Trudy Rebbeck - Profile on Academia.edu (original) (raw)

Papers by Trudy Rebbeck

Research paper thumbnail of A systematic review shows minimal evidence for measurement properties of psychological functioning outcomes in whiplash

A systematic review shows minimal evidence for measurement properties of psychological functioning outcomes in whiplash

Journal of Clinical Epidemiology

Research paper thumbnail of Additional file 1 of Increase in ACC GABA+ levels correlate with decrease in migraine frequency, intensity and disability over time

Additional file 1 of Increase in ACC GABA+ levels correlate with decrease in migraine frequency, intensity and disability over time

Additional file 1.

Research paper thumbnail of Clinimetric Properties of Self-reported Disability Scales for Whiplash

Clinimetric Properties of Self-reported Disability Scales for Whiplash

The Clinical Journal of Pain, 2021

Supplemental Digital Content is available in the text. Objectives: A core outcomes set (COS) for ... more Supplemental Digital Content is available in the text. Objectives: A core outcomes set (COS) for whiplash-associated disorders (WADs) has been proposed to improve consistency of outcome reporting in clinical trials. Patient-reported disability was one outcome of interest within this COS. The aim of this review was to identify the most suitable tools for measuring self-reported disability in WAD based on clinimetric performance. Methods: Database searches took place in 2 stages. The first identified outcome measures used to assess self-reported disability in WAD, and the second identified studies assessing the clinimetric properties of these outcome measures in WAD. Data on the study, population and outcome measure characteristics were extracted, along with clinimetric data. Quality and clinimetric performance were assessed in accordance with the Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN). Results: Of 19,663 records identified in stage 1 searches, 32 were retained following stage 2 searches and screening. Both the Whiplash Disability Questionnaire and Neck Disability Index performed well in reliability (intraclass correlation coefficient=0.84 to 0.98), construct validity (74% to 82% of hypotheses accepted), and responsiveness (majority of correlations in accordance with hypotheses). Both received Category B recommendations due to a lack of evidence for content validity. Discussion: This review identified the Neck Disability Index and Whiplash Disability Questionnaire as the most appropriate patient-reported outcome measures (PROMs) for assessing self-reported disability in WAD based on moderate to high-quality evidence for sufficient reliability, construct validity and responsiveness. However, the content validity of these PROMs has yet to be established in WAD, and until this is undertaken, it is not possible to recommend 1 PROM over the other for inclusion in the WAD COS.

Research paper thumbnail of Additional file 1: of Adoption and use of guidelines for whiplash: an audit of insurer and health professional practice in New South Wales, Australia

Additional file 1: of Adoption and use of guidelines for whiplash: an audit of insurer and health professional practice in New South Wales, Australia

Appendix 1. Insurer and health professional data collected based on recommendations of the guidel... more Appendix 1. Insurer and health professional data collected based on recommendations of the guidelines. Appendix 2. Quebec Task Force classification of grades of WAD. Appendix 3. Flow diagram of claimant files included in the study. (DOCX 37 kb)

Research paper thumbnail of MOESM1 of Evidence-based care in high- and low-risk groups following whiplash injury: a multi-centre inception cohort study

MOESM1 of Evidence-based care in high- and low-risk groups following whiplash injury: a multi-centre inception cohort study

Additional file 1. Questionnaire tool used to assess provision of evidence-based care.

Research paper thumbnail of ral ssBioMed CentBMC Musculoskeletal Disorders

A randomised clinical trial of a comprehensive exercise program for chronic whiplash: trial protocol

Research paper thumbnail of Implementation of a novel stratified PAthway of CarE for common musculoskeletal (MSK) conditions in primary care: protocol for a multicentre pragmatic randomised controlled trial (the PACE MSK trial)

BMJ Open, 2021

IntroductionMusculoskeletal (MSK) conditions constitute the highest burden of disease globally, w... more IntroductionMusculoskeletal (MSK) conditions constitute the highest burden of disease globally, with healthcare services often utilised inappropriately and overburdened. The aim of this trial is to evaluate the effectiveness of a novel clinical PAthway of CarE programme (PACE programme), where care is provided based on people’s risk of poor outcome.Methods and analysisMulticentre randomised controlled trial. 716 people with MSK conditions (low back pain, neck pain or knee osteoarthritis) will be recruited in primary care. They will be stratified for risk of a poor outcome (low risk/high risk) using the Short Form Örebro Musculoskeletal Pain Screening Questionnaire (SF-ÖMSPQ) then randomised to usual care (n=358) or the PACE programme (n=358). Participants at low risk in the PACE programme will receive up to 3 sessions of guideline based care from their primary healthcare professional (HCP) supported by a custom designed website (mypainhub.com). Those at high risk will be referred to...

Research paper thumbnail of Reply to Dr Quintner re: Masterclass: A pragmatic approach to pain sensitivity in people with musculoskeletal disorders and implications for clinical management for musculoskeletal therapists

Musculoskeletal Science and Practice, 2021

Research paper thumbnail of A randomised controlled trial of implementation of a guideline-based clinical pathway of care to improve health outcomes following whiplash injury (Whiplash ImPaCT): Statistical analysis plan

Brazilian journal of physical therapy, 2021

BACKGROUND Statistical analysis plans describe the processes of data handling and analysis in cli... more BACKGROUND Statistical analysis plans describe the processes of data handling and analysis in clinical trials; by doing so they increase the transparency of the analysis and reporting of studies. This paper reports the planned statistical analysis plan for the Whiplash ImPaCT study. For individuals with whiplash injury, Whiplash ImPaCT aims to assess the effectiveness of a guidelines-based clinical pathway of care compared with usual care. METHODS We report the planned procedures, methods, and reporting for the primary and secondary analyses of the Whiplash ImPaCT study. The primary outcomes are Global Recovery and Neck Disability Index at 3 months post-randomisation. Outcomes will be analysed according to the intention to treat principle using linear mixed models. A cost-utility analysis will be conducted to compute the incremental cost-effectiveness of the intervention to usual care. We describe data handling, our analytical approach, assumptions about missing data, and our planne...

Research paper thumbnail of Is a 12-Week Comprehensive Physiotherapy Exercise Program More Effective Than Advice for People with a Chronic Whiplash Injury

Is a 12-Week Comprehensive Physiotherapy Exercise Program More Effective Than Advice for People with a Chronic Whiplash Injury

Research paper thumbnail of The diagnostic test accuracy of two rules used to diagnose serious cervical spine injury: a systematic review

The diagnostic test accuracy of two rules used to diagnose serious cervical spine injury: a systematic review

Research paper thumbnail of Increased GABA+ in People With Migraine, Headache, and Pain Conditions- A Potential Marker of Pain

The Journal of Pain, 2021

Treatment outcomes for migraine and other chronic headache and pain conditions typically demonstr... more Treatment outcomes for migraine and other chronic headache and pain conditions typically demonstrate modest results. A greater understanding of underlying pain mechanisms may better inform treatments and improve outcomes. Increased GABA+ has been identified in recent studies of migraine, however, it is unclear if this is present in other headache, and pain conditions. We primarily investigated GABA+ levels in the posterior cingulate gyrus (PCG) of people with migraine, whiplash-headache and low back pain compared to age-and sex-matched controls, GABA+ levels in the anterior cingulate cortex (ACC) and thalamus formed secondary aims. Using a cross-sectional design, we studied people with migraine, whiplash-headache or low back pain (n = 56) and compared them with a pool of age-and sex-matched controls (n = 22). We used spectral-edited magnetic resonance spectroscopy at 3T (MEGA-PRESS) to determine levels of GABA+ in the PCG, ACC and thalamus. PCG GABA+ levels were significantly higher in people with migraine and low back pain compared with controls (eg, migraine 4.89 IU § 0.62 vs controls 4.62 IU § 0.38; P = .02). Higher GABA+ levels in the PCG were not unique to migraine and could reflect a mechanism of chronic pain in general. A better understanding of pain at a neurochemical level informs the development of treatments that target aberrant brain neurochemistry to improve patient outcomes. Perspective: This study provides insights into the underlying mechanisms of chronic pain. Higher levels of GABA+ in the PCG may reflect an underlying mechanism of chronic headache and pain conditions. This knowledge may help improve patient outcomes through developing treatments that specifically address this aberrant brain neurochemistry.

Research paper thumbnail of Impact of an interactive workshop on specialist physiotherapists’ practice when implementing a new clinical care pathway for people with musculoskeletal conditions

Impact of an interactive workshop on specialist physiotherapists’ practice when implementing a new clinical care pathway for people with musculoskeletal conditions

Musculoskeletal Science and Practice, 2021

BACKGROUND A new pathway of care proposes early comprehensive assessment and targeted management ... more BACKGROUND A new pathway of care proposes early comprehensive assessment and targeted management by specialist musculoskeletal clinicians for people with musculoskeletal conditions at risk of poor outcomes. Adoption of this care pathway is likely to be influenced by beliefs and behaviours of specialist musculoskeletal clinicians. OBJECTIVE To evaluate the effect of an interactive educational workshop about the proposed clinical care pathway on knowledge, beliefs and practice of specialist musculoskeletal physiotherapists. DESIGN Mixed methods. METHODS Fifty specialist musculoskeletal physiotherapists participated in a 2-day interactive educational workshop. Knowledge, beliefs and clinical practice behaviours were assessed immediately before the workshop and 3 months' later using surveys. RESULTS Knowledge about key guideline messages improved and were maintained at follow-up. Most participants agreed to provide more targeted interventions to patients at risk of poor outcome (92%, 95% CI: 81%-98%) and utilise prognostic screening tools (84%, 95% CI: 71 to 93). However, only 56% (95% CI: 39%-68%) of participants believed implementing a shared care pathway was easy. At follow-up, participants' beliefs were more aligned with the proposed care pathway (i.e., shared care: 83%, 95% CI: 68%-93%). With respect to clinical practice, there were 16% more referrals back to the primary physiotherapist at 3 months than before the workshop. Barriers (practitioner, patient and system factors) to implementation of the care pathway were discussed. CONCLUSION An interactive educational workshop influenced specialist musculoskeletal physiotherapists' knowledge, beliefs and clinical practice, but barriers need to be overcome to facilitate widespread implementation.

Research paper thumbnail of Where to from here with whiplash? New insights and new directions

Research paper thumbnail of Brain GABA and glutamate levels across pain conditions: A systematic literature review and meta-analysis of 1H-MRS studies using the MRS-Q quality assessment tool

NeuroImage, 2020

If citing, it is advised that you check and use the publisher's definitive version for pagination... more If citing, it is advised that you check and use the publisher's definitive version for pagination, volume/issue, and date of publication details. And where the final published version is provided on the Research Portal, if citing you are again advised to check the publisher's website for any subsequent corrections.

Research paper thumbnail of Concussion in Combination With Whiplash-Associated Disorder May Be Missed in Primary Care: Key Recommendations for Assessment and Management

Concussion in Combination With Whiplash-Associated Disorder May Be Missed in Primary Care: Key Recommendations for Assessment and Management

Journal of Orthopaedic & Sports Physical Therapy, 2019

SYNOPSIS Whiplash and concussion may have similar presenting symptoms, biomechanical mechanisms, ... more SYNOPSIS Whiplash and concussion may have similar presenting symptoms, biomechanical mechanisms, and neurophysiological sequelae, but neither enjoys a gold standard diagnostic test. Guidelines for whiplash and concussion are developed and implemented separately. This disparate process may contribute to misdiagnosis, delay appropriate primary care management, and impair patient outcomes. In our clinical commentary, we present 3 cases where signs and symptoms consistent with whiplash were identified in primary care. Symptoms in all cases included neck pain, headache, dizziness, and concentration deficits, raising suspicion of coexisting postconcussion syndrome. All cases were referred for specialist physical therapy. Characteristics consistent with poor recovery in both whiplash and postconcussion syndrome were confirmed, and multidisciplinary management, drawing from both whiplash and concussion guidelines, was implemented. All patients reported improvement in activities of daily living after tailored management addressing both neck and head injury-related factors, suggesting that these conditions were not mutually exclusive. Self-reported outcomes included reductions in neck disability and postconcussion symptoms of between 20% and 40%. It may be appropriate for whiplash and concussion guidelines to be amalgamated, enhanced, and mutually recognized on a patient-by-patient basis. Primary health care professionals might consider minimum screening to identify postconcussion syndrome in patients following motor vehicle collision by administering questionnaires and assessing cranial nerve (CN) function, balance, and cognition. Management should then incorporate principles from both whiplash and concussion guidelines and harmonize with available imaging guidelines for suspected spine and head trauma. J Orthop Sports Phys Ther, Epub 14 Oct 2019. doi:10.2519/jospt.2019.8946.

Research paper thumbnail of Are measures of pain sensitivity associated with pain and disability at 12‐month follow up in chronic neck pain?

Musculoskeletal Care, 2018

Objectives: Pain sensitivity and psychosocial issues are prognostic of poor outcome in acute neck... more Objectives: Pain sensitivity and psychosocial issues are prognostic of poor outcome in acute neck disorders. However, knowledge of associations between pain sensitivity and ongoing pain and disability in chronic neck pain are lacking. We aimed to investigate associations of pain sensitivity with pain and disability at the 12-month follow-up in people with chronic neck pain. Methods: The predictor variables were: clinical and quantitative sensory testing (cold, pressure); neural tissue sensitivity; neuropathic symptoms; comorbidities; sleep; psychological distress; pain catastrophizing; pain intensity (for the model explaining disability at 12 months only); and disability (for the model explaining pain at 12 months only). Data were analysed using uni-and multivariate regression models to assess associations with pain and disability at the 12-month follow-up (n = 64 at baseline, n = 51 at follow-up). Results: Univariable associations between all predictor variables and pain and disability were evident (r > 0.3; p < 0.05), except for cold and pressure pain thresholds and cold sensitivity. For disability at the 12-month follow-up, 24.0% of the variance was explained by psychological distress and comorbidities. For pain at 12 months, 39.8% of the variance was explained primarily by baseline disability. Conclusions: Neither clinical nor quantitative measures of pain sensitivity were meaningfully associated with long-term patient-reported outcomes in people with chronic neck pain, limiting their clinical application in evaluating prognosis.

Research paper thumbnail of Referral to specialist physiotherapists in the management of whiplash associated disorders: Perspectives of healthcare practitioners

Musculoskeletal science & practice, Apr 1, 2018

Guidelines for whiplash associated disorders (WAD) recommend early referral to specialists (e.g. ... more Guidelines for whiplash associated disorders (WAD) recommend early referral to specialists (e.g. specialist physiotherapists) of people who are not recovering. This recommendation is a key component of a proposed clinical pathway of care for WAD. To explore healthcare practitioners' opinions about referral to specialist physiotherapists of people with WAD at high risk of non-recovery. Qualitative descriptive study. Six focus groups were conducted among primary care allied-health practitioners (n = 16) and specialist physiotherapists (n = 12) in New South Wales and Queensland, Australia. Discussions were audio recorded and transcribed for thematic analysis. Ten themes were generated from analysis. Practitioners appeared to have good knowledge of indicators for referral; however, referrals were often made to the medical practitioner, less commonly to specialist physiotherapists. There was general support for referral to specialist physiotherapists, which was deemed as a viable alt...

Research paper thumbnail of Adoption and use of guidelines for whiplash: an audit of insurer and health professional practice in New South Wales, Australia

BMC health services research, Aug 8, 2018

In Australia, the New South Wales (NSW) State Insurance Regulatory Authority has been continuousl... more In Australia, the New South Wales (NSW) State Insurance Regulatory Authority has been continuously developing and implementing clinical practice guidelines to address the health and economic burden from whiplash associated disorders (WAD). Despite this, it is uncertain the extent to which the guidelines are followed. This study aimed to determine insurer and health professional compliance with recommendations of the 2014 NSW clinical practice guidelines for the management of acute WAD; and explore factors related to adherence. This was an observational study involving an audit of 288 randomly-selected claimant files from 4 insurance providers in NSW, Australia between March and October 2016. Data extracted included demographic, claim and injury details, use of health services, and insurer and health professional practices related to the guidelines. Analyses involved descriptive statistics and correlation analysis. Median time for general practitioner medical consultation was 4 days ...

Research paper thumbnail of Six-month clinical course and factors associated with non-improvement in migraine and non-migraine headaches

Cephalalgia : an international journal of headache, 2017

Background Evidence on the medium-term clinical course of recurrent headaches is scarce. This stu... more Background Evidence on the medium-term clinical course of recurrent headaches is scarce. This study explored the six-month course and factors associated with non-improvement in migraine compared with tension-type headache and cervicogenic headache. Methods In this longitudinal cohort study, the six-month course of headaches was prospectively examined in participants (n = 37 with migraine; n = 42 with tension-type or cervicogenic headache). Participants underwent physical examination for cervical musculoskeletal impairments at baseline. Participants also completed questionnaires on pain, disability and other self-report measures at baseline and follow-up, and kept an electronic diary for 6 months. Course of headaches was examined using mixed within-between analyses of variance and Markov chain modeling. Multiple factors were evaluated as possible factors associated with non-improvement using regression analysis. Results Headache frequency, intensity, and activity interference in migr...

Research paper thumbnail of A systematic review shows minimal evidence for measurement properties of psychological functioning outcomes in whiplash

A systematic review shows minimal evidence for measurement properties of psychological functioning outcomes in whiplash

Journal of Clinical Epidemiology

Research paper thumbnail of Additional file 1 of Increase in ACC GABA+ levels correlate with decrease in migraine frequency, intensity and disability over time

Additional file 1 of Increase in ACC GABA+ levels correlate with decrease in migraine frequency, intensity and disability over time

Additional file 1.

Research paper thumbnail of Clinimetric Properties of Self-reported Disability Scales for Whiplash

Clinimetric Properties of Self-reported Disability Scales for Whiplash

The Clinical Journal of Pain, 2021

Supplemental Digital Content is available in the text. Objectives: A core outcomes set (COS) for ... more Supplemental Digital Content is available in the text. Objectives: A core outcomes set (COS) for whiplash-associated disorders (WADs) has been proposed to improve consistency of outcome reporting in clinical trials. Patient-reported disability was one outcome of interest within this COS. The aim of this review was to identify the most suitable tools for measuring self-reported disability in WAD based on clinimetric performance. Methods: Database searches took place in 2 stages. The first identified outcome measures used to assess self-reported disability in WAD, and the second identified studies assessing the clinimetric properties of these outcome measures in WAD. Data on the study, population and outcome measure characteristics were extracted, along with clinimetric data. Quality and clinimetric performance were assessed in accordance with the Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN). Results: Of 19,663 records identified in stage 1 searches, 32 were retained following stage 2 searches and screening. Both the Whiplash Disability Questionnaire and Neck Disability Index performed well in reliability (intraclass correlation coefficient=0.84 to 0.98), construct validity (74% to 82% of hypotheses accepted), and responsiveness (majority of correlations in accordance with hypotheses). Both received Category B recommendations due to a lack of evidence for content validity. Discussion: This review identified the Neck Disability Index and Whiplash Disability Questionnaire as the most appropriate patient-reported outcome measures (PROMs) for assessing self-reported disability in WAD based on moderate to high-quality evidence for sufficient reliability, construct validity and responsiveness. However, the content validity of these PROMs has yet to be established in WAD, and until this is undertaken, it is not possible to recommend 1 PROM over the other for inclusion in the WAD COS.

Research paper thumbnail of Additional file 1: of Adoption and use of guidelines for whiplash: an audit of insurer and health professional practice in New South Wales, Australia

Additional file 1: of Adoption and use of guidelines for whiplash: an audit of insurer and health professional practice in New South Wales, Australia

Appendix 1. Insurer and health professional data collected based on recommendations of the guidel... more Appendix 1. Insurer and health professional data collected based on recommendations of the guidelines. Appendix 2. Quebec Task Force classification of grades of WAD. Appendix 3. Flow diagram of claimant files included in the study. (DOCX 37 kb)

Research paper thumbnail of MOESM1 of Evidence-based care in high- and low-risk groups following whiplash injury: a multi-centre inception cohort study

MOESM1 of Evidence-based care in high- and low-risk groups following whiplash injury: a multi-centre inception cohort study

Additional file 1. Questionnaire tool used to assess provision of evidence-based care.

Research paper thumbnail of ral ssBioMed CentBMC Musculoskeletal Disorders

A randomised clinical trial of a comprehensive exercise program for chronic whiplash: trial protocol

Research paper thumbnail of Implementation of a novel stratified PAthway of CarE for common musculoskeletal (MSK) conditions in primary care: protocol for a multicentre pragmatic randomised controlled trial (the PACE MSK trial)

BMJ Open, 2021

IntroductionMusculoskeletal (MSK) conditions constitute the highest burden of disease globally, w... more IntroductionMusculoskeletal (MSK) conditions constitute the highest burden of disease globally, with healthcare services often utilised inappropriately and overburdened. The aim of this trial is to evaluate the effectiveness of a novel clinical PAthway of CarE programme (PACE programme), where care is provided based on people’s risk of poor outcome.Methods and analysisMulticentre randomised controlled trial. 716 people with MSK conditions (low back pain, neck pain or knee osteoarthritis) will be recruited in primary care. They will be stratified for risk of a poor outcome (low risk/high risk) using the Short Form Örebro Musculoskeletal Pain Screening Questionnaire (SF-ÖMSPQ) then randomised to usual care (n=358) or the PACE programme (n=358). Participants at low risk in the PACE programme will receive up to 3 sessions of guideline based care from their primary healthcare professional (HCP) supported by a custom designed website (mypainhub.com). Those at high risk will be referred to...

Research paper thumbnail of Reply to Dr Quintner re: Masterclass: A pragmatic approach to pain sensitivity in people with musculoskeletal disorders and implications for clinical management for musculoskeletal therapists

Musculoskeletal Science and Practice, 2021

Research paper thumbnail of A randomised controlled trial of implementation of a guideline-based clinical pathway of care to improve health outcomes following whiplash injury (Whiplash ImPaCT): Statistical analysis plan

Brazilian journal of physical therapy, 2021

BACKGROUND Statistical analysis plans describe the processes of data handling and analysis in cli... more BACKGROUND Statistical analysis plans describe the processes of data handling and analysis in clinical trials; by doing so they increase the transparency of the analysis and reporting of studies. This paper reports the planned statistical analysis plan for the Whiplash ImPaCT study. For individuals with whiplash injury, Whiplash ImPaCT aims to assess the effectiveness of a guidelines-based clinical pathway of care compared with usual care. METHODS We report the planned procedures, methods, and reporting for the primary and secondary analyses of the Whiplash ImPaCT study. The primary outcomes are Global Recovery and Neck Disability Index at 3 months post-randomisation. Outcomes will be analysed according to the intention to treat principle using linear mixed models. A cost-utility analysis will be conducted to compute the incremental cost-effectiveness of the intervention to usual care. We describe data handling, our analytical approach, assumptions about missing data, and our planne...

Research paper thumbnail of Is a 12-Week Comprehensive Physiotherapy Exercise Program More Effective Than Advice for People with a Chronic Whiplash Injury

Is a 12-Week Comprehensive Physiotherapy Exercise Program More Effective Than Advice for People with a Chronic Whiplash Injury

Research paper thumbnail of The diagnostic test accuracy of two rules used to diagnose serious cervical spine injury: a systematic review

The diagnostic test accuracy of two rules used to diagnose serious cervical spine injury: a systematic review

Research paper thumbnail of Increased GABA+ in People With Migraine, Headache, and Pain Conditions- A Potential Marker of Pain

The Journal of Pain, 2021

Treatment outcomes for migraine and other chronic headache and pain conditions typically demonstr... more Treatment outcomes for migraine and other chronic headache and pain conditions typically demonstrate modest results. A greater understanding of underlying pain mechanisms may better inform treatments and improve outcomes. Increased GABA+ has been identified in recent studies of migraine, however, it is unclear if this is present in other headache, and pain conditions. We primarily investigated GABA+ levels in the posterior cingulate gyrus (PCG) of people with migraine, whiplash-headache and low back pain compared to age-and sex-matched controls, GABA+ levels in the anterior cingulate cortex (ACC) and thalamus formed secondary aims. Using a cross-sectional design, we studied people with migraine, whiplash-headache or low back pain (n = 56) and compared them with a pool of age-and sex-matched controls (n = 22). We used spectral-edited magnetic resonance spectroscopy at 3T (MEGA-PRESS) to determine levels of GABA+ in the PCG, ACC and thalamus. PCG GABA+ levels were significantly higher in people with migraine and low back pain compared with controls (eg, migraine 4.89 IU § 0.62 vs controls 4.62 IU § 0.38; P = .02). Higher GABA+ levels in the PCG were not unique to migraine and could reflect a mechanism of chronic pain in general. A better understanding of pain at a neurochemical level informs the development of treatments that target aberrant brain neurochemistry to improve patient outcomes. Perspective: This study provides insights into the underlying mechanisms of chronic pain. Higher levels of GABA+ in the PCG may reflect an underlying mechanism of chronic headache and pain conditions. This knowledge may help improve patient outcomes through developing treatments that specifically address this aberrant brain neurochemistry.

Research paper thumbnail of Impact of an interactive workshop on specialist physiotherapists’ practice when implementing a new clinical care pathway for people with musculoskeletal conditions

Impact of an interactive workshop on specialist physiotherapists’ practice when implementing a new clinical care pathway for people with musculoskeletal conditions

Musculoskeletal Science and Practice, 2021

BACKGROUND A new pathway of care proposes early comprehensive assessment and targeted management ... more BACKGROUND A new pathway of care proposes early comprehensive assessment and targeted management by specialist musculoskeletal clinicians for people with musculoskeletal conditions at risk of poor outcomes. Adoption of this care pathway is likely to be influenced by beliefs and behaviours of specialist musculoskeletal clinicians. OBJECTIVE To evaluate the effect of an interactive educational workshop about the proposed clinical care pathway on knowledge, beliefs and practice of specialist musculoskeletal physiotherapists. DESIGN Mixed methods. METHODS Fifty specialist musculoskeletal physiotherapists participated in a 2-day interactive educational workshop. Knowledge, beliefs and clinical practice behaviours were assessed immediately before the workshop and 3 months' later using surveys. RESULTS Knowledge about key guideline messages improved and were maintained at follow-up. Most participants agreed to provide more targeted interventions to patients at risk of poor outcome (92%, 95% CI: 81%-98%) and utilise prognostic screening tools (84%, 95% CI: 71 to 93). However, only 56% (95% CI: 39%-68%) of participants believed implementing a shared care pathway was easy. At follow-up, participants' beliefs were more aligned with the proposed care pathway (i.e., shared care: 83%, 95% CI: 68%-93%). With respect to clinical practice, there were 16% more referrals back to the primary physiotherapist at 3 months than before the workshop. Barriers (practitioner, patient and system factors) to implementation of the care pathway were discussed. CONCLUSION An interactive educational workshop influenced specialist musculoskeletal physiotherapists' knowledge, beliefs and clinical practice, but barriers need to be overcome to facilitate widespread implementation.

Research paper thumbnail of Where to from here with whiplash? New insights and new directions

Research paper thumbnail of Brain GABA and glutamate levels across pain conditions: A systematic literature review and meta-analysis of 1H-MRS studies using the MRS-Q quality assessment tool

NeuroImage, 2020

If citing, it is advised that you check and use the publisher's definitive version for pagination... more If citing, it is advised that you check and use the publisher's definitive version for pagination, volume/issue, and date of publication details. And where the final published version is provided on the Research Portal, if citing you are again advised to check the publisher's website for any subsequent corrections.

Research paper thumbnail of Concussion in Combination With Whiplash-Associated Disorder May Be Missed in Primary Care: Key Recommendations for Assessment and Management

Concussion in Combination With Whiplash-Associated Disorder May Be Missed in Primary Care: Key Recommendations for Assessment and Management

Journal of Orthopaedic & Sports Physical Therapy, 2019

SYNOPSIS Whiplash and concussion may have similar presenting symptoms, biomechanical mechanisms, ... more SYNOPSIS Whiplash and concussion may have similar presenting symptoms, biomechanical mechanisms, and neurophysiological sequelae, but neither enjoys a gold standard diagnostic test. Guidelines for whiplash and concussion are developed and implemented separately. This disparate process may contribute to misdiagnosis, delay appropriate primary care management, and impair patient outcomes. In our clinical commentary, we present 3 cases where signs and symptoms consistent with whiplash were identified in primary care. Symptoms in all cases included neck pain, headache, dizziness, and concentration deficits, raising suspicion of coexisting postconcussion syndrome. All cases were referred for specialist physical therapy. Characteristics consistent with poor recovery in both whiplash and postconcussion syndrome were confirmed, and multidisciplinary management, drawing from both whiplash and concussion guidelines, was implemented. All patients reported improvement in activities of daily living after tailored management addressing both neck and head injury-related factors, suggesting that these conditions were not mutually exclusive. Self-reported outcomes included reductions in neck disability and postconcussion symptoms of between 20% and 40%. It may be appropriate for whiplash and concussion guidelines to be amalgamated, enhanced, and mutually recognized on a patient-by-patient basis. Primary health care professionals might consider minimum screening to identify postconcussion syndrome in patients following motor vehicle collision by administering questionnaires and assessing cranial nerve (CN) function, balance, and cognition. Management should then incorporate principles from both whiplash and concussion guidelines and harmonize with available imaging guidelines for suspected spine and head trauma. J Orthop Sports Phys Ther, Epub 14 Oct 2019. doi:10.2519/jospt.2019.8946.

Research paper thumbnail of Are measures of pain sensitivity associated with pain and disability at 12‐month follow up in chronic neck pain?

Musculoskeletal Care, 2018

Objectives: Pain sensitivity and psychosocial issues are prognostic of poor outcome in acute neck... more Objectives: Pain sensitivity and psychosocial issues are prognostic of poor outcome in acute neck disorders. However, knowledge of associations between pain sensitivity and ongoing pain and disability in chronic neck pain are lacking. We aimed to investigate associations of pain sensitivity with pain and disability at the 12-month follow-up in people with chronic neck pain. Methods: The predictor variables were: clinical and quantitative sensory testing (cold, pressure); neural tissue sensitivity; neuropathic symptoms; comorbidities; sleep; psychological distress; pain catastrophizing; pain intensity (for the model explaining disability at 12 months only); and disability (for the model explaining pain at 12 months only). Data were analysed using uni-and multivariate regression models to assess associations with pain and disability at the 12-month follow-up (n = 64 at baseline, n = 51 at follow-up). Results: Univariable associations between all predictor variables and pain and disability were evident (r > 0.3; p < 0.05), except for cold and pressure pain thresholds and cold sensitivity. For disability at the 12-month follow-up, 24.0% of the variance was explained by psychological distress and comorbidities. For pain at 12 months, 39.8% of the variance was explained primarily by baseline disability. Conclusions: Neither clinical nor quantitative measures of pain sensitivity were meaningfully associated with long-term patient-reported outcomes in people with chronic neck pain, limiting their clinical application in evaluating prognosis.

Research paper thumbnail of Referral to specialist physiotherapists in the management of whiplash associated disorders: Perspectives of healthcare practitioners

Musculoskeletal science & practice, Apr 1, 2018

Guidelines for whiplash associated disorders (WAD) recommend early referral to specialists (e.g. ... more Guidelines for whiplash associated disorders (WAD) recommend early referral to specialists (e.g. specialist physiotherapists) of people who are not recovering. This recommendation is a key component of a proposed clinical pathway of care for WAD. To explore healthcare practitioners' opinions about referral to specialist physiotherapists of people with WAD at high risk of non-recovery. Qualitative descriptive study. Six focus groups were conducted among primary care allied-health practitioners (n = 16) and specialist physiotherapists (n = 12) in New South Wales and Queensland, Australia. Discussions were audio recorded and transcribed for thematic analysis. Ten themes were generated from analysis. Practitioners appeared to have good knowledge of indicators for referral; however, referrals were often made to the medical practitioner, less commonly to specialist physiotherapists. There was general support for referral to specialist physiotherapists, which was deemed as a viable alt...

Research paper thumbnail of Adoption and use of guidelines for whiplash: an audit of insurer and health professional practice in New South Wales, Australia

BMC health services research, Aug 8, 2018

In Australia, the New South Wales (NSW) State Insurance Regulatory Authority has been continuousl... more In Australia, the New South Wales (NSW) State Insurance Regulatory Authority has been continuously developing and implementing clinical practice guidelines to address the health and economic burden from whiplash associated disorders (WAD). Despite this, it is uncertain the extent to which the guidelines are followed. This study aimed to determine insurer and health professional compliance with recommendations of the 2014 NSW clinical practice guidelines for the management of acute WAD; and explore factors related to adherence. This was an observational study involving an audit of 288 randomly-selected claimant files from 4 insurance providers in NSW, Australia between March and October 2016. Data extracted included demographic, claim and injury details, use of health services, and insurer and health professional practices related to the guidelines. Analyses involved descriptive statistics and correlation analysis. Median time for general practitioner medical consultation was 4 days ...

Research paper thumbnail of Six-month clinical course and factors associated with non-improvement in migraine and non-migraine headaches

Cephalalgia : an international journal of headache, 2017

Background Evidence on the medium-term clinical course of recurrent headaches is scarce. This stu... more Background Evidence on the medium-term clinical course of recurrent headaches is scarce. This study explored the six-month course and factors associated with non-improvement in migraine compared with tension-type headache and cervicogenic headache. Methods In this longitudinal cohort study, the six-month course of headaches was prospectively examined in participants (n = 37 with migraine; n = 42 with tension-type or cervicogenic headache). Participants underwent physical examination for cervical musculoskeletal impairments at baseline. Participants also completed questionnaires on pain, disability and other self-report measures at baseline and follow-up, and kept an electronic diary for 6 months. Course of headaches was examined using mixed within-between analyses of variance and Markov chain modeling. Multiple factors were evaluated as possible factors associated with non-improvement using regression analysis. Results Headache frequency, intensity, and activity interference in migr...