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Journal articleBates AV, McGregor AH, Alexander CM, 2016, , GAIT & POSTURE, Vol: 44, Pages: 37-42, ISSN: 0966-6362
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- Citations: 15
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Journal articleSugand K, Mawkin M, Gupte C, 2016, , INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED, Vol: 47, Pages: 448-452, ISSN: 0020-1383
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- Citations: 27
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Journal articleCobb J, 2016, , TRENDS IN UROLOGY & MENS HEALTH, Vol: 7, Pages: 25-27, ISSN: 2044-3730
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Journal articlePapi E, Murtagh GM, McGregor AH, 2016, , BMJ Open, Vol: 6, ISSN: 2044-6055
Objective This study investigates clinicians’ views of health-related wearable technologies in the context of supporting osteoarthritis (OA) long-term management. Clinicians’ preferences are critical in identifying realistic implementation strategies for such technologies.Design Qualitative study incorporating an inductive thematic analysis applied to identify key themes from clinicians’ responses.Participants Clinicians, including 4 general practitioners, 4 physiotherapists and 5 orthopaedic surgeons were interviewed.Setting The study was conducted in a University setting.Results Participants all agreed wearable technologies could positively complement their role and enhance their relationship with patients. Perceived benefits of wearable technologies included monitoring patients’ progress, treatment evaluation, monitoring compliance and informing clinical decision-making. The device should be designed to provide objective data of patients’ locomotion capability in an easy and timely fashion via a simple interface. Data should be available to both clinicians and patients to provide them with the motivation to achieve clinical goals and allow them to take ownership of their treatment. The use of technology was also seen as a way to more effectively plan treatment and manage patients’ contact time saving time and cost.Conclusions Findings support the use of wearable technologies to enhance current OA management and suggest clinical uses. Adoption of technologies could have implications on the effectiveness of treatment provided overcoming current barriers, in particular compliance with treatment.
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Journal articleMasjedi M, Mandalia R, Aqil A, et al., 2016, , COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING, Vol: 19, Pages: 67-73, ISSN: 1025-5842
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- Citations: 2
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Journal articleGreenwood J, McGregor A, Jones F, et al., 2016, , Spine, Vol: 41, Pages: E28-E36, ISSN: 0362-2436
STUDY DESIGN: A systematic review with meta-analysis. OBJECTIVE: The aim of this study was to conduct a systematic review and meta-analysis of current evidence evaluating the effectiveness of rehabilitation following lumbar fusion surgery (LFS). SUMMARY OF BACKGROUND DATA: LFS for the management of lower back pain, with(out) neurogenic leg pain, is increasing as the population ages. Clinical outcomes commonly lag behind surgical outcomes and 40% of patients experience significant back-related disability 12 months after LFS. Identifying rehabilitation strategies to improve function and quality of life following LFS is important. METHODS: A systematic review of databases were searched, including MEDLINE, CINAHL, and grey literature. Studies identified were screened for inclusion by title and abstract. Full text of eligible/potentially eligible studies was evaluated against predetermined eligibility criteria. Included studies were subjected to critical appraisal and risk of bias evaluation. The GRADE approach to quality of evidence was utilized. A meta-analysis comparing usual care with "complex rehabilitation," comprising exercise and cognitive behavioral therapy, for outcomes relating to pain, disability, fear of movement, and mental health was conducted at short and longer term (<3 and >12 months postsurgery) time points. RESULTS: Three studies were identified for the systematic review and 2 included in the meta-analysis (n = 237, female = 62%, mean age = 55). Low-quality evidence suggests that "complex rehabilitation" provides short-term improvement in disability [effect size, -0.85, 95% confidence interval (95% CI), -1.41 to -0.29] and fear avoidance behavior (-1.07, 95% CI -1.33, -0.80), compared with usual care. Low-quality evidence exists favoring "complex rehabilitation" over usual care for longer term disability (-0.84, 95% CI -1.11 to -0.58) and fear avoidance behavior (-1.40, 95% CI -1.69 to -1.12). CONCLUSIONS: A small n
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Journal articleLogishetty K, Jones GG, Cobb JP, 2016, , Clinical Orthopaedics and Related Research, Vol: 474, Pages: 272-273, ISSN: 1528-1132
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Book chapterIranpour F, Aframian A, Cobb JP, 2016, , Joint Preservation in the Adult Knee, Pages: 43-53
The patellofemoral joint has traditionally been poorly understood and interventions for patellofemoral joint problems have generally been less successful than those employed for the tibiofemoral joint. Pathologies affecting the patellofemoral joint in the adult can be largely divided into three groups: instability, osteochondral defects and osteoarthritis. These three conditions share a number of aetiological factors and all represent disorders of the normal mechanics of the patellofemoral articulation. As such, understanding the normal and abnormal anatomy and kinematics of the joint are vital to clinicians treating patellofemoral disorders. Treating the symptoms of these conditions without addressing the underlying disorder of kinematics will be likely to fail. In this chapter, the normal and abnormal anatomy and physiology of the joint are discussed as are the clinical features and treatments for the three commonly encountered pathologies of the patellofemoral joint.
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Book chapterTang QO, Gupte CM, 2016, , Joint Preservation in the Adult Knee, Pages: 1-11
The art of clinical examination is often forgotten with the advent of increasingly precise imaging modalities but in fact remains the most powerful tool in the surgeon’s armamentarium and is at the heart of the patient- clinician relationship. A clear examination sequence forms a fundamental tool for the diagnosis and correct treatment of knee pathology. Whilst this is important, the advanced examiner together with the history will tailor a specific exam series depending on the suspected pathology. In general, there are three broad series: one for patellofemoral/extensor mechanism pathologies; one for meniscal and chondral (articular) lesions; and one for instability. This chapter will provide an overview of advanced physical examination of the knee and outlines the most commonly used tests. Images and detailed descriptions will provide the reader with a thorough understanding of hand positions and identifying a positive sign.
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Journal articleCole JM, Wood JC, Lopes NC, et al., 2016, , Plasma Physics and Controlled Fusion, Vol: 58, ISSN: 1361-6587
A laser-wakefield driven x-ray source is used for the radiography of human bone. The betatron motion of accelerated electrons generates x-rays which are hard (critical energy ${{E}_{\text{crit}}}>30$ keV), have small source size (<3 μm) and high average brightness. The x-rays are generated from a helium gas cell which is near-instantly replenishable, and thus the average photon flux is limited by the repetition rate of the driving laser rather than the breakdown of the x-ray source. A tomograph of a human bone sample was recorded with a resolution down to 50 μm. The photon flux was sufficiently high that a radiograph could be taken with each laser shot, and the fact that x-ray beams were produced on 97% of shots minimised failed shots and facilitated full micro-computed tomography in a reasonable time scale of several hours, limited only by the laser repetition rate. The x-ray imaging beamline length (not including the laser) is shorter than that of a synchrotron source due to the high accelerating fields and small source size. Hence this interesting laboratory-based source may one day bridge the gap between small microfocus x-ray tubes and large synchrotron facilities.
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Journal articleLangley RE, Kynaston HG, Alhasso AA, et al., 2015, , European Urology, Vol: 69, Pages: 1016-1025, ISSN: 1421-993X
BACKGROUND: Luteinising hormone-releasing hormone agonists (LHRHa), used as androgen deprivation therapy (ADT) in prostate cancer (PCa) management, reduce serum oestradiol as well as testosterone, causing bone mineral density (BMD) loss. Transdermal oestradiol is a potential alternative to LHRHa. OBJECTIVE: To compare BMD change in men receiving either LHRHa or oestradiol patches (OP). DESIGN, SETTING, AND PARTICIPANTS: Men with locally advanced or metastatic PCa participating in the randomised UK Prostate Adenocarcinoma TransCutaneous Hormones (PATCH) trial (allocation ratio of 1:2 for LHRHa:OP, 2006-2011; 1:1, thereafter) were recruited into a BMD study (2006-2012). Dual-energy x-ray absorptiometry scans were performed at baseline, 1 yr, and 2 yr. INTERVENTIONS: LHRHa as per local practice, OP (FemSeven 100μg/24h patches). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary outcome was 1-yr change in lumbar spine (LS) BMD from baseline compared between randomised arms using analysis of covariance. RESULTS AND LIMITATIONS: A total of 74 eligible men (LHRHa 28, OP 46) participated from seven centres. Baseline clinical characteristics and 3-mo castration rates (testosterone ≤1.7 nmol/l, LHRHa 96% [26 of 27], OP 96% [43 of 45]) were similar between arms. Mean 1-yr change in LS BMD was -0.021g/cm(3) for patients randomised to the LHRHa arm (mean percentage change -1.4%) and +0.069g/cm(3) for the OP arm (+6.0%; p<0.001). Similar patterns were seen in hip and total body measurements. The largest difference between arms was at 2 yr for those remaining on allocated treatment only: LS BMD mean percentage change LHRHa -3.0% and OP +7.9% (p<0.001). CONCLUSIONS: Transdermal oestradiol as a single agent produces castration levels of testosterone while mitigating BMD loss. These early data provide further supporting evidence for the ongoing phase 3 trial. PATIENT SUMMARY: This study found that prostate cancer patients treated with transdermal oestradiol for ho
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Journal articleAframian A, Boughton OR, Auvinet E, et al., 2015, , British Medical Journal, Vol: 351, ISSN: 1468-5833
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Journal articleMcGregor AH, Buckeridge E, Murphy AJ, et al., 2015, , Proceedings of the Institution of Mechanical Engineers Part P - Journal of Sports Engineering and Technology, Vol: 230, Pages: 246-252, ISSN: 1754-3371
The use of representations of physiological parameters to an athlete and coach during training is becoming increasingly common. Their utility is enhanced when the appropriate data are captured and communicated in real time for the athlete to make training adjustments immediately. The aim of this work was to develop a biofeedback tool for ergometer rowing by creating a data acquisition system, data analysis and interpretation that could be conducted in real time and a feedback system with appropriate cues to the athlete. This fourteen year study resulted in a set of measured parameters with inferred correlations between the directly measured parameters acquired during the activity and performance and injury outcome measures. These parameters were represented through a customisable visual display in real-time during ergometer training. An athlete and coach open survey was conducted to assess the utility of the biofeedback tool. This survey found that all parties valued the feedback system since it provided a common language to identify body motion and performance parameters in a way that was accessible and meaningful to all parties as well available during training and coaching. Athletes noted that it helped them to understand body segment motion and its relation to performance and both coaches and medical staff valued this in enhancing performance and monitoring injury and injury prediction. There was also speculation that the system help to underpin coaching practice and its translation to the team. The biofeedback tool has been adopted by the British elite rowing squad.
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Conference paperPavlova A, Deane JA, Aspden R, et al., 2015,
Lumbar spine curvature varies with modic changes and disc degeneration in asymptomatic individuals
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Journal articleShah SIMRANA, Jin ANDI, Wilson HANNAHCP, et al., 2015, , European Journal of Medicine, Vol: 10, Pages: 214-220, ISSN: 2310-3434
Osteoporosis with resultant fractures is a major global health problem with huge socioeconomicimplications for patients, families and healthcare services. Areal (2D bone mineraldensity (BMD) assessment is commonly used for predicting such fracture risk, but is unreliable,estimating only about 50% of bone strength. By contrast, computed tomography (CT) basedtechniques could provide improved metrics for estimating bone strength such as bone volumefraction (BVF; a 3D volumetric measure of mineralised bone), enabling cheap, safe and reliablestrategies for clinical application, and to help divert resources to patients identified as most likelyto benefit, meeting an unmet need.Here we describe a novel method for measuring BVF at clinical-CT like low-resolution(550µm voxel size). Femoral heads (n=8) were micro-CT scanned ex-vivo. Micro-CT data weredowngraded in resolution from 30µm to 550µm voxel size and BVF calculated at high and lowresolution. Experimental mechanical testing was applied to measure ex vivo bone strength ofsamples. BVF measures collected at high-resolution showed high correlation (correlationcoefficient r2=0.95) with low-resolution data. Low-resolution BVF metrics showed high correlation(r2=0.96) with calculated sample strength. These results demonstrate that measuring BVF at lowresolution is feasible, which also predicts bone strength. Measures of BVF should be useful for clinically estimating bone strength and fracture risk. The method needs to be validated using clinical CT scans.
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Journal articleChen A, Sabharwal S, Akhtar K, et al., 2015, , KNEE, Vol: 22, Pages: 640-645, ISSN: 0968-0160
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- Citations: 49
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Journal articleAqil A, Wiik A, Clarke S, et al., 2015, , Eur J Orthop Surg Traumatol, Vol: 25, Pages: 1301-1305
BACKGROUND: Joint registries report that peri-prosthetic fractures are the most common reason for early revision of a hip resurfacing arthroplasty (HRA) and are twice as likely with small implant sizes. However, a national survey found peri-prosthetic fracture to be strongly associated with surgical accuracy. We therefore asked whether the force required to induce a peri-prosthetic fracture: (1) was significantly lower when using smaller implants and (2) correlated to the size of implant used, when surgery was performed accurately. METHODS: To ensure an adequate power, we calculated our sample size from pilot data. Forty-four femurs were tested in two experiments. The first experiment tested femurs with either a small (48 mm) or a large (54 mm) HRA implant. The second involved testing femurs with a range of implant sizes. A rapid prototyped femur-specific guide ensured accurate implantation. Specimens were then vertically loaded in a servo-hydraulic testing machine till fracture. Displacement (mm) and force (N) required for fracture were recorded. RESULTS: A median force of 1081 N was required to fracture specimens implanted with small 48-mm heads, while 1134 N was required when a 54-mm head was used (U = 77, z = -0.054, p = 0.957). Implant head size and force required to fracture were not related, r = 0.12, p = 0.63. CONCLUSIONS: The force required to induce a resurfacing peri-prosthetic fracture was not related to the size of the implant. The increased failure rate seen in all registries is unlikely to be directly the result of this single variable. Correctly performed resurfacing arthroplasty is highly resistant to fracture.
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Journal articleSugand K, Akhtar K, Khatri C, et al., 2015, , Acta Orthopaedica, Vol: 86, Pages: 695-701, ISSN: 1745-3682
Background and purpose - Virtual reality (VR) simulation offers a safe, controlled, and effective environment to complement training but requires extensive validation before it can be implemented within the curriculum. The main objective was to assess whether VR dynamic hip screw (DHS) simulation has a training effect to improve objective performance metrics. Patients and methods - 52 surgical trainees who were naïve to DHS procedures were randomized to 2 groups: the training group, which had 5 attempts, and the control group, which had only one attempt. After 1 week, both cohorts repeated the same number of attempts. Objective performance metrics included total procedural time (sec), fluoroscopy time (sec), number of radiographs (n), tip-apex distance (TAD; mm), attempts at guide-wire insertion (n), and probability of cut-out (%). Mean scores (with SD) and learning curves were calculated. Significance was set as p < 0.05. Results - The training group was 68% quicker than the control group, used 75% less fluoroscopy, took 66% fewer radiographs, had 82% less retries at guide-wire insertion, achieved a reduced TAD (by 41%), had lower probability of cut-out (by 85%), and obtained an increased global score (by 63%). All these results were statistically significant (p < 0.001). The participants agreed that the simulator provided a realistic learning environment, they stated that they had enjoyed using the simulator, and they recognized the need for the simulator in formal training. Interpretation - We found a significant training effect on the VR DHS simulator in improving objective performance metrics of naïve surgical trainees. Patient safety, an important priority, was not compromised.
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Journal articleSugand K, Mawkin M, Gupte C, 2015, , INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED, Vol: 46, Pages: 2212-2216, ISSN: 0020-1383
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- Citations: 42
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Journal articleChawla A, McGregor A, 2015, , Future Science OA, Vol: 1, ISSN: 2056-5623
This EuroSciCon Sports Science Summit represented a significant gathering of leading professionals in the field of sports science. The conference was held on 13-15 January 2015 at the O2 arena, London, UK. The chairman on the third day was Mr Greg Robertson, a specialist trainee Orthopedic surgeon from Edinburgh. The conference attracted over 80 attendants from all over the world, with 32 presentations from invited speakers and peer-reviewed submissions. This meeting report provides a summary of the best abstracts from the conference.
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