Rory O'Connor

University of Leeds · Division of Rheumatic and Musculoskeletal Medicine

Introduction Chronic pain and sleep disturbance are bi-directionally related. Cortical electrical activity in the alpha frequency band can be enhanced with sensory stimulation via the phenomenon of entrainment, and may reduce pain perception. A smartphone based programme which delivers 10 Hz stimulation through flickering light or binaural beats wa...

Background: Spinal Cord Injury (SCI) or Acquired Brain Injury (ABI) leads to disability, unemployment, loss of income, decreased quality of life and increased mortality. The impact is worse in Low-and Middle-Income Countries (LMICs) due to a lack of efficient long-term rehabilitative care. This study aims to explore the feasibility and acceptabili...

Background: The C19-YRS is the literature's first condition-specific, validated scale for patient assessment and monitoring in Post-COVID-19 syndrome (PCS). The 22-item scale's subscales (scores) are: symptom severity (0-100), functional disability (0-50), additional symptoms (0-60), and overall health (0-10). Objectives: This study aimed to tes...

Background The C19-YRS was the first validated scale reported in the literature for patient assessment and monitoring in Long Covid or Post-COVID syndrome. The 22-item scale contains four subscales measuring symptom severity, functional disability, overall health and additional symptoms. Objectives This study aimed to modify and refine the scale b...

Study design Systematic review. Objective To systematically review the evidence for the effectiveness of telerehabilitation as an intervention for people with spinal cord injury (SCI) in low-and middle-income countries (LMICs). Setting Not applicable. Methods MEDLINE (Ovid), Embase (Ovid), Pubmed and Global Health databases were used to identify...

Background As our understanding of the nature and prevalence of Post-COVID-19 syndrome (PCS) is increasing, a measure of the impact of COVID-19 could provide valuable insights into patients’ perceptions in clinical trials and epidemiological studies as well as routine clinical practice. Objective To evaluate the clinical usefulness and psychometri...

Research question Would there be differences in muscle activation between healthy subjects’ (HS) dominant leg and transfemoral amputees’ (TFA) intact-leg/contralateral-limb (IL) during normal transient-state walking speed? Methods The muscle activation patterns are obtained by calculating the linear envelope of the EMG signals for each group. The...

Background: As our understanding of the nature and prevalence of Post-COVID-19 syndrome (PCS) is increasing, a measure of the impact of COVID-19 could provide valuable insights into patients' perceptions in clinical trials and epidemiological studies, as well as routine clinical practice. Objective: To evaluate the clinical usefulness and psychomet...

The C19-YRS was the first scale reported in the literature for patient assessment and monitoring in Long Covid or Post-COVID syndrome. The scale has demonstrated content validity in a previous COVID-19 follow-up study. The growing number of patients with Post-COVID syndrome required the development of a self-report version (and a digital format) so...

Purpose: World Health Organisation's data show that low and middle-income countries have a higher prevalence of disabilities. Madagascar is the ninth poorest country in the world. This report aims to analyse the current difficulties faced by physiotherapists and physicians working in the hospital setting, and offer recommendations for how healthca...

Background Return to work (RTW) is achieved by less than 50% of stroke survivors. The rising incidence of stroke among younger people, the UK economic forecast, and clinical drivers highlight the need for stroke survivors to receive support with RTW. However, evidence for this type of support is lacking. This randomised controlled trial (RCT) will...

We thank Dr Garg and colleagues for their interest in our work and their useful comments.1 We agree that our cohort of hospitalised patients is correspondingly older, more likely to have had severe disease and have more comorbidities than groups whose primary COVID‐19 infection was mild and managed in the community.

Background There is currently very limited information on the nature and prevalence of post‐COVID‐19 symptoms after hospital discharge. Methods A purposive sample of 100 survivors discharged from a large University hospital were assessed 4‐ 8 weeks after discharge by a multidisciplinary team of rehabilitation professionals using a specialist telep...

Background: Return to work (RTW) is achieved by less than 50% of stroke survivors. The rising incidence of stroke among younger people, the UK economic forecast, and clinical drivers highlight the need for stroke survivors to receive support with RTW. However, evidence for this type of support is lacking. This randomised controlled trial (RCT) will...

Objective: To determine the long-term clinical problems in adult survivors of coronavirus (CoV) infection [Coronavirus disease 2019 (COVID-19), Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS)] after hospitalisation or Intensive Care Unit (ICU) admission. Design: Systematic review and meta-analysis of the literat...

Purpose: To explore the factors affecting access to timely trauma care and rehabilitation in Madagascar. Materials and methods: A qualitative study based in the outpatient departments of two large rehabilitation centres. Semi-structured interviews and focus groups were conducted with 12 patients or family members and 11 healthcare professionals. In...

Objective To assess the clinical and cost-effectiveness of cognitive rehabilitation for attention and memory problems in people with multiple sclerosis. Design Multicentre, pragmatic, randomized controlled trial. Setting Community Participants People with multiple sclerosis aged 18–69 years, who reported cognitive problems in daily life and had...

Background Lower limb amputation is a major public health issue globally, and its prevalence is increasing significantly around the world. Previous studies on lower limb amputees showed analogous complexity implemented by the neurological system which does not depend on the level of amputation. Research question What are the differences in muscle s...

Objective: Rehabilitation services play an important role in optimizing functional ability and societal integration for people with disabilities. The Madagascar Rehabilitation Programme (2011-2013) resulted from a global training partnership and led to 8 doctors achieving a university diploma in rehabilitation medicine. This paper describes a 2014...

Objectives Adults with knee instability related to neuromuscular disorders or central nervous conditions often experience mobility problems and rely on orthoses to improve function and mobility. Patient views of device effectiveness and acceptability are underexplored. Our study aimed to elicit device users’ perspectives regarding fitting, acceptab...

Purpose: This study aims to describe the current provision of trauma rehabilitation in Antananarivo, Madagascar and explore the experiences and perspectives of users of this service in order to inform future research and service development. Material and methods: A qualitative study supplemented by a descriptive service review were applied in the c...

This interdisciplinary paper, drawing on empirical and doctrinal research regarding artificial limbs and digital avatars, analyses two concepts which are argued to be core to the person – integrity and identity. From the perspective of a person who is a prosthetic user, the paper then evaluates the extent to which two legal regimes which are highly...

It is paramount that surgeons performing amputations have an understanding of the rehabilitation pathway and the prosthetic options for their patients following the amputation procedure. Some surgeons consider an amputation a failure of their previous treatment, but for their patients, it is the beginning of their rehabilitation. In limb loss, the...

Background Up to 160,000 people incur traumatic brain injury (TBI) each year in the UK. TBI can have profound effects on many areas of human functioning, including participation in work. There is limited evidence of the clinical effectiveness and cost-effectiveness of vocational rehabilitation (VR) after injury to promote early return to work (RTW)...

Rehabilitation for people with spinal cord injury in many low- and middle-income countries is not avail-able or is in the early stages of development. However, rehabilitation is recognized as crucial in order to optimize functional recovery and outcomes for patients with spinal cord injury. With an increasing incidence of spinal cord injury, the un...

This interdisciplinary co-authored Analysis piece introduces identity and integrity, which are argued to sit at the core of the person. It analyses approaches taken to these concepts by legal regimes, particularly in the context of individuals using artificial limbs or digital avatars. The piece concludes that law engages with identity and integrit...

Objectives To assess the effectiveness of orthotic devices for the management of instability of the knee in adults with a neuromuscular disorder or central nervous system disorder. Design A systematic review of primary studies. Setting Community. Participants Adults with a neuromuscular disorder or central nervous system disorder and impaired wa...

Editorial introduction for special guest issue on Bodily Extensions and Performance

Introduction: Two widely used outcome measures to assess functioning in neurological rehabilitation are the Functional Independence Measure (FIM™) and the Barthel Index. The current study aims to establish the equivalence of the total score of the FIM™ motor scale and the Barthel Index through the application of the International Classification of...

Background: Patients who have knee instability that is associated with neuromuscular disease (NMD) and central nervous system (CNS) conditions can be treated using orthoses, such as knee-ankle-foot orthoses (KAFOs). Objectives: To assess existing evidence on the effectiveness of orthoses; patient perspectives; types of orthotic devices prescribe...

Objective: Ponseti treatment for clubfoot is effective and inexpensive, improving children's social participation. Two rehabilitation centres in Madagascar piloted Ponseti treatment; however, at one centre 46% of infants failed to complete treatment. The aim of this study was to determine the causes of defaulting in order to facilitate subsequent...

Purpose: To evaluate the International Classification of Functioning, Disability and Health (ICF) as a framework to ensure that key aspects of user feedback are identified in the design and testing stages of development of a home-based upper limb rehabilitation system for stroke survivors. Methods: Seventeen stroke survivors with residual upper...

Rehabilitation robots can provide exercise for stroke survivors with weakness at the shoulder and elbow, but most do not facilitate hand movements. The aim was to combine robotics and functional electrical stimulation to facilitate exercise in stroke survivors with upper limb impairment. iPAM Mk II was used to assist active reaching in combination...

Technological advances have helped to improve functional ability in spinal cord injury survivors. The aim of this study is to systematically review the evidence for functional electrical stimulation (FES) on functional tasks involving the upper limb in people with spinal cord injuries. The authors systematically searched from September 2009 to Sept...

Objective: To evaluate the potential benefits of computer-assisted arm rehabilitation gaming technology on arm function of children with spastic cerebral palsy. Design: A single-blind randomized controlled trial design. Power calculations indicated that 58 children would be required to demonstrate a clinically important difference. Setting: In...

Background: Over one million people sustain traumatic brain injury each year in the UK and more than 10 % of these are moderate or severe injuries, resulting in cognitive and psychological problems that affect the ability to work. Returning to work is a primary rehabilitation goal but fewer than half of traumatic brain injury survivors achieve this...

A rehabilitation programme may initially appear expensive, resulting in a lack of enthusiasm to develop them by funding bodies and commissioners. Therefore, demonstrating the long-term cost-effectiveness of rehabilitation is extremely important. Many people with long-term neurological conditions will live for many years and investment in their phys...

Home-based robotic technologies may offer the possibility of self-directed upper limb exercise after stroke as a means of increasing the intensity of rehabilitation treatment. The current literature has a paucity of robotic devices that have been tested in a home environment. The aim of this research project was to evaluate a robotic device Home-ba...

Rehabilitation medicine is an educational, problem-solving specialty that relies on excellent team communication, honest discussion with patients and their families, and collaborative goal setting. The case conference has been described as the technology of rehabilitation medicine because it encompasses all of these functions. Trainees should have...

Objective: Decision making within amputee rehabilitation includes the assessment of whether a patient is suitable for a prosthesis and if so, what components to provide. This study seeks to increase understanding about clinicians' perspectives on what factors influence these decisions. Method: One-to-one semi-structured interviews were completed...

An instrumented walking aid, the iWA system, has been developed to measure kinematic and kinetic properties of walking aid (WA) use and deliver feedback to improve gait. The clinical requirements, technical specification and design of the system are developed through clinical collaboration. The development of the system is described, including hard...

Around 150,000 people experience a stroke every year in the UK. Nearly one million people in England are living with the effects of a stroke; one third of whom are moderately to severely disabled. A quarter of stroke survivors are under the age of 65 meaning that many are in work and/or have responsibility for caring for children or elderly parents...

Rory J O’Connor and colleagues outline the purpose and the pathway of a career in rehabilitation medicine

Objective: To investigate whether simple clinical measures can predict walking ability after lower limb prosthetic rehabilitation. Design: Prospective observational study. Subjects: Ninety five adults who were assessed as suitable for lower limb prosthetic rehabilitation by the multidisciplinary team. Methods: Information regarding baseline...

Tremor is a frequent disabling consequence of many neurological conditions. We performed a search of MEDLINE, CINAHL, EMBASE and the Cochrane Library to identify all primary research studies published up to November 2010 which investigated non-pharmacological and non-surgical treatments for tremor in humans. Neuromuscular physiotherapy, strength tr...

To classify and evaluate outcome measures currently used in robot-assisted exercise trials (RAET) in stroke, and to determine selection criteria for outcome measures in future trials. Outcome measures used in RAET were identified from MEDLINE, EMBASE, CINAHL, PubMed and PsychINFO databases. The scale items were categorized into International Classi...

This paper examines the reductions in care costs that result from inpatient multidisciplinary rehabilitation for younger people with acquired brain injury. Thirty-five consecutive patients admitted following a stroke over one year were recruited to this observational study. Physical ability, dependency and potential community care costs were measur...

The objective of this paper was to systematically review published studies to determine if disability limits access to health care and to attempt to identify what body functions, structures and activities and participation, as well as contextual factors (environmental and personal factors), interact with the health condition to limit this access. T...

The aim of this review is to describe aspects of vocational rehabilitation relevant for a physician aiming to become a specialist in physical and rehabilitation medicine (PRM). The review discusses the epidemiology of incapacity for work, the major patient groups in vocational rehabilitation (musculoskeletal and psychiatric diagnoses comprise appro...

To investigate factors that predict walking with a prosthesis after lower limb amputation. Systematic literature review. A computer-aided literature search of MEDLINE, EMBASE, CINAHL and the Cochrane Library was performed to identify studies published up to August 2007 that investigated factors that predicted walking ability after lower limb amputa...

Myeloproliferative disorders predispose individuals to bleeding and thrombosis, often with devastating consequences. We report a 41-year-old man who presented with headache, amnesia and dysphagia due to cerebral haemorrhage. Extensive investigation revealed the cause of the neurological syndrome as an underlying essential thrombocytosis. The patien...

To measure the impact of botulinum toxin A on associated reactions in patients following stroke. Randomized placebo-controlled trial. Forty patients with spasticity in their paretic arm (median time since stroke: 2.7 years) were randomized to botulinum toxin A (Dysport; 1000 mouse units (MU) divided between elbow, wrist and finger flexors) or place...

The Barthel Index (BI) may underestimate disability change because its items have few response options. We examined whether a similar scale with more response options (Functional Independence Measure, FIM) was more responsive (n = 1,396). The FIM had greater potential for responsiveness and identified more people who changed. However, its actual re...

The Multiple Sclerosis Walking Scale (MSWS-12) was developed to measure the impact of multiple sclerosis on walking. Many other disabling neurological conditions affect patients' ability to walk, and a generic measure of walking could provide valuable insights into patients' perceptions in clinical trials and epidemiological studies as well as rout...

Prospective data collection on all patients with spinal cord injury (SCI) admitted for a comprehensive management programme. To examine the epidemiology of SCI in Ireland over 1 year. Ireland's National Spinal Cord Injury Centre. Systematic data collection on all patients admitted with SCI for management. A total of 46 patients (40 males) were admi...

Botox is not just for hiding wrinkles, it also has important clinical uses, says Dr Rory O'Connor.

Provision and funding of healthcare in Britain today is undergoing one of the most profound revolutions in the 58 year history of the National Health Service. Clinicians and managers are being presented with a series of organizational reforms that affect how care to their patients is delivered and funded. Choose and book, practice-based commissioni...

Community rehabilitation is a well established and valuable part of the service response to the needs of people with long-term conditions. The authors explored the value of a Leeds-based community rehabilitation programme, before more formal evaluation, through two case reports of people living with long-term neurological conditions. Interventions...

To identify factors that impact on the ability of patients with multiple sclerosis (MS) to remain in work in order to make recommendations for future clinical management. Cross-sectional studies using qualitative (phase one) and quantitative (phase two) methods. In phase one, 62 patients were interviewed and completed an exploratory questionnaire r...

Neurological rehabilitation aims to improve quality of life of patients with acute and chronic neurological conditions. Much of the existing research focuses on the impact of rehabilitation on physical functioning, with less emphasis on emotional wellbeing. This study assessed changes in psychological functioning in patients on discharge from rehab...

Stroke has a major impact on physical and cognitive ability, and quality of life. This study aims to examine the effect of multidisciplinary rehabilitation on outcome in an Irish young stroke population. Fifty consecutive patients younger than 65 were prospectively recruited to this observational study. Physical and cognitive ability, and quality o...

Evaluating rehabilitation requires rating scales that detect change. The authors examined Barthel Index (BI) data from 1,495 patients at a neurorehabilitation unit to determine whether total scale responsiveness accurately reflects item responsiveness. Total score effect sizes were moderate to large (0.47 to 1.09). Item-level effect sizes (0.13 to...

(1). To examine the prevalence of depressive symptoms and operationally defined depressive disorder (major depression) in an Irish sample of subjects undergoing inpatient rehabilitation following their first stroke. (2). To investigate factors predictive of depression following stroke. (3). To examine the relationship between post-stroke depression...

The aim of this study was to describe a young disabled unit (YDU). These units are increasingly required to serve the needs of people with severe disabilities. Forty-two patients were included in the study; the age range was 22 to 61 years. Traumatic brain injury was the most common diagnosis on admission (13), followed by sub-arachnoid haemorrhage...