Pain Perception after Isometric Exercise in Women with Fibromyalgia

Objective: The purpose of this study was to identify exercise protocols incorporating isometric contractions that provide pain relief in women with fibromyalgia. Design: A before-after trial. Setting: A physical therapy department in an academic setting. Participants: Fifteen women (mean ± SD, 52 ± 11y) with fibromyalgia. Interventions: Subjects completed 4 sessions: 1 familiarization and 3 experimental. The following randomized experimental sessions involved the performance of isometric contractions with the elbow flexor muscles that varied in intensity and duration: (1) 3 maximal voluntary contractions (MVCs), (2) 25% MVC held to task failure, and (3) 25% MVC held for 2 minutes. Main Outcome Measures: Experimental pain (pain threshold and pain rating), Fibromyalgia Impact Questionnaire, and fibromyalgia pain intensity (visual analog scale). Results: After all 3 isometric contractions, there was considerable variability between subjects in the pain response. Based on the changes in experimental pain, subjects were divided into 3 groups (increase, decrease, no change in pain). Multiple regression analysis revealed that age, baseline experimental pain, and change in fibromyalgia pain intensity were significant predictors of the experimental pain response after the isometric contractions. Conclusions: We identified subgroups of women with fibromyalgia based on how they perceived pain after isometric contractions. The greatest pain relief for women with fibromyalgia occurred at a younger age and in women with the greatest experimental pain before exercise. Additionally, we established a link between experimental and clinical pain relief after the performance of isometric contractions

Gateway to health: promoting the physical and psychosocial wellbeing of older adults and people with long-term conditions

The ageing population and predicted increase in the number of people with long-term conditions (LTCs) presents a challenge to healthcare systems when faced with demands to provide more cost-effective and sustainable services. Optimising citizens’ health and wellbeing (HWB) could offer an efficient way to provide holistic care; however, it is not clear as to how to achieve this. This thesis demonstrates how my publications have helped to contribute to knowledge within the HWB arena for older adults and people with LTCs, and, specifically, to gain more understanding of their physical and psychosocial health needs and models of care that can promote their HWB. To offer context to these publications, this thesis provides a critical review of the relevant theory. This includes an appraisal of healthcare policy to highlight the issues faced by current health services, drivers for change and approaches to models of care. The concept of HWB has also been deliberated including a critical evaluation of its role in relation to healthy ageing and the wellbeing agenda. Six publications are contained within this thesis and, as a collective, reflect a mixed methods research design as they involve interviews, a focus group and surveys. The final publication, a theoretical paper, is an amalgamation of all the research findings discussed within the context of a critical review of the literature and linked explicitly to the physiotherapist’s role in long-term condition management. The findings of the publications are from insights gained from the perspectives of people with LTCs, though, mainly from those with neuromuscular disorders and mental ill-health, as well as older adults. The publications’ findings demonstrate the capacity of voluntary, community and social enterprises (VCSE) to provide integrated care that meets the holistic needs of those who access them whilst, potentially, addressing the social determinants of health. They also highlight the necessity for supporting people with LTCs to improve their life circumstances through their own personal empowerment. This includes the ability to facilitate their readiness to take on the responsibility with partnership working between the individual and the healthcare worker and psychological support when needed being identified as key. Developing the person’s social skills and aptitude to build interdependent relationships have been determined as the ultimate goal to enhance capacity for community engagement and further access to HWB resources. The publications’ findings also show that capitalising on the power of social networks to foster older adults’ adherence to community physical activity (PA) groups may promote HWB and, thus, the ability to age healthily. It was also found that if older adults become embedded within the PA group’s network they could shape the environment to fulfil their own needs. In addition, the findings advocate the necessity for a transformation in physiotherapy practice including enhancing the physiotherapists’ role as health promoters. It is proposed that only by doing so; they can remain contemporary and continue to support the optimisation of the HWB of older adults and people with LTCs. Further to the publications, this thesis comprises a critical commentary that includes how VCSE can support healthcare services by promoting the HWB of people with LTCs and older adults. Finally, this thesis culminates in a critical discussion of the implications, for practice and policy, of the findings from my publications, with recommendations for further research

Physical activity counselling among junior doctors in the UK: A qualitative study

Background: Evidence supporting physical activity (PA) as an effective modality in the prevention and management of non-communicable diseases is robust. Medical doctors are ideally placed to translate this into practice; however, realising this has proved challenging. To ensure doctors are well prepared, the training of medical students to be proficient in PA counselling seems essential. This study aimed to explore the PA counselling practice of junior doctors, to gain insight into how undergraduate training might influence their future practice. Methods: Interviews were conducted with 11 junior doctors recruited by purposive sampling from across seven different medical schools. All junior doctors were currently undertaking their post-graduate training in North-West England. Interviews were digitally recorded, transcribed verbatim and analysed using thematic analysis. Results: Themes developed from the data were PA attitudes and practices, and barriers and facilitators to PA counselling in clinical practice. Conclusion: The PA counselling practice of junior doctors was found to be inadequate, and attitudes towards PA promotion were particularly discouraging while in the hospital setting. Lack of training in PA counselling at both the undergraduate and postgraduate level and lack of support from consultants were major hindrances. However, unexplored opportunities exist for junior doctors to incorporate PA counselling into primary and secondary care and thus transform the practice of the next generation of doctors

Nigerian physiotherapists’ knowledge, current practice and perceptions of their role for promoting physical activity: A cross-sectional survey

Background: Nigeria has the highest rates of physical inactivity in Africa. As physical inactivity is a leading global risk factor for non-communicable diseases (NCD), physical activity promotion is a strategy for their mitigation. Physiotherapists are already ideally situated to undertake this role and can assist in the reversal of NCD. Gaining insight into how physiotherapists in Nigeria perceive their role in relation to physical activity promotion is needed to ensure this undertaking will be effective. This national survey aimed to investigate Nigerian physiotherapists’ knowledge and current practice for promoting physical activity across Nigeria and perceptions of their role related to this. Methods: Following ethical approval, a cross-sectional, online questionnaire survey design was employed to investigate the aim. 330 qualified physiotherapists, working across Nigeria were recruited. Internal consistency of the survey was examined using Cronbach’s alpha. Descriptive statistics were used to analyse closed questions. Thematic content analysis was used to analyse open-ended questions. Chi-square inferential statistic was used to investigate the association between variables with alpha interpreted at a level of 0.05. Results: The internal consistency of the questionnaire survey was good overall (Cronbach Alpha α = 0.71). 330 physiotherapists participated. 99.4% agreed that discussing the benefits of a physically active lifestyle with patients is part of their role. However, over 60% did not feel confident in suggesting specific physical activity programs for their patients. 59.7% were aware of one or more physical activity guideline. However, only 49.1% were incorporating it into their practice. 85.5% felt that developing a physical activity guideline specifically for Nigeria would promote physical activity. 63.3% of respondents did not use any resource in promoting physical activity. An association was found between the physiotherapist’s awareness of physical activity guidelines and male sex (χ2 = 8.95, df = 2, p = 0.01). Conclusion: Whilst most physiotherapists had a positive perception of their role in promoting physical activity, translating this into practice would seem to be challenging. A systems approach to physical activity health promotion is recommended with the need for a commitment by the Nigerian Government to the development and implementation of national guidelines. Incorporating more training in physiotherapy education could foster more confidence in the delivery of these guidelines. Greater use of resources and working with community organisations could help to optimise physical activity uptake in Nigeria

Views and experiences of non-medical prescribing: a national survey of prescribing physiotherapists

Background: Physiotherapy non-medical prescribing (NMP) is a contemporary development whereby physiotherapists can prescribe medications within their scope of practice. Despite institutional and professional support for its implementation, data regarding physiotherapists’ views and experiences of NMP is limited. Objectives: To explore the views and experiences of NMP for UK prescribing physiotherapists. Design: Cross-sectional study, using an anonymous, online survey. Methods: Recruitment involved non-probability sampling targeting UK physiotherapists with a NMP qualification. Data was gathered about the role, scope, and activity of prescribing physiotherapists via closed and open-ended questions. Descriptive statistics and inductive content analysis were undertaken. Results: Of the 552 respondents, most worked in FCP roles (122/552, 22%) and 82% (450/552) prescribed medication. NSAIDs were the most prescribed drug class (267/450, 59%). Perceived benefits were enhanced patient care, reduced burden on other prescribers, and improved medication access. Challenges included restrictions on prescribing or deprescribing controlled drugs (CDs), limited scope of practice, and inadequate CPD. Themes identified to improve physiotherapy NMP were increasing the CDs that physiotherapists can independently prescribe and deprescribe, improving CPD and supervision, and increasing awareness amongst the public and healthcare professionals. Conclusions: This study provides novel findings of the perceived benefits, challenges, and development areas for physiotherapy prescribing. There is a need to review and potentially expand the drug formulary for physiotherapists. Improving education and supervision is crucial for the sustainable growth of physiotherapy NMP. Increasing the awareness amongst the public and healthcare professionals may enhance the acceptance of physiotherapy prescribing. Contribution of the paper: - This study provides novel insights into physiotherapy NMP in the UK and highlights future development needs. - The survey identifies that NMP physiotherapists perceive a need to review and expand the current drug formulary to allow physiotherapists to independently prescribe and deprescribe more CDs within their scope of practice. - Physiotherapy prescribing is rapidly increasing across the UK, improving the education, supervision, and awareness of physiotherapy NMP should be considered to enhance future practice

"Promoting the mental and physical wellbeing of people with mental health difficulties through social enterprise”

Purpose Interventions that promote both mental and physical wellbeing have been advocated for people with mental health difficulties, as they have been found to engage less in healthy behaviours and have lower levels of physical fitness. However, no optimal approach to facilitate this undertaking has been identified. This exploratory research aims to explore the experiences of people with psychological distress who accessed a social enterprise that fosters the building of positive social networks in the community, as part of a personalised recovery programme. The intention was to gain an insight into its therapeutic effect in relation to mental and physical health. Methodology An exploratory survey design was undertaken with a purposive sample of 50 individuals who had attended the enterprise. Descriptive statistics and thematic analysis were employed to analyse the data from both closed and open-ended questions. Findings The wellbeing service appeared to provide a supportive environment that offered people access to social networks through their participation in local services and activities. Fostering participants’ active participation, connection building and the ability to make meaningful contributions helped to facilitate health behaviours that had a positive impact on their health and wellbeing Originality/value This study highlights the potential role of a social enterprise in optimising the social context for promoting the health and wellbeing of people with mental health difficulties

Future-proofing the Profession: Physiotherapists’ perceptions of their current and emerging role

Objectives As healthcare systems continue to modernise, physiotherapists are required to transform their practice to remain contemporary and meet future population needs. The study aims to gain an insight into physiotherapists’ perceptions of their current and emerging future role. The intention is to develop an understanding of the physiotherapist’s role and how it can continue to evolve to support populations’ needs in more sustainable and innovative ways. Design A qualitative design using semi-structured interviews was undertaken informed by Gadamerian hermeneutic philosophy. Participants Participants were gained from a postgraduate physiotherapy programme in Northwest England that recruits physiotherapists from across the UK; via the research teams’ professional networks and using snowball sampling. Interviews were digitally recorded and transcribed verbatim. Thematic analysis was undertaken. Ethical approval and informed consent was obtained. Results 23 participants (15 female). 4 themes were identified: ‘An underpinning philosophy of practice’ that promotes holistic care and supports patient wellbeing. An ‘evolving role broadening the scope of practice’ with many ‘agents of change shaping the profession’. When ‘preparing the future workforce and their transition into practice’, graduates were seen as more adaptable and resilient. However, more affiliation between the university and placement providers to enhance learning environments is needed. Conclusions Physiotherapists need to re-evaluate their role so a clear vision for the future can be co-created to ensure they remain contemporary and continue to optimise their potential. An emerging role that re-envisages a holistic approach that incorporates health promotion as fundamental to this role could support physiotherapists’ transformation in practice

Evidence for a correlation between the sizes of quiescent galaxies and local environment to z ~ 2

We present evidence for a strong relationship between galaxy size and environment for the quiescent population in the redshift range 1 < z < 2. Environments were measured using projected galaxy overdensities on a scale of 400 kpc, as determined from ~ 96,000 K-band selected galaxies from the UKIDSS Ultra Deep Survey (UDS). Sizes were determined from ground-based K-band imaging, calibrated using space-based CANDELS HST observations in the centre of the UDS field, with photometric redshifts and stellar masses derived from 11-band photometric fitting. From the resulting size-mass relation, we confirm that quiescent galaxies at a given stellar mass were typically ~ 50 % smaller at z ~ 1.4 compared to the present day. At a given epoch, however, we find that passive galaxies in denser environments are on average significantly larger at a given stellar mass. The most massive quiescent galaxies (M_stellar > 2 x 10^11 M_sun) at z > 1 are typically 50 % larger in the highest density environments compared to those in the lowest density environments. Using Monte Carlo simulations, we reject the null hypothesis that the size-mass relation is independent of environment at a significance > 4.8 sigma for the redshift range 1 < z < 2. In contrast, the evidence for a relationship between size and environment is much weaker for star-forming galaxies.Comment: Accepted for publication in MNRAS. 16 pages, 11 figures, 6 table