currently exist. The aim of this study was to develop and evaluate such a questionnaire: the Universal Disability Index (UD...
Abstract
Introduction Patellar tendinopathy (PT) rehabilitation programmes frequently incorporate eccentric exercise (EE), where participants have limited control over the range of motion, speed, force production and load. Newly developed training protocols that employ visual feedback with specialised devices offer controlled management of loads, s...
[This corrects the article DOI: 10.1371/journal.pone.0276983.].
Large language models (LLMs) provide powerful means to leverage prior knowledge for predictive modeling when data is limited. In this work, we demonstrate how LLMs can use their compressed world knowledge to generate intrinsically interpretable machine learning models, i.e., decision trees, without any training data. We find that these zero-shot de...
Background
Spinal manipulation (SM) has been claimed to change anatomy, either in structure or position, and that these changes may be the cause of clinical improvements. The aim of this systematic review was to evaluate and synthesise the peer-reviewed literature on the current evidence of anatomical changes in response to SM.
Methods
The review...
Background
Disability is an important multifaceted construct. The aim of this study was to develop and evaluate a brief, generic self-reported disability questionnaire: the Universal Disability Index (UDI).
Methods
Convenience sampling was used to collect general population data via an online survey. Data were randomly divided into training and va...
Background
Disability is an important multifaceted construct. Identifying sources of disability could help optimise patient care. The aim of this study was to test an approach that not only estimates severity of disability, but also identifies the source(s) of this disability.
Methods
An online survey was used to collect data from a convenience sa...
Background: Pressure pain threshold (PPT) measurements require standardised verbal instructional cues to ensure that the increasing pressure is stopped at the correct time consistently. This study aimed to compare how PPT values and their test-retest reliability were affected by different instructional cues. Methods: At two separate sessions, two P...
Background
Lumbar mobility is regarded as important for assessing and managing low back pain (LBP). Inertial Measurement Units (IMUs) are currently the most feasible technology for quantifying lumbar mobility in clinical and research settings. However, their gyroscopes are susceptible to drift errors, limiting their use for long-term remote monitor...
Background
Musculoskeletal conditions are the leading contributor to global disability and health burden. Manual therapy (MT) interventions are commonly recommended in clinical guidelines and used in the management of musculoskeletal conditions. Traditional systems of manual therapy (TMT), including physiotherapy, osteopathy, chiropractic, and sof...
Wearable sensors like inertial measurement units (IMUs), and those available as smartphone or smartwatch applications, are increasingly used to quantify lumbar mobility. Currently, wearable sensors have to be placed on the back to measure lumbar mobility, meaning it cannot be used in unsupervised environments. This study aims to compare lumbar sagi...
Introduction:
The Tampa Scale of Kinesiophobia (TSK) is commonly used to assess fear of movement (FoM) in people with low back pain (LBP). However, the TSK does not provide a task-specific measure of FoM, whereas image-based or video-based methods may do so.
Objectives:
To compare the magnitude of FoM when assessed using 3 methods (TSK-11, image...
The purpose of this study was to understand how weightlifting/powerlifting (WL/PL) influences low back pain (LBP) beliefs and pain-related fear, and the potential influence of training, individual, and injury characteristics on these psychological features. Responses to the Photographic Series of Daily Activities-Short Electronic Version (PHODA-SeV...
Background and objective:
Traumatic injuries are among the leading causes of death and disability in the world across all age groups. This systematic review aimed to (1) describe the role of post-traumatic stress symptoms (PTSS) on the development of chronic pain and/or pain-related disability following musculoskeletal trauma, and (2) report pain...
Purpose
Pain-free adults in the general population have been shown to possess unhelpful beliefs that certain movements and postures are harmful to the spine, potentially reinforcing fear-avoidance behaviour. Whether such beliefs occur in individuals undertaking regular powerlifting (PL) and Olympic weightlifting (OWL) training is unclear.
Methods...
Introduction:
Post-traumatic stress symptoms (PTSS) can be triggered following exposure to a traumatic event, such as violence, disasters, serious accidents and injury. Little is known about which interventions provide the greatest benefit for PTSS. This systematic review aims to estimate the effects of early interventions on PTSS following muscul...
Background
Exercise has been used to manage symptoms of post-traumatic stress disorder (PTSD). The effect of exercise on PTSD outcomes has been previously explored in several studies. However, it still remains unclear what type of exercise/physical activity, intensity and duration is most effective for reducing symptoms of PTSD. A systematic review...
Abstract
Background: Exercise has been used to manage symptoms of post-traumatic stress disorder (PTSD). The effect of exercise on PTSD outcomes has been previously explored in several studies. However, it still remains unclear what type of exercise/physical activity, intensity and duration is most effective for reducing symptoms of PTSD. A system...
Researchers, clinicians, and patients have good reasons for wanting answers to causal questions of disease and therapeutic intervention. This paper uses microbiologist Robert Koch’s pioneering work and famous postulates to extrapolate a logical sequence of evidence for confirming the causes of disease: association between individuals with and witho...
Background and aims:
Pain drawings are commonly used in the clinical assessment of people with cervical radiculopathy. This study aimed to assess: 1) the agreement of clinical interpretation of pain drawings and MRI findings in identifying the affected level of cervical radiculopathy 2) the agreement of these predictions based on the pain drawing...
This study investigates whether baseline pain extent, extracted from an electronic pain drawing, is an independent predictive factor of pain and disability measured 1 year and 2 years later in people with chronic WAD. Participants completed questionnaires assessing neck pain intensity, disability via the Neck Disability Index (NDI), psychological f...
Introduction
Post-traumatic stress symptoms (PTSS), pain and disability frequently co-occur following traumatic injuries. Although the coexistence of these symptoms is common, the relation between these symptoms and the impact on longer-term outcome remains poorly understood. This systematic review aims to determine the role of PTSS on the developm...
The inter-session Intraclass Correlation Coefficient (ICC) is a commonly investigated and clinically important metric of reliability for pressure pain threshold (PPT) measurement. However, current investigations do not account for inter-repetition variability when calculating inter-session ICC, even though a PPT measurement taken at different sessi...
Introduction:
Not all factors that predict persistent pain and disability following whiplash injury are known. In particular, few physical factors, such as changes in movement and muscle behaviour, have been investigated. The aim of this study is to identify predictive factors that are associated with the development of persistent pain and disabil...
Assessing the responses of body tissue subjected to mechanical load is a fundamental component of the clinical examination, psychophysical assessments and bioengineering research. The forces applied during such assessments are usually generated manually, via the hands of the tester, and aimed at discreet tissue sites. It is therefore desirable to o...
Traumatic injuries affect approximately 978 million people worldwide with 56.2 million requiring inpatient care. Quantitative sensory testing (QST) can be useful in predicting outcome following trauma, however the reliability of multiple QST including temporal summation (TS), heat and cold pain thresholds (HPT, CPT) and pressure pain thresholds (PP...
Introduction
Pain is an expected and appropriate experience following traumatic musculoskeletal injury. By contrast, chronic pain and disability are unhelpful yet common sequelae of trauma-related injuries. Presently, the mechanisms that underlie the transition from acute to chronic disabling post-traumatic pain are not fully understood. Such knowl...
Causation is important when considering: how an organism maintains health; why disease arises in a healthy person; and, how one may intervene to change the course of a disease. This paper explores the form of causative relationships in health, disease and intervention, with particular regard to the pathological and biopsychosocial models. Consisten...
Background
Low back pain is a common and costly health complaint for which there are several moderately effective treatments. In some fields there is evidence that funder and financial conflicts are associated with trial outcomes. It is not clear whether effect sizes in back pain trials relate to journal impact factor, reporting conflicts of intere...
Sir Austin Bradford Hill's 'aspects of causation' represent some of the most influential thoughts on the subject of proximate causation in health and disease. Hill compiled a list of features that, when present and known, indicate an increasing likelihood that exposure to a factor causes-or contributes to the causation of-a disease. The items of Hi...
Evidence-based clinical guidelines attempt to guide the decisions and behaviour of clinicians using recommendation statements. In contrast, the osteopathic profession has opted for a more fundamental set of guiding principles, which are intended to be true for all health problems, across all people, under all circumstances, for all time. This is a...
Study design:
Systematic review.
Objective:
To evaluate randomized controlled trials validating the effects of a clinical prediction rule for patients with non-specific low back pain (LBP). The outcomes of interest were any back pain or pain-related measures.
Summary of background data:
LBP is a common and costly condition. Interventions for b...
This paper describes the development and implementation of a hand exercise intervention for rheumatoid arthritis (RA) as part of a large multi-centred randomised controlled trial in a U.K. National Health Service (NHS) setting. Participants are eligible if diagnosed with RA according to American College of Rheumatology criteria, have a history of d...
Group cognitive behavioural intervention (CBI) is effective in reducing low back pain and disability over a 12-month period, in comparison to best practice advice in primary care. The aim was to study the effects of this CBI beyond 12 months. We undertook an extended follow-up of our original randomised, controlled trial of a group CBI and best pra...
Due primarily to its colloquial function, 'manipulation' is a poor term for distinguishing one healthcare intervention from another. With reports continuing to associate serious adverse events with manipulation, particularly relating to its use in the cervical spine, it is essential that the term be used appropriately and in accordance with a valid...
Randomized controlled trial.
To investigate the effect of a printed information package on the low back pain (LBP)-related beliefs and reported behavior of musculoskeletal practitioners (chiropractors, osteopaths, and musculoskeletal physiotherapists) across the United Kingdom.
A substantial proportion of musculoskeletal practitioners in United Kin...
For centuries, techniques used to manipulate joints in the spine have been passed down from one generation of manipulators to the next. Today, spinal manipulation is in the curious position that positive clinical effects have now been demonstrated, yet the theoretical base underpinning every aspect of its use is still underdeveloped. An important q...
Background.
Low back pain (LBP) is a common and costly problem. In western society, huge resources have been directed at providing solutions to this problem, yet this investment has shown relatively little return. One possible avenue for reducing the societal impact of LBP is through improving the quality of healthcare. In the UK, the three profess...
Background & Objectives: The physical therapy professions (musculoskeletal physiotherapy, osteopathy and chiropractic) are involved in the management of low back pain (LBP) in approximately 15–20% of all cases in the UK. LBP accounts for between 50% and 67% of the workload of this group. Initiatives to implement evidence-based practice (EBP) in the...
In the hierarchy of evidence that influences healthcare policy, randomised controlled trials (RCTs) are considered by most to be the top individual unit of research. RCTs of treatments for simple, ‘mechanical’ low back pain have consistently shown comparative treatments to have small effect sizes. There are arguments for using both explanatory and...
Background
Low back pain (LBP) is a common and costly problem. Initiatives designed to assist practitioner and patient decisions about appropriate healthcare for LBP include printed evidence-based clinical guidelines. The three professional groups of chiropractic, osteopathy and musculoskeletal physiotherapy in the UK share common ground with their...
When the clinical efficacy of spinal manipulative treatment for spinal pain has been assessed, high-velocity low-amplitude thrust (HVLAT) manipulation and mobilization have been regarded as clinical interventions giving identical and equivalent biologic effects. The objective of this review is to critically discuss previous theories and research of...