Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Musculoskeletal Research

Research in musculoskeletal physiotherapy encompasses the areas of orthopaedics, rheumatology and sports physiotherapy.

Projects undertaken have included psychometric testing of outcome measures, validity and reliability of assessment procedures and effectiveness of various interventions for people with musculoskeletal disorders, such as hip and knee osteoarthritis, low back pain and neck pain. Research is undertaken both in our Movement Laboratory based in RCSI and in clinical sites such as Beaumont, Cappagh, St Vincent's University, Mater Misericordiae University hospitals and Adelaide, Meath hospital, Dublin (incorporating the National Children's hospital) (AMNCH).

Projects

Greater Trochanter Pain Syndrome

Physiotherapy Management of Greater Trochanteric Pain Syndrome (GTPS): an international survey of current physiotherapy practice.

Research team
Dr Helen French and Ms Louise O’Connor, School of Physiotherapy, RCSI, Ireland, Dr Alison Grimaldi, Faculty of Health Science and Rehabilitation, University of Queensland, Brisbane, Australia; Dr Stephanie Woodley, School of Biomedical Science, University of Otago, New Zealand; Dr Angela Fearon, Faculty of Health, University of Canberra, Australia.
Project description
The primary aim of this research is to identify the current management of GTPS as reported by physiotherapists across three countries. Secondary aims are to compare the management approaches between three different countries and to differentiate physiotherapists’ preferred methods for updating their knowledge in this field of practice in each country. A cross-sectional online survey which is targeted at musculoskeletal physiotherapists who are members of the professional bodies in their respective countries and working musculoskeletal or sports settings (e.g. acute hospital outpatient departments, primary care centres and private practice clinics) in Ireland, Australia and New Zealand will be administered.

Do features of Central Sensitisation exist in Greater Trochanter Pain Syndrome (GTPS)? a case control study. Funding (RCSI Summer Student Research 2016)

Research team
Dr Helen French, School of Physiotherapy, RCSI, Ms Mary McCallan, Physiotherapy Dept, Connolly Hospital, Dublin 15, Mr Chie Jong, School of Medicine, RCSI.
Project description
Greater trochanteric pain syndrome (GTPS) refers to pain in and around the lateral hip. This condition, previously classified as trochanteric bursitis also shows tendinopathic changes in Gluteus Minimus/Medius. Central nervous system sensitization has been identified in other tendinopathies, which may explain the chronic and intractable pain often associated with tendinopathy No studies have examined if central sensitization (CS) is a feature of GTPS. This cross-sectional case-control study aims to determine if features of CS in people in GTPS. Patients with unilateral GTPS were recruited from an acute hospital in Dublin, Ireland. Age and gender-matched symptom-free controls were recruited from an academic institution in Dublin. The following CS measures were used: self-report Central Sensitisation Inventory (CSI) and pain pressure thresholds (PPTs) at local and remote sites in upper and lower limbs using pressure algometry. Other outcomes included the VISA-G (GTPS-specific disability), pain severity (NPRS) and hip abductor and adductor strength using a hand-held dynamometer.

The PACeR Trial

The PACeR Trial - A Randomised Controlled Trial of Multimodal Physiotherapy for Patients with Acute / Sub-acute Cervical Radiculopathy: 2014-2016

Research team
Louise Keating (PI - PhD candidate), School of Physiotherapy, RCSI, Dr. Dara Meldrum (RCSI), Prof. Ciaran Bolger (Consultant Neurosurgeon, Beaumont Hospital) and Dr. Catherine Doody (UCD).
Clinical Collaborators
Caroline Treanor and Julie Sugrue (Physiotherapy Dept, Beaumont Hospital)
Project description
Multimodal physiotherapy involving manual therapy and exercise has demonstrated a positive effect on pain and disability in sub-acute and chronic cervical radiculopathy (CR) but a research gap exists for optimal management in the first 12 weeks and short-term natural history of the condition is somewhat unclear, although thought to be favourable. The primary aim of this single blind, 2 group randomised controlled trial is to investigate the effects of a 4 week (6-8 sessions) programme of manual therapy, exercise and upper limb unloading tape compared to advice to stay active, on disability, pain and other biopsychosocial measures (including pressure algometry), in acute / sub-acute cervical radiculopathy patients. A secondary objective is to identify whether variables from the baseline examination and aetiology confirmed by MRI can predict response to treatment. Outcomes will be measured at baseline, 4 and 12 weeks. Patients' report of pain, disability and their rating of recovery will also be recorded by telephone interview at 6 months.
Funding
EuroSpine - the Spine Society of Europe and ISCP AIG Glennon Insurance Research Bursary 2014.

The use of eccentric exercises and topical glyceryl trinitrate (GTN) in the treatment of midportion Achilles tendinopathy

A randomised placebo controlled trial:2014-2019

Research team
Paul Kirwan, Physiotherapy Department , Connolly Hospital (PhD Candidate), Dr Helen French, School of Physiotherapy RCSI, Professor Trevor Duffy, Consultant Rheumatologist, Connolly Hospital.
Project description
Preliminary research has explored the use of topical glyceryl trinitrate (GTN) as an adjunct to exercise to enhance healing, but to date, the sample sizes have been small, the GTN dose may have been inadequate and results have been conflicting. The purpose of this placebo controlled double-blind randomized controlled trial is to investigate whether topical GTN when used in conjunction with an eccentric exercise program can improve clinical outcomes for individuals with Achilles Tendinopathy. Patients will be randomly allocated to one of two intervention groups. Group 1 will receive  GTN for 6 months in combination with a supervised eccentric exercise programme delivered over 3 months. Group 2 will receive placebo GTN in addition to the same exercise programme.
Funding
Health Research Board Research Training fellowships for Healthcare Professionals

Primary Care Musculoskeletal Physiotherapy in Ireland

A qualitative study of current service provision : 2012 to date

Research team
Dr. Helen French, School of Physiotherapy, RCSI; Dr. Rose Galvin, HRB Centre for Primary Care, Department of General Practice, RCSI
Project description
This study aims to determine the current service provision of musculoskeletal physiotherapy services in primary care in Ireland and secondly to identify the Continuing Professional Development (CPD) needs and CPD provision for primary care physiotherapists working in musculoskeletal services. A mixed methods approach will be used. Phase 1 will comprise qualitative focus groups of senior and staff grade physiotherapists who work in musculoskeletal primary care services. Physiotherapy managers will be survey using one-to-one semi-structured interviews. Key themes from the qualitative surveys will be used to develop a survey of physiotherapists working in primary care.
Funding
O'Driscoll O'Neill Research Bursary (Irish Society of Chartered Physiotherapists)

Prevalence and burden of Osteoarthritis amongst older people in Ireland

Findings from The Irish Longitudinal Study on Ageing study (TILDA) 2013-14

Research team
Dr Helen French, School of Physiotherapy, RCSI; Dr. Rose Galvin, HRB Centre for Primary Care Research, Department of General Practice, RCSI; Professor Rose Ann Kenny, The Irish Longitudinal Study of Ageing, Chemistry Extension, Trinity College, Dublin.
Project description
This study aimed to investigate the prevalence of OA in a population aged 50 years and older in Ireland and to determine its relationship with demographic and health-related variables. Cross-sectional data from Wave 1 of the Irish Longitudinal Study on Ageing (TILDA), a population-based study of people aged 50 years and older assessing health, economic and social aspects of ageing in Ireland were analysed. Logistic regression was used to determine associations between the presence of OA and a range of demographic and health-related variables.

Cochrane Review

Adjunctive therapies in addition to exercise therapy for osterarthritis (OA) of the hip or knee : 2012 to date

Research team
Dr Helen French, School of Physiotherapy, RCSI; Dr Rose Galvin, HRB Centre for Primary Care, Department of General Practice, RCSI : Dr J. Haxby Abbot, Research Associate Professor, Dunedin School of Medicine, University of Otago, New Zealand; Professor Marlene Fransen, Associate Professor of Physiotherapy, University of Sydney, Australia.
Project description
Although a number of Cochrane reviews have evaluated the effectiveness of exercise and other conservative therapies in the management of hip or knee OA, no review has determined the benefit of exercise when used in combination with conservative adjunctive therapies. The purpose of this review is to determine whether adjunctive therapy in addition to exercise therapy is beneficial for people with hip or knee OA , compared with exercise only or exercise delivered in conjunction with a placebo adjunctive therapy.

The Effectiveness Of Supervised Exercise Without And Without Manual Therapy For Hip Osteoarthritis

A Randomised Controlled Trial

Research team
Dr H French
Project description
A multicentre randomised controlled trial was undertaken whereby people with hip osteoarthritis in four Dublin hospitals were allocated to receive exercise only, exercise and manual therapy and a control group. Outcomes included function, pain severity, hip range of motion, anxiety/depression, quality of life, pain medication usage, patient-perceived change and patient satisfaction
Collaborations
Physiotherapy and rheumatology departments Beaumont hospital, Mater Misericordiae University hospital, St Vincent's University hospital and Adelaide, Meath hospital Dublin (incorporating the National Children's hospital)
Funding
Health Research Board Research Fellowships for the Therapy Professions 2006
Publications
  • French HP, Brennan, A, White B, Cusack T. Manual therapy for osteoarthritis of the hip or knee- A systematic review. Manual Therapy 2011; 16; 109-117.
  • French HP, Cusack T, Brennan A, White B, Gilsenan C, Fitzpatrick M, O'Connell P, Kane D, Fitzgerald O, McCarthy GM. Exercise and manual physiotherapy arthritis research trial (EMPART): a multicentre randomised controlled trial. BMC Musculoskelet Disord. 2009 Jan 19;10:9
  • French HP, Gilsenan C, Cusack T. Gluteal muscle dysfunction and the role of specific strengthening in hip osteoarthritis: a review. Physical Therapy Reviews 2008: 13; 333-344

Physiotherapy Management Of Hip OA In Ireland

Research team
Dr Helen French
Project description
A questionnaire survey of physiotherapists working in public hospitals and private practice in Ireland was undertaken to identify current physiotherapy interventions and approaches used in the management of hip osteoarthritis.
Publication:
French HP. Physiotherapy management of osteoarthritis of the hip: a survey of current practice in acute hospitals and private practice in the Republic of Ireland. Physiotherapy 2007: 93: 256-260.

Gait Impairment In Cervical Spondylotic Myelopathy

Analysis, Impact On Function, And Effect Of Surgical Intervention.

Research team
Ailish Malone (nee McDermott)
Project description
The aim of this project was to compare gait in people with cervical spondylotic myelopathy (CSM) to age- and gender-matched healthy controls using three-dimensional gait analyis, and to assess changes in the CSM gait following surgical decompression of the spinal cord. People with clinical and radiological evidence of CSM were prospectively recruited from a neurosurgery clinic at Beaumont Hospital. Three-dimensional gait analysis and surface electromyography data were obtained during gait assessments conducted before surgery and at six months and one year after surgery. Secondary outcome measures included functional mobility, severity of myelopathy and health-related quality of life.
Funding
  • Health Research Board Research Fellowship for the Therapy Professions 2008.
  • Irish Society of Chartered Physiotherapists O’Driscoll O’Neil Bursary 2010.
Publications
McDermott A, Bolger C, Keating L, McEvoy L, Meldrum D (2010). Reliability of three dimensional gait analysis in cervical spondylotic myelopathy. Gait & Posture 32, 552-8.
Malone A, Meldrum D, Gleeson J, Bolger C (2011). Reliability of surface electromyography timing parameters in gait in cervical spondylotic myelopathy. Journal of Electromyography & Kinesiology, 21, 1004-10.

A survey of Chartered Physiotherapists’ knowledge and current clinical practice regarding concussion in sport

Research team
P McGrann, L Keating
Project description
An online survey of members of Chartered Physiotherapy in Sports and Exercise Medicine (CPSEM) was undertaken to identify current knowledge and clinical practice patterns (assessment and management) regarding concussion in sport.
Funding
HRB Summer Student Research Grant
Presentation
Presented at ISCP Annual Conference, November 2012.

A study to investigate the incidence of Neck Pain in patients with Complex / Refractory Headaches presenting to Headache Clinic in Beaumont Hospital

Research team
J Dickson, J Sugrue, L Keating.
Project description
A survey was undertaken of all new patients presenting to Beaumont Hospital Headache Clinic with the aim of profiling their headache types and establish the concurrent incidence of neck pain.
Collaborations
Physiotherapy Dept, Beaumont.
Funding
HRB Summer Student Research Grant.
Presentation
Poster presented at ISCP Annual Conference, Mullingar, November 2011.

Randomised, controlled trial comparing physiotherapy and Pilates in the treatment of ordinary low back pain

Research team
Niamh O'Brien, Margaret Hanlon, Dara Meldrum
Project description
Single-blinded, randomised, controlled trial comparing the effectiveness of a course of Pilates exercise (PLT) with standard physiotherapy treatment (PT) in the treatment of sub-acute low back pain (LBP). The results of this study suggested that a Pilates exercise program was equally as effective as conventional physiotherapy in the treatment of subacute low back pain when compared to no treatment.
Publication
O'Brien N; Hanlon M; Meldrum D (2006) Randomised, controlled trial comparing physiotherapy and Pilates in the treatment of ordinary low back pain. Physical Therapy Reviews, Sep; 11 (3): 224-CINAHL AN: 2009338423

Maximum Voluntary Contraction - Normative Data

Research team
Meldrum D, Cahalane E, Conroy R, Fitzgerald D, Hardiman O. (2007).
Project description
Maximum voluntary isometric contraction: reference values and clinical application. Amyotroph Lateral Scler. Feb;8(1):47-55. PMID: 17364436 QMA Normative Data is available here.