Lorna Paul

Glasgow Caledonian University | GCU · School of Health and Life Sciences

Objectives Skeletal muscle dysfunction is the primary cause of functional limitations in osteoarthritis, associated biomarkers have the potential as targets for early disease identification, diagnosis, and prevention of osteoarthritis disability. This review aimed to identify associations between biomarkers and lower limb skeletal muscle function i...

Background Between 1990 and 2017, stroke cases nearly doubled, ranking as the second leading cause of death and disability globally. Inadequate physical activity (PA) is a leading risk factor. Recent guidelines advise stroke survivors to follow population-based PA guidelines. Given stroke heterogeneity personalised PA interventions are recommended....

Background Reduced walking ability, especially decreased gait speed, is one of the most common and disabling impairments reported by people with multiple sclerosis (MS). Considering the impact of muscle strength on walking ability, resistance training may have the potential to improve walking speed in MS. Therefore, this systematic review and meta‐...

Objectives The overall aim of the current study was to quantify physical activity levels in inflammatory rheumatic diseases (IRDs) and to explore its role in fatigue. Methods Secondary analysis of data from the Lessening the Impact of Fatigue in IRDs (LIFT) trial of the personalized exercise programme (PEP) intervention for fatigue. Participants w...

Introduction Stroke is the second-leading cause of death and disability globally. Participation in physical activity (PA) is a cornerstone of secondary prevention in stroke care. Given the heterogeneous nature of stroke, PA interventions that are adaptive to individual performance are recommended. Mobile health (mHealth) has been identified as a po...

Background The number of published studies of exercise training in multiple sclerosis (MS) has grown exponentially with increasing numbers of outcomes capturing exercise effects. This has complicated the selection of relevant indicators and interpretation of intervention effects. Objectives The Outcomes subgroup of the MoXFo initiative aimed to (1...

Introduction: Life-long exercise is essential in axial spondyloarthritis (axSpA) management, however long-term adherence is challenging. Online exercise programmes are an alternative to face-to-face physiotherapy. Objectives: 1) To measure adherence to a 12-month, individualised, online physiotherapy programme for people with axSpA, and investiga...

Background: After a stroke, inpatients often receive less than the recommended dose of therapy. Telerehabilitation may assist by providing personalised rehabilitation programmes without face-to-face therapy time. This study aimed to evaluate the acceptability and feasibility of an individualised programme of upper-limb rehabilitation that is deliv...

BACKGROUND Finding enjoyable and effective long-term approaches to rehabilitation for improving upper limb (UL) function for people with multiple sclerosis (pwMS) is challenging. Using virtual reality (VR) could be a solution to this challenge however; there is a lack of reporting on pwMS’ and clinicians’ views on VR-based approaches and recommenda...

Background Finding enjoyable and effective long-term approaches to rehabilitation for improving the upper limb (UL) function of people with multiple sclerosis (MS) is challenging. Using virtual reality (VR) could be a solution to this challenge; however, there is a lack of reporting on the views of people with MS and clinicians on VR-based approach...

Background: Evidence of the benefits of dance for people with Parkinson disease is well established, but only recently has dance been investigated for people with multiple sclerosis (MS). The purpose of this review was to identify and evaluate the feasibility and effectiveness of dance interventions to improve functional, psychosocial, and partici...

Purpose: People with rare neurological conditions (RNCs) struggle to achieve regular physical activity (PA). This study explored experiences of people with RNC engaging in PA, their carers, and health care professionals (HCPs) working with them. Materials & methods: We developed three surveys: for individuals living with RNCs, their carers, and...

Background Up to 50% of people in low- and middle-income countries do not receive the rehabilitation they require. Telerehabilitation has the potential to improve access to neurorehabilitation services especially in low- and middle-income countries. Although there are reports of the barriers and facilitators to telerehabilitation in such settings,...

BACKGROUND Up to 50% of people in low- and middle-income countries do not receive the rehabilitation they require. Telerehabilitation has the potential to improve access to neurorehabilitation services especially in low- and middle-income countries. Although there are reports of the barriers and facilitators to telerehabilitation in such settings,...

Objectives: To estimate the cost-effectiveness of a Cognitive Behavioural Approach (CBA) or a Personalised Exercise Programme (PEP), alongside usual care (UC), in patients with Inflammatory Rheumatic Diseases who report chronic, moderate to severe, fatigue. Methods: A within-trial cost-utility analysis, was conducted using individual patient dat...

Unmet healthcare needs and interventions for people with long-term neurological conditions during the Covid pandemic. PROSPERO 2023 CRD42023406433 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023406433 Review question 1. What were the unmet healthcare needs of adults with long-term neurological conditions (LTNC)...

Introduction Greater Trochanteric Pain Syndrome (GTPS) impacts on daily activity, work and quality of life. GTPS is prevalent in both active and sedentary populations, however it is unclear whether both groups have similar clinical presentations. The aim of this study was to compare the clinical characteristics for active and sedentary individuals...

Objective Fatigue is a challenging feature of all inflammatory rheumatic diseases. LIFT (Lessening the Impact of Fatigue in inflammatory rheumatic diseases: a randomized Trial) included remotely delivered personalized exercise programme (PEP) or cognitive-behavioural approach (CBA) interventions. The aim of this nested qualitative evaluation was to...

Lower limb muscle dysfunction is a key driver for impaired physical capacity and frailty status, both characteristics of sarcopenia. Sarcopenia is the key pathway between frailty and disability. Identifying biological markers for early diagnosis, treatment, and prevention may be key to early intervention and prevention of disability particularly mo...

Objectives: Fatigue can be a disabling symptom of inflammatory rheumatic diseases. LIFT (Lessening the Impact of Fatigue in inflammatory rheumatic diseases: a randomized Trial) is a randomized trial of remotely delivered cognitive-behavioural approach or personalized exercise programme interventions, compared with usual care. The aim of this neste...

Background Active passive trainers are frequently used as a safe, feasible way for people with neurological disabilities to exercise. However, evidence regarding their efficacy is limited. The aim of this study was to review the literature investigating the effects of lower limb active passive trainer cycling, with or without functional electrical...

Background Chronic fatigue is a poorly managed problem in people with inflammatory rheumatic diseases. Cognitive behavioural approaches (CBA) and personalised exercise programmes (PEP) can be effective, but they are not often implemented because their effectivenesses across the different inflammatory rheumatic diseases are unknown and regular face-...

Purpose: There is a gap in research on how best to support exercise in moderate to severe MS. The objective of this study is to share perspectives of people living with MS and physiotherapists on their experiences in a randomized clinical trial of online physiotherapy vs. an active comparator. Methods: Semi-structured exit interviews were conduc...

Background : The activPAL accelerometer is used widely for assessment of free-living activity and postural data. Two algorithms, VANE (traditional) and CREA (new), are available to analyze activPAL data, but the comparability of metrics derived from these algorithms is unknown. Purpose : To determine the comparability of physical activity and seden...

Multiple sclerosis (MS) is a debilitating disease which gradually reduces motor function and mobility. Virtual reality (VR) has been successfully utilised in support of existing therapeutic approaches for many different conditions, and new innovative and experimental features could be the future of VR rehabilitation. The Quest is a new headset by O...

Background: Evidence indicates that exercise holds the potential to counteract neurodegeneration experienced by persons with multiple sclerosis (pwMS), which is in part believed to be mediated through increases in neurotrophic factors. There is a need to summarize the existing evidence on exercise-induced effects on neurotrophic factors alongside...

Rare neurological conditions (RNCs) encompass a variety of diseases that differ in progression and symptoms but typically include muscle weakness, sensory and balance impairment and difficulty with coordinating voluntary movement. This can limit overall physical activity, so interventions to address this are recommended. The aim of this study was t...

Although autonomic nervous system (ANS) dysfunction in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) has been proposed, conflicting evidence makes it difficult to draw firm conclusions regarding ANS activity at rest in ME/CFS patients. Although severe exercise intolerance is one of the core features of ME/CFS, little attempts have bee...

Background: This systematic review and meta-analysis aimed to compare the oxygen cost of walking in people with multiple sclerosis (MS) and controls and to assess the relationship between oxygen cost of walking and fatigue in people with MS. Methods: Four databases (CINAHL, MEDLINE, ProQuest, Web of Science) were searched up to September 2020. Stud...

Background/Aims There is evidence for non-pharmacological interventions to support patients to self-manage fatigue, however implementation in clinical practice is a challenge. LIFT (Lessening the Impact of Fatigue in inflammatory rheumatic diseases: a randomised Trial) is a multi-centre three-arm randomised trial using a remotely delivered cogniti...

Background/Aims Fatigue is a substantial, disabling symptom of inflammatory rheumatic diseases (IRDs). LIFT (Lessening the Impact of Fatigue in inflammatory rheumatic diseases: a randomised Trial) is a multi-centre three-arm randomised trial using remotely delivered cognitive-behavioral approach (CBA) and personalised exercise programme (PEP) inte...

Background and purpose: Long periods of daily sedentary time, particularly accumulated in long uninterrupted bouts, are a risk factor for cardiovascular disease. People with stroke are at high risk of recurrent events and prolonged sedentary time may increase this risk. We aimed to explore how people with stroke distribute their periods of sedenta...

Background Multiple sclerosis is a chronic progressive neurological disease. Evidence attests to the benefits of exercise, guidelines for exercise in multiple sclerosis are available. Remote-delivery of exercise adherence programmes based on the exercise guidelines require urgent testing. Aims The design, and outcomes of Behaviour towards Aerobic...

Background Balance, mobility impairments and falls are problematic for people with multiple sclerosis (MS). The “Balance Right in MS (BRiMS)” intervention, a 13-week home and group-based exercise and education programme, aims to improve balance and minimise falls. This study aimed to evaluate the feasibility of undertaking a multi-centre randomised...

Background Research on Virtual Reality (VR) based motor rehabilitation for people with multiple sclerosis (MS) is rapidly growing in popularity, although few studies have focused on the upper limb (UL). The aims of this review were to investigate the effect of VR interventions on UL function in people with MS and determine if the type of VR interve...

Objective To systematically review and critically appraise the literature on the effectiveness of isometric exercise in comparison with other treatment strategies or no treatment in tendinopathy. Design A systematic review and meta-analysis of randomised controlled trials. Data sources Electronic searches of Medline, Cumulative Index to Nursing a...

Objective This review sought to (1) compare physical function and fitness outcomes in people infected with Severe Acute Respiratory Syndrome-related Coronavirus (SARS-CoV) with healthy controls, (2) quantify the recovery of physical function and fitness following SARS-CoV infection, and (3) determine the effects of exercise following SARS-CoV infec...

Multiple sclerosis (MS) is an autoimmune disorder caused by damage to the myelin that protects nerve fibres, resulting in demyelinated lesions and causing various symptoms, one of which is muscle weakness. Physical rehabilitation is an integral part of managing MS, as well as its symptoms, and over time, the forms of implementing rehabilitation hav...

Background Gait, balance, and cognitive disorders are common in people with Multiple Sclerosis (MS). In addition, people with MS have impaired ability to concurrently perform gait/balance and cognitive tasks due to cognitive-motor interference (CMI). Clinical features of MS may affect CMI; however, the relationship between CMI and clinical features...

Background Determining adherence with orthoses is important for clinicians prescribing devices. Measuring orthotic use often relies on patient recall which has poor agreement with objective measures. Measuring step count whilst wearing an orthosis could help objectively quantifying adherence. The Odstock Drop Foot Stimulator (ODFS) Pace, used in fo...

Relapses are a common feature of multiple sclerosis; however, recovery from relapses is often incomplete, with up to half of people experiencing residual disabilities postrelapse. Therefore, treatments are required to promote recovery of function and reduce the extent of residual disabilities postrelapse. Accordingly, this Perspective article explo...

Exercise as a subset of physical activity is a cornerstone in the management of multiple sclerosis (MS) based on its pleotropic effects. There is an exponential increase in the quantity of research on exercise in MS, yet a number of barriers associated with study content and quality hamper rapid progress in the field. To address these barriers and...

Introduction Engaging in physical activity (PA) is a key aspect in the management of axial spondyloarthritis (axial SpA) however its relationship with clinical measures is unknown. Previous research has mainly focused on subjective methods of measuring Physical Activity (PA) and Sedentary Behaviour (SB). Objective The aim of this study was to exp...

Background: Options to support adherence with physical activity in moderate-to-severe MS are needed. The primary aim was to evaluate adherence to a web-based, individualized exercise program in moderate-to-severe MS. Secondary aims were to explore changes in MSIS-29, HADS, grip strength, T25FWT, and TUG. Methods: Inclusion criteria were diagnosis o...

Background: People living with rare neurological conditions (RNCs) often face common physical, cognitive and psychological challenges that lead to reduced physical activity and associated deconditioning. Physical activity interventions are routinely utilised to address disease specific limitations with the intention of promoting participation in pe...

To synthesise the body of evidence in relation to common physical activity interventions that seek a change in physical fitness in people with rare neurological conditions

Objectives Greater trochanteric pain syndrome (GTPS) is a common cause of lateral hip pain. Limited evidence exists for the effectiveness of exercise for GTPS. This study aimed to compare the effectiveness of isometric and isotonic exercise for individuals with GTPS. Methods This randomised controlled pilot trial recruited 30 participants with GTP...

Objective: Determine the relationship between self-reported fatigue and aerobic capacity and muscle strength in people with Multiple Sclerosis (MS). Data sources: Four databases (CINAHL, MEDLINE, ProQuest, and Web of Science Core Collections) were searched up to October 2018. Study selection: Cross-sectional or longitudinal studies that reported th...

Background: Fatigue is a common and debilitating symptom of Multiple Sclerosis (MS); however, it is unknown what constitutes a clinically significant change in fatigue. Establishing the minimally important difference (MID) of fatigue outcome measures can inform the interpretation of changes in fatigue by estimating the level of change that is consi...

Background Despite the number of guidelines and available therapies, many individuals with fibromyalgia (FM) still experience significant pain and a reduced quality of life. Patient heterogeneity and clinical uncertainty can lead to delays in selecting the most appropriate management strategy. There are more than 300,000 publications surrounding th...

Background: Exercise options for those with moderate to high levels of disability are limited. The aim of the study was to evaluate the feasibility of a progressive, four week lower limb cycling programme using active-passive trainers (APT's) on spasticity, cardiovascular fitness, function and quality of life in people with moderate to severe MS....

Background Balance, mobility impairments and falls are common problems for people with multiple sclerosis (MS). Our ongoing research has led to the development of Balance Right in MS (BRiMS), a 13-week home- and group-based exercise and education programme intended to improve balance and encourage safer mobility. Objective This feasibility trial a...

Background: High levels of sedentary time increases the risk of cardiovascular disease, including recurrent stroke. Objective: This study aimed to identify factors associated with high sedentary time in community-dwelling people with stroke. Methods: For this data pooling study, authors of published and ongoing trials that collected sedentary time...

Objective: To compare the clinical- and cost-effectiveness of ankle-foot orthoses (AFOs) and functional electrical stimulation (FES) over 12 months in people with Multiple Sclerosis with foot drop. Design: Multicentre, powered, non-blinded, randomized trial. Setting: Seven Multiple Sclerosis outpatient centres across Scotland. Subjects: Eigh...

Purpose: Oxidative stress has been proposed as a contributor to pain in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). During incremental exercise in patients with ME/CFS, oxidative stress enhances sooner and antioxidant response is delayed. We explored whether oxidative stress is associated with pain symptoms or pain c...

Multiple sclerosis (MS) often affects motor function, leading to an adverse effect on daily living. Rehabilitation is important in terms of improving mobility and activities of daily living. Virtual environments (VE) are increasing in popularity within this research area, but research in terms of VE is still rare, for both the upper and lower limb,...

Background: Web-based exercise and physical activity interventions are being developed as a potential way to help people with multiple sclerosis achieve and maintain increased physical activity levels. Seeking feedback from people who have used such interventions will help guide the development process. Methods: In-depth interviews were used to exp...

Objective: Lower extremity amputation (LEA) is more common in people from lower socio-economic groups. This study examined this further by investigating the influence of socio-economic status on mobility, participation, and quality of life (QoL) after LEA. Methods: Prospective data were gathered for all LEAs performed in one year in one Scottish...

Background: Rehabilitation interventions are recommended to manage Multiple Sclerosis (MS) related fatigue. However, existing research has largely been generalised to those with relapsing-remitting MS, making it difficult to determine the effectiveness of these interventions amongst people with progressive MS. Therefore, this study aimed to systema...

Background: Fatigue is a complex and disabling symptom of Multiple Sclerosis (MS); however, there is conflicting evidence of the relationship between fatigue and clinical features of MS. Furthermore, few studies have considered these relationships specifically in a progressive MS population. Aims: (1) estimate the prevalence of self-reported fatigu...

Abstract Rheumatology INTERNATIONAL Adherence is a primary determinant of the effectiveness of any intervention. Exercise is considered essential in the manage- ment of spondyloarthritis (SpA); however, the overall adherence to exercise programmes and factors affecting adherence are unknown. The aim of this systematic review was to examine measures...

Introduction Fatigue remains pervasive, disabling and challenging to manage across all inflammatory rheumatic diseases (IRDs). Non-pharmacological interventions, specifically cognitive-behavioural approaches (CBAs) and graded exercise programmes designed to support and increase exercise, are valuable treatments which help patients with IRD to manag...

Objective: To examine the feasibility of a trial to evaluate web-based physiotherapy compared to a standard home exercise programme in people with Multiple Sclerosis (MS). Design: Multi-centre, randomised controlled, feasibility study Setting; Three Multiple Sclerosis out-patient centres Participants: Ninety people with Multiple Sclerosis (Expande...

BACKGROUND: Physical activity (PA) in stroke survivors is low however the ubiquitous nature of smartphone technology means smartphone-based interventions could be a feasible and cost-effective approach to increase PA. We developed STARFISH, a group behavioural change intervention delivered via a smartphone app to help increase PA. OBJECTIVE: Follow...

Background: Remaining physically active is important to maintain functional ability and reduce the incidence of co-morbidities in people with Multiple Sclerosis. The aim of this review was to evaluate the effectiveness of interventions on physical activity or sedentary behaviour in people with Multiple Sclerosis. Methods: A systematic search was co...

Background: Multiple sclerosis (MS) is a chronic, progressive neurological condition. The aim of this study was to explore consensus on the barriers and solutions to exercise for people with MS living in Scotland. Method: Thirty-five people with MS, not regularly exercising, were recruited and took part in five Nominal Group Technique groups throug...

The aim of this systematic review was to evaluate the effectiveness of interventions which target Physical Activity (PA) and / or Sedentary Behaviour (SB) in PwMS.

Background: Aerobic high intensity interval training (HIIT) is safe in the general population and more efficient in improving fitness than continuous moderate intensity training. The body of literature examining HIIT in multiple sclerosis (MS) is expanding but to date a systematic review has not been conducted. The aim of this review was to invest...

Background: Foot drop affects walking in people with multiple sclerosis (pwMS). This study compares the initial orthotic effects of two treatments for foot drop: ankle-foot orthoses (AFO) and functional electrical stimulation (FES), on the speed and oxygen cost of walking in MS. Method and materials: Seventy-eight pwMS were randomised to receive...

Objectives: The impact of exercise interventions on south Asians with type 2 diabetes (T2DM), who have a higher T2DM incidence rate compared to other ethnic groups, is inconclusive. This study aimed to systematically review the effect of exercise interventions in south Asians with T2DM. Method: Five electronic databases were searched up to April 20...

Background: People with relapsing remitting multiple sclerosis (PwRRMS) suffer disproportionate decrements in gait under dual-task conditions, when walking and a cognitive task are combined. There has been much less investigation of the impact of cognitive demands on balance. Objectives: This study investigated whether: (1) PwRRMS show dispropor...