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AECC Research ReviewExcellence in education, clinical training and research

September2013 –

August2015

The Bournemouth Open Upright MRI scanner, one of only five in the

country and housed in the AECC clinic

Welcome

Research at the AECC

PhD student stories

From undergraduate to clinician to researcher: A personal story

The patient’s story: Telling it to improve outcomes

MSc student stories

A graduate perspective

A group perspective

A student perspective

Teaching the future: Innovations in healthcare monitoring

Visions of the future: Bringing imaging techniques together

Measuring the future: The promise of big data

Awards & Grants

Publications

PhD research projects

MSc dissertations & clinical audits

Contents

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Welcome

The world is a complex place and healthcare provides some of the most challenging problems in providing answers to the question of how best to deliver patient care.

When it comes to such questions, the scientific approach has proven to be the most successful way of generating reliable knowledge and at the AECC, the scientific ethos is embedded deeply in our educational tradition.

We believe, in line with the World Health Organisation, that health is not merely the absence of disease and our research attempts to take this broad view. This includes addressing questions concerned with living healthier lives, as well as exploring how to best manage the increasing problems that people face – particularly with musculoskeletal conditions that can stand as barriers to attaining and maintaining a healthy and fulfilling life.

However, no man is an island and similar to the notion that being embedded in a wider community is central to our health and wellbeing, we, as an institution also foster collaboration with other world-leading centres of research in order to share our expertise, further our learning and support our research endeavours.

While we have achieved much in the time we have been pursuing these goals, we are, as yet, a small albeit specialised player in the starry firmament of research in this field. We will continue to work hard to build on our achievements and cement our reputation in excellence across all our activities, ultimately for the benefits of our students, our patients and our community.

Dr David Newell Director of Research

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AECC RESEARCH REPORT

Great things are done by a series of small things brought together.

Vincent van Gogh

“”

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Over the last 50 years there has been a major shift in health concerns, particularly in the developed world, away from diseases caused by infections, heart disease and trauma toward more chronic problems.

While these are often non-life threatening conditions, they significantly undermine the quality of millions of peoples’ lives. This trend represents a growing challenge in terms of access to appropriate care and management and spiralling costs in a difficult economic environment.

Musculoskeletal (MSK) problems such as back and neck pain are a major part of this health challenge. A recent report concerning the UK burden of disability ranked low back and neck pain as first and fourth on the list of all health problems.

While high technology medicine has become the mainstay of modern medical care, chronic MSK conditions are generally not best managed by high tech interventions, despite impacting huge numbers of individuals. This has resulted in a pressing need to provide appropriate and evidenced-based care to the very large numbers of patients experiencing episodes of, or living with, MSK conditions. Providing this care requires diverse skills and approaches and understanding how to best deliver this care is achieved by answering complex questions through research.

A brief introduction to research at the AECC


Now in its 50th anniversary year, the AECC has a long history of generating research. Initially this was mainly part of its undergraduate degree activity but since the mid-80s has been increasingly at higher degree level (MSc and PhD) and on the national and international stage. As evidence of this, nearly half of AECC faculty have PhD degrees in a wide range of subjects and using a diversity of methodological approaches.

At present, the AECC’s major research focus lies within three broad areas: clinical imaging; patient reported outcome measures (PROMS); and treatment/physiological investigations including laboratory and clinical trial-based investigations. Of these, clinical imaging and PROMs have been uniquely innovating and have resulted in the production of world-leading research.

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Imaging

The AECC has developed unique tracking software for use during Quantitative Fluoroscopy (QF) of the moving spine, which was first granted a patent in 2001.

QF involves taking multiple low dose x-rays of the spine during movements and has been developed to explore the detailed movement of individual vertebrae while patients are moved by a motorised table or actively bend themselves. A number of PhDs have been completed in this area, culminating this year with two projects exploring the association of vertebral movement with low back pain or neck pain.

This is part of an ongoing research project and is complemented by the AECC’s recent acquisition of an upright MRI – the Bournemouth Open Upright MRI scanner – which will be used alongside other imaging expertise such as MSK ultrasound as foundations for future research.

One of the research focus articles within this publication includes a description of a new project that involves the simultaneous use of QF and MRI to determine the loads vertebrae experience during movement.

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Patient Reported Outcome Measures

Another innovative area that the AECC has been involved in is the creation of, and subsequent delivery and use of, PROMs.

In 1997, a senior AECC faculty member, Professor Jenni Bolton, created what is known in the field as a ‘condition specific outcome measure’. These are increasingly used in healthcare to measure how patients are faring during their treatment.

This particular measure – known as the Bournemouth Questionnaire – has subsequently been validated and used extensively in research and clinical scenarios. It has also been incorporated into software that automatically collects ongoing health measures from patients undergoing manual care across a number of professions and the collection of PROMs using digital technology is one of the projects described by a PhD student jointly supervised by the AECC and Southampton University later in this publication.

The AECC’s research expertise and our relationships with the University of Southampton, Bournemouth University, Portsmouth University and Teesside University with whom we have joint PhDs, make up a burgeoning and increasingly collaborative group of research groups.

We are proud of our efforts and successes in this collaborative effort and only see this expanding in the future.

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“”

Dr David Newell, Director of Research


Like many who turn to a new profession, it was a specific incident that got me there. On holiday in India from my demanding job as an Operations Manager, I fell down a flight of stairs and herniated a disk in my lumbar spine.

I’d had no previous problems so I didn’t realise people could survive such pain! I couldn’t sit or stand easily so I tried everything and what helped me most was a chiropractic approach. It really resonated with me and after doing a little research about what was involved at each of the UK colleges; I made a massive decision to change my life. I downsized my job, moved house and enrolled at the McTimoney College of Chiropractic.

After five years of what seemed like endless study and exams, I became a chiropractor and clinic owner. My clinic has grown steadily and allowed me to develop my skills. Numerous post-graduate training and CPD courses exposed me to other people’s ideas of what it meant to be a chiropractor and I gradually learnt more techniques and skills to add to my repertoire.

My interest in research grew from completing my undergraduate dissertation. Until then I had always thought research was something done by other far more knowledgeable people, but with support from my supervisor and to my delight, my findings were published in a peer reviewed journal.

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From student to clinician to researcher: A personal journey


Sara Glithro Bournemouth University & AECC PhD student

Opening my clinic as a new graduate was daunting, but with the support of others my skills and confidence grew and I am now in my fourth year of practice.

As a clinician I began to ask myself questions about the impact I was having upon my patients, the techniques I was using and how I might adapt them from patient to patient.

Practitioners have similar success stories but questions arose such as why do different types of care offered to similar patients by different healthcare professionals get similar results – some positive and some not? Why do apparently similar chronic non-specific low back pain sufferers get better; but others just keep coming back with the same niggles in the same place. Discussing such questions with other practitioners highlighted how little we really knew about even common conditions like low back pain.

To improve our understanding of and advance our knowledge we need more quality research from cohesive teams of people with varied backgrounds and shared interests. With so few graduates continuing with research, I felt it was as much my responsibility as anyone else’s, so when the opportunity to apply for a PhD with the AECC and Bournemouth University came up, I jumped at the chance. I had always planned to be involved at a professional level so while I continue to provide care for my patients, I could also learn to be a good researcher and perhaps get involved in academic teaching in the future.

I firmly believe it is our lifelong duty to improve and share our understanding of what we do and how we care for our patients. We cannot do that effectively without the growth, advancement and cohesion of our profession and I am delighted to be a part of it at as a PhD Fellow at the AECC and Bournemouth University.

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As a chiropractor who trained at a different college and in a different technique, it was quite nerve-wracking coming into the AECC but everyone has been so welcoming and helpful.

“”

Patient reported outcome measures are increasingly being used to collect patient feedback on clinical outcomes on a routine basis in healthcare.

Theoretical analyses of these measures remain under-developed and the evidence-base evaluating them in clinical settings is relatively new – important questions remain about the consequences of collecting such data, for patients, practitioners, and the interactions between them.

From a psychological perspective, asking patients to rate their own health during the course of care can be viewed a potentially powerful component of complex clinical interventions because they involve patients actively monitoring and reporting their symptoms in detail. It is even possible that the act of monitoring symptoms through such reporting might itself directly trigger health changes.

My PhD will use different approaches and methods to identify potential beneficial or adverse effects of patients monitoring their own symptoms and examine the processes underpinning such effects, in the context of musculoskeletal health.

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The patient’s story: Telling it to improve outcomes


Michelle Holmes University of Southampton & AECC PhD student

The first stage of my PhD has involved an extensive search of the research literature and writing a systematic review.

The next stage of my PhD is a feasibility study to examine the achievability of conducting a trial in a chiropractic setting to examine the potential effects of using different frequencies of patient reporting during chiropractic care for low back pain. This feasibility study will examine the recruitment of chiropractors and patients, the study design, measurement tools and participant experience of a trial and hopefully will begin later this year. Following the feasibility study, a pilot study will be conducted to start to understand the effects of using patient reported measures on the patient’s clinical outcomes and the process of care.

This PhD is funded by the University of Southampton with the AECC, the Royal College of Chiropractors, and the Southampton Complementary Medicine Research Trust.

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By examining the clinical uses of PROMs within the management of non-specific low back pain, my PhD findings will contribute to the current agenda of finding new ways to improve the effectiveness and delivery of existing therapies for low back pain.

“”

Recently one of our graduates gained a position working at the World Health Organisation (WHO) in an area of public health. Here is his story:

It is a great honour to have been offered a consultancy at the WHO.

Currently there is only one chiropractor working as a Staff Member at WHO; Dr Molly Meri Robinson Nicol, a technical officer in the CTS team. Another, Dr Nicole Homb, is completing a one year WHO-WFC Collaborative Fellowship, also on consultancy contract.

Working in public health at this level brings with it a huge amount of responsibility and requires the ability to work quickly and to a very high standard. Individuals must have the ability to work well not just within their own team, but also with other teams within WHO and with experts from around the world.

The work that WHO engages in requires a multidisciplinary, highly-skilled workforce including researchers, epidemiologists, and clinicians, alongside a host of other professionals, specialists, and support staff. My current position requires excellent critical appraisal skills, with the ability to read, evaluate, and summarise the quality of research within the context of the projects that I work on.

Working with the Blindness and Deafness Prevention, and Disability and Rehabilitation team (BDD) has exposed me to resources that I had not previously been familiar with, such as GRADE* and GRADE CERQual**.

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A graduate perspective


Richard Nicol

AECC MSc student

These tools help to evaluate the quality of research, within the context of a particular PICO† question, and facilitate the creation of transparent recommendations that go towards the production of a WHO guideline.

My hope is that more students will see the opportunities available to them in the field of public health and engage with the internship program that WHO has available to all healthcare students. Naturally, this requires that colleges support students who would like to pursue a career that has not been a traditional focus for the chiropractic profession.

*GRADE – Grades of Recommendation, Assessment, Development & Evaluation

**CERqual – Confidence in the Evidence from Reviews of Qualitative Research

†PICO – Patient/Population, Intervention, Comparison and Outcomes

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My hope is that more students will see the opportunities available to them in the field of public health and engage with the internship program that WHO has available to all healthcare students.

“”

After completing our three-year bachelor’s degree we advanced to the MSc in Chiropractic. Our Master’s programme is a two-year clinical internship here at the AECC clinic and as part of this we are required to complete a group project.

We had already begun to plan our dissertation during our third year here and, as we are a Scandinavian group with three Norwegians, one Swedish and one Finn, it was not the easiest task to create and find a topic. Following a few meetings we decided to research the cost-effectiveness of chiropractic care in our three Scandinavian countries. However, after realising how big this task was, we decided to rethink.

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A group perspective


Samu Ruoppa, Ida Nordqvist, Fredrikke Rustad, Hilde Hamre, Ida Karlsen

AECC MSc student group project

The beginning of the dissertation was quite challenging as the project constantly changed and further developed beyond what we had in mind at the start. However, as time went on we managed to slowly solve the problems and the tasks became clearer.

In our project we are carrying out psychometric research which involves translating and validating the Bournemouth Questionnaire (BQ), which is a comprehensive multi-dimensional outcome questionnaire to assess patient outcomes in a routine clinical setting. Because non-specific musculoskeletal conditions are multi-factorial and affect individuals in different ways, it can be a challenge to measure outcomes quickly and efficiently in a busy chiropractic clinical setting. But we felt that this questionnaire would be useful in clinical settings in Scandinavian countries.

This project has been reliant on communication between each nation’s chiropractic association and their research groups. We have learned a lot from the process of translating the BQ, especially about communication skills. Communication has been the key to succeeding in our project, which has been quite challenging at certain times.

As this is a group of five individuals, the hardest task was to organise time to work on the project together. These processes have taught us a lot about teamwork and problem-solving. The fact that the product of our research can be useful for our chiropractic colleagues makes the hard work worth it in the end. It’s been a journey, and we are thankful for all the help we have received from researchers in England and Scandinavia.

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The last year has been very interesting and has given us a good opportunity to learn about the process of doing research.

“”

My interest in research did not blossom until after I had begun; I thought it would be something that I used rather than created.

A few months into my Master’s group project, which is to create and validate a paediatric outcomes questionnaire, I had caught the bug. The hands-on practical aspect of research is what I really enjoy, watching the data come together, wondering what it could mean for the individual in front of me, the wider population, and even for the future of chiropractic profession.

Most of the work I have carried out so far has been qualitative, and the human aspect of this has been really interesting. Over the summer I conducted interviews with mothers about their experiences of health care with their babies, and the work that followed this has now been published. After a year of planning, doing, and writing, it has been really exciting to see the hard work come together, and to see how it is applicable to many different healthcare providers in their respective fields, whilst most importantly, giving a voice to mothers about how we can best serve their needs.

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A student perspective


Amy Miller AECC MSc student

Collecting data as to how patients are progressing with their care and the degree with which their symptoms are changing is a challenge, particularly so in busy clinics.

However, this is increasingly an expectation of healthcare providers with the UK government piloting this in four elective surgical interventions, with a view to rolling this out across healthcare environments in the UK in the near future, including GPs. This initiative is also being trialled in other countries and it is likely that the routine collection of patients’ views and clinical impression of their progress will be increasingly part of modern healthcare.

The questionnaires by which clinicians monitor their patients’ own perceptions of their symptoms are called Patient Reported Outcome Measures (PROMs) and usually consist of paper forms that are handed out in clinic or sent to the patients by post. However, one of the problems with paper-based outcomes is that collecting them can be disruptive for the patients and the clinics they attend, given that they take time, which is limited in clinics, get lost and take a considerable amount of administration resources and cost in managing the data collection, storage and analysis.

To help to solve some of these problems, over the last five years or so, we have been involved in the development of an electronic web-based system that allows patients to complete these questionnaires in their own homes and at their convenience.

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Teaching the future: Innovations in healthcare monitoring


Dr David Newell AECC Director of Research

Patients’ answers filled in online are automatically sent back to their clinician who can then monitor how the patient is coping and use the data, comments and graphs to further engage with the patient about their ongoing care, symptoms and management choices, putting the patient firmly at the centre of their care experience.

We and members of the profession have increasingly utilised a system called Care Response, which has successfully been employed to monitor many thousands of patients attending for chiropractic care. We believe this innovative approach to collecting PROMs has the potential to put the chiropractic profession at the forefront of research in this area. We recently implemented this system in our large teaching clinic here at the AECC and are encouraging students to become familiar and comfortable with this way of collecting ongoing information and outcomes from patients.

A recent joint study between the University of South Wales and the AECC has explored the implementation of this system in teaching clinics. We will use this information in the near future to enhance its use in our clinic as we believe this is part of the future of healthcare and we wish to provide our new graduates with the most up-to-date and contemporary tools to deliver excellent and evidenced-based care to their patients.

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We wish to provide our new graduates with the most up to date and contemporary tools to deliver excellent and evidenced-based care to their patients.

“”

The AECC’s Institute for Musculoskeletal Research and Clinical Implementation (IMRCI) has been awarded a grant.

The new Chiropractic Research Council has awarded £40,344 to the IMRCI, in collaboration with the MRI Research Centre at the University of Exeter, to develop a way to integrate fluoroscopy and MRI to determine the loading between spinal segments during motion.

The distribution of load of one lumbar vertebra on its neighbour during motion is historically impossible to determine in the living spine. Yet it is of central concern when considering the capacity of patients with chronic back pain to undertake routine tasks.

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Visions of the future: Bringing imaging techniques together


Alan Breen AECC Director of IMRCI

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The Institute for Musculoskeletal Research and Clinical Implementation (IMRCI) is a research institute within the AECC.

It is the home of quantitative fluoroscopy technology, which measures the motion of spinal segments in living individuals.

Researchers in the biophysics group at the University of Exeter have developed a technique that accurately predicts static loading between vertebrae in different positions using subject-specific MRI images as inputs. We are applying these models to enable the loading between lumbar vertebrae during bending to be calculated in specific patients by adding the motion information from quantitative fluoroscopic recordings to the MRI-generated models.

It represents the first step in the development of a process to measure the loads on vertebrae during tasks in the assessment of patients with chronic, disabling back pain.

“”This will be the first time patient-specific information has been used in such models. It is only possible due to the availability of both upright MR and quantitative fluoroscopy at the AECC.

The UK government, along with many other developed nations, has increasingly put the patient at the centre of healthcare.

This has led to concerted efforts to ask patients directly about how they are doing in terms of their symptoms, their experiences and their satisfaction with the care they are given.

Asking patients to rate their own symptoms during a period of care for low back or neck pain is something we have been developing expertise in for a number of years, including the development of a specific outcome measure used extensively in monitoring the clinical outcomes of patients with musculoskeletal conditions across a number of professions.

Recently colleagues at the AECC completed a study that collected more than 8,000 patient outcomes over the course of a month of chiropractic care.

Of these patients, 40% were referred from the NHS through a government scheme called Any Qualified Provider. We collected outcomes, including the BQ from these patients, and compared their reports to patients who sought chiropractic care privately. Although patients from the NHS started out with more pain and disability than private patients, once corrected, their improvement over time was very similar to those patients who sought care privately.

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Measuring the future: The promise of big data


Dr David Newell AECC Director of Research

In the process of being published, this large research study using our PROMs expertise allied with digital innovation, is allowing the profession to provide sound evidence and justification in its efforts to show healthcare managers and local health funders how patients fare, what they say about us and the excellent job the profession does.

Without such hard data, these efforts often go unnoticed and we are proud to be leading this effort by providing data which will position the chiropractic profession at the forefront of modern healthcare.

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Although patients from the NHS started out with more pain and disability than private patients, once corrected, their improvement over time was very similar to those patients who sought care privately.

“”

The UK PROMs collection initiative: Final results and reflections on an 18 month study: Dave Newell, Emily Diment, Jenni Bolton.

Clinical outcomes in a large cohort of musculoskeletal patients undergoing chiropractic care in the UK: A comparison of self and NHS referred routes: Jonathan Field and Dave Newell.

Development of an effective and low-cost system to monitor PROMs using mobile technology and the internet: An exploratory trial of the Patient Health Information (PHI) software application: Ahmet Ullusan, Andrew Vitiello and Dave Newell.

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Awards & Grants


Awards

ECU Jean Robert 1st prize & WFC NCMIC Louis Sportelli Original Research Award 2nd prize (May 2015)

WFC NCMIC Louis Sportelli Original Research Award Private Practice Award (May 2015)

WFC Student Poster 2nd prize (May 2015)

Newell D

Reconceptualising Patient-Reported Outcome Measures as Active Components of Complex Interventions; Royal College of Chiropractors and Southampton University: 2014-2017; £62,000.

Potential relationships between self-rated health, body image, aspects of sensory perception and function in patients with chronic low back pain; Royal College of Chiropractors, Bournemouth University and McTimoney College of Chiropractic 2014-2017; £62,000.

Registered chiropractors’ and undergraduate students’ attitudes, knowledge and understanding of clinical governance and patient safety: A National Review. Royal College of Chiropractors and Teesside University 2015-2018; £60,000.

Development, and validation of a smart phone/tablet-based innovative and objective Clinical Photographic Posture Assessment Tool (CPPAT App) to explore the impact of chiropractic care on back and neck postural changes and their relationship to patient reported outcomes. Royal College of Chiropractors and Teesside University 2015-2018; £60,000.

Branney J

Bournemouth University Santander Travel Award. 2013-14 £760.

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Grants

Breen AC

Estimation of in vivo inter-vertebral loading during motion using fluoroscopic and MRI informed finite element models. 2015-16 Chiropractic Research Council £40,344.

A study of lumbar inter-vertebral motion patterns to inform the design of clinical trials and prognostic studies. 2015-16 European Academy of Chiropractic £14,719.

Du Rose A

SBPR Travelling Fellowship. 2014-15 Society for Back Pain Research £2,000.

AECC TAM Club. 2014 Equipment grant £514Bournemouth University. 2014 Research travel award.

Mellor FE

Determining the relationship between disc degeneration and intervertebral motion using MRI and Quantitative Fluoroscopy. 2014-15 Radiological Research Trust £3,000.

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BREEN AX, BREEN AC. (2015) Accuracy and repeatability of quantitative fluoroscopy for the measurement of sagittal plane translation and instantaneous axis of rotation in the lumbar spine. Medical Engineering and Physics (submitted)

BREEN AC, MELLOR FE, BREEN AX, HILTON A. (2015) Intersegmental kinematic findings in patients with persistent low back pain: a review of quantitative fluoroscopy referrals. European Spine Journal (submitted)

BREEN AX, DUPAC M, OSBORNE N. (2015) Dynamic neutral zone vs initial attainment rate in a multi-segmental porcine model. Chiropractic and Manual Therapies (submitted)

SHILTON M., BRANNEY J., PENNING DE VRIES B., BREEN AC. (2015) Measuring changes in cervical lordosis following spinal manipulative therapy – a prospective cohort study. Chiropractic and Manual Therapies (submitted).

DU ROSE A, BREEN AC. (2015) Influence of paraspinal muscle activity on lumbar inter-vertebral flexion rotation range. (abstract) The Spine Journal 15 (2015)50S-85S, pp565-6).

STEELE J, BRUCE-LOW S, SMITH D, JESSOP D, OSBORNE N. (2015) A Randomized Controlled Trial of the Effects of Isolated Lumbar Extension Exercise on Lumbar Kinematic Pattern Variability during Gait in Chronic Low Back Pain. PM&R. 2015 Jun 21. pii: S1934-1482(15)00320-2. doi: 10.1016/j.pmrj.2015.06.012. [Epub ahead of print].

DEWHURST P, RIX J, NEWELL D. (2015) Influence of year-on-year performance on final degree classification in a chiropractic master’s degree program. J Chiropr Educ;00(0):1–6.

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Publications


2015

EIRIK JOHAN SKEIE, JAN ARVE BORGE, CHARLOTTE LEBOEUF-YDE, JENNI BOLTON AND NIELS WEDDERKOPP. (2015) Reliability of diagnostic ultrasound in measuring the multifidus muscle. Chiropractic & Manual Therapies, 23:15.

SARA GLITHRO, DAVID NEWELL, LORNA BURROWS, ADRIAN HUNNISETT, CHRISTINA CUNLIFFE. (2015) Public health engagement: detection of suspicious skin lesions, screening and referral behaviour of UK based chiropractors. Chiropractic & Manual Therapies, 23:5.

FIKAR PE, EDLUND KA, NEWELL D. (2015) Current Preventative and Health Promotional Care Offered to Patients by Chiropractors in the United Kingdom: A Survey. Chiropractic & Manual Therapies Chiropractic & Manual Therapies, 23:10.

ABDUL RAZZAK R, BAGUST J, DOCHERTY S, HASAN Z, IRSHAD Y, RABIAH A. (2015) Menstrual phase influences gender differences in visual dependence: A study with a computerised Rod and Frame Test. J Cognitive Psychology, 27, 80-88.

ABDUL RAZZAK R, BAGUST J, DOCHERTY S, HUSSEIN W, AL-OTAIBI A. (2015) Augmented asymmetrical visual field dependence in asymptomatic diabetics: Evidence of subclinical asymmetrical bilateral vestibular dysfunction. Journal of Diabetes and Its Complications. 29, 68-72.

BRANNEY, J., BREEN, A.C. (2014) Does inter-vertebral range of motion increase after spinal manipulation? A prospective cohort study. Chiropractic and Manual Therapies 22:24.

MELLOR, F.E., THOMAS, P., BREEN, A.C. (2014) Moving back: The radiation dose received from lumbar spine quantitative fluoroscopy compared to lumbar spine radiographs with suggestions for dose reduction. Radiography 20, 251-257.

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2014

MELLOR, F.E., BREEN, A.C. (2014) Discrimination of Biomechanical Back Pain Patient Subgroups from Continuous Inter-Vertebral Motion Data - A Protocol.” Bone and Joint Journal 96-B (Suppl 4):5.

MELLOR, F.E., THOMAS, P., THOMPSON, P., BREEN, A.C. (2014) “Proportional lumbar spine inter-vertebral motion patterns: A comparison of patients with chronic, non-specific low back pain and healthy controls.” European Spine Journal DOI: 10.1007/s00586-014-3273-3.

BALDWIN MW, BAGUST J, DOCHERTY S, BROWMAN A, JACKSON JC. (2014) The Rod and Frame Test? Relationship priming influences cognitive-perceptual performance. J Soc Psychol. Sep-Oct; 154(5):441-6.

BOLTON J. (2014) Evidence-based case reports. Journal of the Canadian Chiropractic Association 58(1): 6-7.

CLARK, C., DOCHERTY, S., OSBORNE, N. AND KHATTAB, A. (2014) A pilot study to compare passive lumbar spine re-positioning error in those with chronic low back pain with healthy volunteers. International Musculoskeletal Medicine 36(3):104-110.

HOLMES E, MILLER J. (2014) Adverse reactions of medications in children: the need for vigilance, a case study. Journal of Clinical Chiropractic Pediatrics. 2014; 14(2).

HOUWELING T, BOLTON J, NEWELL D. (2014) Comparison of two methods of collecting healthcare usage data in chiropractic clinics: patient-report versus documentation in patient files. Chiropractic & Manual Therapies 2014, 22:32.

MARILLIER KE, LIMA AM, DONOVAN LY, TAYLOR C, MILLER J. (2014) Mama, please stop crying: lowered postnatal depression scores in mothers after a course of chiropractic care for their infants. Journal of Clinical Chiropractic Pediatrics;14(3): 1179-1182.

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NAVRUD IM, BJORNLI ME, FEIER CH, HAUGSE T, MILLER J. (2014) A survey of parent satisfaction with chiropractic care of the pediatric patient. Journal of Clinical Chiropractic Pediatrics;14(3):1167-1171.

NEWELL D, FIELD J, POLLARD D. (2014) Using the STarT back tool: Does timing of stratification matter? Manual Therapy (doi:10.1016/j.math.2014.08.001). Epub. Aug 9th.

POHLMAN K, O’BEIRNE M, THIEL H, CASSIDY J, MIOR S, HURWITZ E, WESTAWAY M, ISHAQUE S, YAGER J, VOHRA S. (2014) Development and Validation of Providers’ and Patients’ Measurement Instruments to Evaluate Adverse Events after Spinal Manipulation Therapy. European Journal of Integrative Medicine;6:451-466.

RUBINSTEIN SM, BOLTON J, WEBB AL, HARTVIGSEN J. (2014) The first research agenda for the chiropractic profession in Europe. Chiropractic and Manual Therapies 22:9.

STEELE J, BRUCE-LOW S, SMITH D, JESSOP D, OSBORNE N. (2014) Lumbar kinematic variability during gait in chronic low back pain and associations with pain, disability and isolated lumbar extension strength. Clin Biomech. 29(10):1131-8.

WIESER R, THIEL H. (2014) A survey of “mental hardiness” and “mental toughness” in professional male football players. Chiropractic & Manual Therapies, 22:17.

WRIGHT C, BEARD H, COX J, SCOTT P, MILLER J. (2014) Parents’ choice of non-supine sleep position for newborns: a cross-sectional study. British Journal of Midwifery; 22(9):625-629.

WRIGHT C, BEARD H, COX J, SCOTT P, MILLER J. (2014) Parents’ choice of non-supine sleep position for newborns: a cross-sectional study. Journal of Health Visiting; 2(9):2-6.

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BAGUST J, DOCHERTY S, RAZZAK RA. (2013) Rod andframe alignment times increase when the frame is tilted.Psychology and Behavioral Sciences 2(2): 66-72.

KALAMIR A, GRAHAM PL, VITIELLO AL, BONELLOR, POLLARD H. (2013) Intra-oral myofascial therapyversus education and self-care in the treatment of chronic,myogenous temporomandibular disorder: a randomised,clinical trial. Chiropractic and Manual Therapies 21:17.

MILLER JE. (2013) Costs of routine care for infant colicin the UK and costs of chiropractic manual therapy as amanagement strategy alongside a RCT for this condition.Journal of Clinical and Chiropractic Pediatrics 14:1063-1069.

MILLER JE, WEBBER HELLSTENIUS S. (2013) Is infantcolic an allergic response to cow’s milk? What is theevidence? Journal of Clinical and Chiropractic Pediatrics14:1097-1102.

MILLER JE, FONTANA M, JERNLAS K, OLOFSSONH, VERWIJST I. (2013) Risks and rewards of earlymusculoskeletal assessment. British Journal of Midwifery21:736-743.

NEWELL D, FIELD J, VISNES N. (2013) Prognostic accuracy of clinicians for back, neck and shoulder patients in routine practice. Chiropractic and Manual Therapies 21:42.

WANGLER M, PETERSON C, ZAUGG B, THIEL H,FINCH R. (2013) How do chiropractors manage clinical risk? A questionnaire study. Chiropractic and Manual Therapies 21: 18.

WESTON D, TANDBERG T, JOHN C, AXEN I. (2013) GPsopinions and perceptions of chiropractic in Sweden andNorway: a descriptive survey. Chiropractic and ManualTherapies 21:29.

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2013

MELLOR, F.E., BREEN, ALEXANDER. 2013 “Ionizing radiation exposure and the development of intervertebral disc degeneration-no case to answer.” The Spine Journal 13(3) 224-228.

BREEN, ALEX., MELLOR, F., BREEN A.C. (2013) “Lumbar Intervertebral Motion in Vivo: A Preliminary Comparison of Recumbent and Weight Bearing Motion Patterns in Adult Males.” Bone and Joint Journal 95-B (Suppl 17) 20.

PERNILLE IRGENS, LISE R LOTHE, OLE CHRISTIAN KVAMMEN, JONATHAN FIELD AND DAVID NEWELL. (2013) The psychometric profile of chiropractic patients in Norway and England: using and comparing the generic versions of the STarT Back 5-item screening tool and the Bournemouth Questionnaire. Chiropractic & Manual Therapies, 21:41.

STEELE J, BRUCE-LOW S, SMITH D, JESSOP D, OSBORNE N. (2013) A Randomized Controlled Trial of Limited Range of Motion Lumbar Extension Exercise in Chronic Low Back Pain. SPINE Volume 38, Number 15, pp 1245–1252.

TYCHO J. ZUZAK, JOHANNA BONKOVÁ, DOMENICO CAREDDU, MIKLÓS GARAMI, ADAMOS HADJIPANAYIS, JANEZ JAZBEC, JOAV MERRICK, JOYCE MILLER, CANDAN OZTURK, INGRID A.L. PERSSON, GUENKA PETROVA, PABLO SAZ PEIRÓ, SIMON SCHRAUB, A. PAULA SIMÕES-WÜST, ASLAK STEINSBEKK, KARIN STOCKERT, ASSENA STOIMENOVA, JAN STYCZYNSKI, ALEXANDRA TZENOVA-SAVOVA, SØREN VENTEGODT, ARINE M. VLIEGER, ALFRED LÄNGLER. (2013) Use of complementary and alternative medicine by children in Europe published data and expert perspectives. Complementary Therapies in Medicine;21 Suppl 1:S34-47.

ZUZAK TJ, BONKOVA J, CAREDDU D, ET AL. (2013) Use of complementary and alternative medicine by children in Europe published data and expert perspectives. Complementary Therapies in Medicine 21 Suppl 1:S34-47.

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Ongoing

Alex Breen (Bournemouth University and AECC): A quantitative fluoroscopic study of the relationships between lumbar intervertebral and residual limb/socket kinematics in the coronal plane in adult male unilateral amputees, start date 2010 (Dupac M, Naroozi S, and Osborne, N - supervisor)

Michelle Holmes (University of Southampton and AECC): Reconceptualising Patient-Reported Outcome Measures as Active Components of Complex Interventions, start date September 2014 (Bishop J, Lewith G, Newell D - supervisor)

Sara Glithro (Bournemouth University and AECC): Potential relationships between self-rated health, body image, aspects of sensory perception and function in patients with chronic low back pain, start date September 2014 (Clarke C, Osborne N, Newell D and Docherty S - supervisor)

Alistair Du Rose (Bournemouth University and AECC): Normal biomechanics of the lumbar spine: A quantitative fluoroscopy and surface electromyography study, start date 1st October 2012 (Breen A, Dupac M and Swain I - supervisor)

Pending appointment

(Teesside University and AECC) Registered chiropractors’ and undergraduate students’ attitudes, knowledge and understanding of clinical governance and patient safety: A National Review, start date September 2015 (McSherry R, Thiel H, Josette B Saltikov and Newell D - supervisor)

33

PhD projects


Names in bold are AECC faculty

(Teesside University, AECC and University of Montreal)Development, and validation of a smart phone/tablet-based innovative and objective Clinical Photographic Posture Assessment Tool (CPPAT App) to explore the impact of chiropractic care on back and neck postural changes and their relationship to patient reported outcomes, start date September 2015 (Saltikov JB, Newell D and Fortin C - supervisor)

Part-time

Jonathan Field (University of Ulster and AECC): Changes in catastrophisation and fear-avoidance beliefs in patients following an initial consultation with a chiropractor and their effect on rate of recovery and short term outcomes (Newell D - supervisor)

Completed

Johnny Branney: (Bournemouth University and AECC) An observational study of changes in cervical intervertebral motion and the relationship with patient reported outcomes in patients undergoing spinal manipulative therapy for neck pain Bournemouth University, start date September 2010 (Breen A, Bolton J and Hean S - supervisor)

Fiona Mellor: (Bournemouth University and AECC) Diagnosing chronic low back pain: a biomechanical assessment of intervertebral motion in symptomatic and asymptomatic participants, start date 2008 (Breen A - supervisor)

Joyce Miller (Bournemouth University) Effects of musculoskeletal dysfunction in excessive crying syndromes of infancy- start date 2012 (Van Teijlingen E - supervisor)

34


2013/14MSc Ultrasound (Musculoskeletal)

Seth, RThe diagnostic accuracy of ultrasonography in evaluating remission in rheumatoid arthritis.(Cook J - supervisor)

Walden, DFor a Graf Type IIa Hip that fails to mature to a Normal Graf Type I after two Ultrasound Scans, Assuming a Linear Progression of Acetabular Maturation, is it possible to Predict the Eventual Outcome by Graphical Extrapolation?(Hussain B - supervisor)

Fenech, CThe patellar tendon in high level youth football players – A prevalence study in Malta.(Hussain B - supervisor)

Fischhoff, CUltrasound measurements for patellofemoral pain syndrome: an inter-operator reliability study.(Cook J - supervisor)

Gronstvedt, AThe use of dynamic ultrasound for examination of activity of the lumbar multifidus muscle group.(Bolton J - supervisor)

35

MSc dissertations and clinical audits


Hume, PInter and Intra examiner reliability of evaluating the strain ratio between the patella tendon and Hoffa’s fat pad using sonoelastography.(Newell D - supervisor)

Rick, SAn investigation into ultrasound reporting practices to determine the level of educationreceived, whether reporting guidelines are followed and if standardisation should be introduced.(Hussain B - supervisor)

Sahbudin, IA comparison of sonoelastography with Power doppler and B-mode ultrasound imaging in the assessment of enthesitis in patients with spondyloarthropathy in routine clinical practice(Hussain B - supervisor)

MSc APP (Chiropractic Paediatrics)

Bhuta, KPost Natal Depression in Mothers and the Sleep Times of Infants presenting to the AECC Clinic; Chicken or Egg?(Miller J - supervisor)

Kvitvaer Nordmo, BMaternal postpartum depression and excessive infant crying:: a cross-sectional study.(Miller J - supervisor)

May, HThe Prevalence of sub-optimal breastfeeding in an infant population presenting to two chiropractic clinics: a cross-sectional survey.(Miller J - supervisor)

36


Msc APP (Musculoskeletal Rehabilitation)

Garstin, SThe difference between erect and slumped seated posture in active range of motion of the cervical spine and electromyographic activity of the sternocleidomastoid and upper trapezius muscles in healthy subjects.(Osborne N - supervisor)

MSc Professional Development

Schultz, RReliability and validity study of diagnostic procedures evaluating equine cervical spine hypomobility.(Bolton J - supervisor)

MSc APP (Paediatric Muscoloskeletal Health)

Blikstad, APhysical Activity and Inactivity and the Association with Musculoskeletal Conditions in Norwegian School-aged Children.(Miller J - supervisor)

Giuliani, CDiagnosis of Functional Asymmetry of the Neck in infants:a pragmatic cross- sectional study.(Miller J - supervisor)

Herneblad-Due, CPrevalence of muskuloskeletal complaints in norwegian school-aged children:a cross sectional survey.(Miller J - supervisor)

37


Korsnes, MCare seeking behaviour for pain: A survey of 9-11 year old Norwegian children.(Miller J - supervisor)

Lavigne, VLactation Consultant’s Perception of Musculoskeletal Disorders of Breastfeeding: A Cross-Sectional Survey.(Miller J - supervisor)

Newton, AParental Perspectives of Autistic Children Undergoing a Course of Chiropractic Treatment:A Qualitative Study.(Miller J - supervisor)

Rauskolb, SProprioception: A pilot study employing a prospective cohort design investigating the feasibility of using the one leg stance test to detect changes in children’s balance after chiropractic treatment.(Miller J - supervisor)

Willard, RChiropractic Examination of Paediatric Patients: An Audit of Best Practice.(Miller J - supervisor)

Williams-Frey, SIs there a relationship between back pain and body coordination as well as cognitive executive functions in 10 to 16 year old children and adolescents? A cross-sectional study.(Miller J - supervisor)

MSc APP (Sports and Rehabilitation)

Dijkstra, DA retrospective assessment of the influence of previous injury on the outcome of the forward step down test.(Battiston, A - supervisor)

38


Foss, AWhat effect does a change from natural- to artificial grass have on injury frequency, locations, and incidence for Sogndal Fotball.(Hussain, B - supervisor)

MSc Medical Ultrasound

Agbagidi, OIs the increase in congenital anomalies diagnosed postnatally linked to pregnant women not attending screening ultrasound scans at 12 and 20 weeks ?: A clinical audit of routine ultrasound scans in a tertiary teaching hospital in Niger-Delta region.(Hussain B - supervisor)

Stan, DInteroperator agreement in ultrasound diagnosis of rotator cuff tears.(Hussain B - aupervisor)

MSc Ultrasound (General and Gynaecology)

Attard, MOne Year Retrospective Study of the Role of Thyroid Ultrasound in the Diagnostic Evaluation of Thyroid Nodules in Adult Population Attending Gozo General Hospital.(Hussain B - supervisor)

39


2014/15MSc APP (Clinical Sciences)

Emary, PAttitudes toward drug prescription rights: a survey of Ontario chiropractors.(Bolton J - supervisor)

Lambers, NPerceptions of the quality of the therapeutic alliance in chiropractic care in The Netherlands:A cross-sectional survey.(Bolton J - supervisor)

MSc APP (Orthopaedics)

Mallard, FThe inter-examiner reliability of the Kemp’s test.(Jones-Harris A - supervisor)

Phelan, AA Mixed Methods Study on Appointment Reminders.(Jones-Harris A - supervisor)

MSc APP (Paediatric Musculoskeletal Health)

Allen-Unhammer, AChiropractic for Children and Adolescents: A Survey of Chiropractors and their Patients in Norway.(Wilson F - supervisor)

40

MSc dissertations and clinical audits


Douglas, NThe Outcomes of Chiropractic Care on Positional Head Deformity in Infants.(Miller J - supervisor)

Moksness, AThe Presentation and Management of Paediatric Patients attending a Norwegian Chiropractor.(Miller J - supervisor)

Nervik, GRecognition of musculoskeletal problems in infants by Norwegian public health nurses: a cross-sectional survey.(Miller J - supervisor)

Tavares, HInfants, neck dysfunction and plagiocephaly: an observational cross-sectional study.(Miller J - supervisor)

Zimmer, AChiropractic care of the pediatric patient in Brazil: a descriptive survey.(Miller J - supervisor)

MSc Medical Ultrasound

Alaya, AThe diagnostic performance of second trimester ultrasound screening examination in low risk population in a primary ultrasound centre in the Hague, Netherlands.(Hussain B - supervisor)

Brown, BAn Evaluation of the Sheffield Teaching Hospitals Foundation Trust (STHFT) Integrated Clinical Assessment & Treatment Service for Foot & Ankle Musculoskeletal Conditions (MSK-ICATS).(Hussain B - supervisor)

41


Cullen, PThe aims of this study are to investigate and evaluate the need for saline instillation sonography (SIS) and Hystero-salpingo-contrast-sonography (HyCoSy) in an initial fertility workup. (Hussain B - supervisor)

Foster, WAn examination of the current patient outcome following Barbotage and subacromial injection of Kenolog exploring the possible associations with physical therapy.(Bolton J - supervisor)

McCulloch, RAn audit to assess cryosurgery of interdigital neuroma at The London Podiatry Centre.(Hussain B - supervisor)

Mørch, BIs the Physiotherapy Department at Klinikken meeting the standard(s) of diagnostic ultrasound of patients with shoulder pain?(Allen D - supervisor)

Parmar, KThe purpose of the audit is to ascertain adherence to the accepted standard of consent form usage prior to performing interventional procedures at Pure Sports Medicine, a Sports Medicine and High Performance Centre in Central London for Dr Kalpesh Pa.(Cook J - supervisor)

Reader, LEvaluation of Patient Response to a new Health Information Protocol Regarding Ultrasound Guided Steroid Injections.(Hussain B - supervisor)

Turner, JAn Audit on Shockwave Therapy.(Bolton J - supervisor)

42


MSc Ultrasound (General and Gynaecology)

Gonzi, MThe prevalence of abdominal aortic aneurysm and the analysis of cardiovascular risk factors for abdominal aortic aneurysm: A family practice survey and study.(Hussain B - supervisor)

Orah, OPatterns and prevalence of pelvic masses in Mid-West Nigeria – A One-year retrospective study using ultrasound screening.(Hussain B - supervisor)

MSc Ultrasound (Musculoskeletal)

Johanneson, E The effect of musculoskeletal ultrasound investigation on diagnosis for shoulder pain.(Allen D - supervisor)

Magnesen, EThe use of ultrasound for examination of the longus colli muscle; an intra- and inter-rater reliability study.(Bolton J - supervisor)

Myhrvoid, BReliability of ultrasound measurement of muscle thickness of the suboccipital muscles (Rectus Capitis Posterior Major): A cross-sectional study.(Bolton J - supervisor)

Øverås, CThe use of diagnostic ultrasound imaging to measure the cervical extensor muscle semispinalis capitis:An intra- and inter-rater reliability study.(Bolton J - supervisor)

43


Røesok, GThe use of ultrasound for examination of the deep cervical extensor muscles; an intra and inter-rater reliability study.(Bolton J - supervisor)

Shanker, KCharacteristics of Symptom Severity, Clinical Testing and Ultrasound Scanning for Referral for Surgery in Patients with Carpal Tunnel Syndrome(Bolton J - supervisor)

Swan, TAn interventional prospective cohort study using Rehabilitative Ultrasound Imaging (RUSI) as a ‘biofeedback’ tool, to aid in the selective activation of Transversus Abdominis (TrA) in a military population with chronic LBP (CLBP).(Bolton J - supervisor)

Vagsether, EClinical usefulness of diagnostic musculoskeletal ultrasound (MSUS) on diagnosis, treatment and perceived prognosis for Achilles complaints.(Allen D - supervisor)

44


Produced by the AECC, 2015

For more details about AECC research, developments and projects, visit:

www.aecc.ac.uk/research

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