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UOA 12A - Allied Health Professions and Studies: Applied Biomedical Sciences

King's College London

RA5a: Research environment and esteem

Background. The Division of Applied Biomedical Research (DABR) developed from a strategic reorganisation of health related research at King’s.  Most members are physiotherapists working with those from related established disciplines e.g. physiologists, psychologists and bioengineers. 

 

In the 2001 RAE it was one of three groups forming a single submission to Panel 11. This was jointly awarded the highest ranking (4) for a submission predominantly composed of Allied Health Professionals. This submission represents a single division and contains a much more cohesive and focussed programme of work.

 

DABR is part of the School of Biomedical and Health Sciences, one of the five Health Schools that are organised into 17 multidisciplinary research Divisions. A key feature of King’s is the breadth of research in subjects allied to medicine including biological and social sciences. Heads of Division are responsible for scientific strategy, line management and budgetary control. Resource allocation returns surpluses to Divisions for strategic development and facilitates cross-divisional working. Success is evidenced by the 45% increase in research income over the past year. King’s is the only university to be the academic partner for each of the three types of NIHR Research Centres and is building Clinical Research Facilities on each of its three hospital sites.

  

Research structure and strategy. The purpose of DABR is to apply research to real, whole person, problems. Links with basic science provide the building blocks for an integrated approach. We are interested in the scientific problems themselves and how to apply solutions and methodologies to individuals and the community. The aim is to; a) improve understanding of underlying mechanisms, b) develop rational interventions and c) evaluate the outcome of new and existing interventions at all levels of impairment and function.

There are four groups with strong and effective interactions: [1] musculo-skeletal, [2] neuro-muscular, [3] growth, development and ageing and [4] health related beliefs, perceptions and attitudes. Most work is interdisciplinary and the overarching theme is optimising human function.

 

Until recently the biomedical model has predominated although it is recognised that the richness of much human research is enhanced by incorporating psychosocial methodology and therefore we have appointed a psychologist (Godfrey) to strengthen this aspect. The current national emphasis on translational research fits well with our approach and this portfolio is being developed. 

 

a) Research culture and capacity building. New staff and those at an early career stage have a formal mentor in addition to the regular meetings with the Head of Division (HoD, Newham) that occur for all staff to monitor progression and career development. Mentors are trained as part of the College’s Staff Development programme. Collaboration (within and outside the Division) is strongly encouraged, aiding interdisciplinary work and research development. All grant applications are reviewed by the Management Board and a senior member of staff is involved from early stages of development. 

 

Staff and students attend monthly seminars presented by internal and external speakers. Each group holds regular journal clubs. The Management Board, Resource Manager and Divisional Administrator meet regularly to oversee progress and strategic development. 

 

b) Infrastructure.   DABR is based in a single building with excellent facilities on the Guy’s Hospital Campus and ideally located for clinical studies. Most laboratories are multi-user, avoiding unnecessary duplication of expensive equipment (e.g. motion analysis, ultrasound, magnetic stimulation, EMG etc), facilitating preliminary studies and supporting the work of newly appointed staff prior to attaining external funding. They also enhance research exposure and internal interactions. Personal financial incentive allocations are top-sliced for multi-user facilities where they are not covered by external funding. 

 

There are excellent electronic library facilities along with dedicated IT staff and statistical support. The College has an extensive programme of training courses for staff and students. All PhD students make at least one presentation at Divisional seminars, run their own support group and are members of the College Graduate School. The School runs an annual programme for PhD students in each year of study. 

 

c) Relations with users.  Most staff work closely with NHS staff and have honorary appointments with local Trusts. Morrissey is the Research Lead for the Therapies at King’s College Hospital. A number of staff are involved with user support groups and their views inform the research. 

 

We act as the R&D support for the manufacturer of a motion analysis system, testing new hard- and soft- ware and providing feedback about user views. King’s Business helps to make staff aware of research opportunities and to establish new collaborations, particularly with industry. 

 

3 Staffing policy

a) Appointments are made on the basis of the quality and fit of current research or, in the case of ECRs, their potential. Annual appraisals, part of the promotion structure, are conducted by the HoD and head of relevant teaching department to ensure an appropriate balance between teaching and research that this is particularly important for those at earlier career stages. 

 

b) Changes and sustainability. Six staff submitted previously have left King’s (4) or moved to another Division (2). They have been more than compensated for by the addition of 10 staff who are either strategic new appointments (5), existing staff who have developed their research to the required level (4), or who have transferred into the Division (1).

 

They have substantially increased the research culture and breadth, along the strategic lines outlined in the last RAE. They include two physiologists (one at professorial level) with expertise in muscle and human research, a bioengineer with expertise in biomechanics and assistive devises and a health psychologist. These appointments enhance the potential for translational work and collaborations, the development of more junior staff and the ability to attract further external funding. 

 

Support from the College Strategic Investment Initiative enabled one proleptic appointment. Two senior members are due to retire in a couple of year’s time and their replacements are already being planned (one each in Anatomy and Physiology). Institutional support of >£300k has provided facilities and equipment for new staff and lines of research.

 

4 Research staff and students  

The Division has four postdoctoral researchers from none in 2001. Sixteen doctorates have been awarded since 2001, 25 students are currently registered (non-clinical and clinical), 4 of whom have submitted their theses, and we have funding for another three.  A total of 12 studentships have been awarded from competitive funding applications. Three students were from non-EU countries, funded by their home institutions and a Commonwealth Studentship. Current HEFCE data shows King’s to be the most successful university for PhD completion rates.

 

5. Research income

The income per FTE and also the number of staff has increased substantially since the last RAE.  Over the assessment period grants totalling >£5.6 million have been awarded from research councils, charities and industry. 

 

6. Research Groups
[1] Musculo-skeletal group
Staff: Bearne, Beith, Buckland-Wright, Critchley (ECR), Hurley, Johnson, Morrissey, Newham,  Rowlerson, Shortland, Smith, Woledge.

Overview: This group studies the underlying mechanisms of common musculo-skeletal disorders, how they are best managed and factors affecting muscle function. There is a substantial programme of work focussing on chronic low back pain (CLBP, overlaps with [2]) and common conditions such as osteo- and rheumatoid- arthritis (OA and RA).

Achievements:
Buckland-Wright’s group has been involved in 4 large international, multicentre trials to evaluate the effect of new generation of knee OA therapies as the Central Analysis Facility and provided quantitative evaluation from standard radiographs of the primary outcome measure. One of these was the largest clinical trial in OA involving approximately 2,500 patients across North America and Europe. Novel methods of quantifying cancellous bone organisation demonstrated for the first time that risedronate preserved trabecular bone, maintaining the joint’s structural integrity.

Hurley has conducted several clinical trials investigating the clinical- and cost-effectiveness of rehabilitation for common rheumatic conditions using typical community and hospital settings. An exercise-based rehabilitation programme was demonstrated to improve function more than usual primary care management for chronic knee pain and was more cost-effective. It has been incorporated into NICE guidelines for the management of OA. A related programme for chronic hip pain is nearing completion and may be a “generic” pain management intervention with applications for many chronic conditions (with Jones, King’s College Hospital).


Bearne and Hurley have found that RA patients have lower limb sensorimotor dysfunction and disabilities that can be improved by rehabilitation, without exacerbating disease activity. Preliminary work suggests that sensorimotor dysfunction may also contribute to upper limb dysfunction and they are evaluating the effect of exercise on that and functional performance.


Beith, Critchley and
Hurley showed that three types of physiotherapy commonly used in CLBP gave similar long-term reductions in disability, pain, sickness absence and improved quality of life (QoL).  A pain management programme was clearly most cost-effective and would save the NHS >£126 million annually if adopted nationally. The results are highly generalisable as participants were treated in hospitals by NHS physiotherapists.

 

Ultrasound imaging is widely used clinically to evaluate deep abdominal muscle activity, despite having unknown validity and reliability. Critchley, Beith and Newham (with McMeeken, Australia) simultaneously recorded electromyography and muscle thickness changes to demonstrate that both these were good.   

 

Johnson (with Moxham, Medicine, KCL) has shown that pulmonary rehabilitation improves the strength and endurance of skeletal muscles, exercise capacity and tolerance as well as QoL in patients with pulmonary disease. A home exercise video has been produced for those unwilling to participate in group exercise and a pilot study found that its use improved exercise capacity and QoL.

 

Morrissey and Woledge (with Morrissey, Royal London) used a novel technique of motion analysis combined with ultrasound imaging to define the normal pattern of shoulder movement, showing that the subjective physiotherapy assessments are highly inaccurate. Morrissey has evaluated the risk factors for knee traumatic injury in sportswomen and found that a home exercise programme was as effective as supervised physiotherapy after knee keyhole surgery, thus reducing the NHS burden (with Ratcliffe, Sheffield; Omar, UCL). Contrary to the belief of most clinicians, strengthening exercises performed after knee reconstructive surgery did not damage the joint and resulted in improved function. A commonly used method of treating swelling after ankle sprain was found to be ineffective (with Lewis, Chelsea and Westminster NHS Trust among others).

 

In patients with anterior compartment syndrome, Newham showed that the increase in compartment size during exercise was normal, as were the strength and damage susceptibility although they demonstrated voluntary activation failure and abnormally high pain levels (with Jones, Birmingham; Cassey, QinetiQ; Padhiar, Royal London), challenging current management. Newham and Woledge developed a novel technique to enable real time ultrasound studies of patellar movement during functional activities, together with motion analysis. Evidence to date indicates that biomechanical factors are less significant than previously thought and more effective intervention strategies should result. Studies on anaesthetised patients undergoing surgery showed that motion analysis with surface markers has excellent accuracy when compared with the gold standard of bone markers (with Amis, Imperial and surgeons at Charing Cross Hospitals).

 

Rowlerson with maxillofacial surgeons (Lille, France) and orthodontists (KCL Dentistry and Pittsburgh, USA) has identified relationships between the composition of the jaw muscles and craniofacial shape discrepancies requiring surgical correction. Muscle structure and composition is being evaluated at corrective surgery and in cases of relapse.

 

Work by Smith on the contractile properties of the human vas deferens aims to develop a non-hormonal male contraceptive. The mechanical responses of vasectomy specimens have lead to understanding the mechanisms whereby drugs known for their clinical side-effects of reduced fertility can selectively inhibit longitudinal muscle. The ideas have provisional patents and application to male fertility is under discussion with pharma. Smith and Newham have shown that the nervous system effectively compensates to minimise functional changes in the presence of muscle fatigue.

 

Objectives: Hurley is co-applicant on an NIH-funded, longitudinal epidemiological study investigating biomechanical, psychosocial and related outcomes in >3,000 OA subjects (grant held at Harvard and UCLA, USA). He, Beith, Critchley and Godfrey are attempting to identify the factors that predict the most suitable intervention for individuals with CLBP.

 

Johnson is developing a full scale RCT of the effectiveness of a home exercise video for COPD patients unwilling or unable to participate in group exercise.

 

Morrissey and Woledge are developing their model of simultaneous motion analysis and ultrasound imaging to study the pathomechanics of shoulder instability and impingement syndromes in order to develop more rational and effective physical treatment (with orthopaedic consultants and physiotherapists). Morrissey and Shortland are using similar techniques to evaluate physical interventions in children with cerebral palsy (also [2]).

 

Newham and Woledge (with Amis, Imperial) are investigating the role of biomechanical and neuromuscular factors in patello-femoral pain patients who are prone to developing OA.

 

Rowlerson has just embarked on a study of the histology of the hand muscles in patients with carpal tunnel syndrome (with orthopaedic surgeons at Guy’s Hospital) with the aim of better understanding why the success rate of surgery on grip strength is variable and on average less good in older people (also [3]). 

 

Smith is testing the hypothesis that specific drugs cause the vas to behave as a functional sphincter to block sperm transport with real implications for male fertility.

 

[2] Neuromuscular group 

Staff: Beith, Green (ECR), Hurley, Pavlou, Harridge, Newham, Rowlerson, Shortland, White. 

 

Overview:  This group studies neuromuscular conditions with the aim of better understanding underlying mechanisms, leading to the development and evaluation of rational interventions.

 

Achievements: Beith aims to better understand the role of altered reflex and descending muscle control in CLBP and has identified novel normal reflex connections (with Harrison, UCL). Transcranial magnetic stimulation has identified common descending control from the cortex to bilateral abdominal muscles (with Davey et al, Imperial). These novel findings challenge the validity of many current physical interventions for CLBP patients who have a delay in the reflex to the back, but not abdominal, muscles (with Harrison, UCL). Ultrasonography and electromyography revealed that subjective clinical techniques currently used to assess muscle activity in CLBP patients are inadequate; activation of individual muscles is difficult and often impossible, challenging the premise of  much current CLBP physiotherapy treatment (with Harrison, UCL and the late Nick Davey, IC).

 

Pavlou and Green (ECR) work on balance control. Studies on the treatment of imbalance and vertigo in adults with peripheral vestibular disorders have shown that customised exercise regimes incorporating visual motion are most beneficial, particularly for visual vertigo symptoms, and have a major impact on QoL (with Bronstein, IC; Davies, National Hospital for Neurology and Neurosurgery).

 

Harridge and Newham have worked on the structure and function of skeletal muscle in spinal cord injured (SCI) people whose muscles contain low proportions of slow myosin heavy chain 1 (MHC-1)) fibres. Harridge showed that following chronic electrical stimulation, myogenic transcription factors (MyoD and myogenin) were upregulated first, followed by MHC-1 mRNA, providing the first evidence of a fast to slow phenotypic switch in humans (with Andersen and Schjerling, Copenhagen Muscle Research Centre). MHC isoform expression primarily determines muscle shortening speed.  An in vitro motility assay of human myosins extracted from single fibres has shown them to produce similar speeds of actin motility in MHC-I and MHC-IIa isoforms, independent of the subjects’ age (overlaps with [3]). However, strength training increased motility speed (i.e. altered cross-bridge function) of MHC-IIa isoforms.  These changes were independent of altered myosin light chain composition, suggesting a post-translation modification of the fast MHC isoform (with Bottinelli and Canepari, Italy).  A novel system has been developed for studying in vitro mechanical properties of single fibres.

 

Newham completed a multicentre international trial on the effects of electrically stimulated cycling training (with Donaldson, UCL; Hunt, Glasgow; Swain, Salisbury). Health related parameters and muscle strength and endurance improved substantially but the power output achieved was less than expected and remained below that necessary to enable outdoor cycling – one of the key aims.

 

Newham (with Mills and Rushton, Medicine and Neuroscience, KCH) found that the subjective clinical assessment of spasticity is not related to muscle electromyographic activity after stroke and therefore does not measure the reflex component. Muscle strength was the main determinant of functional ability, although this is often ignored during rehabilitation. Function of the upper limb after stroke was improved by electrical muscle stimulation but only when triggered by voluntary efforts. 

 

Shortland’s studies on the mechanisms of reduced functional capacity and participation in ambulant children with spastic cerebral palsy (SCP) and the effects of intervention (also [3]) have shown that deformity is not always caused by muscle fibre shortness as commonly thought. Complex relationships are suggested between the dimensions of individual muscle bellies and clinical measures of deformity, with implications for how deformities are better corrected. With Imaging Sciences (KCL) he has found that the atrophy of SCP particularly affects distal leg muscles. Muscle lengthening surgery is traditionallythought to result in long-term atrophy, but greater than normal growth rates occurred in the following year. 

 

White led a Cochrane systematic review of the effects of exercise in peripheral neuropathy, concluding that there was insufficient evidence to inform physiotherapy practice (with Pritchard, Guy’s and King’s Hospital Trusts; Turner-Stokes, KCL). Preliminary studies suggest that fatigue was of a central, not peripheral, nature and an exercise programme improved physiological factors, functional activity and QoL without any adverse reactions.

 

Objectives: Beith (with Alexander, UCL) is investigating the differences in reflex and descending muscle control between CLBP patients, asymptomatic controls and groups of elite athletes who demonstrate unusually coordinated control, along with the mechanism for the delayed reflexes in CLBP and its clinical significance. With Hurley and Jones and Thacker (KCL) he is attempting to sub-classify CLBP patients, particularly those who have a neuropathic component in order to develop rational interventions.

 

Pavlou is extending previous work to improve vestibular rehabilitation in children (with Luxon, Institute of Child Health) and also older people who fall (with Mayagoitia-Hill, Bioengineering, KCL; Hopper & Martin, Guy’s Hospital and Luxon, Institute of Child Health). They are also using accelerometry to evaluate the changes after therapy in people with vestibular disturbances when free walking in busy public areas. 

 

Green (ECR) is working on the effects of the vestibular system on cardiorespiratory control and the vestibular-visual conflict, the use of the arms for balance (with Bronstein, IC). He is exploring the effect of passive unpredictable motion upon motion sickness and cardiorespiratory control (with Gresty, IC) and motion sickness and hypothermia (Tipton, Royal Navy).

 

Harridge is using the novel system he developed to study in vitro mechanical properties of single fibres under more natural loading conditions (shortening against virtual elastic and inertial loads) than currently used.

 

Harridge, Newham and Rowlerson (with Donaldson, UCL) are systematically evaluating possible physiological and engineering explanations for the unexpectedly low power output achieved after electrically stimulated cycle training for SCI subjects, including using muscle biopsy and Near Infra-red Spectroscopy techniques to reveal muscle structure, anabolic gene expression and metabolism.

 

Newham (with Mills & Rushton, Medicine, KCL) is investigating the optimal parameters for magnetic brain stimulation to increase cortical excitability in stroke patients and its effect on functional performance.

 

Shortland is investigating whether the natural history of deformity in cerebral palsy can be modified by muscle strengthening and improved surgical techniques. He is leading a multi-centre UK study on the outcomes of current clinical services, aiming to establish whether function and participation of adolescents with SCP is improving. He and Harridge are investigating the hypothesis that much of the reduced functional capacity is explained by novelmeasurements of impairment (instrumented spasticity measures, muscle activation, muscle and bone morphology). 

 

White is developing a multi-centre RCT of exercise and mechanisms of fatigue in patients with inflammatory neuropathy which includes a two year follow up to assess cost-effectiveness and cost-utility (with Hughes, KCL and others). A new collaboration (with Van Doorn, Garssen, Netherlands) is commencing on a Cochrane review of interventions for fatigue in this population.

 

[3] Growth, development and ageing 

Staff: Harridge, Kitchen, Newham, Pavlou, Rowlerson, Smith, Velloso (ECR) and Woledge,

 

Overview: This group focuses on improving knowledge of the function and control of skeletal muscle and the whole body throughout the life cycle and the controlling factors. A key aim is to better preserve functional ability, independence and QoL during ageing.

 

Harridge has shown intrinsic age related muscular changes which long-term high resistance exercise cannot prevent. Elite master weight-lifters loose strength and power at a similar rate as untrained individuals, but retain muscle function equivalent to untrained individuals 25 years younger (with Pearson, Manchester; Nimmo, Strathclyde; Young, Edinburgh). He has implicated IGF-I in sarcopenia and the expression of different splice variants of the IGF-I gene has been demonstrated. MGF is upregulated a couple of hours after a single bout of high resistance exercise in young, but not elderly, subjects and IGF-IEa is unaltered in both groups.  This highlights both age and exercise related differences in the regulation of the two isoforms (with Goldspink, UCL).  After 5-12 weeks of training older people upregulated both MGF and IGF-IEa; important splice variants regulating muscle growth in animal models.  Elderly people are functionally GH deficient but upregulated both IGF-I variants following recombinant human growth hormone (rhGH) administration although hypertrophy did not increase unless combined with high–resistance training (with Goldspink, UCL & Kjaer, Denmark).

 

Harridge and Velloso (ECR) have shown that rhGH does not upregulate MGF or IGF-IEa in young people’s muscle, but does elevate serum IGF-I, suggesting that GH status and tissue specific mechanisms regulate IGF-I expression. Expression of MGF and IGF-IEa is upregulated in cultured muscle cells following GH treatment and inhibited by concomitant IGF-I treatment (with Goldspink, UCL). This suggests that IGF-I splice variant expression in muscle is regulated by both GH and IGF-I and may provide a model to explain the lack of anabolic effect of rhGH. An RCT on strength trained athletes showed that serum IGF-I and PIIP are significantly elevated following rhGH administration, providing a basis for a test to detect rhGH abuse (with Goldspink, UCL; Cowan, KCL; Godfrey, Brunell).

 

Velloso (ECR) has shown that interspecies hybrid myotubes can be made by fusing mammalian and newt myoblasts. Their dominant in response to serum stimulation was cell cycle re-entry, as in the parental newt cells. The conversion of multinucleate postmitotic muscle fibers to dividing mononucleate progeny cells (cellularisation) occurs during limb regeneration in salamanders, and is an important aspect of the ability to regenerate various tissues and appendages. The process of cellularisation requires expression of the homeobox gene msx1 but not cell cycle re-entry, thus suggesting that cellularisation of myotubes precedes cycling (with Brockes, UCL).

 

There is a strong programme aimed at understanding and preventing the incidence of falls in older people. Kitchen (with Mayagoitia-Hill, Bioengineering) found that a recently developed and patented stair-climbing device was effective and acceptable to older people. Accelerometry studies showed the balance of healthy, active, people >65 years who prefer to handrails to be clearly different to those who do not. Smith and Woledge (with Mayagoitia-Hill)found that joint proprioception and walking stability in healthy older people is best when walking on hard surfaces and in shoes with thin, non-damping soles. Newham (with Narici, Manchester; du Chateau, Belgium; Bottinelli, Italy and others) studied possible neuro-muscular causes of medically unexplained falls in older people. Muscle strength per se was less of a fall risk than the neural control of the remaining muscle and older fallers showed significantly worse balance control, particularly in activities such as descending stairs and sitting down which should respond to specific physical training. Using novel processing of motion analysis data Woledge and Newham found that there are clear age related differences in the pattern of random, but not regular, sway in the medio-lateral plane - the direction in which most falls occur.

 

Rowlerson was part of a NATO programme on muscle growth regulators in fish (with Radaelli, Italy; Funkenstein, Israel), partly stimululated by the potential for application in the meat production industry and in the newer ‘in vitro meat’ field.  They developed new research tools, documented the natural time course of expression of muscle growth regulators such as IGFs and myostatin and characterised an explant culture system which could be used as a bioassay. 

 

Objectives: Harridge and Velloso are developing tests to detect rhGH abuse by athletes using mass spectrometry (with Creaser, Nottingham Trent and Teale, HFL, Newmarket) and cell based approaches (with Goldspink, UCL). With Moxham (KCL) and Polkey (Brompton Hospital) they plan to study mechanisms of muscle wasting in patients with Chronic Obstructive Pulmonary Disease, the role of IGF-I splice variant expression in patients with chronic heart disease (Kjaer, Copenhagen) and  muscle loss in sarcopenia and its prevention by long term resistance exercise (with Ahtiainen and Hakkinen, Finland).

 

Kitchen (with Mayagoitia-Hill, Bioengineering) is further exploring biomechanical assessments during stair climbing to identified categories of physical function that predict what, if any, assistive technologies are required for safely managing stairs. Long term and unobserved monitoring by accelerometry is providing better information about the use of stair handrails and the prevention of trips and falls. 

 

Newham is investigating the effect of whole body vibration on bone and muscle strength and also functional ability in frail older people and the underlying mechanisms of any change (with Martin, Elderly Care, Guys’ Hospital).

 

Pavlou (with Hopper, Elderly Care, Guy’s Hospital)is assessing the effect of vestibular exercises and optokinetic stimulation on falls risk in older patients who fall and also postural stability in older people who fall in the presence of head movements and optokinetic stimulation.

 

Smith and Woledge (with Mayagoitia-Hill, Bioengineering) are developing portable accelerometer and rate gyroscope systems incorporating innovative signal processing and biomechanical modelling. These systems can be used for unobserved, long term monitoring of gait and balance of people in their own environment. In the medium to long term the aim is to develop a clinical system for accurately assessing balance. While laboratory studies are valuable, people perform differently and important events may be missed; long term monitoring should provide better information about the causes of trips and falls. The system has potential for use as an alarm system to summon help.

 

Rowlerson is working on a project comparing the effect of peri-conceptional with late-gestational moderate maternal nutrient restriction on muscle fibre number in late gestation fetal sheep (with the Centre for Developmental Origins of Health and Disease, Southampton). She and Poston (KCL) are studying the prenatal programming of adult muscle characteristics thought to contribute to hypertension and insulin resistance in adult life.  

 

[4]  Health related beliefs, perceptions and attitudes 

Staff: Bearne, Critchley (ECR), Godfrey, Hurley, Johnson, Kitchen 

 

Overview: This relatively new group (formed since the last RAE) studies the psychosocial factors that impact on an individuals response to treatment and how these can best be employed to optimise the effects of an intervention.

 

Achievements: Godfrey’s work on the cause and management of medically unexplained symptoms has shown that Cognitive Behavioural Therapy (CBT) and counselling were equivalently effective for people with chronic fatigue syndrome (CFS) in primary care and identified factors associated with response to treatment. Current research is using fMRI techniques to explore the neurobiological basis of CFS and more specifically the neural correlates of its symptoms and changes after completing a CBT program.

 

Kitchen has studied the satisfaction of patients, stratified for socioeconomic profile, with out-patient physiotherapy in a national study. This was largely dependent on their expectations which can be strongly influenced by the therapist. Important differences between those with acute and chronic conditions emerged and a model has been developed to describe satisfaction in both groups. Care staff expressed concern about implementing 'physiotherapy' interventions which they saw as 'expert' tasks and expressed training needs and concerns about liability in contrast with physiotherapists’ views that the tasks were very simple and adequate training had been provided. 

 

Objectives: Godfrey (with colleagues at the Institute of Psychiatry) is examining the neural correlates of the cognitive symptoms associated with CFS (working memory deficits), provoking feelings of fatigue and examining whether CFS patients present deficits in emotional regulation. Planned future work will include a cohort study of the development of food intolerance in children (with colleagues at the Institute of Psychiatry and Nutrition at KCL and Surrey).  With Critchley and Hurley she is evaluating the efficacy of complex healthcare interventions for CLBP with the aim of improving complex psychosocial parameters such as pain, QoL, health beliefs, work capacity and establishing clinical- and cost-effectiveness of physical and psychosocial interventions.

 

Hurley is comparing the effects of a graded exercise regimen and counselling for CFS patients in primary care (with Ridsdale, KCL).  He and Bearne are assimilating qualitative and quantitative work with the aim of improving the understanding of how and why management is successful or not. They are evaluating the efficacy of complex healthcare interventions with the aim of improving psychosocial parameters and establishing clinical- and cost- effectiveness of physical interventions.

 

Johnson is examining factors which influence patients’ decisions to participate in pulmonary rehabilitation.  Reasons for non-attendance are also being studied and whether they can be influenced by information provided by expert patients through an educational video (with Moxham and colleagues at KCH).

 

Kitchen is studying the views of students from a number of health professions on both accelerated training and standard entry programmes on inter-professional learning (with London South Bank). Emerging differences would impact on the running of these programmes.  

 

Esteem indicators 

All members (including ECRs) are regular reviewers for scientific and professional journals, review grant applications for national and international funding bodies, including research councils and charities and the majority regularly act as PhD examiners, including internationally (Buckland-Wright, Harridge, Morrissey, Newham, Woledge).

Editor: Harridge (Br J Pharmacol ); Newham (Eur J Appl Physiol).

Associate editors: Harridge (Eur J Sports Sci, Scand J Sports Med, J Strength Training and Conditioning Res); Kitchen (Physiotherapy Theory and Practice); Newham (Australian J Physiotherapy).

Editorial Board membership: Buckland-Wright (Osteoarthritis and Cartilage), Hurley (Arthritis Care and Research, Physiotherapy, J Sports Rehabil, Advances in Physiotherapy; Kitchen (Physiotherapy Res Internat; Morrissey (Clin Biomech); Newham (Disability & Rehabil, Physical Therapy Revs, Manual Therapy, J Sports Sci, Physiotherapy Theory & Practice).

Invitations to speak at international meetings: Beith, Buckland-Wright, Harridge, Hurley, Newham, Pavlou, Velloso (ECR), Shortland, White, Woledge.

Bearne and Hurley: contributed to national EBP guidelines for the management of RA in the elderly.

Beith: convenor for the London hub of the National Physiotherapy Research Network.

Buckland-Wright: Consultant for national and international clinical trials; scientific adviser to NIH & FDA and a number of pharmaceutical companies; conference organiser and board member, MICCAI 2006 Joint Disease Workshop (Copenhagen).

 

Critchley (ECR):  Invited by the Arthritis and Rheumatism Campaign (arc) to write a report on back pain (with Hurley) aimed at doctors, AHPs and medical students (http://www.arc.org.uk/arthinfo/medpubs/6533/6533.asp).

 

Green (ECR); consultant for Exoscience.

 

Harridge: Wellcome Trust Career Development Fellowship; elected convenor, Human Physiology Special Interest Group, the Physiological Society; Scientific Committee of the European College of Sports Science; organiser of 5 international meetings; 7 invited book chapters and reviews.

Hurley: Clinical Advisor to arc; Research and Clinical Effectiveness Committee, Chartered Society of Physiotherapy; member - NICE OA Guidelines Committee; DoH and Royal College of Physicians Working Group guidelines for management of OA and RA; International Steering Committee for CARE (development of best rheumatology practice); Inaugural Droitwich Lecturer, British Society of Rheumatology.

Johnson: Keynote address at the annual Congress of the Chartered Society of Physiotherapy (CSP).

Kitchen: NICE - Specialist advisor, Interventional Procedures Programme; WeLReN Research Project Facilitator, Dept of Primary Care and General Practice Centre for Primary Care and Social Medicine Faculty of Medicine, Imperial College of Science.


Morrissey
: Head of Research, Institute for Joint and Sports Injuries, Slovenia; Scientific Advisory Board, Institute of Medical Technology, Switzerland; research consultant to the Therapy Departments, King's College Hospital; European Space Agency Topical Team “Aetiology of low back pain in microgravity and strategies for prevention” based at Erasmus University. 

Newham: Research Committees of arc and Research into Ageing; Scientific Strategy Committee of arc; executive member, National Physiotherapy Research Network (funded by the CSP); Fellow, CSP. Visiting Professor, University of Melbourne.

Pavlou; invited member of the Action on ENT project (DoH) on developing guidelines for management of the dizzy patient.

Shortland: Chair, Special Interest Group in Rehabilitation Engineering in Medicine and Biomechanics;  member, Science Engineering and Technology Committee, Institute of Physics and Engineering in Medicine; Clinical and Technical Standards Officer, European Society of Movement Analysis in Adults and Children.

 

Velloso (ECR): Invited review in Br J Pharmacol.

 

White: Member of Medical Advisory Board of the Guillain-Barré Syndrome Support Group UK; member of the Cochrane neuromuscular disease review group. 

 

Woledge: Session chair at International Energetics Meeting; NHS biomechanics consultant; keynote address to Society of Experimental Biology symposium; visiting professor at Imperial College.