ORCID Profile
0000-0001-7743-6986
Current Organisation
Deakin University - Melbourne Burwood Campus
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Publisher: Springer Science and Business Media LLC
Date: 24-03-2020
Publisher: Wiley
Date: 11-11-2019
DOI: 10.1111/PAPR.12846
Abstract: Nonspecific chronic low back pain (CLBP) is a common clinical condition that has impacts at both the in idual and societal level. Pain intensity is a primary outcome used in clinical practice to quantify the severity of CLBP and the efficacy of its treatment however, pain is a subjective experience that is impacted by a multitude of factors. Moreover, differences in effect sizes for pain intensity are not observed between common conservative treatments, such as spinal manipulative therapy, cognitive behavioral therapy, acupuncture, and exercise training. As pain science evolves, the biopsychosocial model is gaining interest in its application for CLBP management. The aim of this article is to discuss our current scientific understanding of pain and present why additional factors should be considered in conservative CLBP management. In addition to pain intensity, we recommend that clinicians should consider assessing the multidimensional nature of CLBP by including physical (disability, muscular strength and endurance, performance in activities of daily living, and body composition), psychological (kinesiophobia, fear-avoidance, pain catastrophizing, pain self-efficacy, depression, anxiety, and sleep quality), social (social functioning and work absenteeism), and health-related quality-of-life measures, depending on what is deemed relevant for each in idual. This review also provides practical recommendations to clinicians for the assessment of outcomes beyond pain intensity, including information on how large a change must be for it to be considered "real" in an in idual patient. This information can guide treatment selection when working with an in idual with CLBP.
Publisher: Informa UK Limited
Date: 02-2023
DOI: 10.2147/JPR.S386440
Publisher: S. Karger AG
Date: 2020
DOI: 10.1159/000506643
Abstract: b i Introduction: /i /b To determine whether combined exercise training with an energy-restricted diet leads to improved physical fitness and body composition when compared to energy restriction alone in free-living premenopausal women with clinically severe obesity. b i Methods: /i /b Sixty premenopausal women (BMI of 40.4 ± 6.7) were randomised to energy restriction only (ER) or to exercise plus energy restriction (EXER) for 12 months. Body composition and fitness were measured at baseline, 3, 6 and 12 months. b i Results: /i /b VO sub peak /sub improved more for EXER compared to ER at 3 (mean difference ± SEM 2.5 ± 0.9 mL ∙ kg sup –1 /sup ∙ min sup –1 /sup , i /i = 0.006) and 6 (3.1 ± 1.2 mL ∙ kg sup –1 /sup ∙ min sup –1 /sup , i /i = 0.007) but not 12 months (2.3 ± 1.6 mL ∙ kg sup –1 /sup ∙ min sup –1 /sup , i /i = 0.15). Muscle strength improved more for EXER compared to ER at all time points. No differences between groups for lean mass were observed at 12 months. b i Conclusion: /i /b Combining exercise training with an energy-restricted diet did not lead to greater aerobic power, total body mass, fat mass or limit lean body mass loss at 12 months when compared to energy restriction alone for premenopausal women with clinically severe obesity in free-living situations. Future research should aim to determine an effective lifestyle approach which can be applied in the community setting for this high-risk group.
Publisher: Springer Science and Business Media LLC
Date: 27-08-2021
DOI: 10.1007/S40279-021-01526-6
Abstract: Pain is the most disabling characteristic of musculoskeletal disorders, and while exercise is promoted as an important treatment modality for chronic musculoskeletal conditions, the relative contribution of the specific effects of exercise training, placebo effects and non-specific effects such as natural history are not clear. The aim of this systematic review and meta-analysis was to determine the relative contribution of these factors to better understand the true effect of exercise training for reducing pain in chronic primary musculoskeletal pain conditions. Systematic review with meta-analysis DATA SOURCES: MEDLINE, CINAHL, SPORTDiscus, EMBASE and CENTRAL from inception to February 2021. Reference lists of prior systematic reviews. Randomised controlled trials of interventions that used exercise training compared to placebo, true control or usual care in adults with chronic primary musculoskeletal pain. The review was registered prospectively with PROSPERO (CRD42019141096). We identified 79 eligible trials for quantitative analysis. Pairwise meta-analysis showed very low-quality evidence (GRADE criteria) that exercise training was not more effective than placebo (g [95% CI]: 0.94 [- 0.17, 2.06], P = 0.098, I There is very low-quality evidence that exercise training is not more effective than non-exercise placebo treatments in chronic pain. Exercise training and the associated clinical encounter are more effective than true control or standard medical care for reductions in pain for adults with chronic musculoskeletal pain, with very low quality of evidence based on GRADE criteria.
Publisher: Springer Science and Business Media LLC
Date: 19-10-2021
Publisher: MDPI AG
Date: 03-06-2020
DOI: 10.3390/JCM9061726
Abstract: Exercise and spinal manipulative therapy are commonly used for the treatment of chronic low back pain (CLBP) in Australia. Reduction in pain intensity is a common outcome however, it is only one measure of intervention efficacy in clinical practice. Therefore, we evaluated the effectiveness of two common clinical interventions on physical and self-report measures in CLBP. Participants were randomized to a 6-month intervention of general strength and conditioning (GSC n = 20 up to 52 sessions) or motor control exercise plus manual therapy (MCMT n = 20 up to 12 sessions). Pain intensity was measured at baseline and fortnightly throughout the intervention. Trunk extension and flexion endurance, leg muscle strength and endurance, paraspinal muscle volume, cardio-respiratory fitness and self-report measures of kinesiophobia, disability and quality of life were assessed at baseline and 3- and 6-month follow-up. Pain intensity differed favoring MCMT between-groups at week 14 and 16 of treatment (both, p = 0.003), but not at 6-month follow-up. Both GSC (mean change (95%CI): −10.7 (−18.7, −2.8) mm p = 0.008) and MCMT (−19.2 (−28.1, −10.3) mm p 0.001) had within-group reductions in pain intensity at six months, but did not achieve clinically meaningful thresholds (20mm) within- or between-group. At 6-month follow-up, GSC increased trunk extension (mean difference (95% CI): 81.8 (34.8, 128.8) s p = 0.004) and flexion endurance (51.5 (20.5, 82.6) s p = 0.004), as well as leg muscle strength (24.7 (3.4, 46.0) kg p = 0.001) and endurance (9.1 (1.7, 16.4) reps p = 0.015) compared to MCMT. GSC reduced disability (−5.7 (−11.2, −0.2) pts p = 0.041) and kinesiophobia (−6.6 (−9.9, −3.2) pts p 0.001) compared to MCMT at 6-month follow-up. Multifidus volume increased within-group for GSC (p = 0.003), but not MCMT or between-groups. No other between-group changes were observed at six months. Overall, GSC improved trunk endurance, leg muscle strength and endurance, self-report disability and kinesiophobia compared to MCMT at six months. These results show that GSC may provide a more erse range of treatment effects compared to MCMT.
Publisher: Informa UK Limited
Date: 23-04-2020
DOI: 10.1080/17461391.2019.1606942
Abstract: This study assessed the deconditioning hypothesis of low back pain (LBP) by examining physical function in relation to LBP and self-reported physical activity in women. This cross-sectional study recruited a representative population-based s le of females aged greater than 60 years. In total, 1182 women were included in the study and completed questionnaires (physical activity and LBP intensity) and functional testing (countermovement jump, chair rise, gait speed and grip strength). In iduals were stratified into four groups based on physical activity and LBP status and analysed via a two-way ANOVA. Most participants (87%) reported current LBP and 25% were physically active. Countermovement jump height, chair rise and grip strength were lower in physically inactive women (
Publisher: Springer Science and Business Media LLC
Date: 27-05-2017
DOI: 10.1007/S11136-017-1602-9
Abstract: Obesity is associated with a decline in health-related quality of life (HRQOL), while weight loss and exercise training have a positive influence. The aim of this systematic review was to compare the effects of energy restriction (ER) alone intervention to diet and exercise intervention on HRQOL. MEDLINE, CINAHL and PsycINFO databases were searched for randomised controlled trials examining HRQOL through lifestyle interventions which examined ER and energy restriction plus exercise in obese adults. Nine hundred and fifty-two papers were assessed for inclusion in this review with nine being deemed suitable. This review indicates that four studies provide evidence to support the role of exercise in addition to ER to improve HRQOL in adults with obesity. The findings of this review are limited due to the limited number of studies as well as substantial heterogeneity in ER, exercise prescription variables and outcome measures utilised within studies. A definitive conclusion regarding the capacity of exercise to facilitate greater improvement in HRQOL than diet alone, or, to formulate an exercise prescription for obese adults to address HRQOL is not feasible based on the existing evidence. Future studies should utilise comparable HRQOL assessment tools along with ensuring full reporting of results.
Publisher: Public Library of Science (PLoS)
Date: 08-2019
Publisher: Springer Science and Business Media LLC
Date: 09-07-2020
DOI: 10.1038/S41746-020-0303-X
Abstract: Artificial intelligence and machine learning (AI/ML) could enhance the ability to detect patterns of clinical characteristics in low-back pain (LBP) and guide treatment. We conducted three systematic reviews to address the following aims: (a) review the status of AI/ML research in LBP, (b) compare its status to that of two established LBP classification systems (STarT Back, McKenzie). AI/ML in LBP is in its infancy: 45 of 48 studies assessed s le sizes people, 19 of 48 studies used ≤5 parameters in models, 13 of 48 studies applied multiple models and attained high accuracy, 25 of 48 studies assessed the binary classification of LBP versus no-LBP only. Beyond the 48 studies using AI/ML for LBP classification, no studies examined use of AI/ML in prognosis prediction of specific sub-groups, and AI/ML techniques are yet to be implemented in guiding LBP treatment. In contrast, the STarT Back tool has been assessed for internal consistency, test−retest reliability, validity, pain and disability prognosis, and influence on pain and disability treatment outcomes. McKenzie has been assessed for inter- and intra-tester reliability, prognosis, and impact on pain and disability outcomes relative to other treatments. For AI/ML methods to contribute to the refinement of LBP (sub-)classification and guide treatment allocation, large data sets containing known and exploratory clinical features should be examined. There is also a need to establish reliability, validity, and prognostic capacity of AI/ML techniques in LBP as well as its ability to inform treatment allocation for improved patient outcomes and/or reduced healthcare costs.
Publisher: BMJ
Date: 16-06-2020
Publisher: BMJ
Date: 10-06-2021
Publisher: Informa UK Limited
Date: 03-2018
DOI: 10.2147/CIA.S154664
Publisher: Elsevier BV
Date: 2021
Publisher: Springer Science and Business Media LLC
Date: 08-03-2016
Publisher: Hindawi Limited
Date: 16-09-2021
DOI: 10.1111/IJCP.14600
Publisher: BMJ
Date: 02-2022
DOI: 10.1136/BMJOPEN-2021-052644
Abstract: To explore a protection motivation theory screening tool for predicting rehabilitation adherence. Analysis of a randomised controlled trial. An exercise physiology and physiotherapist clinic. Patients with chronic low back pain (n=40). General strength and conditioning (GSC) compared with motor control and manual therapy. Primary and secondary outcome measures: predicting patient adherence to supervised sessions and dropout using the Sports Injury Rehabilitation Beliefs Scale, seven-item barriers checklist and Positive and Negative Affect Schedule and Sports Injury Rehabilitation Adherence Scale. Average attendance was 77% (motor control and manual therapy) and 60% (GSC) with eight dropouts. No Sports Injury Rehabilitation Adherence Scale values other than 5 across all three components were recorded. Treatment efficacy (p=0.019), self-efficacy (p=0.001), rehabilitation value (p=0.028) and injury severity (p=0.002) positively correlated with susceptibility (the extent of vulnerability to having health problems from not taking action). Rehabilitation value positively correlated with self-efficacy (p=0.005). Injury severity positively correlated with rehabilitation value (p=0.011). The final model for number of cancellations included rehabilitation value only and accounted for approximately 12% of variance (p=0.033). Perceived value of rehabilitation should be considered by clinicians in the rehabilitation setting to improve treatment adherence in patients with chronic low back pain. ACTRN12615001270505.
Publisher: Springer Science and Business Media LLC
Date: 20-04-2017
Publisher: The Royal Australian College of General Practitioners
Date: 03-2021
Publisher: Springer Science and Business Media LLC
Date: 21-12-2021
Publisher: BMJ
Date: 30-10-2020
DOI: 10.1136/BJSPORTS-2019-100886
Abstract: Examine the effectiveness of specific modes of exercise training in non-specific chronic low back pain (NSCLBP). Network meta-analysis (NMA). MEDLINE, CINAHL, SPORTDiscus, EMBASE, CENTRAL. Exercise training randomised controlled/clinical trials in adults with NSCLBP. Among 9543 records, 89 studies (patients=5578) were eligible for qualitative synthesis and 70 (pain), 63 (physical function), 16 (mental health) and 4 (trunk muscle strength) for NMA. The NMA consistency model revealed that the following exercise training modalities had the highest probability (surface under the cumulative ranking (SUCRA)) of being best when compared with true control: Pilates for pain (SUCRA=100% pooled standardised mean difference (95% CI): −1.86 (–2.54 to –1.19)), resistance (SUCRA=80% −1.14 (–1.71 to –0.56)) and stabilisation/motor control (SUCRA=80% −1.13 (–1.53 to –0.74)) for physical function and resistance (SUCRA=80% −1.26 (–2.10 to –0.41)) and aerobic (SUCRA=80% −1.18 (–2.20 to –0.15)) for mental health. True control was most likely (SUCRA≤10%) to be the worst treatment for all outcomes, followed by therapist hands-off control for pain (SUCRA=10% 0.09 (–0.71 to 0.89)) and physical function (SUCRA=20% −0.31 (–0.94 to 0.32)) and therapist hands-on control for mental health (SUCRA=20% −0.31 (–1.31 to 0.70)). Stretching and McKenzie exercise effect sizes did not differ to true control for pain or function (p .095 SUCRA %). NMA was not possible for trunk muscle endurance or analgesic medication. The quality of the synthesised evidence was low according to Grading of Recommendations Assessment, Development and Evaluation criteria. There is low quality evidence that Pilates, stabilisation/motor control, resistance training and aerobic exercise training are the most effective treatments, pending outcome of interest, for adults with NSCLBP. Exercise training may also be more effective than therapist hands-on treatment. Heterogeneity among studies and the fact that there are few studies with low risk of bias are both limitations.
Publisher: Public Library of Science (PLoS)
Date: 25-11-2013
Publisher: Elsevier BV
Date: 04-2022
DOI: 10.1016/J.BONE.2022.116338
Abstract: Animal and human cross-sectional data suggest that bone marrow adipose tissue (MAT) may respond to mechanical loads and exercise. We conducted the first randomised controlled trial of exercise on MAT modulations in humans. Forty patients with chronic non-specific low back pain (NSCLBP) were enrolled in a six-month single-blinded randomised controlled trial (ACTRN12615001270505). Twenty patients loaded their spines via progressive upright aerobic and resistance exercises targeting major muscle groups (Exercise). Twenty patients performed non-weightbearing motor control training and manual therapy (Control). Testing occurred at baseline, 3-months (3mo) and 6-months (6mo). Lumbar vertebral fat fraction (VFF) was measured using magnetic resonance imaging axial mDixon sequences. When compared to baseline (percent change), lumbar vertebral fat fraction (VFF measured using magnetic resonance imaging axial mDixon sequences) was lower in Exercise at 3mo at L2 (-3.7[6.8]%, p = 0.033) and L4 (-2.6[4.1]%, p = 0.015), but not in Control. There were no between-group effects. The effects of Exercise on VFF were sex-specific, with VFF lower in men at L2, L3, L4 at 3mo and at L1, L2, L3 and L4 at 6mo (p all ≤ 0.05), but not in women. Leg and trunk lean mass were increased at 3mo in Exercise. Changes in VFF correlated significantly with changes in total fat (ρ = 0.40) and lean (ρ = -0.41) masses, but not with lumbar BMD (ρ = -0.10) or visceral adipose tissue volume (ρ = 0.23). This trial provided first prospective evidence in humans that a moderate exercise intervention may modulate lumbar VFF as a surrogate measure of MAT at 3mo, yet not 6mo. The effect of exercise on MAT may be more prominent in males than females.
No related grants have been discovered for Clint Miller.