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Congratulations to Professor Tim Theologis, who has been awarded three NIHR HTA grants to extend research in orthopaedic disorders in children.

Tim Theologis

Two funded projects will test new exercise programmes for children with cerebral palsy, a condition that affects movement and co-ordination. The studies will explore whether exercises targeting the leg muscles of children with cerebral palsy work better than their usual NHS physiotherapy treatment in improving their walking and their ability to carry out daily activities.

The 'stretching programme for ambulant children with cerebral palsy' (SPELL) study will test whether stretching exercises for the leg muscles have a better outcome in walking and daily activity than current physiotherapy treatment. The 'strengthening programme for ambulant adolescents with cerebral palsy' (ROBUST) study will compare the impact of resistance exercises on walking and daily activity against current physiotherapy treatment.

For both SPELL and ROBUST, Tim and co-chief investigator Professor Sally Hopewell, together with a large team of clinicians and researchers, are developing the exercise programmes with the child in mind. The aim is to make the exercises fun and interesting and include interactive technology to engage and motivate the participants. They will compare the new exercise programmes to standard NHS physiotherapy practice, and if successful, they hope that the results will be adopted widely by health professionals and help policy makers develop national guidelines for the physiotherapy treatment of children with Cerebral Palsy.

The third study funded by an NIHR HTA grant will investigate how helpful ultrasound and MRI (Magnetic Resonance Imaging) scans are in diagnosing bone and joint infections in children.

The challenge comes from the difficulty in diagnosing paediatric bone and joint infection, which is rare but can be life threatening.

"When a child is brought to the emergency department with a painful limb the diagnosis of bone or joint infection could be confused with a temporary benign swelling within their joints which does not require treatment," said Tim. "Telling them apart is often not easy, and involves x-rays, blood tests, and often ultrasound and/or MRI scans. We are aiming to better understand the role of ultrasound and MRI imaging so that we can develop clear advice on which tests to perform and when, to ensure that bone infections are diagnosed quickly and reduce unnecessary tests on children who do not have an infection."

Working with Dan Perry as co-Investigator, the study will consist of two phases. Firstly, a multicentre retrospective cohort study based on hospital records to establish the diagnostic accuracy of MRI and ultrasound and to develop a clinical algorithm for diagnosis. Secondly, to validate the algorithm in a multicentre prospective cohort study of children with suspected infection. The study will involve patients and parents in the design and implementation of the pathway.

"We hope that the pathway we produce will be adopted widely by doctors and help develop national guidelines for the investigation of bone and joint infections in children,” said Tim.

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