Human Movement and Rehabilitation
Nicola works as part of a team of researchers focused to personalised rehabilitation for patients presenting with musculoskeletal pain of spinal and traumatic origin. As well as leading and supporting spinal and trauma research, she is the Public and Patient Involvement (PPI) Lead within the Centre of Precision Rehabilitation for Spinal Pain. Having many years of experience of working with patient groups, she coordinates PPI for all funded projects within CPR Spine; chairing meetings and provision of training for termly CPR Spine PPI Group Meetings. As part of this role we have set up a dedicated database of individuals with spinal complaints (CPR Spine Register) to support projects within the centre.
Research programme overview:
It is widely acknowledged that assessment and management of musculoskeletal and spinal pain disorders is an international challenge and comes at great patient and societal cost, particularly as many problems become long term chronic conditions. We are developing and validating new assessment protocols which offer new opportunities to objectively characterise the presentation of patients presenting with musculoskeletal pain of spinal and traumatic origin. As a result, this enables appropriate identification of patient-specific safe targeted interventions. Effective targeted rehabilitation can enable improved effectiveness (clinical and cost) as it identifies which patients to target with specific rehabilitation approaches, and therefore enables more effective use of rehabilitation resources. The process of developing effective targeted rehabilitation is lengthy and requires several stages to ensure rigour and applicability to practice.
Nicola’s current role is as
1] PI for projects focused thoracic spine pain and rehabilitation
2] Co-I for projects focused to spinal surgery for low back problems
3] Co-I for projects focused to acute low back pain and musculoskeletal polytrauma.
4] Co-I for projects focused to neuroplasticity in musculoskeletal rehabilitation
- 1. PI for projects focused to the thoracic spine
The development novel measurement approaches to evaluate thoracic spine mobility has enabled us to investigate dysfunction in this relatively under research spinal region. Reviews and observational studies completed or in progress in populations include but are not limited to COPD, whiplash associated disorders, sedentary and active populations (elite athletes, sedentary and older adults). Understanding the scope and nature of thoracic dysfunction and current management approaches will inform future research investigating interventions (1 book contribution, 3 papers published, 2 under review, 2 under preparation). Further research (survey, Delphi) with international collaborators from University of Nevada, Las Vegas and University of Newcastle, Australia is underway to investigate current international practice and inform the development of clinical guidelines in the management of the thoracic spine.
- 2. Co-I for projects focused to spinal surgery for low back problems
Physiotherapy rehabilitation post lumbar discectomy (Co-I)
Phase III trial funding application for evaluation of stepped care intervention is under preparation targeting ARUK / NIHR EME. Collaboration with MDS, Oxford Surgical Trials Unit, Manchester Metropolitan University, and 7 clinical sites. Based on an established programme of research: survey of current UK practice, systematic review evaluating effectiveness of interventions, development of leaflet intervention, pilot and feasibility trial, development of physiotherapy intervention, analysis of intervention (all published); and systematic reviews of natural course of symptoms and prognostic factors, qualitative analysis of patients’ experiences (papers under preparation) and an evaluation of the lived experience of patients undergoing this type of surgery through further qualitative research projects.
Physiotherapy stratified rehabilitation post lumbar spinal fusion (Co-I)
Prospective cohort observation study evaluating prognostic factors indicative of poor clinical outcome using the British Spine Registry and equivalent databases in collaborating countries (Netherlands and Switzerland) commenced January 2017 with internal UoB pump priming. Results will inform stratified care physiotherapy intervention. Based on established programme of research, surveys of current national surgeon and physiotherapy practice, systematic review evaluating effectiveness of interventions are complete (all published) and we are currently conducting an evaluation of the lived experience of patients undergoing this type of surgery following successful funding bid in 2016.
Spine research in collaboration with the English Institute of Sport (Co-I)
Collaborative research contract in place with English Institute of Sport for spine research group. To date 7 funded MSc students with projects focused on research priorities within gymnastics, rowing swimming, Paralympic sport and boxing (2 publications, 2 under review, 2 under preparation, 1 PhD student).
- 3. Projects focused to acute low back pain and musculoskeletal polytrauma (collaborator)
Trauma National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre (NIHR SRMRC; Trauma Centre) (Start: 01/08/2016; Duration: 36 months; Source: NIHR; Amount: £200,000 funded)
To apply state-of-the-art methodologies and statistical approaches to better understand acute post-traumatic pain and prognosis in relation to the development of ongoing pain and disability (Co-I). Moreover, to utilise this knowledge to develop and evaluate the feasibility of incorporating timely interventions for concomitant physical functioning and psychological health to prevent and/or reverse processes that mediate the transition from acute to chronic pain.
- 4. Neuroplasticity in musculoskeletal rehabilitation (international collaboration)(Co-I)
A series of international collaborative research projects focused to understanding neuroplasticity in musculoskeletal rehabilitation and drawing on expertise cross discipline in neurological and musculoskeletal physiotherapy. (4 publications)