Chris Littlewood
@ChrisLittlew00d
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Professor of Musculoskeletal Research @RACER_2_UK
Cheshire, England
Joined June 2021
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Well, that's nice, I've been awarded an Honorary Fellowship by the Chartered Society of Physiotherapy for contribution to musculoskeletal research, leadership of the CSP's Scientific Panel & support of novice & early career researchers. Thank you to colleagues for nominating me😊
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I have a dream…a ‘musculoskeletal’ conference where, for a few moments, we don’t think about x-rays, MRI scans, steroid injections, biomechanics, manual therapy and we create a forum to learn from other disciplines, e.g. diabetes, cardiovascular, cancer
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Well, it’s now official - I’ll be joining
@edgehill
University from 1st January as Associate Dean for Research & Innovation in the Faculty of Health, Social Care & Medicine. Very much looking forward to it!
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'Accumulating evidence indicates that obesity causes chronic low-grade inflammation...' Adipokines in inflammation and metabolic disease 'I didn't have an injury, it just started aching/ hurting, and it's not getting better'
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The Natural History of Full-Thickness Rotator Cuff Tears '...patients with rotator cuff tears...improve over time, whether treated operatively or nonoperatively.'
Open access version here:
Useful for shared decision-making
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We can finally announce our
@RACER_2_UK
(rehab following rotator cuff repair) randomised controlled trial has been funded by
@NIHRresearch
We aim to recruit 638 participants across 24 hospitals & will be in touch with interested sites soon
@marcusbatemanPT
@B_Mzqn
@DerbyCTSU
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Life changing experience; toughest thing I've ever done! A physical & psychological rollercoaster filled with self-doubt & anxiety about being able to run another marathon! Every day filled with aches & pains! As a team we've raised over £150k; amazing!
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Does teaching physical therapists to deliver a biopsychosocial treatment program result in better patient outcomes? A randomized controlled trial no
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Congratulations Dr
@AndrewVCuff
following a successful
#PhD
defence today - rationale for use of diagnostic imaging for people with common musculoskeletal disorders. Great journey together 🤓
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A privilege to have been awarded an honorary fellowship of the chartered society of Physiotherapy tonight amidst a challenging time for the profession. I’ll be reflecting on some of these challenges and future opportunities at this weeks
#HopeSR22
conference
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Marathon number 4 done, 6 to go! Felt stronger today after struggling yesterday 😊🌳🏃♂️
#Brathay10in10
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Marathon number 9 done, one ‘lap of honour’ to go! Felt tired today and my right quad joined my right knee in complaining loudly!!
#Brathay10in10
😊🌳🏃♂️
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The advice given by physiotherapists to people with back pain in primary care 'Clinicians must avoid contradictory and unhelpful messages when giving advice'
@AndrewVCuff
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Marathon number 5 done, 5 to go! Found the first few miles tough but felt stronger in the later stages. Halfway there!
#Brathay10in10
😊🌳🏃♂️
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Pain Associated Psychological Distress is More Strongly Associated with Shoulder Pain and Function than Tear Severity in Patients Undergoing Rotator Cuff Repair are these messages reaching the clinical frontline and informing shared decision-making?
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Good news, our review led by
@WhelanGareth
'Do corticosteroid injections suppress the immune system in adults with MSK pain? SR & meta-analysis' provisionally accepted for publication. Much needed guidance - look forward to sharing the published paper
@mmoffatt408
@benedsmith
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Marathon number 8 done, 2 to go! Had to manage my knee pain over the first half and endure it for the second!
#Brathay10in10
😊🌳🏃♂️
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Our paper 'Current and future advances in practice: tendinopathies of the shoulder' has now been published
#openaccess
@mmoffatt408
@tash_maher
@gregjirving
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Marathon number 7 done, 3 to go! Struggled today; knee biting ++ 184.6 miles covered in the last 7 days!
#Brathay10in10
😊🌳🏃♂️
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Boom! 💥Marathon personal best this morning at Chester and, given my advancing years, a good for age qualifying time for London! 😊🌳🏃♂️
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Effects of manual therapy on fear avoidance, kinesiophobia & pain catastrophizing in people with chronic MSK pain: Systematic review & meta-analysis 'MT may not be superior to no treatment or other treatments' but frequently cited reason for use
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This was a difficult trial to deliver through Covid, thanks to an amazing team
@mmoffatt408
@DerbyCTSU
@DerbyRandD
@JuliaWadeBris
@LisaPitt19
@staceylalande
@LisaArm41464044
@catrinulphysio
@garethphysio1
@helen_hedfan
@jess_pawson
& colleagues, and all patients who took part
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Well, I wasn’t expecting that! Oulton Park marathon - PB by 5 mins and possible Boston qualifying time! 😊🌳🏃♂️
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Comprehensive supervised heavy training program versus home training regimen in patients with subacromial impingement syndrome: a randomized trial the comparative effects of different exercise regimes remains unremarkable
@julie_bury
@mmoffatt408
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Marathon number three done, 7 to go! Heels felt the best they have in months today but quads shot and not playing ball!
#Brathay10in10
😊🌳🏃♂️
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Many folk are interested in doing a PhD but often don't know what a PhD thesis 'looks' like. Understanding this can be helpful in preparation and planning. Here is an open access repository that you can search for examples:
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This is the philosophy that underpins our community of practice, it doesn't matter whether someone 'can't help back' - although they often do, but don't realise!! It's just nice to help, and that is enough.
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On Tuesday 4 October I'll be talking about my career journey and the importance of people. It's open to anyone who might be interested and you can join in person or via Teams. The registration form is available here:
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So pleased to welcome
@garethphysio1
to
@edgehill
to start his
#PhD
journey
#lifestyle
#clinicaloutcomes
#orthopaedics
🤓🤓🤓
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Accuracy of placement of ultrasound-guided corticosteroid injection for subacromial pain (impingement) syndrome does not influence pain and function
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Congratulations to
@WhelanGareth
- The Impact of introducing hydrodistension as a treatment for frozen shoulder in a primary care musculoskeletal service: A retrospective audit - accepted for publication; data from 204 patients 👏will share
#openaccess
paper soon
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Pay attention to the evidence: in the longer term, intraarticular corticosteroid injections offer only harm for ......
Cortisone injections for knee osteoarthritis are harmful in the longer term, so doctors should stop doing them
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No difference between manual therapy & exercise versus sham ultrasound for people with rotator cuff disorder unclear why manual therapy & local shoulder exercise feature so strongly in clinical practice guidelines & ultrasound has been discarded. Thoughts?
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What matters most: 'Community physiotherapists may aim for a more person-centered approach; however, their habits, practices and behaviors remain within a culturally entrenched, clinician-centric, biomedical model.'
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We've completed our POWER pilot study; physio-led exercise vs waiting list for patients awaiting rotator cuff repair surgery. We're plotting next steps & are keen to consult with UK clinicians. Please email chris.littlewood
@edgehill
.ac.uk if you'd like to join us
@mmoffatt408
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Our
@NIHRresearch
funded
@RACER_2_UK
is live! 10-month set-up period working with 24 hospitals, aiming to randomise 638 patients who have undergone rotator cuff repair. Individualised vs standard/protocol based rehabilitation
@DerbyCTSU
@B_Mzqn
@marcusbatemanPT
@VijayGC
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It's torn, so surely it needs repairing is the consistent message we hear from patients. Why would 'physio' help? We don't know the answer to that but many patients with rotator cuff tears do as well without surgery, so I think we just need to be more open about treatment options
The Natural History of Full-Thickness Rotator Cuff Tears '...patients with rotator cuff tears...improve over time, whether treated operatively or nonoperatively.'
Open access version here:
Useful for shared decision-making
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Attempting to Separate Placebo Effects from Exercise in Chronic Pain: A Systematic Review and Meta-analysis
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Fantastic news that
@tash_maher
@PaulineG_27
@kieranmitham
have all been awarded Health Education England/NIHR Pre-doctoral Fellowships - looking forward to the journey! Congratulations all!
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What is ‘successful rehabilitation’? A multi-stakeholder nominal group technique study to inform rehabilitation outcome measurement
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It's really interesting looking at the characteristics of patients with 'musculoskeletal' pain in randomised controlled trials, consistently the majority are reported as overweight/ obese, yet little is done in these trials to address that.
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I think the time has come to compare 'best practice physiotherapy' with natural history for common musculoskeletal conditions in high-quality research to optimise service provision and ensure patients can access the most appropriate care. Not a threat, just an evolution.
The physio profession is struggling to prove it has any significant efficacy and many just cant accept or deal with that!
Ask yourself what would happen to the world if the physio profession disappeared over night?
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@ListonMatt
The post-doctoral cliff edge is as apparent as ever. Many physio’s now completing PhD’s, including through fellowships, but then desire from Trusts to support clinical-academic roles for physio’s is limited.
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Thank you everyone, I've had so many kind and thoughtful messages since my lecture on Tuesday. Was the most challenging presentation I have ever done! Will share the link to the recording when available! Now looking forward to a day off for
@mooj07
's wedding!!
A truly inspirational and emotional evening listening to my best friend
@ChrisLittlew00d
@edgehill
it’s been a pleasure to work with you and be part of the journey with so many other amazing people! You’ve helped so many other people on the way including me. Thank you my friend
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General health status & smoking reported as independent predictors of outcome following arthroscopic rotator cuff repair 'importance is often placed on technical aspects of the operation and rehabilitation..' Other factors important too
#lifestyle
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Developing an application for the UK Pre-Doctoral Clinical and Practitioner Academic Fellowship (PCAF): The collective experience of a community of physiotherapists
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How effective are physiotherapy interventions in treating people with sciatica? A systematic review and meta-analysis
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Our
@NIHRresearch
funded
@RACER_2_UK
trial (rehabilitation after rotator cuff repair) now has Health Research Authority & Ethical approval. Site initiation visits booked from May - 638 participants, 24 hospitals - all systems go!
@DerbyCTSU
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Excellent news! 'Developing an application for the UK Pre-Doctoral Clinical & Practitioner Academic Fellowship (PCAF): The collective experience of a community of physiotherapists' led by
@PaulineG_27
accepted 4 publication in Physiotherapy! Should be useful for other applicants
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Barriers & enablers to implementation of a self-managed exercise intervention
Physiotherapists might not implement research evidence because the findings do not align with their current practice preferences.
#OpenAccess
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Sometimes musculoskeletal disorders are viewed as less ‘important’ than other ‘diseases’. This report, among many others, highlights why that narrative needs to be challenged! We have a long way to go to optimise care for people with musculoskeletal disorders.
A new AIHW report reveals the top 4 disease groups that cost the most, making up one-third of health spending. Highlights the need for less low value care and more high value care. See more:
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Effect of subacromial decompression during repair of rotator cuff tears 'These results suggest that ASD has a limited effect on clinical outcomes' - we have to evolve thinking beyond technique or implant; more important factors to consider
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Hold the date! My inaugural professorial lecture at Edge Hill University entitled ‘People’ is scheduled for Tuesday 4th October starting at 6pm GMT. It will be a hybrid event and everyone is welcome! Registration details to follow shortly
@edgehill
@edgehill_HRI
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Our ‘community of practice’
#nihramc22
good times!
@julie_bury
@LisaPitt19
@PaulineG_27
@WhelanGareth
@marcusbatemanPT
@kieranmitham
@h_carter43
@foxcroftphysio
@PhysioDaveA
😊🤓
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Spent much of the morning parked on the M6, then subsequently received one research grant rejection, and then one fellowship rejection! Smooth sailing and success always welcome, but delays and rejection often the expected outcome! Onwards and upwards!
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My inaugural professorial lecture 'People' at Edge Hill University is now online:
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Oomph, academia is tough at times. Feedback: 'Not competitive - poor candidate and application'. 20 + years of graft judged not good enough! Resilience is definitely a key attribute to 'succeeding' in this game!
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Great start! Already received 18 expressions of interest to participate in our
@RACER_2_UK
trial funded by
@NIHRcommunity
Long road ahead, but looking forward to the journey
@B_Mzqn
@marcusbatemanPT
@mmoffatt408
@A_Xime
@VijayGC
@apostolosfakis
@DerbyCTSU
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Oulton Park
#marathon
finished in the snow ❄️ 🏃♂️ Quite enjoyed doing the 10 laps rather than one long course 😊
#Brathay10in10
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At 10-Years, Tendon Repair Is Superior to Physiotherapy in the Treatment of Small & Medium-Sized Rotator Cuff Tears
I wrote a blog in relation to this: As always, the devil is in the detail & headlines/titles/ abstracts, risk misrepresenting the data
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Bid submitted! An intense 2 months has flown by! Aiming to optimise care for people with MSK conditions, widen inclusivity, & foster clinical academic career development-fingers crossed!
@mmoffatt408
@rach_ward247
@DerbyCTSU
@MichaelRathleff
@MikkelBek
@TBandholm
@DrPeteMalliaras
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My PhD study: A self-managed single exercise programme versus usual physiotherapy treatment for rotator cuff tendinopathy: a randomised controlled trial (the SELF study)
#openaccess
version here:
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What are People That Seek Care for Rotator Cuff Tendinopathy Experiencing in Their Daily Life? 'tenuous relationships and limited trust with clinicians; loss of hope; and a sense that care is directionless.'
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The most contentious part of designing a clinical trial…agreeing on the acronym!!
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Study protocol for a randomized clinical trial of
glenohumeral joint steroid injection versus suprascapular nerve block in patients with frozen shoulder
@WhelanGareth
@PhysioDaveA
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Are you a UK-based physiotherapist involved in the management of patients with shoulder rotator cuff disorders? If so, please consider completing our survey:
The survey takes <10 mins. No personally identifiable data will be collected. Thanks
@mmoffatt408
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All set for
#BESS2022
@bessconference
Rehabilitation following rotator cuff repair
@RACER_2_UK
@DerbyCTSU
@B_Mzqn
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No difference in clinical outcome after rotator cuff repair performed within or later than 3 months after trauma: a retrospective cohort study non-randomised study = risk of over inferring/ mis-leading
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On 3/4 May we're hosting our 1st in-person community of practice meeting at
@edgehill_HRI
with international colleagues
@MichaelRathleff
@TBandholm
@MikkelBek
- developing collaborations and plotting plans to support clinical-academic career development; exciting times!
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10 years after first meeting in Torquay at BESS 2012 - a celebratory vino with
@marcusbatemanPT
at
#BESS22
in Liverpool. Photo courtesy of
@AnjuJaggi
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Evidence-based practice in critical care nursing; reality or rhetoric? Professor
@lyvonnetume
‘s Inaugural Lecture this evening
@edgehill
@edgehill_HRI
😊🤓
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Marathon number 6 done, 4 to go! Felt goosed before the start but felt better once I got moving!
#Brathay10in10
😊🌳🏃♂️
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POWER study results presented to the trial management group today with discussion about next steps. This was a difficult trial to deliver during Covid but completed with amazing support from colleagues!
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'Change is the only constant in life.' Huge congratulations to Dr. Maria Moffatt
@mmoffatt408
who will be taking up a new position as Lecturer in Physiotherapy at the University of Liverpool in January 2024. New horizons; our loss is definitely their gain!
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I'm fortunate to work with great colleagues doing PhD's
@julie_bury
@marcusbatemanPT
@garethphysio1
@AndrewVCuff
@Aidanoshea9632
& others on that journey
@LisaPitt19
@WhelanGareth
@tash_maher
@PaulineG_27
@kieranmitham
great to see how these clinical-academic paths have evolved
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Great work by
@Aidanoshea9632
'Barriers & facilitators related to self-management of shoulder pain: a systematic review & qualitative synthesis' accepted for publication in
@ClinicalRehab
A synthesis of all qualitative research to date - lots of clinical messages 👏
@mcveigh_joe
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In our RaCeR pilot RCT (rehab following rotator cuff repair) patients gradually removed their sling following surgery over the first 4-weeks. Significantly more patients in the early patient-directed rehabilitation group reported less sling use
@RACER_2_UK
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Do we really allow patient decision-making in rotator cuff surgery? A prospective randomized study 'The way that information on rotator cuff disorders is provided strongly influences patients’ treatment decisions'
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New cup and pen after today's visit to
@DerbyCTSU
with
@mmoffatt408
@B_Mzqn
@A_Xime
@JoanneThornhil1
@rach_ward247
Start of recruitment on the horizon so will be sharing these with participating sites soon!
@RACER_2_UK
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Embracing uncertainty - using research evidence to support shared decision making with people with shoulder pain.
@mmoffatt408
and I are launching a not-for-profit CPD course from September. 2 hours to full-day course, let us know if you would like to host.
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Welcoming
@TBandholm
@MichaelRathleff
@MikkelBek
to
@edgehill_HRI
today for our 2-day community of practice meeting 😊🤓
0
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Tremendous effort by
@staceylalande
@helen_hedfan
@jess_pawson
@LisaPitt19
@garethphysio1
@catrinulphysio
- 69/76 participants now recruited to our POWER study! What a turnaround since the start of the year! Back on track!
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We’re just looking back over books that we used to read with our kids when they were younger; good memories! Time fly’s, make the most of it!
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My face looks so much older than it did 10 years ago, but it doesn't hurt. Then I see how much reliance is placed on imaging by patients & clinicians where age-related changes are assumed to cause pain & disability. I predict we'll look back & think we got a lot of things wrong
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After 2 marathons in 2 days, my heel pain is the best it has been for 18 months! Actually able to walk in human form! Loving these pre- and post-run massages! Shame my quads are shot! Bring on marathon number 3!
#Brathay10in10
😊🌳🏃♂️
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Looking forward to joining the 3rd Shoulder Rehabilitation Conference - Zebras and Horses: Thinking outside the box in shoulder pain Here's an intro to my talk, look forward to seeing you there
#HopeSR22
@Omid_HopeUni
@ShoulderGeek1
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89% of patients reported sleep disturbances b4 rotator cuff repair surgery. 77% reported resolution of sleep disturbance by 6-months post-op (1/4 didn't); 81% reported resolution at 2-years post-op (1/5 didn't) useful info to share with patients
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Manuscript word count = 2601
Current response to reviewers comments = 6495
Almost there, possibly a couple of hours to go - useful comments making the paper better though, which is not common, so motivation maintained!
#resillience
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