ORCID Profile
0000-0002-6676-026X
Current Organisation
University of South Australia
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Publisher: Elsevier BV
Date: 03-2020
Publisher: Informa UK Limited
Date: 03-07-2019
Publisher: Public Library of Science (PLoS)
Date: 29-09-2023
Publisher: Elsevier BV
Date: 12-2021
DOI: 10.1016/J.PHYSIO.2021.08.004
Abstract: Complex physical interventions are widely used in physiotherapy, despite doubts over the validity of clinical trial results due to lack of credible shams. Credible shams are critically needed, so too, therefore, is a process by which they can be developed. The authors used a novel methodology to develop and test blinding protocols for dry needling, a complex physical intervention for which blinding is particularly difficult. The research design was a practical three-day workshop influenced by Participatory Action Research, which uses iteration and reflection to solve a problem. Five multidisciplinary experts (researchers, clinicians, technician, magician) were invited. Healthy volunteers ('recipients', n=17) and accredited physiotherapists (n=6) were recruited to enable testing of blinding strategies. Primary outcomes were expert opinion on the potential to blind recipients/therapists for (1) in idual blinding strategies, and (2) entire blinding protocols. Secondary outcomes included recipient/therapist blinding effectiveness and acceptability. Experts iteratively developed 11 blinding protocols involving 22 blinding strategies. Experts rated 18 of the blinding strategies to 'definitely have potential' and identified four categories: knowledge of the sham, clinical interaction, disinformation, and sensation. Recipient and therapist blinding became more successful as the protocols evolved. Credible shams capable of simultaneous recipient and therapist blinding have been regarded to be impossible in dry needling. The preliminary success of the devised protocols suggest that our novel approach may be a crucial step in sham development. Improvements in expert rankings and blinding effectiveness as the protocols progressed support the value of this workshop approach.
Publisher: BMJ
Date: 25-05-2023
Publisher: Elsevier BV
Date: 04-2022
DOI: 10.1016/J.MSKSP.2022.102515
Abstract: Participants' previous experience with an intervention may be an important variable when conducting sham-controlled trials. This study explored if previous experience with dry needling (DN) influenced blinding effectiveness and pain outcomes, after the application of DN in patients with neck pain. A preliminary randomized, sham-controlled study. Participants were randomized to receive a single session of real or sham DN. Previous experience with DN (yes/no) was recorded. Blinding effectiveness was assessed by asking participants to guess their group allocation (real/sham/not sure) 5 min post-intervention. Outcomes including pain intensity, pressure pain thresholds, and self-perceived improvement, were assessed by a blinded assessor at baseline, one- and seven-days post-intervention. Of 50 patients recruited, 30 had previous experience and 20 did not. Fifty-seven percent (n = 17/30) with previous experience and 35% (n = 7/20) without experience correctly identified their group allocation, but this difference was not significant (χ Participants with previous experience were 22% more accurate at identifying their group allocation than those without experience, but the difference was not significant. Previous experience did not influence most clinical outcomes, except for pain intensity after real DN. Future studies evaluating effects of previous experience of DN should include more detailed information of previous experience.
Publisher: Elsevier BV
Date: 08-2023
Publisher: Springer Science and Business Media LLC
Date: 03-01-2021
Publisher: Elsevier BV
Date: 07-2017
DOI: 10.1016/J.CORTEX.2017.06.024
Abstract: Spatially-defined disruption of autonomic and sensory function has been identified in Complex Regional Pain Syndrome (CRPS). This study aimed to determine whether motor performance is also disrupted in a spatially-defined manner in people with CRPS. Thirteen people with CRPS type 1 of the upper limb participated in two motor experiments. In Experiment 1 participants performed a circle drawing task that primarily tested motor accuracy. In Experiment 2 participants performed a button pressing task that tested motor co-ordination. In both experiments the motor tasks were performed with either hand (affected or healthy), and on either side of the body midline - that is, on the affected side of space or healthy side of space. There was a main effect of both Limb and Side for the motor tasks. In Experiment 1, motor accuracy for the circle drawing task was poorer when participants used their affected hand than when they used their healthy one (p < .001), and when the task was performed on the affected side of their body midline than when it was performed on the healthy side (p < .001). In Experiment 2, motor co-ordination for the button pressing task was poorer when participants used their affected hand than when they used their healthy one (p < .001), and when the task was performed on the affected side of the midline (p < .001), as compared to the healthy side of the midline. Unilateral CRPS is associated with a spatially-defined disruption of motor performance. Participants perform worse when the task is performed on the affected side of the body midline, regardless of whether they use their affected or healthy hand.
Publisher: Elsevier BV
Date: 12-2021
DOI: 10.1016/J.PHYSIO.2021.08.007
Abstract: Dry needling is widely used in physiotherapy. Lack of blinding in clinical trials means that dry needling effects and mechanisms remain unclear, with blinding issues accepted as an unavoidable barrier to better evidence. The authors aimed to overcome this barrier by designing a protocol to double-blind dry needling trials. A prospectively registered randomised experiment tested a novel blinding protocol for blinding effectiveness. University physiotherapy clinic. Therapists (n=15) and asymptomatic volunteers ('recipients') (n=45) were randomly allocated to real and/or sham interventions. The protocol involved custom-made needles and cognitive and multisensory blinding techniques. The primary outcome was guesses about allocation. The a priori criterion for successful blinding was ≤50% correct guesses (random chance). Secondary analyses explored blinding patterns using blinding indices. Correct guesses were not different from 50% for therapists [41% (95%CI 30 to 50), n=120 guesses] or recipients [49% (95%CI 38 to 60), n=90 guesses]. Blinding indices supported the primary result but revealed that recipients were better at detecting real dry needling than sham. Both therapists and recipients were successfully blinded, which contrasts with the widely held assumption that double-blinding is impossible for needling interventions. The authors recommend that any future trials can, and therefore should, blind therapists. However, secondary analyses revealed that recipients receiving real dry needling were less blinded than sham recipients, which may still create bias in clinical trials and suggests further work is needed to improve recipient blinding. Nonetheless, the current findings offer an opportunity to gain better evidence concerning the effects and mechanisms of dry needling. osf.io/rkzeb/.
Publisher: Wiley
Date: 03-06-2022
DOI: 10.1002/EJP.1976
Abstract: Complex Regional Pain Syndrome (CRPS) is a rare but disabling pain condition. Accurate and timely education about CRPS is key to promote optimal clinical outcomes, but it is unclear what the content of that education should be. We aimed to determine the content that both people with CRPS and expert health care professionals (HCPs) reported as important. An international three‐round e‐Delphi was conducted, recruiting adults diagnosed with CRPS and HCPs. In Round 1, participants were asked to list the most important information people with CRPS should know regarding the condition . Data were organized into concepts and allocated to themes. In Rounds 2 and 3, participants rated each concept on a 9‐point Likert Scale, categorized as ‘not important’ (0–3), ‘important’ (4–6) and ‘very important’ (7–9). A concept attained consensus when ≥75% agreement was reached within a category. Sixty‐two participants (HCPs: n = 7 CRPS: n = 55) proposed 193 concepts in Round 1, resulting in 22 themes. Fifteen additional concepts were identified in Round 2, resulting in a total of 208 concepts. From that list, 48 concepts that emphasized understanding and evidence‐based management of the disorder, the importance of self‐management strategies, pacing and movement, reached joint consensus as ‘very important’. One concept: ‘Advise that movement does not help’ reached joint consensus as ‘not important’. Forty‐eight concepts were jointly considered ‘very important’ for future CRPS‐related educational content. Future research to better understand group differences and to canvas a broader HCP group is warranted. This e‐Delphi study identified the 48 core concepts that those with the lived experience of CRPS, and advanced practitioner health care professionals jointly rated as ‘very important’ to include in fundamental and accessible educational material.
Publisher: Wiley
Date: 24-04-2020
DOI: 10.1002/EJP.1571
Publisher: Elsevier BV
Date: 07-2023
Publisher: Wiley
Date: 12-04-2020
DOI: 10.1002/EJP.1573
Abstract: This journal recently published a paper by Suso‐Marti et al., entitled “Effectiveness of motor imagery and action observation training on musculoskeletal pain intensity: A systematic review and meta‐analysis” (2020). Motor imagery training and action observation training are rehabilitation approaches that involve imagining oneself executing a particular action, and watching actions that are performed by others, respectively. Both are thought to activate similar neural substrates that are responsible for the actual execution of an action (Eaves et al., 2016). Motor imagery and action observation have been used to enhance motor skill performance in several groups – including athletes and musicians who require highly accurate and precise movement for professional performances, and a similar approach has been employed during rehabilitation with variable outcomes in people after stroke, spinal cord injury and persistent pain.
Publisher: Wiley
Date: 07-2022
DOI: 10.1002/EJP.1992
Abstract: Negative experiences of needle procedures in childhood can lead to medical avoidance and vaccine hesitancy into adulthood. We evaluated the feasibility of two new interventions provided by clinical nurses to reduce the negative impact of vaccinations: ided attention (DA) and positive memory reframing (PMR). Children (8–12 years) were randomized into four groups: usual care (UC), DA, PMR or combined (DA + PMR). To evaluate feasibility, we undertook in‐depth analysis of video‐recorded interventions, nurse experiences (phone interviews) and child arent memory recall of interventions (phone interviews at 2 weeks post‐vaccination). Key clinical outcomes included child and parent ratings of needle‐related pain intensity and fear assessed at baseline, immediately post‐vaccination and 2 weeks post‐vaccination (recalled). A total of 54 child–parent dyads were screened, with 41 included (10/group, except PMR [ n = 11]). The interventions were not always completed as intended: 10%–22% of participants received complete interventions and two had adverse events related to protocol breach. Preliminary within‐group analyses showed no effects on child arent pain ratings. However, children in DA + PMR had reduced recalled fear ( p = 0.008), and PMR ( p = 0.025) and DA + PMR ( p = 0.003) had reduced fear of future needles. Parent ratings of child fear were also reduced immediately post‐vaccination for UC ( p = 0.035) and PMR ( p = 0.035). The interventions were feasible, although enhanced nurse training is required to improve fidelity. Preliminary clinical results appear promising, particularly for reducing needle‐related fear. Protocol registration: Protocol number ACTRN12618000687291 at ANZCTR.org.au Two new nurse‐led interventions to reduce negative impacts of vaccinations in children, ided attention and positive memory reframing, were feasible and may reduce needle‐related fear. Nurses were able to deliver the interventions in various environments including non‐clinical settings (schools). These interventions have potential to facilitate broader dissemination of vaccinations for children in a manner that minimizes distress.
Publisher: Informa UK Limited
Date: 27-03-2020
Publisher: PeerJ
Date: 20-08-2021
DOI: 10.7717/PEERJ.11882
Abstract: Anecdotally, people living with Complex Regional Pain Syndrome (CRPS) often report difficulties in localising their own affected limb when it is out of view. Experimental attempts to investigate this report have used explicit tasks and yielded varied results. Here we used a limb localisation task that interrogates implicit mechanisms because we first induce a compelling illusion called the Disappearing Hand Trick (DHT). In the DHT, participants judge their hands to be close together when, in fact, they are far apart. Sixteen volunteers with unilateral upper limb CRPS (mean age 39 ± 12 years, four males), 15 volunteers with non-CRPS persistent hand pain (‘pain controls’ mean age 58 ± 13 years, two males) and 29 pain-free volunteers (‘pain-free controls’ mean age 36 ± 19 years, 10 males) performed a hand-localisation task after each of three conditions: the DHT illusion and two control conditions in which no illusion was performed. The conditions were repeated twice (one for each hand). We hypothesised that (1) participants with CRPS would perform worse at hand self-localisation than both the control s les (2) participants with non-CRPS persistent hand pain would perform worse than pain-free controls (3) participants in both persistent pain groups would perform worse with their affected hand than with their unaffected hand. Our first two hypotheses were not supported. Our third hypothesis was supported —when visually and proprioceptively encoded positions of the hands were incongruent ( i.e . after the DHT), relocalisation performance was worse with the affected hand than it was with the unaffected hand. The similar results in hand localisation in the control and pain groups might suggest that, when implicit processes are required, people with CRPS’ ability to localise their limb is preserved.
Publisher: Australasian Society for Computers in Learning in Tertiary Education
Date: 09-2021
DOI: 10.14742/AJET.7100
Abstract: This article provides a description and analysis of the way in which research degree students and their supervisors at one Australian university (the University of South Australia) use a popular online plagiarism-detection system, iThenticate. The study identifies how these two groups use iThenticate by analysing usage data together with data from an anonymous online survey conducted 12 months after the university took out a pilot subscription to the system. One hundred and nineteen students and 26 supervisors responded to the survey, representing 61% and 43% of the active users in each category. The survey found that the two groups of respondents used the system differently but that, while for both groups iThenticate’s regulatory function in preventing plagiarism (whether international or accidental) was important, the system’s potential educational function in improving research writing capability and publication was equally important. The study highlights the value of regarding the use of anti-plagiarism software so as to encourage a move way from a simple focus on its punitive regulatory dimension and towards its educational possibilities and suggests directions for future research on the relationship between this type of software and the ways scholars work with other people’s texts to recreate meanings and develop original contributions. Implications for practice or policy: Online plagiarism detection systems (such as iThenticate) can be used either negatively to police doctoral students’ practice or positively to improve their research writing practice. Academic developers should promote a positive approach, aimed at improving research writing practice, as the preferable pedagogy in using online plagiarism-detection systems.
Publisher: Oxford University Press (OUP)
Date: 02-08-2019
DOI: 10.1093/PTJ/PZZ111
Abstract: Blinding of participants and therapists in trials of physical interventions is a significant and ongoing challenge. There is no widely accepted sham protocol for dry needling. The purpose of this review was to summarize the effectiveness and limitations of blinding strategies and types of shams that have been used in dry needling trials. Twelve databases were searched from inception to February 2016. Trials that compared active dry needling with a sham that simulated dry needling were included. The main domains of data extraction were participant/therapist details, intervention details, blinding strategies, blinding assessment outcomes, and key conclusions of authors. Reported blinding strategies and sham types were synthesized descriptively, with available blinding effectiveness data synthesized using a chance-corrected measurement of blinding (blinding index). The search identified 4894 in idual publications with 27 trials eligible for inclusion. In 22 trials, risk of methodological bias was high or unclear. Across trials, blinding strategies and sham types were heterogeneous. Notably, no trials attempted therapist blinding. Sham protocols have focused on participant blinding using strategies related to group standardization and simulation of tactile sensations. There has been little attention given to the other senses or cognitive strategies to enhance intervention credibility. Nonpenetrating sham types may provide effective participant blinding. Trials were clinically and methodologically erse, which limited the comparability of blinding effectiveness across trials. Reported blinding evaluations had a high risk of chance findings with power clearly achieved in only 1 trial. Evidence-based consensus on a sham protocol for dry needling is required. Recommendations provided in this review may be used to develop sham protocols so that future protocols are more consistent and potentially more effective.
Publisher: PeerJ
Date: 23-05-2022
DOI: 10.7717/PEERJ.13383
Abstract: Bodily state is theorised to play a role in perceptual scaling of the environment, whereby low bodily capacity shifts visuospatial perception, with distances appearing farther and hills steeper, and the opposite seen for high bodily capacity. This may play a protective role, where perceptual scaling discourages engaging with the environment when capacity is low. Our protocol was pre-registered via Open Science Framework ( osf.io/6zya5/ ) with all amendments to the protocol tracked. We performed a systematic review and meta-analysis examining the role of bodily state/capacity on spatial perception measures of the environment. Databases (Medline, PsychINFO, Scopus, Embase, and Emcare) and grey literature were searched systematically, inclusive to 26/8/21. All studies were assessed using a customised Risk of Bias form. Standard mean differences and 95% CIs were calculated via meta-analysis using a random-effects model. A total of 8,034 studies were identified from the systematic search. Of these, 68 experiments (3,195 participants) met eligibility and were included in the review. These were grouped into the following categories: fatigue pain age embodiment body size/body paty size glucose levels fitness and interoception, and interoceptive accuracy. We found low level evidence (limited studies, high risk of bias) for the effect of bodily state on spatial perception. There was consistent evidence that both glucose manipulations and age influence spatial perception of distances and hills in a hypothesised direction (lower capacity associated with increased distance and hill steepness). Mixed evidence exists for the influence of external loads, embodiment, body/body-part size manipulations, pain, and interoceptive accuracy. Evidence for fitness and/or fatigue influencing spatial perception was conflicting notably, methodological flaws with fitness and fatigue paradigms and heterogenous spatial perception measures may underlie null/conflicting results. We found limited evidence for bodily state influencing spatial perception of the environment. That all studies had high risk of bias makes conclusions about reported effects reflecting actual perceptual shifts ( vs merely reflecting experimental demands or error due to inadequate study design) pre-emptive. Rigorous evaluation is needed to determine whether reported effects reflect more than bias ( e.g ., experimental demands, inadequate blinding). Future work using reliable measures of spatial perception, comprehensive evaluation of relevant confounders, and methodologically robust (and experimentally confirmed) bodily state experimental paradigms is warranted.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2020
Publisher: SAGE Publications
Date: 10-03-2020
Abstract: In clinical trials of physical interventions, participant blinding is often poorly addressed and therapist blinding routinely omitted. This situation presents a substantial barrier to moving the field forward. Improving the success of blinding will be a vital step towards determining the true mechanisms of physical interventions. We used a Delphi approach to identify important elements of shams for physical interventions to maximise the likelihood of participant and therapist blinding in clinical trials. Two expert groups were recruited: (1) experts in research methodology and (2) experts in deceptive and/or hypnotic techniques including magic. Magicians were included because they were considered a potentially rich source of innovation for developing credible shams due to their unique skills in altering perceptions and beliefs. Three rounds of survey were conducted, commencing with an open-ended question. Responses were converted to single ‘items’, which participants rated in the following two rounds using a 9-point Likert scale, categorised as ‘Not important’ (0–3), ‘Depends’ (4–6) and ‘Essential’ (7–9). Consensus was pre-defined as ≥80% agreement within a 3-point category. Thirty-eight experts agreed to participate (research methodology: n = 22 deceptive and/or hypnotic techniques: n = 16), and 30 experts responded to at least one round (research methodology: n = 19 deceptive and/or hypnotic techniques: n = 11). Of 79 items, five reached consensus in the ‘Essential’ category in both groups, which related to beliefs of participants ( n = 3 items), interactions with researchers ( n = 1 item) and standardisation of clinical assessments ( n = 1 item). Thirteen additional items reached consensus in the ‘Essential’ category in one group. Experts in research methodology had one additional item reach consensus, related to authentic delivery of study information. The remaining 12 additional items that reached consensus in the deceptive and/or hypnotic techniques group related mainly to therapist attitude and behaviour and the clinical interaction. Experts agreed that, for shams to be believable, consideration of cognitive influences is essential. Contrary to the focus of previous shams for physical interventions, replicating the tactile sensation of the active treatment was not considered an essential part of sham development. Therefore, when designing sham-controlled clinical trials, researchers should carefully consider the cognitive credibility of the entire intervention experience, and not just the indistinguishability of the sham intervention itself. The findings provide new guidance to researchers on important contributors to blinding in physical intervention trials.
Publisher: Springer Science and Business Media LLC
Date: 28-08-2021
DOI: 10.1186/S12891-021-04561-6
Abstract: Despite well-established benefits of physical activity for knee osteoarthritis (OA), nine of ten people with knee OA are inactive. People with knee OA who are inactive often believe that physical activity is dangerous, fearing that it will further damage their joint(s). Such unhelpful beliefs can negatively influence physical activity levels. We aim to evaluate the clinical- and cost-effectiveness of integrating physiotherapist-delivered pain science education (PSE), an evidence-based conceptual change intervention targeting unhelpful pain beliefs by increasing pain knowledge, with an in idualised walking, strengthening, and general education program. Two-arm, parallel-design, multicentre randomised controlled trial involving 198 people aged ≥50 years with painful knee OA who do not meet physical activity guideline recommendations or walk regularly for exercise. Both groups receive an in idualised physiotherapist-led walking, strengthening, and OA/activity education program via 4x weekly in-person treatment sessions, followed by 4 weeks of at-home activities (weekly check-in via telehealth), with follow-up sessions at 3 months (telehealth) and 5 and 9 months (in-person). The EPIPHA-KNEE group also receives contemporary PSE about OA ain and activity, embedded into all aspects of the intervention. Outcomes are assessed at baseline, 12 weeks, 6 and 12 months. Primary outcomes are physical activity level (step count wrist-based accelerometry) and self-reported knee symptoms (WOMAC Total score) at 12 months. Secondary outcomes are quality of life, pain intensity, global rating of change, self-efficacy, pain catastrophising, depression, anxiety, stress, fear of movement, knee awareness, OA/activity conceptualisation, and self-regulated learning ability. Additional measures include adherence, adverse events, blinding success, COVID-19 impact on activity, intention to exercise, treatment expectancy erceived credibility, implicit movement/environmental bias, implicit motor imagery, two-point discrimination, and pain sensitivity to activity. Cost-utility analysis of the EPIPHA-KNEE intervention will be undertaken, in addition to evaluation of cost-effectiveness in the context of primary trial outcomes. We will determine whether the integration of PSE into an in idualised OA education, walking, and strengthening program is more effective than receiving the in idualised program alone. Findings will inform the development and implementation of future delivery of PSE as part of best practice for people with knee OA. Australian New Zealand Clinical Trials Registry: ACTRN12620001041943 (13/10/2020).
Publisher: Informa UK Limited
Date: 03-07-2022
DOI: 10.1080/00207144.2022.2105147
Abstract: Chronic low back pain (CLBP) is a debilitating and burdensome condition, and new treatment strategies are needed. This study aimed to evaluate (1) the feasibility of undertaking a controlled clinical trial investigating a novel intervention for people with CLBP: hypnotically reinforced pain science education, and (2) the acceptability of the intervention as rated by participants.
Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1016/J.MSKSP.2019.01.010
Abstract: Left/right judgement (LRJ) of body parts is commonly used to assess the ability to perform implicit motor imagery and the integrity of brain-grounded maps of the body. Clinically, LRJ are often undertaken using a mobile tablet, but the concurrent validity and reliability of this approach has not yet been established. To evaluate the concurrent validity and test-retest reliability of a mobile tablet for assessing LRJ. Participants completed LRJ for 50 hand images (Experiment 1), and 40 back, foot, or neck images (Experiment 2) using a mobile tablet and desktop computer in random order. Participants in Experiment 2 performed a repeat test the following day to assess test-retest reliability. Accuracy and response time (RT) were recorded. Twenty participants aged 55.3 (±6.7) years in Experiment 1, and 37 participants aged 38.2 (±12.3) years in Experiment 2, were recruited. Concurrent validity of the mobile tablet was good to excellent for hand judgements (ICC The mobile tablet demonstrated good to excellent concurrent validity with the desktop computer in two separate s les. The mobile tablet also demonstrated good to excellent test-retest reliability. The mobile tablet for LRJ is a valid alternative to the original desktop version.
No related grants have been discovered for Felicity Braithwaite.