Key publications
Nunns M, Mayhew D, Ford T, Rogers M, Curle C, Logan S, Moore D (2018). Effectiveness of nonpharmacological interventions to reduce procedural anxiety in children and adolescents undergoing treatment for cancer: a systematic review and meta-analysis.
Psychooncology,
27(8), 1889-1899.
Abstract:
Effectiveness of nonpharmacological interventions to reduce procedural anxiety in children and adolescents undergoing treatment for cancer: a systematic review and meta-analysis.
OBJECTIVE: Children and young people (CYP) with cancer undergo painful and distressing procedures. We aimed to systematically review the effectiveness of nonpharmacological interventions to reduce procedural anxiety in CYP. METHODS: Extensive literature searches sought randomised controlled trials that quantified the effect of any nonpharmacological intervention for procedural anxiety in CYP with cancer aged 0 to 25. Study selection involved independent title and abstract screening and full text screening by two reviewers. Anxiety, distress, fear, and pain outcomes were extracted from included studies. Where similar intervention, comparator, and outcomes presented, meta-analysis was performed, producing pooled effect sizes (Cohen's d) and 95% confidence intervals (95% CI). All other data were narratively described. Quality and risk of bias appraisal was performed, based on the Cochrane risk of bias tool. RESULTS: Screening of 11 727 records yielded 56 relevant full texts. There were 15 included studies, eight trialling hypnosis, and seven nonhypnosis interventions. There were large, statistically significant reductions in anxiety and pain for hypnosis, particularly compared with treatment as usual (anxiety: d = 2.30; 95% CI, 1.30-3.30; P
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Nunns MP, House CM, Rice H, Mostazir M, Davey P, Stiles V, Fallowfield J, Allsopp A, Dixon SJ (2016). Four biomechanical and anthropometric measures predict tibial stress fracture:. A prospective study of 1065 Royal Marines.
British Journal of Sports MedicineAbstract:
Four biomechanical and anthropometric measures predict tibial stress fracture:. A prospective study of 1065 Royal Marines
Background: Tibial stress fractures cause a significant burden to Royal Marines recruits. No prospective running gait analyses have previously been performed in military settings.
Aim: We aimed to identify biomechanical gait factors and anthropometric variables associated with increased risk of TSF.
Methods: 1065 Royal Marines recruits were assessed in week-2 of training. Bilateral plantar pressure and 3D lower limb kinematics were obtained for barefoot running at 3.6 m.s-1, providing dynamic arch index, peak heel pressure and lower limb joint angles. Age, bimalleolar breadth, calf girth, passive hip internal/external range of motion and body mass index (BMI) were also recorded. Ten recruits who sustained a TSF during training were compared with 120 recruits who completed training injury-free using a binary logistic regression model to identify injury risk factors.
Results: Four variables significantly (p
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Nunns M, House C, Fallowfield J, Allsopp A, Dixon S (2013). Biomechanical characteristics of barefoot footstrike modalities.
J Biomech,
46(15), 2603-2610.
Abstract:
Biomechanical characteristics of barefoot footstrike modalities.
Barefoot running has increased in popularity over recent years, with suggested injury risk and performance benefits. However, despite many anecdotal descriptions of barefoot running styles, there is insufficient evidence regarding the specific characteristics of barefoot running. The present study provided reference data for four footstrike modalities adopted across a large cohort of habitually shod male runners while running barefoot: heel strikers (HS), midfoot strikers (MS), forefoot strikers (FS) and a newly defined group, toe runners (TR - contact made only with the forefoot), compared with the three modalities previously reported. Plantar pressure analysis was used for the classification of footstrike modality, with clearly distinguishable pressure patterns for different modalities. In the present study, the distribution of footstrike types was similar to that previously observed in shod populations. The absence of differences in ground contact time and stride length suggest that potential performance benefits of a non-HS style are more likely to be a function of the act of running barefoot, rather than of footstrike type. Kinematic data for the knee and ankle indicate that FS and TR require a stiffer leg than HS or MS, while ankle moment and plantar pressure data suggest that a TR style may put greater strain on the plantar-flexors, Achilles tendon and metatarsal heads. TR style should therefore only be adopted with caution by recreational runners. These findings indicate the importance of considering footstrike modality in research investigating barefoot running, and support the use of four footstrike modalities to categorise running styles.
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Publications by year
In Press
Rice HM, Nunns M, House C, Fallowfield J, Allsopp A, Dixon S (In Press). A narrow bimalleolar width is a risk factor for ankle inversion injury in male military recruits: a prospective study.
Clinical Biomechanics Full text.
Nunns M, Dixon SJ, Clarke J, carre M (In Press). Boot-insole effects on comfort and plantar loading at the heel and fifth metatarsal during running and turning in soccer.
Journal of Sports Sciences Full text.
Moore D, Nunns M, Shaw L, Rogers M, Walker E, Ford T, Garside R, Ukoumunne O, Titman P, Shafran R, et al (In Press). Improving the mental health of children and young people with long term conditions: Linked evidence syntheses.
Health Technology Assessment Full text.
Nunns MPI, Shaw L, Briscoe S, Thompson Coon J, Hemsley A, McGrath JS, Lovegrove CJ, Thomas D, Anderson R (In Press). What is the effectiveness and cost-effectiveness of hospital-based multi-component strategies to reduce the length of stay of planned inpatient admissions of older adults.
Health Services and Delivery Research Full text.
2019
Shaw L, Moore D, Nunns M, Thompson Coon J, Ford T, Berry V, Walker E, Heyman I, Dickens C, Bennett S, et al (2019). Experiences of interventions aiming to improve the mental health and well-being of children and young people with a long-term physical condition: a systematic review and meta-ethnography.
Child Care Health DevAbstract:
Experiences of interventions aiming to improve the mental health and well-being of children and young people with a long-term physical condition: a systematic review and meta-ethnography.
BACKGROUND: Children and young people with long-term physical health conditions are at increased risk of experiencing mental health and well-being difficulties. However, there is a lack of research that explores the experiences of and attitudes towards interventions aiming to improve their mental health and well-being. This systematic review seeks to address this gap in the literature by exploring what children and young people with long-term conditions, their caregivers, and health practitioners perceive to be important aspects of interventions aiming to improve their mental health and well-being. METHODS: an information specialist searched five academic databases using predefined criteria for qualitative evaluations of interventions aiming to improve the mental health or well-being of children with long-term physical conditions. Reviewers also performed supplementary citation and grey literature searches. Two reviewers independently screened titles, abstracts, and full texts that met the inclusion criteria and conducted data extraction and quality assessment. Meta-ethnography was used to synthesize the findings. RESULTS: Screening identified 60 relevant articles. We identified five overarching constructs through the synthesis: (a) Getting in and Staying In, (b) Therapeutic Foundation, (c) Social Support, (d) a Hopeful Alternative, and (e) Empowerment. The line of argument that links these constructs together indicates that when interventions can provide an environment that allows young people to share their experiences and build empathetic relationships, it can enable participants to access social support and increase feelings of hope and empowerment. CONCLUSION: These findings may provide a framework to inform the development of mental health interventions for this population and evaluate existing interventions that already include some of the components or processes identified by this research. Further research is needed to establish which of the constructs identified by the line of argument are most effective in improving the mental well-being of young people living with long-term conditions.
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Dixon S, Nunns M, House C, Rice H, Mostazir M, Stiles V, Davey T, Fallowfield J, Allsopp A (2019). Prospective study of biomechanical risk factors for second and third metatarsal stress fractures in military recruits.
Journal of Science and Medicine in Sport,
22(2), 135-139.
Abstract:
Prospective study of biomechanical risk factors for second and third metatarsal stress fractures in military recruits
© 2018 Objectives: This prospective study investigated anatomical and biomechanical risk factors for second and third metatarsal stress fractures in military recruits during training. Design: Prospective cohort study. Methods: Anatomical and biomechanical measures were taken for 1065 Royal Marines recruits at the start of training when injury-free. Data included passive range of ankle dorsi-flexion, dynamic peak ankle dorsi-flexion and plantar pressures during barefoot running. Separate univariate regression models were developed to identify differences between recruits who developed second (n = 7) or third (n = 14) metatarsal stress fracture and a cohort of recruits completing training with no injury (n = 150) (p < 0.05). A multinomial logistic regression model was developed to predict the risk of injury for the two sites compared with the no-injury group. Multinomial logistic regression results were back transformed from log scale and presented in Relative Risk Ratios (RRR) with 95% confidence intervals (CI). Results: Lower dynamic arch index (high arch) (RRR: 0.75, CI: 0.63–0.89, p < 0.01) and lower foot abduction (RRR: 0.87, CI: 0.80–0.96, p < 0.01) were identified as increasing risk for second metatarsal stress fracture, while younger age (RRR: 0.78, CI: 0.61–0.99, p < 0.05) and later peak pressure at the second metatarsal head area (RRR: 1.19, CI: 1.04–1.35, p < 0.01) were identified as risk factors for third metatarsal stress fracture. Conclusions: for second metatarsal stress fracture, aspects of foot type have been identified as influencing injury risk. For third metatarsal stress fracture, a delayed forefoot loading increases injury risk. Identification of these different injury mechanisms can inform development of interventions for treatment and prevention.
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2018
Moore D, Russell A, Matthews J, Ford T, Rogers M, Ukoumunne O, Kneale D, Thompson Coon J, Sutcliffe K, Nunns M, et al (2018). Context and Implications Document for: School-based interventions for attention-deficit/hyperactivity disorder: a systematic review with multiple synthesis methods.
Review of Education,
6 Full text.
Nunns M, Mayhew D, Ford T, Rogers M, Curle C, Logan S, Moore D (2018). Effectiveness of nonpharmacological interventions to reduce procedural anxiety in children and adolescents undergoing treatment for cancer: a systematic review and meta-analysis.
Psychooncology,
27(8), 1889-1899.
Abstract:
Effectiveness of nonpharmacological interventions to reduce procedural anxiety in children and adolescents undergoing treatment for cancer: a systematic review and meta-analysis.
OBJECTIVE: Children and young people (CYP) with cancer undergo painful and distressing procedures. We aimed to systematically review the effectiveness of nonpharmacological interventions to reduce procedural anxiety in CYP. METHODS: Extensive literature searches sought randomised controlled trials that quantified the effect of any nonpharmacological intervention for procedural anxiety in CYP with cancer aged 0 to 25. Study selection involved independent title and abstract screening and full text screening by two reviewers. Anxiety, distress, fear, and pain outcomes were extracted from included studies. Where similar intervention, comparator, and outcomes presented, meta-analysis was performed, producing pooled effect sizes (Cohen's d) and 95% confidence intervals (95% CI). All other data were narratively described. Quality and risk of bias appraisal was performed, based on the Cochrane risk of bias tool. RESULTS: Screening of 11 727 records yielded 56 relevant full texts. There were 15 included studies, eight trialling hypnosis, and seven nonhypnosis interventions. There were large, statistically significant reductions in anxiety and pain for hypnosis, particularly compared with treatment as usual (anxiety: d = 2.30; 95% CI, 1.30-3.30; P
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Author URL.
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Shaw EH, Nunns MP, Briscoe S, Anderson R, Thompson Coon J (2018). Experiences of the ‘Nearest Relative’ provisions in the compulsory detention of people under the Mental Health Act: rapid systematic review.
Health Services and Delivery Research Full text.
Moore D, Russell A, Matthews J, Ford T, Rogers M, Ukoumunne O, Kneale D, Thompson Coon J, Sutcliffe K, Nunns M, et al (2018). School‐based interventions for attention-deficit/hyperactivity disorder: a systematic review with multiple synthesis methods.
Review of Education,
6 Full text.
2017
Nunns M, Stiles V, Fulford J, Dixon S (2017). Estimated third metatarsal bending stresses are highly susceptible to variations in bone geometry.
Footwear Science,
9(3), 127-137.
Abstract:
Estimated third metatarsal bending stresses are highly susceptible to variations in bone geometry
© 2017 Informa UK Limited, trading as Taylor. &. Francis Group. Background: Third metatarsal stress fractures are relatively common during Royal Marines recruit training; however, their aetiology is poorly understood. Mathematical modelling of the third metatarsal may aid in understanding risk factors for stress fracture, particularly if the influence of footwear on peak bending stresses can be determined. This study built on previous models of metatarsal bending stress by integrating individual metatarsal geometry and gait data. Methods: Data from five males with size 11 (UK) feet were acquired. MRI images were digitised to determine cross-sectional bone parameters. Gait variables included vertical ground reaction forces, plantar pressure and foot orientation. The magnitude and location of peak bending stresses were calculated for barefoot running, before standard issue combat boots and trainers were compared. Findings: Estimated peak compressive, tensile and torsional stresses were greater in combat assault boots than in trainers (p < 0.05) with medium effect sizes but wide confidence intervals. However, differences in bone geometry between individuals had a much greater influence on estimated peak stresses. Interpretation: Results suggest that bone geometry has a greater influence on third metatarsal stress fracture risk than footwear. Future bone stress simulations should account for bone geometry. Further development of the model in a variety of participants should proceed to verify these suggestions.
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2016
Jie LJ, Goodwin V, Kleynen M, Braun S, Nunns M, Wilson MR (2016). Analogy learning in Parkinson’s; as easy as a walk on the beach: a proof-of-concept study.
International Journal of Therapy and RehabilitationAbstract:
Analogy learning in Parkinson’s; as easy as a walk on the beach: a proof-of-concept study
Background/Aims: Analogy learning is a motor learning strategy that uses biomechanical metaphors to chunk together explicit rules of a to-be-learned motor skill. This proof-of-concept study aims to establish the feasibility and potential benefits of analogy learning in enhancing stride length regulation in people with Parkinson’s.
Methods: Walking performance of thirteen individuals with Parkinson’s was analysed using a Codamotion analysis system. An analogy instruction; “following footprints in the sand” was practiced over 8 walking trials. Single- and dual- (motor and cognitive) task conditions were measured before training, immediately after training and 4-weeks post training. Finally, an evaluation form was completed to examine the interventions feasibility.
Findings: Data from 12 individuals (6 females and 6 males, mean age 70, Hoehn and Yahr I-III) were analysed, one person withdrew due to back problems. In the single task condition, statistically and clinically relevant improvements were obtained. A positive trend towards reducing dual task costs after the intervention was demonstrated, supporting the relatively implicit nature of the analogy. Participants reported that the analogy was simple to use and became easier over time.
Conclusions: Analogy learning is a feasible and potentially implicit (i.e. reduced working memory demands) intervention to facilitate walking performance in people with Parkinson’s.
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Nunns MPI, Dixon SJ, Clarke J, Carré M (2016). Boot-insole effects on comfort and plantar loading at the heel and fifth metatarsal during running and turning in soccer.
J Sports Sci,
34(8), 730-737.
Abstract:
Boot-insole effects on comfort and plantar loading at the heel and fifth metatarsal during running and turning in soccer.
Plantar loading may influence comfort, performance and injury risk in soccer boots. This study investigated the effect of cleat configuration and insole cushioning levels on perception of comfort and in-shoe plantar pressures at the heel and fifth metatarsal head region. Nine soccer academy players (age 15.7 ± 1.6 years; height 1.80 ± 0.40 m; body mass 71.9 ± 6.1 kg) took part in the study. Two boot models (8 and 6 cleats) and two insoles (Poron and Poron/gel) provided four footwear combinations assessed using pressure insoles during running and 180° turning. Mechanical and comfort perception tests differentiated boot and insole conditions. During biomechanical testing, the Poron insole generally provided lower peak pressures than the Poron/gel insole, particularly during the braking step of the turn. The boot model did not independently influence peak pressures at the fifth metatarsal, and had minimal influence on heel loads. Specific boot-insole combinations performed differently (P
Abstract.
Author URL.
Nunns MP, House CM, Rice H, Mostazir M, Davey P, Stiles V, Fallowfield J, Allsopp A, Dixon SJ (2016). Four biomechanical and anthropometric measures predict tibial stress fracture:. A prospective study of 1065 Royal Marines.
British Journal of Sports MedicineAbstract:
Four biomechanical and anthropometric measures predict tibial stress fracture:. A prospective study of 1065 Royal Marines
Background: Tibial stress fractures cause a significant burden to Royal Marines recruits. No prospective running gait analyses have previously been performed in military settings.
Aim: We aimed to identify biomechanical gait factors and anthropometric variables associated with increased risk of TSF.
Methods: 1065 Royal Marines recruits were assessed in week-2 of training. Bilateral plantar pressure and 3D lower limb kinematics were obtained for barefoot running at 3.6 m.s-1, providing dynamic arch index, peak heel pressure and lower limb joint angles. Age, bimalleolar breadth, calf girth, passive hip internal/external range of motion and body mass index (BMI) were also recorded. Ten recruits who sustained a TSF during training were compared with 120 recruits who completed training injury-free using a binary logistic regression model to identify injury risk factors.
Results: Four variables significantly (p
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2015
Dixon S, Nunns M, TenBroek T (2015). Influence of increased shoe lateral stiffness on running biomechanics in older females.
Nunns M, Stiles V (2015). The influence of variable medial–lateral stiffness footwear on frontal plane kinematics and joint moments at the knee and ankle in healthy young males.
Nunns M, Stiles V (2015). The influence of variations in heel and forefoot midsole stiffness on sagittal plane kinematics and joint moments at the knee and ankle.
2014
Moore IS, Pitt W, Nunns M, Dixon S (2014). Effects of a seven-week minimalist footwear transition programme on footstrike modality, pressure variables and loading rates. Footwear Science
2013
Nunns M, Rice H, House C, Fallowfield J, Allsopp A, Stiles V, Dixon S (2013). A prospective study identifying risk factors for tibial stress fracture in Royal Marine recruits: initial findings.
Dixon S, Nunns M, House C, Rice H, Stiles V (2013). Ankle joint kinematics influence risk of third metatarsal stress fracture in military recruits.
Nunns M, House C, Fallowfield J, Allsopp A, Dixon S (2013). Biomechanical characteristics of barefoot footstrike modalities.
J Biomech,
46(15), 2603-2610.
Abstract:
Biomechanical characteristics of barefoot footstrike modalities.
Barefoot running has increased in popularity over recent years, with suggested injury risk and performance benefits. However, despite many anecdotal descriptions of barefoot running styles, there is insufficient evidence regarding the specific characteristics of barefoot running. The present study provided reference data for four footstrike modalities adopted across a large cohort of habitually shod male runners while running barefoot: heel strikers (HS), midfoot strikers (MS), forefoot strikers (FS) and a newly defined group, toe runners (TR - contact made only with the forefoot), compared with the three modalities previously reported. Plantar pressure analysis was used for the classification of footstrike modality, with clearly distinguishable pressure patterns for different modalities. In the present study, the distribution of footstrike types was similar to that previously observed in shod populations. The absence of differences in ground contact time and stride length suggest that potential performance benefits of a non-HS style are more likely to be a function of the act of running barefoot, rather than of footstrike type. Kinematic data for the knee and ankle indicate that FS and TR require a stiffer leg than HS or MS, while ankle moment and plantar pressure data suggest that a TR style may put greater strain on the plantar-flexors, Achilles tendon and metatarsal heads. TR style should therefore only be adopted with caution by recreational runners. These findings indicate the importance of considering footstrike modality in research investigating barefoot running, and support the use of four footstrike modalities to categorise running styles.
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Author URL.
Rice H, Nunns M, House C, Fallowfield J, Allsopp A, Dixon S (2013). High medial plantar pressures during barefoot running are associated with increased risk of ankle inversion injury in Royal Marine recruits.
Gait and Posture,
38(4), 614-618.
Abstract:
High medial plantar pressures during barefoot running are associated with increased risk of ankle inversion injury in Royal Marine recruits
Background: Ankle inversion injury is common in military populations but associated biomechanical risk factors are largely unknown. This prospective study examined the association between pressure and kinematic variables, and ankle inversion injury risk in Royal Marine (RM) recruits. It was hypothesised that a more medially concentrated pressure at the heel-off phase of stance, greater impulse and peak pressure at the first metatarsal head, greater peak rearfoot eversion angle and greater eversion excursion would be associated with ankle inversion injury. Methods: Data from 145 male, injury-free RM recruits were recorded in week-2 of a 32-week military training programme. Each recruit completed five running trials at 3.6ms-1, along a 2m pressure plate. Kinematic data were simultaneously recorded. Injuries sustained during the training programme were prospectively recorded. Findings: Data from eleven recruits who had suffered an ankle inversion injury during RM training were compared with 20 uninjured controls. The injury group displayed a higher (P < 0.05) peak first metatarsal pressure, peak metatarsal impulse and more medially concentrated pressure at heel-off than control recruits. There were no differences in kinematic variables between groups. The injury group had a lower body mass than controls (P < 0.05). Interpretations: the findings from this study support existing literature, providing evidence that high medial concentration of vertical forces when running are associated with increased ankle inversion injury risk. This may be due to the lateral ankle ligaments being less accustomed to loading, resulting in relatively weak lateral ligaments, or ligaments less able to deal with fatigue than those of the control group. © 2013.
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2012
Nunns MPI, Stiles VH, Dixon SJ (2012). The effects of standard issue Royal Marine recruit footwear on risk factors associated with third metatarsal stress fractures.
Nunns M, Stiles V, Dixon S (2012). The effects of standard issue Royal Marine recruit footwear on risk factors associated with third metatarsal stress fractures.
Abstract:
The effects of standard issue Royal Marine recruit footwear on risk factors associated with third metatarsal stress fractures
Abstract.
2011
Dixon S, Nunns M, House C, Fallowfield J (2011). Does limited ankle dorsi-flexion increase forefoot loading during running in military recruits?.
2009
Nunns M, Dixon SJ, Clarke J, Carré M (2009). Boot-insole effects on heel and fifth metatarsal loading for running and turning in soccer.
