Valerie Sparkes - Academia.edu (original) (raw)

Papers by Valerie Sparkes

Journal of Bone and Joint Surgery-british Volume, 2014

Background CB-CFT targeting specific pain provoking posture/movements in NSCLBP patients was show... more Background CB-CFT targeting specific pain provoking posture/movements in NSCLBP patients was shown more beneficial than current best practice. Resources for such interventions are substantial and so modifications for today9s NHS are warranted. This study investigated feasibility and effect of CB-CFT delivered in a group setting (CB-CFT/G). Methods Twenty three patients referred to Physiotherapy with NSCLBP undertook (i) 6 week CB-CFT/G(n=13) or (ii) current best practice (C)(n=10). Outcomes: Oswestry Disability Questionnaire (ODQ), pain (VAS), fear avoidance (Tampa Scale of Kinaesiophobia;TSK), physical activity (International Physical Activity Questionnaire;IPAQ), distress&risk assessment (DRAM), StarTBack and satisfaction. Unpaired t-tests assessed between-group difference in mean change of each outcome (p Results With no between-group baseline differences, there was a statistically significant difference between the groups mean change (SD) in ODQ [CB-CFT/G=14.9(8.0), C=5.2(12.4) ...

Staying active, including walking is promoted as being beneficial for patients with low back pain... more Staying active, including walking is promoted as being beneficial for patients with low back pain (LBP). The abdominal muscles appear to influence the stability of the spine and their activity has been shown to change when patients have LBP. Walking with Nordic walking poles has been shown to influence forces on the lower limbs, but little research has investigated the effect on the trunk muscles. Aim: to study the effect of walking using Nordic walking poles on abdominal muscle activity and lower limb forces. Method 15 healthy subjects gave informed consent (5 males. 10 females, age 21.06 yrs.(±88), height 174.45cms (±11.1), weight 71.44 kg (±15.2)). Following a period of walking training with Nordic walking poles data was obtained during a period of walking for internal IO) and external oblique (EO) using surface electromyography activity and vertical lower limb forces (Newtons, (N)) with (WP) and without Nordic walking poles (NP). SEMG data was normalised to maximum voluntary con...

Evidence suggests that anterior cruciate ligament (ACL) injured individuals do not use the same m... more Evidence suggests that anterior cruciate ligament (ACL) injured individuals do not use the same movement strategies as healthy individuals. It is unknown how this may affect them in more challenging activities of daily living and sport. The aim of this study is to evaluate how ACL injured patients perform a single leg squat (SLS) compared to healthy controls. SLS was evaluated as it is more challenging than gait and therefore more relevant to clinical decision making about progressing to sporting maneuvers. To date, 6 ACL deficient (ACLD) (5 males, 1 female; mass=88±22 kg; height=1.78±0.11 m; age=35±11 years), 5 ACL reconstructed (ACLR) (5 males; mass= 83±12 kg; height=1.74±0.07 m; age=29±10 years) and 5 controls (3 males, 2 females; mass= 72±13 kg; height=1.70±0.09 m; age=30±3 years) performed a SLS on the injured leg for the ACL injured participants and the dominant leg for the control group. Motion analysis was performed using a Vicon Nexus system and a Kistler force platform. Kn...

Low back pain (LBP) is the leading cause of disability worldwide and accounts for a large proport... more Low back pain (LBP) is the leading cause of disability worldwide and accounts for a large proportion of work related musculoskeletal disorders. Despite mandatory manual handling programmes delivered routinely Despite manual handling training being delivered routinely in the workplace, LBP still affects up to 25% of industrial workers in a calendar year. One factor thought to contribute to LBP are sustained increased muscle forces reported to be deleterious to spinal health by creating prolonged high compressive loads on the spinal structures1. Manual handling training that involves structured guidance on moving, lifting and supporting a load following traditional biomechanical principles to ensure spinal stability is mandatory in many workplace environments. however the Its effect that manual handling training on trunk muscle activity during lifting is not yet known and could provide a valuable insight into why manual handling training is unable to prevent the development of LBP

Challenge: In the clinical setting it is challenging to evaluate multi-planar joint motion whilst... more Challenge: In the clinical setting it is challenging to evaluate multi-planar joint motion whilst a patient is performing dynamic functional activities. Conventional clinical assessments are usually subjective and involve clinician or patient-rated scales [1]. We have established the reliability and validity of a portable sensor-based motion-capture system (Xsens MVN BIOMECH) in a variety of clinical functional tasks [2], and have custom written a programme in Matlab software (Mathworks) that processes sensor data and generates an immediate, userfriendly clinical movement analysis report in pdf format. Our current aim was to explore how this sensor-based clinical movement analysis report would inform clinical decision making.

Clinical Biomechanics

Background: Low back pain (LBP) classification systems are used to deliver targeted treatments ma... more Background: Low back pain (LBP) classification systems are used to deliver targeted treatments matched to an individual profile, however, distinguishing between different subsets of LBP remains a clinical challenge. Methods: A novel application of the Cardiff Dempster-Shafer Theory Classifier was employed to identify clinical subgroups of LBP on the basis of repositioning accuracy for subjects performing a sitting and standing posture task. 87 LBP subjects, clinically subclassified into flexion (n = 50), passive extension (n = 14), and active extension (n = 23) motor control impairment subgroups and 31 subjects with no LBP were recruited. Thoracic, lumbar and pelvic repositioning errors were quantified. The Classifier then transformed the error variables from each subject into a set of three belief values: (i) consistent with no LBP, (ii) consistent with LBP, (iii) indicating either LBP or no LBP. Findings: In discriminating LBP from no LBP the Classifier accuracy was 96.61%. From no-LBP, subsets of flexion LBP, active extension and passive extension achieved 93.83, 98.15% and 97.62% accuracy, respectively. Classification accuracies of 96.8%, 87.7% and 70.27% were found when discriminating flexion from passive extension, flexion from active extension and active from passive extension subsets, respectively. Sitting lumbar error magnitude best discriminated LBP from no LBP (92.4% accuracy) and the flexion subset from no-LBP (90.1% accuracy). Standing lumbar error best discriminated active and passive extension from no LBP (94.4% and 95.2% accuracy, respectively). Interpretation: Using repositioning accuracy, the Cardiff Dempster-Shafer Theory Classifier distinguishes between subsets of LBP and could assist decision making for targeted exercise in LBP management.

BMC Musculoskeletal Disorders

Background Trunk muscle dysfunction is often regarded as a key feature of non-specific chronic lo... more Background Trunk muscle dysfunction is often regarded as a key feature of non-specific chronic low back pain (NSCLBP) despite being poorly understood and variable with increases, decreases and no change in muscle activity reported. Differences in thoraco-lumbar kinematics have been observed in motor control impairment NSCLBP subgroups (Flexion Pattern, Active Extension Pattern) during static postures and dynamic activities. However, potential differences in muscle activity during functional tasks has not been established in these subgroups to date. Methods A case-control study design recruited 50 NSCLBP subjects (27 Flexion Pattern, 23 Active Extension Pattern) and 28 healthy individuals. Surface electromyography determined muscle activity during functional tasks: reaching upwards, step-down, step-up, lifting and replacing a box, stand-to-sit, sit-to-stand, bending to retrieve (and returning from retrieving) a pen from the floor. Normalised (% sub-maximal voluntary contraction) mean...

Orthopedic Research and Reviews

Objective: To examine functional performance differences using kinematic and kinetic analysis bet... more Objective: To examine functional performance differences using kinematic and kinetic analysis between participants with and without knee osteoarthritis (OA) to determine which outcomes best characterize persons with and without knee OA. Methods: Participants with unilateral moderate knee OA (Kellgren-Lawrence grades 2 or 3) and controls without knee pain were matched for age, gender, and body mass index. Primary outcomes included temporal parameters, joint rotations and moments, and ground reaction forces assessed via 3D motion capture during walking and ascending/descending stairs. Secondary outcomes included timed functional activities (sit to stand; tying shoelaces), 48 hrs lower limb activity monitoring, and patient-reported outcome measures (Knee Injury and Osteoarthritis Outcome Score, Western Ontario and McMaster Universities Osteoarthritis Index, European Quality of Life-5 Dimensions). Results: Eight matched pairs were analyzed. Compared with controls, OA participants exhibited significant reductions in peak frontal hip and sagittal knee moments, and decreased peak anterior ground reaction force with the affected limb while walking. Ascending stairs, OA participants had slower speed, fewer strides per minute, longer cycle and stance times, and increased trunk range of motion (ROM) in assessments of both limbs; longer swing time and reduced ankle ROM in the affected limb; and increased knee frontal ROM in the unaffected limb. Descending stairs, OA participants had fewer strides per minute and decreased trunk transverse ROM in assessments of both limbs; increased knee frontal ROM in the affected limb; and longer strides, shorter stance and cycle times, increased trunk sagittal and decreased knee transverse ROMs in the unaffected limbs vs controls. Compared with controls, OA participants had slower walking cadence (120-130 vs 100-110 steps/min, respectively), took significantly longer on timed functional measures, and had significantly worse scores in patient-reported outcomes. Conclusion: Several objectives and patient-reported measures examined in this study could potentially be considered as outcomes in pharmacologic or physical therapy OA trials.

Cogent Engineering

This study determined differences in spinal-pelvic kinematics sitting on (i) mat (ii) block and (... more This study determined differences in spinal-pelvic kinematics sitting on (i) mat (ii) block and (iii) novel 10º forward inclined wedge (Buttafly TM) in a samesubject repeated measures cross-over design in 60 healthy individuals (34 females). Repeated measures ANOVA revealed statistically significant differences between sitting conditions and lumbar and pelvic sagittal angles. Both, the inclined wedge and the block seating aids reduced overall flexion, but the inclined wedge had a greater influence in the lumbar region whilst the block induced the greatest change in the pelvis. This may be relevant for seating aid design personalised to posture type. Statistically significant gender differences were identified in all 3 seating conditions with males adopting more flexed lumbar spine and posteriorly tilted pelvis. Females flexed less in thoracic spine when sitting on an inclined wedge and a block. These statistically significant differences between males and females may provide first explorative direction for bespoke seating aids design.

The Knee

Background: For elite athletes with anterior cruciate ligament (ACL) reconstruction, reducing pel... more Background: For elite athletes with anterior cruciate ligament (ACL) reconstruction, reducing pelvis and trunk obliquities is a common goal of rehabilitation. It is not known if this is also a suitable goal for the general population. This study aimed to quantify pelvis and thorax obliquities during dynamic activities in individuals from the general population with and without history of ACL injury. Methods: Retrospective analysis of cross-sectional data from 30 participants with ACL reconstruction, 28 participants with ACL deficiency (ACLD), and 32 controls who performed overground walking and jogging, single-leg squat, and single-leg hop for distance. Pelvis and thorax obliquities were quantified in each activity and compared across groups using one-way ANOVA. Coordination was quantified using cross covariance. Results: In the stance phase of walking and jogging, pelvis and thorax obliquities were within ±10°o f neutral and there was a negative correlation between the two segments at close to zero phase lag. In single-leg squat and hop, range of obliquities varied across individuals and there was no consistent pattern of coordination. Eight ACLD participants felt unable to perform the single-leg hop. In the remaining participants, range of pelvis (p = 0.04) and thorax (p = 0.02) obliquities was smaller in ACLD than controls. Conclusions: In challenging single-leg activities, minimal frontal plane motion was not the typical movement pattern observed in the general population. Coordination between the pelvis and thorax was inconsistent within and across individuals. Care should be taken when considering minimising pelvis and thorax obliquities in patients with ACL injury.

Trials, Jan 31, 2018

Adalimumab, a biological treatment targeting tumour necrosis factor α, might be useful in sciatic... more Adalimumab, a biological treatment targeting tumour necrosis factor α, might be useful in sciatica. This paper describes the challenges faced when developing a new treatment pathway for a randomised controlled trial of adalimumab for people with sciatica, as well as the reasons why the trial discussed was stopped early. A pragmatic, parallel group, randomised controlled trial with blinded (masked) participants, clinicians, outcome assessment and statistical analysis was conducted in six UK sites. Participants were identified and recruited from general practices, musculoskeletal services and outpatient physiotherapy clinics. They were adults with persistent symptoms of sciatica of 1 to 6 months' duration with moderate to high level of disability. Eligibility was assessed by research physiotherapists according to clinical criteria, and participants were randomised to receive two doses of adalimumab (80 mg then 40 mg 2 weeks later) or saline placebo subcutaneous injections in the p...

Sensors (Basel, Switzerland), Jan 28, 2018

The aim of this study was to investigate the reliability and concurrent validity of a commerciall... more The aim of this study was to investigate the reliability and concurrent validity of a commercially available Xsens MVN BIOMECH inertial-sensor-based motion capture system during clinically relevant functional activities. A clinician with no prior experience of motion capture technologies and an experienced clinical movement scientist each assessed 26 healthy participants within each of two sessions using a camera-based motion capture system and the MVN BIOMECH system. Participants performed overground walking, squatting, and jumping. Sessions were separated by 4 ± 3 days. Reliability was evaluated using intraclass correlation coefficient and standard error of measurement, and validity was evaluated using the coefficient of multiple correlation and the linear fit method. Day-to-day reliability was generally fair-to-excellent in all three planes for hip, knee, and ankle joint angles in all three tasks. Within-day (between-rater) reliability was fair-to-excellent in all three planes du...

Health technology assessment (Winchester, England), Oct 1, 2017

Biological treatments such as adalimumab (Humira(®); AbbVie Ltd, Maidenhead, UK) are antibodies t... more Biological treatments such as adalimumab (Humira(®); AbbVie Ltd, Maidenhead, UK) are antibodies targeting tumour necrosis factor alpha, released from ruptured intervertebral discs, which might be useful in sciatica. Recent systematic reviews concluded that they might be effective, but that a definitive randomised controlled trial was needed. Usual care in the NHS typically includes a physiotherapy intervention. To test whether or not injections of adalimumab plus physiotherapy are more clinically effective and cost-effective than injections of saline plus physiotherapy for patients with sciatica. Pragmatic, parallel-group, randomised controlled trial with blinded participants and clinicians, and an outcome assessment and statistical analysis with concurrent economic evaluation and internal pilot. Participants were referred from primary care and musculoskeletal services to outpatient physiotherapy clinics. Adults with persistent symptoms of sciatica of 1-6 months' duration and wi...

International Journal of Therapy and Rehabilitation

European Spine Journal

Purpose A multidimensional classification approach suggests that motor control impairment subgrou... more Purpose A multidimensional classification approach suggests that motor control impairment subgroups exist in non-specific chronic low back pain (NSCLBP). Differences in sitting lumbar posture have been identified between two such subgroups [flexion pattern (FP) and active extension pattern (AEP)] and healthy individuals; however, functional spinal movement has not been explored. This study will evaluate whether NSCLBP subgroups exhibit regional spinal kinematic differences, compared to healthy individuals, during functional tasks. Methods Observational, cross-sectional study design. Spinal kinematics of 50 NSCLBP subjects (27 FP, 23 AEP) and 28 healthy individuals were investigated using 3D motion analysis (Vicon TM) during functional tasks [reaching upwards, step down, step up, lifting, and replacing a box, stand-to-sit, sit-to-stand, bending to retrieve (and returning from retrieving) a pen from the floor]. Mean sagittal angle for the total thoracic, total lumbar, upper thoracic, lower thoracic, upper lumbar, and lower lumbar regions between groups was compared. Results Significant differences were observed in lower thoracic and upper lumbar regions between NSCLBP subgroups during most tasks. Significant differences were observed between the FP and healthy group in the lower thoracic region during stand-to-sit-to-stand tasks and bending (and returning from) to retrieve a pen from the floor. All significant results demonstrated the FP group to operate in comparatively greater flexion. Conclusions The thoraco-lumbar spine discriminated between FP and AEP, and FP and healthy groups during functional tasks. FP individuals demonstrated more kyphotic thoraco-lumbar postures, which may be pain provocative. No significant differences were observed between AEP and healthy groups, suggesting that alternative mechanisms may occur in AEP. Keywords Non-specific chronic low back pain Á Functional movement Á Kinematics Á Lumbar Á Thoracic Electronic supplementary material The online version of this article (