Primary Care & Health Sciences
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I qualified as a physiotherapist at Manchester Royal Infirmary in 1982. My clinical career was undertaken in Withington, Sevenoaks, Medway and Rochester Hospitals; and the Staffordshire Rheumatology Centre, the Haywood, Burslem. I completed my PhD at Keele University in 1997 and became a Senior Research Fellow at Keele and West Midlands Physiotherapy Clinical Trialist, a post focussing on enhancing evidence based physiotherapy practice through randomised controlled clinical trials. In 2000 I was appointed Arthritis Research UK Senior Lecturer in Physiotherapy. This post was created by the Arthritis Research UK to develop and expand academic activities in research, to provide inspiration and leadership to other allied health professionals, to work in a wider context within research in community rheumatology and to exert an influence at national and international levels. In 2007 Keele was awarded funding from Arthritis Research UK for their first multi-centre trial of Occupational Therapy exercise and joint protection for people with hand osteoarthritis. Then in 2008, the National Institute of Health Research funded a study to see how best to deliver high quality research in primary care practice for people with osteoarthritis. I work as part of an interdisciplinary research team at Keele who was awarded Arthritis Research UK funding as the Arthritis Research UK Primary Care Centre in 2008 and was recognised in 2009-10 by the award of a prestigious Queens Anniversary Award to Keele University. I was awarded a personal chair by Keele University in 2010, as Arthritis Research UK Professor of Musculoskeletal Therapies.
I have led innovations to engage clinical physiotherapists to define questions and develop study proposals in musculoskeletal pain. A workshop for 55 physiotherapists developed a successful funding proposal, and delivered and published it. I have also led initiatives to facilitate therapists and other disciplines to engage with research. I led a group of occupational therapists to develop and design a proposal for a community trial of treatment of hand problems, awarded a grant by the Arthritis Research UK.
I have initiated one of the largest longitudinal clinical hand studies in Europe and established the hand group in the Centre’s epidemiology section. I am a Co-applicant on the Centre’s National Institute of Health Research osteoarthritis programme.
For my research I have
- Been awarded two personal externally-funded posts - West Midlands Regional Trialist in Physiotherapy (1996-2000); Arthritis Research UK Senior Lecturer in Physiotherapy (2000-2005)
- Published original research publications in high impact journals (e.g. Lancet, BMJ)
- Obtained with senior colleagues at Keele external research funding
- Supervised 6 Allied Health Professional research degrees.
Clinical trials have provided evidence for the place and value of physiotherapy nationally and internationally through:
- A trial of pain management delivered by physiotherapists (Hay et al 2005)
- A trial of shoulder pain management (Hay et al 2003)
- A neck pain trial, which supported simple information provision as the most effective intervention (Dziedzic et al 2005)
- Publication in high-ranking journals (e.g. Howell et al 2002)
- Regional facilitation of individual physiotherapists
- International collaboration with the musculoskeletal research groups e.g. Rotterdam.
My clinical epidemiology research has
- Influenced international recommendations on the management and diagnosis of hand osteoarthritis
- Highlighted the impact of hand problems on everyday lives
- Uncovered the importance of beliefs and perceptions in determining disability
- Been invited as oral presentations at the European League Against Rheumatism and the Osteoarthritis Research Society International
My current research aims are:
- To lead completion and dissemination of results from my current programme under the general theme of “improving the management of osteoarthritis in primary care”.
- To extend my research into innovative areas, including the extended role of health care professionals, such as practice nurses, in primary care management of joint pain.
- To continue to increase research capacity and training - in the Centre, and regionally and nationally - for non-medical health professionals.
Selected Publications
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2013. ASSESSING HAND OSTEOARTHRITIS USING DIGITAL PHOTOGRAPHS IN A COMMUNITY-DWELLING POPULATION: RELIABILITY AND ASSOCIATIONS WITH RADIOGRAPHIC AND CLINICAL FEATURES. OSTEOARTHRITIS AND CARTILAGE (vol. 21, p. S135). link>
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2013. COST-EFFECTIVENESS OF JOINT PROTECTION AND HAND EXERCISE FOR HAND OSTEOARTHRITIS. RHEUMATOLOGY (vol. 52, p. 147). link>
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2013. DEFINING OPTIMAL NHS OCCUPATIONAL THERAPY TREATMENT, INDIVIDUALIZED SPLINT AND PLACEBO SPLINT FOR PATIENTS WITH THUMB BASE OA: A DELPHI STUDY. RHEUMATOLOGY (vol. 52, pp. 105-106). link>
Full Publications List show
Journal Articles
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2010. What are the important components of the clinical assessment of hand problems in older adults in primary care? Results of a Delphi study. BMC Musculoskelet Disord, vol. 11, 178. link> doi> full text>
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2009. Radiographic hand osteoarthritis: patterns and associations with hand pain and function in a community-dwelling sample. Osteoarthritis Cartilage, vol. 17(11), 1440-1447. link> doi> full text>
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2009. Research priorities for non-pharmacological therapies for common musculoskeletal problems: nationally and internationally agreed recommendations. BMC Musculoskeletal Disorders, vol. 10, Article 3. doi> full text>
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2009. EULAR evidence-based recommendations for the diagnosis of hand osteoarthritis: report of a task force of ESCISIT. ANNALS OF THE RHEUMATIC DISEASES, vol. 68(1), 8-17. link> doi> full text>
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2008. Clinical course and prognosis of hand and wrist problems in primary care. Arthritis Care and Research, vol. 59(9), 1349-1357.
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2007. EULAR evidence based recommendations for the management of hand osteoarthritis: report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis, vol. 66(3), 377-388. link> doi> full text>
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2007. The Australian/Canadian osteoarthritis hand index in a community dwelling population of older adults: reliability and validity. Arthritis and Rheumatism, vol. 57(3), 423-428. doi>
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2007. The Clinical Assessment Study of the Hand (CAS-HA): a prospective study of musculoskeletal hand problems in the general population. BMC Musculoskelet Disord, vol. 8, 85. link> doi> full text>
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2006. The Knee Clinical Assessment Study-CAS(K). A prospective study of knee pain and knee osteoarthritis in the general population: baseline recruitment and retention at 18 months. BMC Musculoskelet Disord, vol. 7, 30. link> doi> full text>
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2005. Comparison of physical treatments versus a brief pain-management programme for back pain in primary care: a randomised clinical trial in physiotherapy practice. Lancet, vol. 365(9476), 2024-2030.
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2005. A cost consequences analysis of local corticosteroid injections and physiotherapy for the treatment of new episodes of unilateral shoulder pain in primary care. Rheumatology, vol. 44, 1447-51.
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2005. Cost minimisation analysis of local corticosteroid injection and physiotherapy for the treatment of new episodes of unilateral shoulder pain in primary care. Rheumatology, vol. 44, 1447-1451.
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2005. Manual therapy or pulsed shortwave diathermy provide no additional benefit over advice and exercise in the treatment of neck disorders. Focus on Alternative and Complementary Therapies, vol. 10(4), 307-308.
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2004. Assessment of the 3-dimensional Fastrak measurement system in measuring range of motion in ankylosing spondylitis. J Rheumatol, vol. 31(11), 2207-2215.
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2004. Spinal mobility in ankylosing spondylitis: reliability, validity and responsiveness. Rheumatology, vol. 43(6), 750-757. doi>
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2004. ISSUES OF GENERALISABILITY IN RANDOMISED CLINICAL TRIALS. RHEUMATOLOGY, vol. 43, 86-87. link>
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2004. THE IMPACT OF HAND OSTEOARTHRITIS ON THE INDIVIDUAL. RHEUMATOLOGY, vol. 43, 153.
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2004. PREVALENCE OF HAND PROBLEMS AND HAND PAIN IN OLDER PEOPLE: A SURVEY OF THE GENERAL POPULATION IN NORTH STAFFORDSHIRE. RHEUMATOLOGY, vol. 43, 88. link>
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2004. What influences participants' treatment preference and can it influence outcome? Results from a primary care-based randomised trial for shoulder pain. Br J Gen Pract, vol. 54(499), 93-96. link>
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2003. LONG-TERM FOLLOW-UP OF A PRAGMATIC, PRIMARY CARE-BASED RANDOMISED TRIALS FOR SHOULDER PAIN. RHEUMATOLOGY, vol. 42, 35-36. link>
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2003. Patient centered assessment of ankylosing spondylitis-specific health related quality of life: evaluation of the Patient Generated Index. J Rheumatol, vol. 30(4), 764-773. link>
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2003. Cost minimisation analysis of local corticosteroid injection versus physiotherapy for the treatment of new episodes of unilateral shoulder pain in primary care. Rheumatology, vol. 42, 36.
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2003. Describing three-dimensional cervical spine movement in a diseased and non-diseased group using multilevel modelling. Statistics in Medicine, vol. 22(14), 2365-2380. doi>
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2002. Randomised study of long term outcome after epidural versus non-epidural analgesia during labour. BMJ, vol. 325(7360), 357. link>
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2002. A Systematic search & critical review of measures of disability for use in a population survey of hand osteoarthritis (OA). Rheumatology.
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2002. Land and water based exercise therapies for musculoskeletal conditions. Best Practice & Research Clinical Rheumatology, vol. 22(3), 407-418. doi>
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2002. Pragmatic, primary case-based randomised trials for shoulder pain: the issue of external vaildity. Rheumatology, vol. 41(2), 45.
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2002. Randomised study of epidural vesrus non-epidural analgesia for labour long term outcome. British Medical Journal.
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2001. A pragmatic randomised controlled trial (RCT) in primary care for shoulder pain: content of the physiotherapy intervention. RHEUMATOLOGY, vol. 40, 148. link>
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2001. Prevalence of neck pain in the adult UK population. RHEUMATOLOGY, vol. 40, 147. link>
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2001. Responsiveness of the patient generated index-ankylosing spondylitis (PGI-AS). RHEUMATOLOGY, vol. 40, 138-139. link>
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2001. Validity of the patient generated index-ankylosing spondylitis (PGI-AS). RHEUMATOLOGY, vol. 40, 139. link>
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2001. Who gets persistent neck pain in the population?. RHEUMATOLOGY, vol. 40, 132. link>
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2001. Comparison of group and individual physiotherapy for female urinary incontinence in primary care: pilot study. Physiotherapy, vol. 87(5), 235-242.
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1998. Sacroiliitis in an HLA B27-negative patient following giardiasis. Br J Rheumatol, vol. 37(5), 581-583. link>
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1997. Comparison of intra-articular local anaesthetic versus local anaesthetic plus steroid in hip arthritis. ARTHRITIS AND RHEUMATISM, vol. 40(9), 523. link>
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1996. Radiological outcome in ankylosing spondylitis: use of the Stoke Ankylosing Spondylitis Spine Score (SASSS). Br J Rheumatol, vol. 35(4), 373-376. link>
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1996. Smoking and outcome in ankylosing spondylitis. Scand J Rheumatol, vol. 25(3), 138-142. link>
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FORTHCOMING - SMOOTH.
Chapters
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2007. Treatment options of musculoskeletal pain: what is the evidence?. In Pain: Best Practice and Research Compendium. Breivic H and Shipley M (Eds.). Edinburgh: Elsevier.
Other
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2013. ASSESSING HAND OSTEOARTHRITIS USING DIGITAL PHOTOGRAPHS IN A COMMUNITY-DWELLING POPULATION: RELIABILITY AND ASSOCIATIONS WITH RADIOGRAPHIC AND CLINICAL FEATURES. OSTEOARTHRITIS AND CARTILAGE (vol. 21, p. S135). link>
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2013. COST-EFFECTIVENESS OF JOINT PROTECTION AND HAND EXERCISE FOR HAND OSTEOARTHRITIS. RHEUMATOLOGY (vol. 52, p. 147). link>
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2013. DEFINING OPTIMAL NHS OCCUPATIONAL THERAPY TREATMENT, INDIVIDUALIZED SPLINT AND PLACEBO SPLINT FOR PATIENTS WITH THUMB BASE OA: A DELPHI STUDY. RHEUMATOLOGY (vol. 52, pp. 105-106). link>
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2013. THE OA TRIAL BANK: INDIVIDUAL PATIENT DATA META-ANALYSIS OF TRIALS INVESTIGATING THE EFFECTIVENESS OF INTRA-ARTICULAR CORTICOSTEROID INJECTIONS IN PATIENTS WITH KNEE OR HIP OA. OSTEOARTHRITIS AND CARTILAGE (vol. 21, p. S259). link>
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2012. INVOLVING SERVICE USERS IN TRIAL DESIGN: OUTCOMES, SPLINT SELECTION AND PLACEBO DESIGN IN A TRIAL OF TREATMENT FOR THUMB BASE OSTEOARTHRITIS. RHEUMATOLOGY (vol. 51, pp. 54-55). link>
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2012. PATTERN OF INVOLVEMENT AND RISK PROFILE OF SYMPTOMATIC EROSIVE OSTEOARTHRITIS: RESULTS OF AN EXPLORATORY POPULATION-BASED STUDY. OSTEOARTHRITIS AND CARTILAGE (vol. 20, p. S22). link>
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2012. THE CLINICAL EFFECTIVENESS OF JOINT PROTECTION EDUCATION AND EXERCISES IN HAND OSTEOARTHRITIS (OA). OSTEOARTHRITIS AND CARTILAGE (vol. 20, p. S168). link>
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2010. Severity of radiographic hand osteoarthritis predicts a small increase in hand pain and functional limitation at 3-years. Osteoarthritis and cartilage (vol. 18 (suppl. 2), p. S154). Elsevier.
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2010. A MODEL OSTEOARTHRITIS CONSULTATION FOR GENERAL PRACTICE: DEVELOPMENT BY CONSENSUS. RHEUMATOLOGY (vol. 49, pp. I15-I16). link>
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2009. Do perceptions about Hand osteoarthritis change over an 18-month period?. Rheumatology (vol. 48 (suppl. 1), p. I160). Oxford Univ Press.
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2009. LAY SYMPTOM ATTRIBUTIONS FOR KNEE PAIN AND HAND PAIN: A CROSS-SECTIONAL STUDY. RHEUMATOLOGY (vol. 48, p. I12). link>
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2009. PATTERNS OF SELECTED PERIPHERAL JOINT PAINS IN COMMUNITY-DWELLING ADULTS AGED 50 YEARS AND OVER. RHEUMATOLOGY (vol. 48, p. I127). OXFORD UNIV PRESS.
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2009. Radiographic OA in the 1st CMC joint and the thumb as a whole: associations with pain, clinical features and test results. Rheumatology (vol. 48, p. I97). Oxford Univ Press.
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2009. Restricted self-care and looking after the home in adults aged 50 year and older with hand osteoarthritis; prevalence and links with joint specific characteristics. Rheumatology (vol. 48 (suppl. 1), p. I6). Oxford Univ Press.
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2009. SELF-REPORTED HAND FUNCTION AND ADAPTATION BEHAVIOUR IN COMMUNITY-DWELLING OLDER ADULTS OVER AN 18-MONTH PERIOD. RHEUMATOLOGY (vol. 48, pp. I27-I28). OXFORD UNIV PRESS.
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2009. The impact of constant and intermittent pain in people with hand osteoarthritis. Rheumatology (vol. 48 (suppl. 1), pp. I97-I98). Oxford Univ Press.
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2009. EULAR evidence-based recommendations for the diagnosis of hand osteoarthritis: report of a task force of ESCISIT. Ann Rheum Dis (vol. 68, pp. 8-17). link> doi> full text>
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2009. Hand osteoarthritis has a poor prognosis over three years: findings from the clinical assessment study of the hand (CAS-HA). Osteoarthritis and Cartilage (vol. 17 (Suppl 1), pp. S161-S162). Elsevier.
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2008. Defining clinical sub-groups of hand osteoarthritis in older adults: The clinical assessment study of the hand (CAS-HA). Rheumatology (vol. 47 (suppl. 2), p. I1). Oxford Univ Press.
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2008. The effect of adaptation behaviour on hand function in older adults with self-reported hand problems. RHEUMATOLOGY (vol. 47, pp. II23-II24). link>
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2008. Defining 18-month outcome in clinical sub-groups of hand osteoarthritis in older adults: the Clinical Assessment Study of the Hand (CAS-HA). Osteoarthritis and Cartilage (vol. 16 (Suppl. 4), pp. S121-S122). Elsevier.
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2008. Determining patterns of radiographic hand osteoarthritis in a community-dwelling population of adults aged 50 years and over using factor analysis. Osteoarthritis and Cartilage (vol. 16 (Suppl. 4), p. S159). Elsevier.
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2007. Current treatment approaches in a population-based sample with hand osteoarthritis: Comparison with EULAR recommendations. Annals of the Rheumatic Diseases (vol. 66 (suppl. 2), p. 515). BMJ Publishing Group.
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2007. Radiographic presentation of osteoarthritis of the thumb. Rheumatology (vol. 46 (suppl. 1), p. I14). Oxford Univ Press.
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2007. The impact of non-inflammatory musculoskeletal hand conditions in a community dwelling population of older adults. Rheumatology (vol. 46 (suppl. 1), pp. I20-I21). Oxford Univ Press.
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2006. Eular evidence based recommendations for the management of hand osteoarthritis - Report of a task force of the eular standing committe for international clinical studies including therapeutics (ESCISIT). ANNALS OF THE RHEUMATIC DISEASES (vol. 65, p. 412). link>
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2005. Classifying hand OA in a population of older people: A reliability study. RHEUMATOLOGY (vol. 44, p. I14). link>
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2005. The national library for health - Trauma, orthopaedics and musculoskeletal specialist libraries. RHEUMATOLOGY (vol. 44, p. I146). link>
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2004. Early physiotherapy management of back pain in primary care: a randomised clinical trial of physical treatments versus a brief pain management programme. Rheumatology.
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2004. Is video analysis of clinical interventions in treatment trials valuable? Experiences from a low back painstudy. Rheumatology.
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2004. Is video analysis of clinical interventions in treatment trials valuable? Experiences from a low back painstudy. Rheumatology.
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2004. MRC Hand programme - prevalence of hand problems and hand pain in older people: a survey of the general population in North Staffordshire. Rheumatology.
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2004. PANTHER - Issues of generalisability in randomised clinical trials. Rheumatology.
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2004. PANTHER - Physiotherapists' perceived predictors of outcome in neck pain. Rheumatology.
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2004. Physiotherapists' perceived predictors of outcome in neck pain. Rheumatology (vol. 43, p. ii153).
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2004. Prognostic indicators of outcome in shoulder pain: results from an analysis of two pragmatic, primary care-based randomised trials. Rheumatology (vol. 43, p. 72).
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2004. The Development of a Hand Assessment for Clinical Research: A Consensus Study using a Modified Delphi Approach. Rheumatology.
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2004. The impact of hand osteoarthritis on the individual. Rheumatology.
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2003. Cost of minimisation analysis of local conticosteroid injection versus physiotherapy for the treatment of new episodes of unilateral shoulder pain in primary care. Rheumatology.
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2003. Long-term follow-up of a pragmatic, primary care based randomised trials for shoulder pain shoulder trials data. Rheumatology.
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2003. Reliability of two instruments for use in a pilot survey of hand pain in older people. Rheumatology.
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2003. The development of a hand survey questionnaire for an assessment of hand problems in older people. Rheumatology.
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2003. The effectiveness of manual therapy or pulsed shortwave diathermy in addition to exercise & advice for neck disorders: a pragmatic randomized controlled trial in physical therapy clinics. Arthritis & Rheumatism.
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2002. Associations between impairment and activity limitation in rheumatoid arthritis (RA). ARTHRITIS AND RHEUMATISM (vol. 46, p. S557). link>
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2002. Pragmatic primary care based randomised trials for shoulder pain: the issue of external validity.
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2002. Recruitment in the real world - barriers and aids. Rheumatology (vol. 41, p. 88).
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2001. Pragmatic randomised controlled trial of local steroid injection and physiotherapy for the treatment of new episodes of shoulder pain in primary care. Rheumatology (vol. 40, p. 77).
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2001. Pragmatic primary care based randomised controlled trial for shoulder pain: do patients' treatment preferences affect outcome?. Rheumatology (vol. 40, p. 136).
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2001. Randomised study of epidural versus non-epidural analgesia for labour long term outcome. Proceedings of 29th British Congress of Obstetricians & Gynaecologists, Birmingham, 10-13 July 01 2001.
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Assessing features of hand osteoarthritis using digital images: Inter-observer reliability between health professionals. Royal College of Nursing (RCN) Conference, 2007.
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Defining the content of an opportunistic osteoarthritis consultation with health care professionals:A Delphi consensus study. Annals of Rheumatic Disease (vol. 70, p. 756). doi>
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Multidisciplinary interventions for multisite osteoarthritis in primary care: A systematic review. Osteoarthritis and Cartilage (vol. 20, p. s190).
My contribution at Keele and nationally has included
- Leading innovations in evidence-based practice training at Keele by:
- developing programmes and teaching on trials and systematic reviews for the Masters in Medical Science, a unique setting for general practice training as well as postgraduate training for other professions.
- co-editing a book on evidence based rheumatology practice for therapists
- Invited by the British Society for Rheumatology to sit on the Guideline Development Group for the NICE osteoarthritis guidelines, a national and international resource for osteoarthritis care.
- Invited by the Arthritis Research Campaign to contribute to policy committees for Osteoarthritis Clinical Studies, and Research and Academic Capacity.

