Optimising outcomes after upper extremity fracture
- Project No: NDORMS/2021-5
- Intake: 2021
Research Project Outline
Upper extremity fractures represent over 20% of all fractures requiring hospital treatment in the UK. After initial management with casts or surgery people are advised to rehabilitate the injured limb with advice and exercises. Our research has shown that psychosocial factors, such as fear of movement, low self-efficacy and poor social support are important predictors of poor outcome after upper extremity fracture. While these psychosocial factors need consideration, the contribution of physical impairments such as pain severity, frailty, presence of neuropathic pain, muscle weakness, proprioception deficits, loss of dexterity and comorbidities warrant further investigation. We are also unsure of the associated impacts of upper extremity injury (isolation, further injuries, loss of earnings).
Our group has experience in developing biopsychosocial interventions to optimise advice and exercise programmes for people with musculoskeletal disorders and injuries. A targeted intervention has the potential to modify physical impairments that are predictive of outcome and therefore reduce disability after upper extremity fracture.
The aims of this project are to:
- Determine candidate upper extremity impairments that warrant further investigation
- Prospectively assess the identified impairments as predictors of poor outcome in patients with an upper extremity fracture
- Synthesise evidence on interventions to target these impairments
- Co-produce an intervention with health professionals and patient representatives using the MRC framework for development of complex interventions
- Relationship Between Magnitude of Limitations and Patient Experience During Recovery from Upper-Extremity Fracture. Jayakumar P, Teunis T, Vranceanu AM, Lamb S, Ring D, Gwilym S. JBJS. 2019 Jul 22;4(3):e0002.1-7. https://journals.lww.com/jbjsoa/FullText/2019/07000/Relationship_Between_Magnitude_of_Limitations_and.4.aspx
- Prognosis Research Strategy (PROGRESS) 2: Prognostic Factor Research. Riley RD, Hayden JA, Steyerberg EW, Moons KGM, Abrams K, Kyzas PA, et al. PLoS Med. 2013 10(2): e1001380. https://doi.org/10.1371/journal.pmed.1001380
Details of Research Group
The DPhil will be jointly supervised by Dr Steve Gwilym, Dr David Keene, and Dr Bethany Fordham, based across the Oxford Trauma and Emergency Care Group and the Centre for Rehabilitation Research in the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford.
- Dr Steve Gwilym is a clinician scientist orthopaedic surgeon with a specialist interest in upper limb injuries. He has supervised previous DPhil students investigating recovery after upper limb fractures and currently holds a number of national and international research grants in these areas.
- Dr David Keene is a clinical academic physiotherapist. His research focusses on the development and evaluation of complex interventions to optimise recovery and rehabilitation after musculoskeletal injury and has published work in leading journals such as the Journal of the American Medical Association and the British Medical Journal.
- Dr Bethany Fordham is a health psychologist. Her research interests are the integration of psychosocial theory and evidence-based techniques into the management of physical health conditions. Currently she is undertaking a meta-review of systematic review evidence of cognitive behavioural therapy, and is developing and testing, theoretically underpinned, behaviour change interventions within rehabilitation programmes.
The Oxford Trauma and Emergency Care Group is based in the Kadoorie Research Centre and the Centre for Rehabilitation Research is based in the Botnar Research Centre. The groups work collaboratively to produce internationally leading applied health research into musculoskeletal injury management.
Training will be provided in relevant clinical research methodology, including evidence synthesis, handling and analysis of datasets, complex intervention development, qualitative methods, and statistical techniques. In addition, courses from Oxford University Computer Sciences on key skills for the completion of a successful DPhil thesis will be available. Additional on the job training opportunities will arise, and the supervisors will encourage the student to pursue such opportunities.
A core curriculum of lectures will be taken in the first term to provide a solid foundation in a broad range of subjects including musculoskeletal biology, inflammation, epigenetics, translational immunology, data analysis and the microbiome. Students will also be required to attend regular seminars within the Department and those relevant in the wider University. Students will be expected to present data regularly in Departmental seminars, the Oxford Trauma & Emergency Care group and Centre for Rehabilitation Research meetings, and to attend external conferences to present their research globally, with limited financial support from the Department.
Students will also have the opportunity to work with the wider clinical trial investigators and teams within the groups, who work closely with colleagues in the Centre for Statistics in Medicine and the Oxford Clinical Trials Research Unit, that are based within NDORMS. Students will have access to various courses run by the Medical Sciences Division Skills Training Team and other Departments. All students are required to attend a 2-day Statistical and Experimental Design course at NDORMS and run by the IT department (information will be provided once accepted to the programme).
Further academic/project specific queries: Please contact Steve Gwilym (firstname.lastname@example.org)
How to Apply
The Department accepts applications throughout the year but it is recommended that, in the first instance, you contact the relevant supervisor(s) or the Graduate Studies Officer, Sam Burnell (Samuel.email@example.com), who will be able to advise you of the essential requirements.
Interested applicants should have, or expect to obtain, a first or upper second-class BSc degree or equivalent in a relevant subject and will also need to provide evidence of English language competence (where applicable). The application guide and form is found online and the DPhil or MSc by research will commence in October 2021.
Applications should be made to one of the following programmes using the specified course code:
D.Phil in Musculoskeletal Sciences (course code: RD_ML2)
MSc by research in Musculoskeletal Sciences (course code: RM_ML2)
For further information, please visit http://www.ox.ac.uk/admissions/graduate/applying-to-oxford