Mark Hancock

Macquarie University · Department of Health Professions

Purpose Lumbar paraspinal intramuscular fat (IMF) has emerged as a biological factor in low back pain (LBP). Traditional assessments measure IMF across the entire muscle or at specific levels and may miss key information on the role of IMF in LBP. Despite known variations across the lumbar spine, the three-dimensional (3D) distribution of IMF has n...

BACKGROUND The objective of this systematic review and meta-analysis was to update the body of evidence on the efficacy of prehabilitation with exercise interventions, in reducing postoperative complications and length of hospital stay after cancer surgery. METHODS A comprehensive literature search was conducted on MEDLINE, Embase, The Cochrane Li...

OBJECTIVES: To investigate whether improvements in forward bending were related to improvements in pain and disability in people with chronic low back pain (CLBP) who were undergoing Cognitive Functional Therapy (CFT). DESIGN: Longitudinal observational study. METHODS: Two hundred and sixty-one participants with CLBP received CFT. Forward bending w...

Objective To develop and evaluate a new patient-reported outcome measure (PROM) to assess people’s knowledge and beliefs about low back pain. Methods This study followed the COnsensus-based Standards for the selection of health Measurement INstruments guidelines. An 18-item preliminary version of the Back pain Knowledge and beliefs Survey (BacKS)...

Objective The objective was to investigate the effectiveness of cognitive functional therapy (CFT) in the management of people with chronic nonspecific low back pain (LBP) and explore the variability in available trials to understand the factors which may affect the effectiveness of the intervention. Methods A systematic review with meta-analyses...

Background The current literature supports the effectiveness of exercise, education, and self-management interventions for the long-term management of persistent low back pain. However, there is significant uncertainty about the implementation of interventions related to barriers, facilitators, and patient’s preferences. This study will evaluate th...

Objective To explore if there are differences in the design and/or conduct of studies that have tested the STarTBack treatment approach for the management of low back pain (LBP), potentially explaining differences in study results. Design A literature review. Data sources MEDLINE, CINAHL and EMBASE were searched from inception to 26 July 2023. E...

Background Surgery can help patients with leg pain caused by sciatica recover faster, but by 12 months outcomes are similar to nonsurgical management. For many the decision to have surgery may require reflection, and patient decision aids are an evidence‐based clinical tool that can help guide patients through this decision. Objective The aim of t...

Background The availability of multidisciplinary care for the management of chronic pain is uncommon outside specialist clinics. The current study aims to determine the physical intervention use of patients participating in an online psychological pain management program and whether exposure to physical interventions in these patients alters treatm...

Background Physical therapists use diagnostic tests in a variety of settings. Choosing the best diagnostic test to apply in a particular situation can be difficult. The choice of diagnostic test should be informed, at least in part, by evidence of test accuracy. Finding evidence of diagnostic test accuracy has, until recently, been challenging. Ide...

Background The management of low back pain (LBP) is highly variable and patients often receive management that is not recommended and/or miss out on recommended care. Clinician knowledge and behaviours are strongly influenced by entry-level clinical training and are commonly cited as barriers to implementing evidence-based management. Currently the...

Background Randomised controlled trials (RCTs) are considered the gold standard design to determine the effectiveness of an intervention, as the only method of decreasing section bias and minimising random error. However, participant recruitment to randomised controlled trials is a major challenge, with many trials failing to recruit the targeted s...

2023) Adverse childhood experience is associated with an increased risk of reporting chronic pain in adulthood: a stystematic review and meta-analysis ABSTRACT Background: Adverse childhood experiences (ACEs) have been shown to negatively affect health in adulthood. Estimates of associations between ACEs and chronic painful conditions are lacking....

OBJECTIVE: To investigate forward bending range of motion (ROM) and velocity in patients with low back pain who were receiving Cognitive Functional Therapy and determine (1) the amount and timing of change occurring at the trunk and pelvis (global angles), and lumbar spine (intersensor angle), and (2a) differences in changes between participants wi...

Background: Low back pain is a common presentation across different healthcare settings. Clinicians need to confidently be able to screen and identify people presenting with low back pain with a high suspicion of serious or specific pathology (e.g. vertebral fracture). Patients identified with an increased likelihood of having a serious pathology...

OBJECTIVE: Identify factors that elite sport clinicians, coaches, and athletes perceive are associated with low back pain (LBP) recovery. DESIGN: Concept mapping methodology. METHOD: Participants brainstormed, sorted (thematically), and rated (5-point Likert scales: importance and feasibility) statements in response to the prompt, “What factors are...

Questions: What motivates individuals to start a walking program for the prevention of low back pain? What strategies optimise short-term and long-term adherence to a walking program? What strategies can physiotherapists incorporate into clinical practice to facilitate commencement of and adherence to a walking program? Design: Qualitative study...

Background: Characteristics that identify patients who respond differently to certain interventions are called treatment effect modifiers. Some studies inappropriately report the presence of treatment effect modifiers without adequate study designs. Objectives: To evaluate what proportion of single-group studies published in leading physical the...

Background: Low back pain is the leading cause of years lived with disability globally, but most interventions have only short-lasting, small to moderate effects. Cognitive functional therapy (CFT) is an individualised approach that targets unhelpful pain-related cognitions, emotions, and behaviours that contribute to pain and disability. Movement...

Background: To determine the feasibility, reliability, and safety of the remote five times sit to stand test (5STS) test in patients with gastrointestinal cancer. Methods: Consecutive adult patients undergoing surgical treatment for lower gastrointestinal cancer at a major referral hospital in Sydney between July and November 2022 were included. Pa...

Background: The accuracy of diagnostic tests available in primary care to identify the disc, sacroiliac joint, and facet joint as the source of low back pain is uncertain. Methods: Systematic review of diagnostic tests available in primary care. MEDLINE, CINAHL, and EMBASE were searched between March 2006 and 25th January 2023. Pairs of reviewer...

Background Exercise for the prevention of low back pain recurrences is recommended, but under-researched. The effectiveness and cost-effectiveness of a walking program for preventing low back pain recurrence remains unknown. This a priori statistical analysis plan describes the methods of analysis for the WalkBack trial. Methods WalkBack is a pros...

Background: Recurrence of low back pain (LBP) is common. If clinicians could identify an individual's risk of recurrence, this would enhance clinical decision-making and tailored patient care. Objective/design: To develop and validate a simple tool to predict the probability of a recurrence of LBP by 3- or 12-months following recovery. Methods:...

Questions: Do magnetic resonance imaging (MRI) findings predict future low back pain (LBP), associated disability and global recovery in people with current LBP? Do MRI findings predict these outcomes in people with no current LBP? Do MRI findings predict these outcomes in a mixed sample of people with and without current LBP? Design: This revie...

Background: Most studies investigating the prognosis of low back pain (LBP) enrol people presenting for care, rather than all people who have an episode of LBP. We aimed to describe the prognosis of an acute episode of LBP in a community inception cohort. Methods: We used data from two previous studies investigating recurrence of LBP. Participan...

Background Exercise for the prevention of low back pain recurrences is recommended, but under-researched. The effectiveness and cost-effectiveness of a walking program for preventing low back pain recurrence remains unknown. This a priori statistical analysis plan describes the methods of analysis for the WalkBack Trial. Methods WalkBack is a pros...

Background General medical practitioner (GP) recruitment and subsequent data collection in clinical practice are challenging and may limit successful completion of a large-scale trial. The aim of this study was to assess the feasibility of undertaking a cluster randomised controlled trial to test an intervention to reduce non-indicated imaging for...

Background It is unclear if the use of imaging for low back pain (LBP) is impacted by patient beliefs. This study aimed to: (1) describe beliefs about the importance of imaging and whether patients wanted imaging when presenting for chiropractic care for LBP; (2) describe associations between baseline patient characteristics and imaging beliefs and...

Background Practice-based guidelines recommend patient education and exercise as first-line care for low back pain (LBP); however, these recommendations are not routinely delivered in practice. GLA:D® Back, developed in Denmark to assist clinicians to implement guideline recommendations, offers a structured education and supervised exercise program...

Background Wearable sensor technology may allow accurate monitoring of spine movement outside a clinical setting. The concurrent validity of wearable sensors during multiplane tasks, such as lifting, is unknown. This study assessed DorsaVi Version 6 sensors for their concurrent validity with the Vicon motion analysis system for measuring lumbar fle...

The size, shape, and composition of paraspinal muscles have been widely reported in disorders of the cervical and lumbar spine. Measures of size, shape, and composition have required time-consuming and rater-dependent manual segmentation techniques. Convolutional neural networks (CNNs) provide alternate timesaving, state-of-the-art performance meas...

Background Although there is some qualitative research on physiotherapists’ experiences of delivering low back pain treatment, we do not know the extent that these findings apply to low back pain prevention. Objective To explore physiotherapists’ understanding, attitudes and experiences related to delivering low back pain prevention programs. Des...

Background Imaging is overused in the management of low back pain, resulting in overdiagnosis, increased healthcare utilisation, and increased costs. Few effective interventions to decrease inappropriate use have been developed and have typically not been developed using behaviour change theory. An intervention to reduce non-indicated imaging for l...

Objective To determine the inter-rater reliability of identifying differences and types of differences in lumbar degenerative findings comparing supine and upright MRI. Materials and methods Fifty-nine participants, low back pain patients (LBP) with or without leg pain and no-LBP individuals were consecutively enrolled to receive supine and uprigh...

Background and objective: Low back pain is common and remains one of the leading causes of disability globally. This study aimed to develop an evidence map of the quantity of available evidence assessing approaches to manage low back pain, to identify potential redundancies or gaps in the synthesised data, and guide future research focus. Databas...

Objective What model development and external validation studies exist that focus on the prognosis of patients with recent-onset low back pain (LBP)? What is the performance (in terms of discrimination and calibration) of these clinical prediction models? Methods Systematic searches on MEDLINE, Embase and CINAHL were conducted. Model development a...

Background: Patients and clinicians may misinterpret the clinical importance of imaging findings in patients with low back pain, leading to potential harm related to overdiagnosis. Purpose: Our aims were to qualitatively summarize the characteristics of tested interventions that target the reporting, communication, or clinical interpretation of...

Background Evidence suggests that diagnostic imaging for low back pain does not improve care in the absence of suspicion of serious pathology. However, the effect of imaging use on clinical outcomes has not been investigated in patients presenting to chiropractors. The aim of this study was to determine if diagnostic imaging affects clinical outcom...

Objective: To investigate the effectiveness of walking/running, cycling or swimming for treating or preventing non-specific low back pain (LBP). Design: Intervention systematic review. Literature search: Five databases searched to April 2021. Study selection criteria: Randomized controlled trials evaluating walking/running, cycling or swimmi...

There is moderate quality evidence that exercise can help prevent future low back pain (LBP). This study aimed to explore patient needs and preferences for exercise programs to prevent LBP, and the outcomes of these programs that would be most important to a patient. Researchers conducted 26 semi-structured interviews with people with LBP. Intervie...

Objectives: Assessing knowledge and beliefs regarding pain science can identify gaps and misconceptions. The Concept of Pain Inventory (COPI) was recently developed in children with the intent to guide targeted pain science education. We utilized the original COPI item pool to (1) develop a tool to assess an adult's concept of pain in a cohort who...

Background Inappropriate imaging and low-value care for low back pain (LBP) are common. A new patient-education booklet was created to overcome identified barriers to the delivery of recommended care, including the use of inappropriate imaging. Our aim was to assess the effectiveness of this booklet as part of primary care for LBP patients in compa...

Background: The importance of lumbar findings on magnetic resonance imaging (MRI) remains controversial. Changes in lumbar MRI findings over time may provide important insights into the causes of low back pain. However, the reliability and validity of temporal changes are unknown. Objective: To (1) investigate the interrater reliability of subje...

Background To determine the effectiveness of an individualised, daily targeted step count intervention and usual care compared with usual care alone on improving surgical and patient reported outcomes. Methods The Fit-4-Home trial was a pragmatic, randomised controlled trial conducted from April 2019 to February 2021. Patients undergoing elective...

Study design: Population-based cohort studyObjective. We examined associations between common lumbar degenerative changes observed on MRI and present or future low back pain (LBP). Summary of background data: The association between lumbar MRI degenerative findings and LBP is unclear. Longitudinal studies are sparse. Methods: Participants (n =...

Background A variety of treatments aim to reduce thoracic hyperkyphosis in adults, thereby improving posture and reducing possible complications. Objective To investigate the effectiveness of treatments to reduce thoracic hyperkyphosis. Design Systematic review and meta-analysis. Methods MEDLINE, EMBASE, CINAHL, and CENTRAL were searched from in...

Study design: case-control study. Objective: Investigate the association between lumbar spine MRI findings and 5-year trajectories of low back pain (LBP) in young Australian adults. Summary of background data: The association between lumbar spine imaging findings and LBP remains unclear due to important limitations of previous research, such a...

Background Low back pain (LBP) is a long-term health condition with an unpredictable pattern of symptomatic episodes, remission, and recurrence. Recently published systematic reviews suggest that exercise is the most effective intervention for preventing recurrences of LBP in persons that have recovered. Similar programs may also be effective in pr...

Background: Total knee arthroplasty (TKA) is widely considered a successful intervention for osteoarthritis and other degenerative knee diseases. This study addresses the need for a high-quality meta-analysis that outlines the clinical course of pain and function post-TKA. Methods: The review included prospective cohort studies assessing pain or...

Background Inappropriate imaging and low-value care for low back pain (LBP) are common. A new patient-education booklet was created to overcome identified barriers to the delivery of recommended care, including the use of inappropriate imaging. Our aim was to assess the effectiveness of this booklet as part of primary care for LBP patients in compa...

Purpose: To estimate the healthcare resource utilisation of an Australian cohort of people with sciatica and explore individual-level factors associated with expenditure. Methods: Healthcare utilisation (services and medication) data from a randomised, double-blind, placebo-controlled trial of pregabalin in patients with sciatica (n = 185) were...

Objective: To assess whether an exercise and education program was more effective than an education booklet for preventing recurrence of low back pain (LBP). Design: Randomized controlled trial. Methods: Participants aged 18 years or older who had recovered from an episode of LBP within the previous week were recruited from primary care practi...

Introduction Exercise therapy is the most recommended treatment for chronic low back pain (LBP). Effect sizes for exercises are usually small to moderate and could be due to the heterogeneity of people presenting with LBP. Thus, if patients could be better matched to exercise based on individual factors, then the effects of treatment could be great...

Objective: To evaluate the effect of walking promotion strategies on physical activity, pain, and function in people with musculoskeletal disorders. Design: Intervention systematic review with meta-analysis. Literature search: We performed the searches in MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and the Physiotherap...

Introduction: Low back pain (LBP) is recognised globally as a prevalent, costly and disabling condition. Recurrences are common and contribute to much of the burden of LBP. Current evidence favours exercise and education for prevention of LBP recurrence, but an optimal intervention has not yet been established. Walking is a simple, widely accessib...

Background: The prognosis of acute low back pain is generally favourable in terms of pain and disability; however, outcomes vary substantially between individual patients. Clinical prediction models help in estimating the likelihood of an outcome at a certain time point. There are existing clinical prediction models focused on prognosis for patient...