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Orthopaedic Proceedings
Vol. 106-B, Issue SUPP_15 | Pages 41 - 41
7 Aug 2024
Pavlova A Cooper K Deane J Hart-Winks E Hemming R Johnson K
Full Access

Purpose and background

Nearly 70% of UK physiotherapists experience work-related musculoskeletal disorders (WRMSDs) during their career, with a significant proportion occurring in the back and being attributed to patient handling tasks. Evidence suggests that manual handling training alone is ineffective and interventions among nurses indicate that a tailored approach, including targeted exercise (TE), can reduce WRMSD rates. This study aimed to explore physiotherapists’ perspectives of WRMSDs, patient handling, and the role of TE in reducing WRMSDs among physiotherapists.

Methods and Results

Key informant interviews were conducted with 4 physiotherapy operational leads and 1 manual handling trainer from NHS Grampian. Interviews were transcribed and Framework Analysis was utilised to identify key themes, including challenges, barriers, and facilitators. Following this, two online focus groups were conducted with 7 qualified NHS physiotherapists across the UK. Views of manual handling training varied across specialities, with some finding it comprehensive and adaptable, and others finding it less applicable to patients in their speciality or community setting. Physiotherapist views on fitness for work varied, with some highlighting the necessity of TE to ensure workforce health whilst others considered exercise to be a personal matter. Facilitators to implementation identified by participants were having support from management and a strong justification for the exercise content. Varied work schedules and facilities were identified as barriers to implementation of a work-based TE intervention.


Orthopaedic Proceedings
Vol. 106-B, Issue SUPP_15 | Pages 42 - 42
7 Aug 2024
Annetts S Hemming R
Full Access

Background

Musculoskeletal disorders, including low back pain, affects 68% of UK physiotherapists across their career with patient handling considered a key risk factor. Manual handling training is mandatory for all allied health professionals, however there is limited research investigating whether professionals adopt recommended manual handling principles following training.

Purpose of Study

To investigate spinal angles when facilitating sit-to-stand, and a turning manoeuvre in bed, comparing first-year physiotherapy students (who have not received manual handling training) with final-year physiotherapy students (who have received manual handling training).


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_9 | Pages 23 - 23
1 Oct 2022
Bhide J Hemming R Davies J
Full Access

Purpose of study and background

Psychological factors are considered to play a role in development and maintenance of chronic low back pain (CLBP). Stress or anxiety can change pain sensitivity; however, this has predominantly been studied in healthy individuals with limited work in individuals with musculoskeletal pain. The objective of this study was to quantify the effect of acute exposure to a psychosocial stressor on mechanical pain sensitivity in individuals with and without CLBP.

Summary of methods and results

Six individuals with CLBP and 10 individuals without CLBP performed a 10-minute computer task under conditions of low and high psychosocial stress. Psychosocial stress was manipulated using mental maths and memory tasks combined with social evaluative threat. The effect of the stressor was evaluated using blood pressure, heart rate and the state anxiety component of the Spielberger State-Trait Anxiety Index. Mechanical pressure pain threshold (PPT) was recorded on the tibialis anterior muscle using a handheld digital pressure algometer. The stress manipulation increased self-reported anxiety (p<0.001), but not blood pressure or heart rate (p>0.06). Change in PPT from low to high stress was greater in the CLBP group (median ΔPPT = −0.5 kg/cm2) than in the control group (−0.15 kg/cm2; p=0.005).


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_9 | Pages 12 - 12
1 Oct 2022
Mandani M Reagon C Hemming R Sparkes V
Full Access

Purpose and Background

Patients’ engagement with self-management strategies (SMS) is key when managing low back pain (LBP) and relies on appropriate information being delivered by the treating Clinician. However, patients have differing coping mechanisms which may affect success with SMS. This study aimed to determine Patient and Physiotherapist's perceptions of coping responses and SMS in patients with LBP.

Methods

Patient completed a Pain Coping strategies questionnaire, before and after LBP treatment. Semi-structured interviews gathered data from of 10 patients (6 males; and 6 physiotherapists. Questionnaire data was described descriptively, and qualitative data was transcribed/analysed thematically.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_10 | Pages 16 - 16
1 Oct 2019
Hemming R Rose AD Sheeran L van Deursen R Sparkes V
Full Access

Background

Trunk muscle activity and thoraco-lumbar kinematics have been shown to discriminate non-specific chronic low back pain (NSCLBP) subgroups from healthy controls. Thoracic spine kinematics and muscle activity whilst intuitively associated with NSCLBP, has received less attention and the possibility of intra-regional interactions remains an area for exploration.

Purpose

Determine relationships between muscle activation and kinematics in active extension pattern (AEP) and flexion pattern (FP) subgroups and no-low back pain controls during a sagittal bending task.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_10 | Pages 37 - 37
1 Oct 2019
Yang Z Hemming R
Full Access

Background

Previous work has identified differential kinematics and muscle activity between non-specific chronic low back pain (LBP) subgroups (flexion pattern (FP) and active extension pattern) and healthy controls. However, it is unclear if differences in muscle activity are maintained on resolution of pain and/or if they contribute to pain recurrence.

Purpose

To investigate differences in trunk muscle activity between individuals with a history of flexion-related LBP (who are currently pain-free) and no-LBP controls during three functional activities.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_9 | Pages 46 - 46
1 Sep 2019
Breen A Hemming R Claerbout E Breen A
Full Access

Purpose and background

Static plain radiographs at the end of uncontrolled bending are the current standard of care for measuring translatory slip in back pain patients. Quantitative fluoroscopy systems (QF) that employ standardised bending protocols have been found to improve precision and reduce dose, but comparative data are lacking. We compared 4 QF methods with static radiographs in a control population, calculating ranges, population variation and measurement errors over 6 weeks.

Methods

Fifty-four healthy controls (F=22, M=23) received passive recumbent and active weight bearing QF screenings during controlled motion, plus still fluoro imaging in neutral, flexion and extension. The translatory slip of all levels from L2-S1 was determined for each condition using bespoke image tracking codes (Matlab) and pooled to provide means and ranges of variation (+/-1.96SD). The pooled measurement error, or minimal detectable change (MDC95), reflecting the intra subject repeatability over 6 weeks was calculated. Ranges of translation for each level (L2-S1), for each type of motion were also calculated.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_9 | Pages 8 - 8
1 Sep 2019
Breen A Hemming R Mellor F Breen A
Full Access

Background

Dynamic measurement of continuous intervertebral motion in low back pain (LBP) research in-vivo is developing. Lumbar motion parameters with the features of biomarkers are emerging and show promise for advancing understanding of personalised biometrics of LBP. However, measurement of changes over time inevitably involve error, due to subjects' natural variation and/or variation in the measurement process. Thus, intra-subject repeatability of parameters to measure changes over time should be established.

Methods

Seven lumbar spine motion parameters, measured using quantitative fluoroscopy (QF), were assessed for intra-subject repeatability: Intervertebral range-of-motion (IV-RoM), laxity, motion sharing inequality (MSI), motion sharing variability (MSV), flexion translation and flexion disc height. Intra-subject reliability (ICC) and minimal detectable change (MDC95) of baseline and 6-week follow-up measurements were obtained for 109 healthy volunteers (54 coronal and 55 sagittal).


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_2 | Pages 17 - 17
1 Feb 2015
Hemming R Sheeran L van Deursen R Sparkes V
Full Access

Background and Purpose of Study:

Differences in regional lumbar angles in sitting have been observed between subgroups of NSCLBP patients exhibiting motor control impairments (MCI) (O'Sullivan, 2005; Dankaerts et al, 2006). However, differences in standing posture and other spinal regions are unknown. This study aimed to compare regional spinal angles in healthy and MCI subgroups in sitting and standing.

Methods:

An observational, cross-sectional study investigated spinal kinematics of 28 Flexion Pattern (FP), 23 Active Extension Pattern (AEP) (O'Sullivan, 2005) and 28 healthy controls using 3D motion analysis (Vicon) during usual sitting and standing. Mean sagittal angle for Total Lumbar (TotLx), Total Thoracic (TotTx), Upper Thoracic (UTx), Lower Thoracic (LTx), Upper Lumbar (ULx) and Lower Lumbar (LLx) regions between groups were compared using one-way ANOVA.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_4 | Pages 35 - 35
1 Feb 2014
Sheeran L Hemming R Sparkes V
Full Access

Background

CB-CFT targeting specific pain provoking posture/movements in NSCLBP patients was shown more beneficial than current best practice. Resources for such interventions are substantial and so modifications for today's NHS are warranted. This study investigated feasibility and effect of CB-CFT delivered in a group setting (CB-CFT/G).

Methods

Twenty three patients referred to Physiotherapy with NSCLBP undertook (i) 6 week CB-CFT/G(n=13) or (ii) current best practice (C)(n=10). Outcomes: Oswestry Disability Questionnaire (ODQ), pain (VAS), fear avoidance (Tampa Scale of Kinaesiophobia;TSK), physical activity (International Physical Activity Questionnaire;IPAQ), distress&risk assessment (DRAM), StarTBack and satisfaction. Unpaired t-tests assessed between-group difference in mean change of each outcome (p<0.05).