BMRC allied health professions group

Low back pain is the most common musculoskeletal dysfunction worldwide. This is a very costly disorder; it is estimated that 80 per cent of people will suffer from low back pain at some point in their lives. In the United Kingdom 49.1 per cent of the adult population experience back pain for more than a day in any one year. It has been estimated that in the UK 4.7 million working days were lost over a one year period due to conditions affecting the lower back. It is calculated that low back pain causes a much greater economic burden on society than other conditions such as coronary heart disease, rheumatoid arthritis and respiratory tract infections.

Our research largely focuses on increasing understanding of the physiological and functional mechanisms underpinning low back pain, evidencing treatment and management approaches to low back pain and increasing understanding of the experience of low back pain from the patients and clinicians’ perspectives. To this end we engage with laboratory-based research, clinically-based research which includes quantitative and qualitative methods together with mixed methods approaches.

Ann Moore

Professor Ann Moore

Patient recorded outcome measures

Researchers with a musculoskeletal focus at the University of Brighton, in collaboration with the NHS Physiotherapy Consultants across the South East of England, have developed a novel patient recorded outcome measure which will be used principally for patients with musculoskeletal dysfunction; this will in the main be related to low back pain. The outcome measure which also includes components of patients’ expectations is currently being tested for reliability and validity.

Profiling characteristics which may determine patients’ responses to neurodynamic treatments in the management of posterior leg pain referred from conditions of the lumbar spine

Reduced sciatic nerve mobility may be implicated in leg pain. The research of Ridehalgh, Moore and Hough aims to develop suitable scanning techniques to study movements of the sciatic nerve and to examine how nerve movement is brought about my neuro-mobilisation. Reliability and validity of this technique has already been determined and the project is now focussed on whether sub-groups of patients with low back pain and referred leg pain show differences in their outcomes to neuro-mobilisation. If different sub- groups exist, those patients who will benefit from different forms of neuro-mobilisation can be identified quickly for personalised treatment.

Biomechanical and neuro-chemical effects of lumbar spine mobilisations

This study has been conducted by Hebron with Moore, Saber-Sheikh and Jackson. The study is looking at the effects of lumbar mobilisation on range of movement, pain through range, pressure pain, thresholds and stiffness. The pilot work has been completed and data collection has also recently been completed on a symptomatic population.

Assessment of spinal posture and motion in occupational settings using inertial sensor

The work was carried out by Ha Tshui, Jones M, Moore and Saber- Sheikh. The purpose of the project was to develop a portable motion sensing system for identifying spinal postures and measuring spinal motions over an extended period of time. The system comprised of miniature inertial sensors including gyroscopes and accelerometers and data acquired was saved in a data logger for processing at a later time. A simple system which employs accelerometers only was developed and compared with an earlier version. Although the sensor was small in this case the computational method was more complicated. Sensitivity and specificity of the two systems were compared. Different sensor attachment methods and computational algorithms were compared and the best measurement technique was developed. This technique has now been utilised in an occupational setting to monitor the movement and posture of desk workers over a three hour period. The results of the earlier work have now been published and a paper which includes the data analysis of the occupational sitting posture analysis is in progress.

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Effects of ageing on muscle morphology and strength

This project was carried out by Ajit Singh, Bailey (School of Sports and Service Management), Moore, Lee (Roehampton University). The purpose of the project was to study how ageing affects the muscle fibre alignment, recruitment and strength of the paraspinal muscles in the lumbar region. Muscle fibre alignment in different spinal postures was examined using ultrasound scans. The recruitment patterns of fast and low twitch fibres were determined during sustained contraction using electromyography. The strength of the muscles was recorded using a load-cell attached to the measurement jig. The correlation between age and the above dependent variables was established. The change in muscle strength was also correlated with the change in fibre alignment and recruitment patterns.

Visual representation of low back pain

This project is being undertaken by Professor Ann Moore and Dr Kambiz Saber-Sheikh together with Dr Shirley Chubb and Dr Neil Bryant (University of Chichester). This is a collaborative Arts, Health and Science project which focuses on the visual representation of pain in low back pain sufferers. The project explores the reality of walking for individuals with chronic low back pain and involves working with a group of participants from East Sussex who have been invited to identify a short work within their home or elsewhere in their local area which is of particular significance to them. The Research Team works with participants to synthesise video documentation of their personal walks while simultaneously gathering biomechanical data.

The team will further explore how the resulting hybrid footage can be further manipulated in order to identify the most effective way to express the nature and challenge of the participants’ personal movement. The research team following data collection will then compile a range of footage into an immersive video artwork to be exhibited at visual arts and science venues including learning and public environments. This project has been funded by the Welcome trust.

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Patients’ expectations of osteopaths and osteopathic treatment (OPEn study)

This project was carried by Leach, Moore, Cross, Fawkes and Fiske. The aim of this research was to study the expectations of patients receiving osteopathic medicine. The majority of patients who consult osteopaths in a private setting suffer from low back pain. This study was the first study of its kind in this area. Focus groups and individual interviews with osteopathic patients were used to gain an understanding of patients’ expectations of osteopathy. The study was novel in osteopathy internationally and used mixed methods including a literature review, focus groups with patients and a large questionnaire survey of patients in the UK. This project was funded by the General Osteopathic Council.

Standardised data collection in physiotherapy and osteopathic practice

Moore has over the last 18 years been developing standardised data collection tools for use in NHS musculoskeletal outpatient physiotherapy departments, tools for use in private physiotherapy practices and, more lately, has developed tools for use in osteopathic practice. The development of the tools in these three areas has led large amounts of data collection
taking place across the UK. These studies have produced base-line data on osteopathic and physiotherapy clinical practice particularly in the private setting including the characteristics of patients, types of presentation, management, strategies, treatments and lines of referral. Studies in this area have been funded by Maidstone Healthcare Trust, General Osteopathic Council and Physio First (Private Practitioner Organisation for Chartered Physiotherapists in the UK).

Research team

Patient recorded outcome measures

Professor Ann Moore, Dr Liz Bryant, Dr Liz Cheek, and NHS clinicians (Mr Chris Mercer, Dr Carol McCrum, Mr Toby Smith, Ms Sandra Wickham and Ms Laura Finucane.

Profiling characteristics which may determine patients’ responses to neurodynamic treatments in the management of posterior leg pain referred from conditions of the lumbar spine

Mrs Colette Ridehalgh, Professor Ann Moore and Dr Alan Hough (University of Plymouth).

Biomechanical and neuro-chemical effects of lumbar spine mobilisations

Mrs Clare Hebron, Professor Ann Moore, Dr Kambiz Saber-Sheikh and Anne Jackson (Pharmacy and Biomolecular Sciences).

Patients and clinicians’ perceptions and attitudes towards self-management of acute and
chronic low back pain disorder

Professor Ann Moore, Dr Vinette Cross, Dr Carol McCrum (Eastbourne, District General Hospital), Professor Paul Stenner (Open University), Dr Janet McGowan (Consultant at East Sussex Hospital Trust), Mr Robert Poole, Mr Phillip Lloyd (service users).

Assessment of spinal posture and motion in occupational settings using inertial sensors

Dr Tshui Hung Ha (University College Malaysia), Professor Ann Moore, Dr Mark Jones, Dr Kambiz Saber-Sheikh.

Effects of ageing on muscle morphology and strength

Dr Devinder Kaur Ajit Sing (National University of Malaysia), Dr Martin Bailey (School of Sports and Service Management), Professor Raymond Lee (Roehampton University), Professor Ann Moore.

Visual representation of low back pain

Professor Ann Moore, Dr Kambiz Saber-Sheikh, Dr Shirley Chubb, Dr Neil Bryant (University of Chichester).

Patients’ expectations of osteopaths, and osteopathic treatment (OPEn study)

Dr Jan Leach, Dr Vinette Cross, Ms Carol Fawkes (Barts and the London School of Medicine and Dentistry) Mr Adam Fiske (private practitioner)) and Professor Ann Moore.

Standardised data Collection in Physiotherapy and Osteopathic practice

Professor Ann Moore, Dr Liz Bryant, Dr Shemane Murtagh and Mr Emmanuel Defever.

Output

Research Reports

Standardised data Collection in Physiotherapy and Osteopathic practice

1996 Moore, A.P. (1996) ‘The Development of the Mid Kent & Brighton Outcome Measurement Tool for Physiotherapy Outpatient Services:  Full Report.  University of Brighton, Brighton ISBN 1-871966-54-X.

1998 Moore A.P (1998) An Audit of the Outcome of Physiotherapy Intervention for Outpatients with Back Pain Against set Clinical Standards.  University of Brighton, 1-901177-45-9.

1999 Moore A.P (1999) An Audit of the Outcome of Physiotherapy Intervention for Outpatients with cervical spine pain and dysfunction.  University of Brighton ISSN: 1-901177-50-5.

2010  Fawkes C, Leach J, Mathias S, Moore A P (2010) Standardised Data Collection project, General Osteopathic Council and University of Brighton: www.ncor.org.uk/practitioners/standardised-data-collection/

Patients’ expectations of osteopaths, and osteopathic treatment (OPEn study)

2012 Leach J, Cross V, Fawkes C, Mandy A, Hankins M, Fiske A, Bottomley L, Moore AP (2011) Investigating osteopathic patients’ expectations of osteopathic care: the OPEn project. University of Brighton. www.osteopathy.org.uk/resources/Research-and-surveys/GOsC-research/Osteopathic-patient-expectations-study/

Peer-reviewed journal articles

Assessment of spinal posture and motion in occupational settings using inertial sensor

2012 Ha TH, Saber-Sheikh K, Moore AP, Jones MP (2012) Errors in three dimensional spinal motion measurement using surface motion sensors. Journal of Innovation in Engineering Technology and Education. 1(1): 25-40). ISSN: 2232-1357.

2012 Ha TH, Saber-Sheikh K, Moore AP, Jones MP (2012) Measurement of lumbar spine range of movement and coupled motion using inertial sensors – a protocol validity study. Manual Therapy 18(1):87-91. ISSN: 1356-689X.

Profiling characteristics which may determine patients’ responses to neurodynamic treatments in the management of posterior leg pain referred from conditions of the lumbar spine

2012 Ridehalgh C, Moore A, Hough A (2012) Repeatability of measuring sciatic nerve excursion during a modified passive straight leg raise test with ultrasound imaging. Manual Therapy, 17(6): 572-576. ISSN: 1356-689X.

2013 Ridehalgh C, Moore AP, Hough A (2013) Normative sciatic nerve excursion during a modified straight leg raise test. Manual Therapy, ISSN: 1356-689X. Doi: 10.1016/j.math.2013.07.012.

Patients’ expectations of osteopaths, and osteopathic treatment (OPEn study)

2013 Cross V, Leach CMJ, Fawkes CA and Moore AP (2013) Patients’ expectations of private osteopathic care: a qualitative study, Health Expectations. May 2013. Online ISSN: 1369-7625. Doi: 10.1111/hex.12084.

Standardised data Collection in Physiotherapy and Osteopathic practice

2012 Moore AP, Bryant E, Oliver G (2012) Development and use of standardised data collection tools to support and inform musculoskeletal practice. Manual Therapy, 17(6):489-496. ISSN: 1356-689X.

2013 Fawkes C, Leach CMJ, Mathias S, Moore AP (2013) A profile of osteopathic care in private practices in the United Kingdom: a national pilot using standardised data collection.  Manual Therapy, ISSN: 1356-689X. Doi: 10.1016/j.math.2013.09.001.

2013 Fawkes C, Leach CMJ, Mathias S, Moore AP (2013) Development of a data collection tool to profile osteopathic practice: use of a nominal group technique to enhance clinician involvement. Manual Therapy, ISSN: 1356-689X. Impact factor: 2.533. 10.1016/j.math.2013.08.006.

2013 Leach CMJ, Mandy A, Hankins M, Bottomley LM, Cross V,  Fawkes CA, Fiske A and Moore AP (2013) Patients’ expectations of private osteopathic care in the UK, Part II: a national survey of patients, BMC Complementary and Alternative Medicine, 13:122. ISSN: 1472-6882. DOI: 10.1186/1472-6882-13-122.

Sources/links

Centre for health research website

Applied clinical and practice-based research area in the Centre for health research website

Individual links to reports

Standardised data Collection in Physiotherapy and Osteopathic practice

Moore, A.P. (1999) An audit of the outcome of physiotherapy intervention for patients with cervical spine and dysfunction University of Brighton.

Moore, A.P. (1997) An audit outcome of physiotherapy intervention for patients with back pain against set clinical standards. University of Brighton.

Moore, A.P. (1996) The development of the Mid Kent and Brighton outcome and measurement tool for physiotherapy outpatient services. Full report. University of Brighton.

The Standardised Data Collection Project page and final report

Building the evidence base for musculo-skeletal research (video link)

The OPEn project and reports exploring patients’ expectations of osteopaths, and osteopathic treatment

Collaborations

Patient recorded outcome measures

  • Worthing and Southlands NHS Trust
  • Maidstone NHS Trust
  • East Sussex Hospitals NHS Trust - Eastbourne District General Hospital

Profiling characteristics which may determine patients’ responses to neurodynamic treatments in the management of posterior leg pain referred from conditions of the lumbar spine

  • University of Plymouth

Patients and clinicians’ perceptions and attitudes towards self-management of acute and
chronic low back pain disorders.

  • Open University
  • University of Wolverhampton
  • East Sussex Hospitals NHS Trust Eastbourne District General Hospital

Assessment of spinal posture and motion ¡n occupational settings using inertial sensors

  • University College Malaysia

Standardised data Collection in Physiotherapy and Osteopathic practice

  • Barts and The London School of Medicine & Dentistry
  • Physio First (organisation)

Effects of ageing on muscle morphology and strength

  • Roehampton University
  • National University of Malaysia

Visual representation of low back pain

  • University of Chichester

Patients’ expectations of osteopaths and osteopathic treatment (OPEn study)

  • Barts and the London School of Medicine
  • General Osteopathic Council (funding Body)
  • National Council for Osteopathic

Funding

Standardised data Collection in Physiotherapy and Osteopathic practice

1997 - 1998 Consultant to Mid-Kent Health Care Trust: Ten centre study of Physiotherapy Management of Low Back Pain (£5,000)

1998 - 1999 Consultant to Mid-Kent Health Care Trust: Ten centre study of Physiotherapy Management of Cervical Spine Dysfunction (£7,000)

2005 - 2007 Private Practitioners Education Foundation (PPEF): Development of a Standardised

Data Collection in collaboration with Dr G Olivier & Dr Liz Bryant (£129,000)

2007 - 2009 General Osteopathic Council: Standardised data collection in osteopathic practice,

A national study funded by the (£120,000)

2008 - Physio First: Snap shot data collection, One year extension (£51,658)

2010 - Physio First: Snap shot data collection (£61,120)

2011-  Physio First: Snap shot data collection (£81,654)

2012  - Physio First: Snap shot data collection (£71,000)           

2013 - Physio First: Snap shot data collection (£48,000)

Patients’ expectations of osteopaths, and osteopathic treatment (OPEn study)

2007 - 2009 General Osteopathic Council: Investigating patients’ expectations of osteopaths and osteopathic treatment (Open study), (£79,000).

Visual representation of low back pain

2012 - Wellcome Trust: Significant walks: Personal visualisations of the chronic back pain experience in collaboration with the University of Chichester (£30,000)

Patients and clinicians’ perceptions and attitudes towards self-management of acute and chronic low back pain disorders
2010 - NIHR, Research for Patient Benefit grant: An exploration of self-care in chronic low back disorder from the perspective of practitioners and patients: a Q methodological study (£207, 569)

Awards, recognition, impact

Professor Ann Moore received an Honorary Doctorate for her research work in physiotherapy,
osteopathy and other Allied Health Professions from the University of Bedfordshire and the
British School of Osteopathy.

An impact case study based on the expectations study and SDC work has been submitted to REF 2014.