Fiona Cramp | University of the West of England (original) (raw)

Papers by Fiona Cramp

Rheumatology, Apr 1, 2017

Radiography, Nov 1, 2018

Objectives: To determine women's experiences of brachytherapy for cervical cancer. Key findings: ... more Objectives: To determine women's experiences of brachytherapy for cervical cancer. Key findings: Nineteen studies were included for data extraction/synthesis. Twelve studies focussed on psychological issues, seven on pharmacological aspects of women's experiences. Themes of anxiety, distress, pain, informational needs and non-pharmacological interventions were found. Nine out of ten psychological studies described brachytherapy as a distressing experience causing anxiety and distress for most women. Non-pharmacological interventions were found to be effective and inexpensive adjuncts. Peri and post-operative pharmacological management was variable, but duration of procedure was an important factor. Conclusion: Brachytherapy for gynaecological cancer causes varying levels of pain, anxiety and distress. To improve women's experiences there needs to be better pain management, patient information and the development of non-pharmacological interventions. Future recommendations are to develop clinical support guidelines, audit the quality of services and develop effective interventions to improve women's experiences of brachytherapy for locally advanced cervical cancer.

dyspepsia (n=9), abdominal pain (n=7), headache (n=5), loss of appetite (n=4), weight loss (n=3),... more dyspepsia (n=9), abdominal pain (n=7), headache (n=5), loss of appetite (n=4), weight loss (n=3), halitosis (n=1), dry mouth (n=1), palpitations (n=1) and/or depression (n=1). Six patients had to reduce the dose to 30 mg/day. APR was discontinued in 11 patients due to: not obtaining the expected improvement (n=5), intense gastrointestinal adverse effects (n=3), desire of pregnancy (n=1), persistent erythema nodosum (n=1) and development of neurological involvement (n=1). Conclusion: Our data show a rapid and maintained improvement with APR in patients with mucocutaneous ulcers of BD refractory to several systemic drugs, including biologic therapy. REFERENCES: [1] Davatchi F, et al. The International Criteria for Behçet's Disease (ICBD): a collaborative study of 27 countries on the sensitivity and specificity of the new criteria.

PubMed, 2018

This paper describes the personal experience of two novice reviewers in developing and conducting... more This paper describes the personal experience of two novice reviewers in developing and conducting a systematic litera¬ture review (SLR) in the field of medical ultrasound. The review was performed as part of a PhD study by the first author, which required the researcher to critically review all relevant studies in their specific research area. The review was conducted using a formal, scientific process and high¬lighted 20 relevant papers. Among the lessons learnt, undertaking an SLR was a time-consuming process. The search produced 1,987 papers, and screening the search yield was facilitated by using a pre-defined protocol. Extraction of data from each study was standardised and generated a 1-page summary of the key findings and methodology to facilitate comparisons of the included studies. The Critical Appraisal Skills Programme (CASP) tool was used for quality assessment. In the critical appraisal process, it is essential that reviewers have good baseline knowledge in the research subject, a solid under¬standing of the fundamentals of a robust research study including potential bias in research. With the great amount of information that a critical appraisal produces, good information management was key throughout the review to ensure the process was explicit and replicable and so that reviewers could justify their decisions. The methods and processes detailed in this report, as well as its lessons, are relevant to an SLR for any research subject.

Background: There is an increased appreciation of the burden of cognitive impairment in persons w... more Background: There is an increased appreciation of the burden of cognitive impairment in persons with rheumatoid arthritis (RA). Research shows a gap between subjective and objective measures of cognitive impairment in persons with chronic diseases. Objectives: This study explored the relationship between subjective cognitive dysfunction and computerized neuropsychological performance in Korean older adults with RA. Methods: Individuals with RA were recruited by their rheumatologists during follow-up visits at one university hospital in Korea. After getting signed consents, a trained research nurse assessed participants with a range of physical, psychosocial, and biological metrics. Subjective cognitive dysfunction was assessed using the Perceived Deficits Questionnaire (PDQ; range 0-20, higher score=greater impairment). Objective cognitive impairment was assessed using a set of 6 computerized neurocognitive tests yielding 18 indices covering a range of cognitive domains. Subjects were classified as "impaired" if they performed 1 SD below age-based population norms on each test [1]. A total cognitive impairment score was calculated by summing the transformed scores (range: 0-18, higher score=greater impairment). Multiple regression analysis controlling for education, disease severity, and depression was conducted to identify the relationship between objective and subjective cognitive measures. Results: Fifty four subjects with a mean (±SD) age of 63.6 (±10.5) years were included in the final analyses. 85% were female and 87% were married. Mean educational level was 10.2 (±4.9) years and mean disease duration was 8.9 (±8.5) years. 25.9% had depression and 55.6% had sleep problem. Mean PDQ score was 11.8 (±4.5, range 5-25) and mean total cognitive impairment score was 11.0 (±4.1, range=2-18). 92% were classified as cognitively impaired on five or more test indices. There was no significant correlation between PDQ score and total cognitive function score (r=.260, p=.068). However, psychological factors including depression (r=.621, p<.001) and sleep problem (r=.577, p<.001) were significantly correlated with PDQ score. In the multivariate analysis, there was no significant relationship between PDQ score and total cognitive impairment score. However, functional limitations and depression (=0.317, p=0.048; =0.334, p=0.019) were significantly associated with the PDQ score. Conclusions: There was no significant relationship between subjective cognitive dysfunction and computerized neuropsychological performance in this cohort. Functional limitations and depression were significantly associated with perceived cognitive dysfunction. Findings emphasize the gap between subjective and objective measures of cognitive impairment and the importance of considering psychological factors in the context of cognitive complaints in clinical settings. References: [1] Kozora, E., Ellison, M. C., & West, S. (2004). Reliability and validity of the proposed American College of Rheumatology neuropsychological battery for systemic lupus erythematosus. Arthritis Care & Research, 51(5), 810-818.

Respiratory Care, May 24, 2022

... Login |, Low back pain among farriers in the United Kingdom: a survey of incidence and the ro... more ... Login |, Low back pain among farriers in the United Kingdom: a survey of incidence and the role of education. Nelson, J and Cramp, Fiona (Alice) (2001) Low back pain among farriers in the United Kingdom: a survey of incidence and the role of education. ...

Rheumatology, Apr 1, 2018

Background: Fibromyalgia (FM) is a complex long-term condition affecting up to 5.4% of the UK pop... more Background: Fibromyalgia (FM) is a complex long-term condition affecting up to 5.4% of the UK population. It is associated with chronic widespread pain, fatigue, stiffness, sleep problems, memory and concentration difficulties, and irritable bowel syndrome. FM can cause high levels of disability, with individuals making frequent use of healthcare resources, and experiencing loss of work days. There is limited robust evidence for the effectiveness of pharmacological treatments for FM with current guidelines all recommending nonpharmacological interventions. Allied health professionals at the Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust (RUHB), developed the Fibromyalgia Self-Management Programme (FSMP); a non-pharmacological, multidisciplinary exercise and education group intervention. The main aims of the FSMP are to provide condition-specific, patient centred, education and exercise advice, supporting the development of core, selfmanagement skills. The FSMP comprises 2.5 hour weekly sessions over six weeks or four hour weekly session over four weeks. Core components include education about FM, sleep hygiene, goal-setting, pacing, hydrotherapy, and dietary advice. The FSMP was developed clinically and there has been little opportunity for the clinical team to fully understand the mechanisms by which it is effective. To inform successful implementation beyond RUHB, this research aimed to map the FSMP to the NICE recommended Michie et al. behaviour change taxonomy to determine the key behaviour change components. Methods: Non-participatory observations were conducted of the four week and six week FSMP. Detailed notes on the content of the course, therapist delivery, and any additional content not included in the manual were recorded. Subsequently, semi-structured interviews were conducted with both therapists (n ¼ 4) and patients (n ¼ 9). Observations and the review of the therapist manual data were deductively coded in NVIVO to the Michie Behaviour Change Taxonomy using Framework Analysis. Interview data were analysed using Theoretical Thematic Analysis. Results: The review of the course manual and observations of the course show that the FSMP coded onto 12 of the 16 main areas of the BCT, encompassing 22 behaviour change techniques. Patient's interviews indicated that they had made significant behaviour changes as a result of attending the course; including increased activity levels, pacing, better quality sleep, and improved communication with family members. Patients reported positive changes to symptoms as a result of attending the course. Therapists highlighted four key challenges in delivering the course; fidelity between therapists, patient readiness and acceptance of FM, group management and patient fatigue while attending the programme. Conclusion: The FSMP utilises a range of behaviour change techniques. Patients who attend the course make changes to their behaviour which enable them to manage their symptoms of FM more effectively.

Physiotherapy, Jun 1, 2011

Open Access Week. ...

Physiotherapy, Sep 1, 2019

Background: Regular physical activity is safe and beneficial for people with rheumatoid arthritis... more Background: Regular physical activity is safe and beneficial for people with rheumatoid arthritis (RA) but the majority of people with RA are less active than the general population and have a higher risk of co-morbidities. Exploring strategies used by physically active people with RA could inform effective methods to support those who are less active. Objective: To explore the perspectives, experiences and strategies employed by people with RA who successfully engage with regular physical activity. Design: Individual semi-structured interviews and thematic analysis. Participants: A purposive sample of physically active people with RA. Results: Twelve females and three males participated (mean age 56, range 29-80; mean disease duration 13 years, range 10 months to 46 years). Analysis revealed eight constructs clustered into three themes. Theme 1: 'the individual' incorporated constructs of symptoms, feelings and role; theme 2: 'management' incorporated medical and self-management; theme 3: 'physical activity' incorporated constructs of type of physical activity, including barriers or facilitators. Participants reported a long history of physical activity prior to diagnosis and good support networks. All participants recognised that physical activity was key to their RA management, acknowledged the benefits from engaging in physical activity and were able to overcome barriers. Participants • Health professionals delivering exercise interventions for people with RA should consider these motivating factors. If people with RA can be facilitated to engage with appropriate levels of physical activity there is potential for enhancing longer term health and function.

Physical Therapy Reviews, Sep 1, 2003

There are many unresolved views on the efficacy of a wide range of therapeutic approaches in the ... more There are many unresolved views on the efficacy of a wide range of therapeutic approaches in the treatment of Bell's palsy. The purpose of this paper was to review systematically randomised controlled trials, controlled trials and case studies relating to the efficacy of electrotherapy modalities in the management of acute and chronic Bell's palsy. The electrotherapy modalities reviewed included electrical stimulation, electromyography biofeedback, ultrasound, laser and shortwave diathermy. All the included studies were reviewed according to a self-devised checklist. Methodological considerations including the paucity of literature, and overall poor quality of trials impact the conclusions of this review. A clinical reasoning model and reflective practice, which consider the physiological effects of electrotherapeutic modalities according to the stages of healing of nerve injury, is offered. Guidance for electrotherapy intervention is suggested as well as possible areas for future research.

Research Square (Research Square), Jan 30, 2023

Background: Extubation failure, de ned as reintubation within 48 hours is associated with increas... more Background: Extubation failure, de ned as reintubation within 48 hours is associated with increased intensive care unit (ICU) length of stay and higher mortality risk. One cause of extubation failure is secretion retention, resulting from an inability to cough effectively. Mechanical Insu ation-Exsu ation (MI-E) simulates a cough aiding secretion clearance. However, MI-E is not routinely used in the ICU setting for invasively ventilated patients. This study aims to determine the feasibility and acceptability of a randomised controlled trial (RCT) examining MI-E use to promote extubation success in intubated, ventilated adults. Methods: Single centre, feasibility RCT with semi-structured interviews, economic scoping, and an exploratory physiology study. The feasibility RCT (n=50) will compare standard care to a MI-E protocol including a minimum of two MI-E sessions via the endotracheal tube prior to extubation. Post-extubation, MI-E will be delivered via facemask or mouthpiece up to two times/day for 48 hours. MI-E settings will be individualised based on patient tolerance, chest expansion and secretion clearance. All patients will receive standard care in relation to mechanical ventilation, weaning, rehabilitation, physiotherapy techniques such as positioning, manual airway clearance techniques, manual/ventilator hyperin ation, endotracheal suctioning and nebulisation. Clinical data collection will occur before, on completion and 5 minutes after all physiotherapy sessions (intervention and control arms). Resource use will be calculated for each 24 hour period. Analyses will be descriptive and address feasibility outcomes. We will conduct semi-structured online interviews informed by the Theoretical Framework of Acceptability (TFA) with patients, clinicians and family members, exploring the acceptability of the MI-E intervention and study processes.

Supportive Care in Cancer, Jun 1, 2008

Fatigue in gynaecological cancer has received minimal investigation. The aims of this survey were... more Fatigue in gynaecological cancer has received minimal investigation. The aims of this survey were to analyse the fatigue experienced over 12 months by a gynaecological cancer population, to determine if the fatigue was more severe than that reported by non-cancer ...

Physiotherapy, Dec 1, 2021

Physiotherapy, May 1, 2020

Physiotherapy, Feb 1, 2003

Introduction Multiple sclerosis affects approximately 87,000 people in the United Kingdom (Pender... more Introduction Multiple sclerosis affects approximately 87,000 people in the United Kingdom (Pender, 2000). Spasticity is one of the most common symptoms in multiple sclerosis occurring in an estimated 80% of patients (Holland, 2000). Physiotherapy is a popular treatment for this symptom, but scientific evidence regarding its effectiveness in multiple sclerosis is lacking (Freeman et al, 2001). The purpose of this study was to determine the role of physiotherapy in the management of spasticity in this area.

Cochrane Database of Systematic Reviews, Jan 20, 2010

ABSTRACT Fatigue is a common and potentially distressing symptom for people with rheumatoid arthr... more ABSTRACT Fatigue is a common and potentially distressing symptom for people with rheumatoid arthritis with no accepted evidence based management guidelines. Non-pharmacological interventions, such as physical activity and psychosocial interventions, have been shown to help people with a range of other long-term conditions to manage subjective fatigue. To evaluate the benefit and harm of non-pharmacological interventions for the management of fatigue in people with rheumatoid arthritis. This included any intervention that was not classified as pharmacological in accordance with European Union (EU) Directive 2001/83/EEC. The following electronic databases were searched up to October 2012, Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; AMED; CINAHL; PsycINFO; Social Science Citation Index; Web of Science; Dissertation Abstracts International; Current Controlled Trials Register; The National Research Register Archive; The UKCRN Portfolio Database. In addition, reference lists of articles identified for inclusion were checked for additional studies and key authors were contacted. Randomised controlled trials were included if they evaluated a non-pharmacological intervention in people with rheumatoid arthritis with self-reported fatigue as an outcome measure. Two review authors selected relevant trials, assessed risk of bias and extracted data. Where appropriate, data were pooled using meta-analysis with a random-effects model. Twenty-four studies met the inclusion criteria, with a total of 2882 participants with rheumatoid arthritis. Included studies investigated physical activity interventions (n = 6 studies; 388 participants), psychosocial interventions (n = 13 studies; 1579 participants), herbal medicine (n = 1 study; 58 participants), omega-3 fatty acid supplementation (n = 1 study; 81 participants), Mediterranean diet (n = 1 study; 51 participants), reflexology (n = 1 study; 11 participants) and the provision of Health Tracker information (n = 1 study; 714 participants). Physical activity was statistically significantly more effective than the control at the end of the intervention period (standardized mean difference (SMD) -0.36, 95% confidence interval (CI) -0.62 to -0.10; back translated to mean difference of 14.4 points lower, 95% CI -4.0 to -24.8 on a 100 point scale where a lower score means less fatigue; number needed to treat for an additional beneficial outcome (NNTB) 7, 95% CI 4 to 26) demonstrating a small beneficial effect upon fatigue. Psychosocial intervention was statistically significantly more effective than the control at the end of the intervention period (SMD -0.24, 95% CI -0.40 to -0.07; back translated to mean difference of 9.6 points lower, 95% CI -2.8 to -16.0 on a 100 point scale, lower score means less fatigue; NNTB 10, 95% CI 6 to 33) demonstrating a small beneficial effect upon fatigue. For the remaining interventions meta-analysis was not possible and there was either no statistically significant difference between trial arms or findings were not reported. Only three studies reported any adverse events and none of these were serious, however, it is possible that the low incidence was in part due to poor reporting. The quality of the evidence ranged from moderate quality for physical activity interventions and Mediterranean diet to low quality for psychosocial interventions and all other interventions. This review provides some evidence that physical activity and psychosocial interventions provide benefit in relation to self-reported fatigue in adults with rheumatoid arthritis. There is currently insufficient evidence of the effectiveness of other non-pharmacological interventions.

Background Fatigue is a common and potentially distressing symptom for patients with rheumatoid a... more Background Fatigue is a common and potentially distressing symptom for patients with rheumatoid arthritis (RA), with no accepted evidence-based management guidelines. Evidence suggests that biologic interventions improve symptoms and signs in RA as well as reducing joint damage. Objectives To evaluate the e ect of biologic interventions on fatigue in rheumatoid arthritis.

Annals of the Rheumatic Diseases, Jun 1, 2015

0.86-0.91 for self-reporting and 0.83-0.91 for parent reporting). Parent-child concordance for al... more 0.86-0.91 for self-reporting and 0.83-0.91 for parent reporting). Parent-child concordance for all scores was moderate (0.49-0.57) (Table 1). The PedsQL-MFS and VAS-fatigue were highly correlated, with coefficients from-0.38 to-0.45, indicating concurrent validity. Conclusions: We demonstrated the reliability and validity of fatigue measurement using the Turkish version of the PedsQL-MFS in our sociocultural context. the PedsQL-MFS can be utilized as a tool for the evaluation of fatigue in children and adolescents with JIA aged 8-18 years.