Publications by category
Journal articles
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
Shaw E, Nunns M, Briscoe S, Anderson R, Thompson Coon J (In Press). A ’Rapid Best-Fit’ model for framework synthesis: using research objectives to structure analysis within a rapid review of qualitative evidence. Research Synthesis Methods
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
Parker K, Nunns M, Xiao Z, Ford T, Ukoumunne O (In Press). Characteristics and practices of school-based cluster randomised controlled trials for improving health outcomes in pupils in the UK: a methodological systematic review. BMC Medical Research Methodology
Moore D, Nunns M, Shaw L, Rogers M, Walker E, Ford T, Garside R, Ukoumunne O, Titman P, Shafran R, et al (In Press). Interventions to improve the mental health of children and young people with long-term physical conditions: Linked evidence syntheses. Health Technology Assessment
Parker K, Nunns M, Xiao Z, Ukoumunne O (In Press). Intra-cluster correlation coefficients for pupil health outcomes estimated from school-based cluster randomised trials. Journal of Clinical Epidemiology
Briscoe S, Thompson Coon J, Melendez-Torres GJ, Abbott R, Shaw E, Nunns M, Garside R (In Press). Primary care clinicians’ perspectives on interacting with patients with gynaecological conditions or symptoms suggestive of gynaecological conditions: a scoping review of qualitative studies.
NIHR web reportAbstract:
Primary care clinicians’ perspectives on interacting with patients with gynaecological conditions or symptoms suggestive of gynaecological conditions: a scoping review of qualitative studies
Background: in recent years several reports have found that women do not feel listened to either by clinicians or at the system level when discussing health care concerns. In particular, women perceive that they are treated dismissively and that their symptoms are not taken seriously. This finding is reflected both in reports on health care conditions which specifically affect women, such as endometriosis, heavy menstrual bleeding and menopause, and in reports which explore failures of the health care system to listen and intervene when patients feel they are experiencing harm. A particular issue has been highlighted around women not feeling listened to by primary care clinicians, who are seen as the ‘gatekeepers’ to the more specialist care available in secondary care services. This can lead to patients feeling that their health concerns are being dismissed without due consideration. What is less well-known is why this occurs and in what circumstances, or indeed to what extent primary care clinicians perceive that there are problems around listening to women patients.
In order to better understand this issue from the perspective of primary care clinicians, we were asked to carry out a scoping review of evidence on primary care clinicians’ views on listening to and, more broadly, interacting with women patients, including with specific groups of women patients such as ethnic minority women, LGBTQ+, older/younger and disabled women. Following initial exploratory work, we developed a protocol for a scoping review of the qualitative research evidence with the following aim and research questions.
Aim: to identify and summarise qualitative evidence on primary care clinicians’ perspectives on interacting with patients with gynaecological conditions or symptoms suggestive of gynaecological conditions.
Research questions:
1. What evidence is there about primary care clinicians’ perspectives on interacting with patients with gynaecological conditions or symptoms suggestive of gynaecological conditions?
2. What key themes have been raised about challenges of interacting with patients with gynaecological conditions or symptoms suggestive of gynaecological conditions?
Findings: Twenty-three papers, from 18 unique studies, were included in the qualitative scoping review. Most papers (n=8) were about clinicians’ experiences with diagnosing and managing endometriosis, with smaller numbers of papers discussing menopause (n=4), menorrhagia (n=3), polycystic ovary syndrome (n=3) and chronic pelvic pain (n=2). Infertility disease, menstrual disorders and premenstrual symptoms each were discussed in one paper. The papers reported data collected in the UK (n=8), Australia (n=7), US (n=3), Netherlands (n=2), Sweden (n=2) and Norway (n=1). Primary care clinicians who participated in the studies included GPs, nurse practitioners, internists/family practitioners, pharmacists and a community gynaecologist. GPs were included in the majority of papers (n=20).
We also identified a selection of themes and subthemes on or related to the challenge of interacting with patients with gynaecological conditions or symptoms suggestive of gynaecological conditions. Subthemes were organised within four thematic ‘levels’: the individual clinician; structural and organisational factors; community and external factors; and factors specific to gynaecological conditions and symptoms.
Abstract.
Anderson R, Booth A, Eastwood A, Rodgers M, Shaw E, Thompson Coon J, Briscoe S, Cantrell A, Chambers D, Goyder E, et al (In Press). Synthesis for health services and policy: the craft and science of question formulation and scoping.
Health Services and Delivery Research,
TBC, 1-1.
Abstract:
Synthesis for health services and policy: the craft and science of question formulation and scoping
Background:
For systematic reviews to be rigorous, deliverable and useful they need a well-defined review question. Scoping for a review also requires the specification of clear inclusion criteria and planned synthesis methods. Guidance is lacking on how to develop these, especially within the context of undertaking rapid and responsive systematic reviews to inform health services and health policy.
Objective:
This report describes and discusses the experiences of review scoping of three commissioned research centres that conducted evidence syntheses to inform health and social care organisation, delivery and policy in the UK, between 2017 and 2020.
Data sources:
Researcher recollection, project meeting minutes, e-mail correspondence with stakeholders, and scoping searches; from allocation of a review topic through to review protocol agreement.
Methods:
We produced eight descriptive case studies of selected reviews from the three teams. From these we identified key issues that shape the processes of scoping and question formulation for evidence synthesis. The issues were then discussed and lessons drawn.
Findings:
Across the eight diverse case studies we identified 14 recurrent issues that were important in shaping the scoping processes and formulating a review’s questions. These were ‘consultative issues’, relating to securing input from review commissioners, policy customers, experts, patients and other stakeholders: managing and deciding priorities; reconciling different priorities/perspectives; achieving buy-in and engagement; educating the end-user about synthesis processes and products, and; managing stakeholder expectations. There were ‘interface issues’ relating to the interaction between review team and potential review users: identifying the niche/gap and optimising value; assuring and balancing rigour/reliability/relevance, and; assuring transferability/applicability of study evidence to specific policy/service user contexts. There were also ‘technical issues’ associated with the methods and conduct of the review: choosing the method(s) of synthesis; balancing fixed versus fluid review questions/components/definitions; taking stock of what research already exists; Mapping vs Scoping vs Reviewing; scoping/relevance as a continuous process not just at initial stage, and; calibrating general versus specific and broad versus deep coverage of topics.
Limitations:
As a retrospective joint reflection by review teams on their experiences of scoping processes, this report is not based on prospectively collected research data. Also, our evaluations were not externally validated by, for example, policy and service evidence users or patients and the public.
Conclusions:
We have summarised our reflections on scoping from this programme of reviews as 14 common issues and 28 practical ‘lessons learned’. Effective scoping of rapid, responsive reviews extends beyond information exchange and technical procedures for specifying a ‘gap’ in the evidence. These considerations work alongside social processes, in particular the building of relationships and shared understanding between reviewers, research commissioners and potential review users that may be reflective of consultancy, negotiation, and co-production models of research and information use.
Funding:
Commissioned by the National Institute of Health Research Heath Services and Delivery Research programme as NIHR132708 (including work from Award IDs:. 16/47/11, 16/47/17, 16/47/22).
Abstract.
Parker K, Eddy S, Nunns M, Xiao Z, Ford T, Eldridge S, Ukoumunne O (In Press). Systematic review of the characteristics of school-based feasibility cluster randomised trials of interventions for improving the health of pupils in the United Kingdom. Pilot and Feasibility Studies
Lear R, Metcalf B, Brailey G, Nunns M, Bond B, Hillsdon M, Pulsford R (2023). Associations of habitual physical activity and carotid-femoral pulse wave velocity; a systematic review and meta-analysis of observational studies.
PLoS One,
18(4).
Abstract:
Associations of habitual physical activity and carotid-femoral pulse wave velocity; a systematic review and meta-analysis of observational studies.
The aim of this review was to understand the association between habitual physical activity (hPA) and carotid-femoral pulse wave velocity (cfPWV) in an ostensibly healthy adult population. Searches were performed in MEDLINE Web of Science, SPORTDiscus and CINAHL databases published up to 01/01/2022 (PROSPERO, Registration No: CRD42017067159). Observational English-language studies assessing the relationship between cfPWV and hPA (measured via self-report or device-based measures) were considered for inclusion in a narrative synthesis. Studies were excluded if studying specific disease. Studies were further included in pooled analyses where a standardised association statistic for continuous hPA and cfPWV was available. 29 studies were included in narrative synthesis, of which 18 studies provided sufficient data for pooled analyses, totalling 15,573 participants. A weak, significant, negative correlation between hPA and cfPWV was observed; partial r = -0.08 95%CI [-0.15, -0.01]; P = 0.045. Heterogeneity was high (I2 = 94.5% P
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Shaw L, Nunns M, Briscoe S, Garside R, Turner M, Melendez-Torres GJ, Lawal HM, Coon JT (2023). Optimising the prescribing of drugs that may cause dependency: an evidence and gap map of systematic reviews.
J Health Serv Res PolicyAbstract:
Optimising the prescribing of drugs that may cause dependency: an evidence and gap map of systematic reviews.
OBJECTIVES: We set out to map the quantitative and qualitative systematic review evidence available to inform the optimal prescribing of drugs that can cause dependency (benzodiazepines, opioids, non-benzodiazepine hypnotics, gabapentinoids and antidepressants). We also consider how this evidence can be used to inform decision-making in the patient care pathway for each type of medication. METHODS: Eight bibliographic databases were searched for the period 2010 to 2020. All included reviews were initially appraised using four items from the Collaboration for Environmental Evidence Synthesis Assessment Tool, with reviews that scored well on all items proceeding to full quality appraisal. Key characteristics of the reviews were tabulated, and each review was incorporated into an evidence and gap map based on a patient care pathway. The care pathway was based upon an amalgamation of existing NICE guidelines and feedback from clinical and patient stakeholders. RESULTS: We identified 80 relevant reviews and displayed them in an evidence and gap map. The evidence included in these reviews was predominantly of low overall quality. Areas where systematic reviews have been conducted include barriers and facilitators to the deprescribing of drugs that may cause dependency, although we identified little evidence exploring the experiences or evaluations of specific interventions to promote deprescribing. All medications of interest, apart from gabapentinoids, were included in at least one review. CONCLUSIONS: the evidence and gap map provides an interactive resource to support (i) policy developers and service commissioners to use evidence in the development and delivery of services for people receiving a prescription of drugs that may cause dependency, where withdrawal of medication may be appropriate, (ii) the clinical decision-making of prescribers and (iii) the commissioning of further research. The map can also be used to inform the commissioning of further systematic reviews. To address the concerns regarding the quality of the existing evidence based raised in this report, future reviews should be conducted according to best-practice guidelines. Systematic reviews focusing on evaluating interventions to promote deprescribing would be particularly beneficial, as would reviews focusing on addressing the paucity of evidence regarding the deprescription of gabapentinoids.
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Coon JT, Orr N, Shaw L, Hunt H, Garside R, Nunns M, Gröppel-Wegener A, Whear B (2022). Bursting out of our bubble: using creative techniques to communicate within the systematic review process and beyond.
Systematic Reviews,
11(1).
Abstract:
Bursting out of our bubble: using creative techniques to communicate within the systematic review process and beyond
Abstract
. Background
. Increasing pressure to publicise research findings and generate impact, alongside an expectation from funding bodies to go beyond publication within academic journals, has generated interest in alternative methods of science communication.
. Our aim is to describe our experience of using a variety of creative communication tools, reflect on their use in different situations, enhance learning and generate discussion within the systematic review community.
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. Methods
. Over the last 5 years, we have explored several creative communication tools within the systematic review process and beyond to extend dissemination beyond traditional academic mechanisms.
. Central to our approach is the co-production of a communication plan with potential evidence users which facilitates (i) the identification of key messages for different audiences, (ii) discussion of appropriate tools to communicate key messages and (iii) exploration of avenues to share them. We aim to involve evidence users in the production of a variety of outputs for each research project cognisant of the many ways in which individuals engage with information.
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. Results
. Our experience has allowed us to develop an understanding of the benefits and challenges of a wide range of creative communication tools. For example, board games can be a fun way of learning, may flatten power hierarchies between researchers and research users and enable sharing of large amounts of complex information in a thought provoking way, but they are time and resource intensive both to produce and to engage with. Conversely, social media shareable content can be quick and easy to produce and to engage with but limited in the depth and complexity of shareable information.
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. Discussion
. It is widely recognised that most stakeholders do not have time to invest in reading large, complex documents; creative communication tools can be a used to improve accessibility of key messages. Furthermore, our experience has highlighted a range of additional benefits of embedding these techniques within our project processes e.g. opening up two-way conversations with end-users of research to discuss the implications of findings.
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Abstract.
Ahuja L, Price A, Bramwell C, Briscoe S, Shaw L, Nunns M, O'Rourke G, Baron S, Anderson R (2022). Implementation of the Making Safeguarding Personal Approach to Strengths-based Adult Social Care: Systematic Review of Qualitative Research Evidence.
BRITISH JOURNAL OF SOCIAL WORK,
52(8), 4640-4663.
Author URL.
Parker K, Nunns M, Xiao Z, Ford T, Ukoumunne O (2021). Characteristics and practices of school-based cluster randomised controlled trials for improving health outcomes in pupils in the UK: a systematic review protocols. BMJ Open, 11
Walker E, Shaw E, Nunns M, Moore D, Thompson Coon J (2021). No evidence synthesis about me without me: Involving young people in the conduct and dissemination of a complex evidence synthesis.
Health Expect,
24 Suppl 1(Suppl 1), 122-133.
Abstract:
No evidence synthesis about me without me: Involving young people in the conduct and dissemination of a complex evidence synthesis.
OBJECTIVES: to describe and reflect on the methods and influence of involvement of young people with lived experience within a complex evidence synthesis. STUDY DESIGN AND SETTING: Linked syntheses of quantitative and qualitative systematic reviews of evidence about interventions to improve the mental health of children and young people (CYP) with long-term physical conditions (LTCs). METHODS: Involvement was led by an experienced patient and public involvement in research lead. Young people with long-term physical conditions and mental health issues were invited to join a study-specific Children and Young People's Advisory Group (CYPAG). The CYPAG met face to face on four occasions during the project with individuals continuing to contribute to dissemination following report submission. RESULTS: Eight young people joined the CYPAG. Their views and experiences informed (a) a systematic review evaluating the effectiveness of interventions intended to improve the mental health of CYP with LTCs, (b) a systematic review exploring the experiences of interventions intended to improve the mental well-being of CYP with LTCs and (c) an overarching synthesis. The CYPAG greatly contributed to the team's understanding and appreciation of the wider context of the research. The young people found the experience of involvement empowering and felt they would use the knowledge they had gained about the research process in the future. CONCLUSION: Creating an environment that enabled meaningful engagement between the research team and the CYPAG had a beneficial influence on the young people themselves, as well as on the review process and the interpretation, presentation and dissemination of findings.
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Thompson G, Zhelev Z, Peters J, Khalid S, Briscoe S, Shaw L, Nunns M, Ludman S, Hyde C (2021). Symptom scores in the diagnosis of pediatric cow's milk protein allergy: a systematic review.
Pediatr Allergy Immunol,
32(7), 1497-1507.
Abstract:
Symptom scores in the diagnosis of pediatric cow's milk protein allergy: a systematic review.
BACKGROUND: Cow's milk protein allergy (CMPA) is an immune-mediated allergic response to proteins in milk that is common in infants. Broad CMPA symptoms make diagnosis a challenge, particularly in primary care. Symptom scores may improve a clinician's awareness of symptoms, indicating a need for further testing. This systematic review examined the development and evaluation of such symptom scores for use in infants. METHODS: CENTRAL, MEDLINE, EMBASE and CINAHL databases were searched from inception to 3 December 2019 (Updated 14 November 2020) for diagnostic accuracy studies, randomised controlled trials, observational studies, economic evaluations, qualitative studies and studies reporting development of the tools. Data were not suitable for meta-analysis due to clinical and methodological heterogeneity, so were narratively synthesised. RESULTS: We found two symptom scores evaluated in one and fourteen studies, respectively. Estimated sensitivity and specificity ranged from 37% to 98% and 38% to 93%. The evaluations of each tool were at high risk of bias or failed to address issues such as clinical and cost-effectiveness. CONCLUSIONS: Estimates of accuracy of symptom scores for CMPA offered so far should be interpreted cautiously. Rigorous, conflict-free research based on well-defined roles for the tools is urgently required.
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Malik H, Appelboam A, Nunns M (2021). Ultrasound-directed reduction of distal radius fractures in adults: a systematic review.
Emergency Medicine Journal,
38(7), 537-542.
Abstract:
Ultrasound-directed reduction of distal radius fractures in adults: a systematic review
Objective to conduct a systematic review of the clinical literature to determine whether ultrasound can be used to improve the reduction of distal radius fractures in adults in the ED. Methodology a study protocol was registered on PROSPERO. EMBASE, PubMed/MEDLINE, the Cochrane Central Register of Controlled Trials and ClinicalTrials.gov of the US National Library of Medicine were searched for studies evaluating ultrasound-assisted distal radial fracture reductions in comparison with standard care. The primary outcome of interest was manipulation success rates, defined as the proportion of fracture manipulations resulting in acceptable anatomical alignment, with secondary outcome being subsequent surgical intervention rates in ultrasound and standard care group of patients. Results 248 were screened at title and abstract, and 10 studies were included for a narrative synthesis. The quality of this evidence is limited but suggests ultrasound is accurate in determining distal radius fracture reduction and may improve the quality of reduction compared with standard care. However, there is insufficient evidence to determine whether this affects the rate of subsequent surgical intervention or functional outcome. Conclusion There is a lack of evidence that using ultrasound in the closed reduction of distal radius fractures benefits patients. Properly conducted randomised controlled trials with patient-orientated outcomes are crucial to investigate this technology.
Abstract.
Parker K, Eddy S, Nunns M, Xiao Z, Ford T, Eldridge S, Ukoumunne O (2020). Characteristics of school-based feasibility studies with a cluster randomised trial design: a systematic review. PROSPERO: International prospective register of systematic reviews
Nunns M, John JB, McGrath JS, Shaw L, Briscoe S, Thompson Coon J, Hemsley A, Lovegrove CJ, Thomas D, Mythen MG, et al (2020). Evaluating enhanced recovery after surgery: time to cover new ground and discover the missing patient voice.
Perioperative Medicine,
9(1).
Abstract:
Evaluating enhanced recovery after surgery: time to cover new ground and discover the missing patient voice
AbstractMulticomponent peri-operative interventions offer to accelerate patient recovery and improve cost-effectiveness. The recent National Institute of Health Research-commissioned evidence synthesis review by Nunns et al. considers the effectiveness and cost-effectiveness of all types of multicomponent interventions for older adults undergoing elective inpatient surgery. Enhanced recovery programmes (ERPs) were the most commonly evaluated intervention. An association between ERPs and decreased length of stay was observed, whilst complication rates and time to recovery were static or sometimes reduced. Important areas which lack research in the context of ERPs are patient-reported outcome measures, patients with complex needs and assessment of factors pertaining to successful ERP implementation. The next generation of ERP studies should seek to develop our understanding in these key areas.
Abstract.
Briscoe S, Nunns M, Shaw L (2020). How do Cochrane authors conduct web searching to identify studies? Findings from a cross‐sectional sample of Cochrane Reviews.
Health Information & Libraries Journal,
37(4), 293-318.
Abstract:
How do Cochrane authors conduct web searching to identify studies? Findings from a cross‐sectional sample of Cochrane Reviews
AbstractBackgroundSearching the World Wide Web using search engines and websites can be conducted to identify studies for systematic reviews. When searching to support systematic reviews, the searcher faces challenges in using the basic search interfaces of most search engines and websites.ObjectivesTo describe and evaluate current practice of web searching in a cross‐sectional sample of Cochrane Reviews. The study also describes the stated aims of web searching, i.e. the identification of published or unpublished studies or both.MethodsA six‐month cross‐sectional sample of Cochrane Reviews was identified via the Cochrane Library. Reviews were inspected for detail about web searching. Findings were described and evaluated using a framework of key principles for web searching.Results423 Cochrane Reviews published August 2016–January 2017 were identified of which 61 (14%) reported web searching. Web searches were typically simplified versions of the bibliographic database search. Advanced and iterative approaches were not widely used. Google Search and Google Scholar were the most popular search engines. Most reports stated identification of grey literature as their aim.ConclusionBasic web search interfaces necessitate simple searches. However, there is scope to use more diverse search features and techniques and a greater variety of search engines.
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Westwood CS, Fallowfield JL, Delves SK, Nunns M, Ogden HB, Layden JD (2020). Individual risk factors associated with exertional heat illness: a systematic review.
Experimental Physiology,
106(1), 191-199.
Abstract:
Individual risk factors associated with exertional heat illness: a systematic review
New FindingsWhat is the topic of this review?
Exertional heat illness (EHI) remains a persistent problem for athletes and individuals. This threat remains despite numerous athletic position statements and occupational guidance policies. This review explores primary evidence that demonstrates a direct association between ‘known’ risk factors and EHI.
What advances does it highlight?
Primary evidence to support ‘known’ risk factors associated with EHI is not comprehensive. Furthermore, it is not evident that single individual factors predispose individuals to greater risk. In fact, the evidence indicates that EHI can manifest in non‐hostile compensable environments when a combination of risk factors is prevalent.
AbstractDespite the widespread knowledge of exertional heat illness (EHI) and clear guidance for its prevention, the incidence of EHI remains high. We carried out a systematic review of available literature evaluating the scientific evidence underpinning the risk factors associated with EHI. Medline, PsycINFO, SportDiscus and Embase were searched from inception to January 2019 with no date limitation, with supplementary searches also being performed. Search terms included permutations of risk and heat illness, with only studies in English included. Study selection, data extraction and quality assessment, using the QUALSYST tool, were performed by two independent reviewers. of 8898 articles identified by the searches, 42 were included in the systematic review as primary evidence demonstrating a link between a risk factor and EHI. The quality scores ranged from 57.50 to 100%, and studies were generally considered to be of strong quality. The majority of risks attributable to EHI were categorized as those associated with lifestyle factors. The findings from the systematic review suggest complex manifestation of EHI through multiple risk factors rather than any one factor in isolation. Further research is needed to explore the accumulation of risk factors to help in development of effective preventative measures.
Abstract.
Price A, Ahuja L, Bramwell C, Briscoe S, Shaw E, Nunns M, O'Rourke G, Baron S, Anderson R (2020). Research evidence on different strengths-based approaches within adult social work: a systematic review.
HS&DR Evidence Synthesis Centre Topic Report (peer-reviewed), 1-157.
Abstract:
Research evidence on different strengths-based approaches within adult social work: a systematic review
Background
A ‘strengths-based approach’ focusses on peoples’ goals and resources rather than their problems. Social care professionals and organisations are striving to practise in a strengths-based way and since the Care Act of 2014 it is an even stronger requirement. However, there are challenges in implementing strengths-based approaches into practise, and uncertainty remains about their effectiveness.
Objective
To summarise research evidence on the effectiveness and the implementation of different strengths-based approaches within adult social work in the UK.
Data sources
We searched seven databases: MEDLINE ALL, PsycINFO, Social Policy and Practice, HMIC, CINAHL, ASSIA and the Campbell Library. Supplementary web searches were conducted. No date or language limits were used.
Review methods
Eligible studies were about adults (≥18 years) being supported or assessed by social workers; or about initiatives involving adult social care teams. For the effectiveness question, outcomes could be directly related to people’s individual outcomes or outcomes at the level of families or communities. The Cochrane Effective Practice and Organisation of Care group’s Risk of Bias Tool was chosen to appraise the quality of effectiveness studies, and qualitative implementation studies were assessed using the Wallace criteria. Findings were tabulated and analysed using framework synthesis, based on the Consolidated Framework of Implementation Research (CFIR). Studies that were not synthesised were summarised descriptively.
Findings
Of 5,030 studies screened, none met our inclusion criteria for the effectiveness question. Fifteen qualitative or mixed methods studies met the criteria for the implementation question, six of which were assessed as ‘good quality’. Seven examined Making Safeguarding Personal (MSP) and the remaining eight studies examined Local Area Coordination, Solution Focused Therapy, Family Group Conferencing, Asset-based Community Development, Strengths-based with Relationship-based Approach, Asset-based approaches, and Motivational Interviewing.
Seven studies on Making Safeguarding Personal (MSP), were synthesised into the following themes of implementation factors: 1) MSP as an intervention: seen as initially demanding but with long-term advantages; required significant practice change; needed tailoring to local settings. 2) Culture and Settings: required broad cultural changes; ‘outward facing’ and smaller/specialist councils tended to find this easier. 3) Individual characteristics: enhancing the knowledge, skills and confidence of stakeholders in MSP facilitated delivery; depended on practitioner skill in engaging people being supported; and people’s willingness to engage. 4) Embedding and sustaining MSP: depended on strong leadership and active engagement at all levels; required extensive planning and shaping of safeguarding practice that was user-focussed.
For the remaining eight studies of seven strengths-based approaches, we provide a summary of their findings.
Limitations
Our findings are mainly limited by the lack of available evidence in the UK. Higher quality studies may have revealed richer explanations of implementation.
Conclusions
There is a lack of good quality research evidence evaluating the effectiveness or implementation of strengths-based approaches. The synthesis revealed a wide range of factors that enabled or inhibited successful implementation of Making Safeguarding Personal. These factors may have wider relevance for the implementation of other strengths-based models of social work practice.
Future work
Higher quality evaluations of different strengths-based social work models are required.
Study registration: PROSPERO CRD42020166870
Funding
Commissioned by the NIHR HS&DR programme as a review project (NIHR130867) within NIHR HS&DR programme, reference number 16/47/22.
Abstract.
Parker K, Nunns M, Xiao Z, Ford T, Ukoumunne OC (2020). Systematic review of the characteristics, design and analysis methods of school-based cluster randomised controlled trials for improving health outcomes in pupils in the UK. PROSPERO
John JB, Hemsley A, Nunns M, McGrath JS (2020). Time to make enhanced recovery after surgery the standard.
British Journal of Hospital Medicine,
81(3), 1-4.
Abstract:
Time to make enhanced recovery after surgery the standard
Multimodality perioperative interventions could accelerate patient recovery and improve cost-effectiveness. An evidence review found an association between enhanced recovery after surgery and decreased length of stay, while complications and recovery time were unchanged or reduced. More specialties should develop and implement enhanced recovery after surgery pathways.
Abstract.
Thompson Coon J, Gwernan‐Jones R, Garside R, Nunns M, Shaw L, Melendez‐Torres GJ, Moore D (2019). Developing methods for the overarching synthesis of quantitative and qualitative evidence: the interweave synthesis approach.
Research Synthesis Methods,
11(4), 507-521.
Abstract:
Developing methods for the overarching synthesis of quantitative and qualitative evidence: the interweave synthesis approach
The incorporation of evidence derived from multiple research designs into one single synthesis can enhance the utility of systematic reviews making them more worthwhile, useful, and insightful. Methodological guidance for mixed‐methods synthesis continues to emerge and evolve but broadly involves a sequential, parallel, or convergent approach according to the degree of independence between individual syntheses before they are combined.We present two case studies in which we used novel and innovative methods to draw together the findings from individual but related quantitative and qualitative syntheses to aid interpretation of the overall evidence base. Our approach moved beyond making a choice between parallel, sequential, or convergent methods to interweave the findings of individual reviews and offers three key innovations to mixed‐methods synthesis methods:
The use of intersubjective questions to understand the findings of the individual reviews through different lenses,
Immersion of key reviewers in the entirety of the evidence base, and
Commencing the process during the final stages of the synthesis of individual reviews, at a point where reviewers are developing an understanding of initial findings.
Underlying our approach is the process of exploration and identification of links between and across review findings, an approach that is fundamental to all evidence syntheses but usually occurs at the level of the study. Adapting existing methods for exploring and identifying patterns and links between and across studies to interweave the findings between and across reviews may prove valuable.
Abstract.
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 Dev,
45(6), 832-849.
Abstract:
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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Nunns MPI, Shaw L, Briscoe S, Thompson Coon J, Hemsley A, McGrath JS, Lovegrove CJ, Thomas D, Anderson R (2019). Multicomponent hospital-led interventions to reduce hospital stay for older adults following elective surgery: a systematic review. Health Services and Delivery Research, 7(40), 1-178.
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
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.
Abstract.
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
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
Abstract.
Author URL.
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
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
Muir D, Vat LE, Keller M, Bell T, Jørgensen CR, Eskildsen NB, Johnsen AT, Pandya-Wood R, Blackburn S, Day R, et al (2017). Abstracts from the NIHR INVOLVE Conference 2017. Research Involvement and Engagement, 3(Suppl 1).
Mayhew D, Nunns M, Moore D, Ford T (2017). Effectiveness of Non-Pharmacological Interventions to Reduce Procedural Anxiety in Children and Adolescents Undergoing Treatment for Cancer: a Systematic Review and Meta-Analysis. Pediatric Oncall, 14(4).
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
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.
Abstract.
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.
Abstract.
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
Abstract.
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
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.
Abstract.
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.
Abstract.
Conferences
Briscoe S, Shaw E, Nunns M, Lawal H, Orr N, Thompson Coon J, Garside R, Melendez-Torres GJ (2023). Health inequalities were rarely considered in systematic reviews of risk factors for hearing loss: a cross-sectional analysis. Faculty of Health and Life Sciences Early Career Researcher Network Conference. 12th - 12th Jun 2023.
Abstract:
Health inequalities were rarely considered in systematic reviews of risk factors for hearing loss: a cross-sectional analysis
Abstract.
Briscoe S, Shaw E, Nunns M, Lawal H, Orr N, Melendez-Torres GJ, Garside R, Thompson Coon J, Briscoe S (2023). Scoping and question refinement for systematic reviews commissioned by policy customers. Cochrane Colloquium. 4th - 6th Sep 2023.
Abstract:
Scoping and question refinement for systematic reviews commissioned by policy customers
Abstract.
Price A, Ahuja L, Bramwell C, Briscoe S, Shaw L, Nunns M, O’Rouke G, Baron S, Anderson R (2021). P90 Implementation of strategies for fostering strengths-based adult social work in the UK: a systematic review of research evidence. SSM Annual Scientific Meeting.
Coon JT, Orr N, Shaw E, Nunns M, Whear R (2020). BURSTING OUT OF OUR BUBBLE: USING CREATIVE TECHNIQUES TO COMMUNICATE RESEARCH FINDINGS.
Author URL.
Nunns M, Shaw L, Briscoe S, Thompson-Coon J, Hemsley A, McGrath JS, Lovegrove CJ, Thomas D, Anderson R (2019). REDUCING LENGTH OF HOSPITAL STAY FOR OLDER ELECTIVE SURGICAL INPATIENTS: FINDINGS OF a SYSTEMATIC REVIEW.
Author URL.
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.
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 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.
Dixon S, Nunns M, House C, Fallowfield J (2011). Does limited ankle dorsi-flexion increase forefoot loading during running in military recruits?.
Nunns M, Dixon SJ, Clarke J, Carré M (2009). Boot-insole effects on heel and fifth metatarsal loading for running and turning in soccer.
Reports
Shaw E, Lawal H, Briscoe S, Garside R, Thompson Coon J, Liabo K, Turner M, Nunns M, Melendez-Torres GJ (2023). Patient, Carer and Family Experiences of Seeking. Redress and Reconciliation Following a Life-Changing Event: Systematic Review of Qualitative. Evidence.
Briscoe S, Thompson Coon J, Melendez-Torres GJ, Abbott R, Shaw E, Nunns M, Garside R (2022).
Primary care clinicians’ perspectives on interacting with patients with gynaecological conditions or symptoms suggestive of gynaecological conditions: a scoping review of qualitative studies. National Institute for Health and Care Research (NIHR) Policy Research Programme.
Abstract:
Primary care clinicians’ perspectives on interacting with patients with gynaecological conditions or symptoms suggestive of gynaecological conditions: a scoping review of qualitative studies
Abstract.
Briscoe S, Thompson Coon J, Melendez-Torres GJ, Abbott R, Shaw E, Nunns M, Garside R (2022).
Primary care clinicians’ perspectives on interacting with patients with gynaecological conditions or symptoms suggestive of gynaecological conditions: a scoping review of qualitative studies.Abstract:
Primary care clinicians’ perspectives on interacting with patients with gynaecological conditions or symptoms suggestive of gynaecological conditions: a scoping review of qualitative studies
Abstract.
Shaw E, Nunns M, Spicer S, Lawal H, Briscoe S, Melendez-Torres GJ, Garside R, Liabo K, Thompson Coon J (2022).
What multi-disciplinary delivery models for Occupational Health services are effective for whom? an umbrella review. NIHR Policy Research Programme.
Abstract:
What multi-disciplinary delivery models for Occupational Health services are effective for whom? an umbrella review
Abstract.
Thompson Coon J, Nunns M, Shaw E, Briscoe S, Liabo K, Garside R, Melendez-Torres GJ, turner M (2021).
Optimising prescribing of drugs to prevent CVD and drugs that cause dependency: an evidence-gap map.Abstract:
Optimising prescribing of drugs to prevent CVD and drugs that cause dependency: an evidence-gap map
Abstract.
Shaw E, Nunns M, Briscoe S, Anderson R, Thompson Coon J (2020). Evidence for specialist treatment of people with acquired brain injury in secure psychiatric services: systematic review and narrative synthesis., NIHR Health Services and Delivery Research Topic Report.
Price A, Ahuja L, Bramwell C, Briscoe S, Shaw L, Nunns M, O'Rourke G, Baron S, Anderson R (2020). Research evidence on different strengths-based approaches within adult social work: a systematic review., NIHR.
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
Shaw E, Nunns M, Briscoe S, Anderson R, Thompson Coon J (In Press). A ’Rapid Best-Fit’ model for framework synthesis: using research objectives to structure analysis within a rapid review of qualitative evidence. Research Synthesis Methods
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
Parker K, Nunns M, Xiao Z, Ford T, Ukoumunne O (In Press). Characteristics and practices of school-based cluster randomised controlled trials for improving health outcomes in pupils in the UK: a methodological systematic review. BMC Medical Research Methodology
Moore D, Nunns M, Shaw L, Rogers M, Walker E, Ford T, Garside R, Ukoumunne O, Titman P, Shafran R, et al (In Press). Interventions to improve the mental health of children and young people with long-term physical conditions: Linked evidence syntheses. Health Technology Assessment
Parker K, Nunns M, Xiao Z, Ukoumunne O (In Press). Intra-cluster correlation coefficients for pupil health outcomes estimated from school-based cluster randomised trials. Journal of Clinical Epidemiology
Briscoe S, Thompson Coon J, Melendez-Torres GJ, Abbott R, Shaw E, Nunns M, Garside R (In Press). Primary care clinicians’ perspectives on interacting with patients with gynaecological conditions or symptoms suggestive of gynaecological conditions: a scoping review of qualitative studies.
NIHR web reportAbstract:
Primary care clinicians’ perspectives on interacting with patients with gynaecological conditions or symptoms suggestive of gynaecological conditions: a scoping review of qualitative studies
Background: in recent years several reports have found that women do not feel listened to either by clinicians or at the system level when discussing health care concerns. In particular, women perceive that they are treated dismissively and that their symptoms are not taken seriously. This finding is reflected both in reports on health care conditions which specifically affect women, such as endometriosis, heavy menstrual bleeding and menopause, and in reports which explore failures of the health care system to listen and intervene when patients feel they are experiencing harm. A particular issue has been highlighted around women not feeling listened to by primary care clinicians, who are seen as the ‘gatekeepers’ to the more specialist care available in secondary care services. This can lead to patients feeling that their health concerns are being dismissed without due consideration. What is less well-known is why this occurs and in what circumstances, or indeed to what extent primary care clinicians perceive that there are problems around listening to women patients.
In order to better understand this issue from the perspective of primary care clinicians, we were asked to carry out a scoping review of evidence on primary care clinicians’ views on listening to and, more broadly, interacting with women patients, including with specific groups of women patients such as ethnic minority women, LGBTQ+, older/younger and disabled women. Following initial exploratory work, we developed a protocol for a scoping review of the qualitative research evidence with the following aim and research questions.
Aim: to identify and summarise qualitative evidence on primary care clinicians’ perspectives on interacting with patients with gynaecological conditions or symptoms suggestive of gynaecological conditions.
Research questions:
1. What evidence is there about primary care clinicians’ perspectives on interacting with patients with gynaecological conditions or symptoms suggestive of gynaecological conditions?
2. What key themes have been raised about challenges of interacting with patients with gynaecological conditions or symptoms suggestive of gynaecological conditions?
Findings: Twenty-three papers, from 18 unique studies, were included in the qualitative scoping review. Most papers (n=8) were about clinicians’ experiences with diagnosing and managing endometriosis, with smaller numbers of papers discussing menopause (n=4), menorrhagia (n=3), polycystic ovary syndrome (n=3) and chronic pelvic pain (n=2). Infertility disease, menstrual disorders and premenstrual symptoms each were discussed in one paper. The papers reported data collected in the UK (n=8), Australia (n=7), US (n=3), Netherlands (n=2), Sweden (n=2) and Norway (n=1). Primary care clinicians who participated in the studies included GPs, nurse practitioners, internists/family practitioners, pharmacists and a community gynaecologist. GPs were included in the majority of papers (n=20).
We also identified a selection of themes and subthemes on or related to the challenge of interacting with patients with gynaecological conditions or symptoms suggestive of gynaecological conditions. Subthemes were organised within four thematic ‘levels’: the individual clinician; structural and organisational factors; community and external factors; and factors specific to gynaecological conditions and symptoms.
Abstract.
Anderson R, Booth A, Eastwood A, Rodgers M, Shaw E, Thompson Coon J, Briscoe S, Cantrell A, Chambers D, Goyder E, et al (In Press). Synthesis for health services and policy: the craft and science of question formulation and scoping.
Health Services and Delivery Research,
TBC, 1-1.
Abstract:
Synthesis for health services and policy: the craft and science of question formulation and scoping
Background:
For systematic reviews to be rigorous, deliverable and useful they need a well-defined review question. Scoping for a review also requires the specification of clear inclusion criteria and planned synthesis methods. Guidance is lacking on how to develop these, especially within the context of undertaking rapid and responsive systematic reviews to inform health services and health policy.
Objective:
This report describes and discusses the experiences of review scoping of three commissioned research centres that conducted evidence syntheses to inform health and social care organisation, delivery and policy in the UK, between 2017 and 2020.
Data sources:
Researcher recollection, project meeting minutes, e-mail correspondence with stakeholders, and scoping searches; from allocation of a review topic through to review protocol agreement.
Methods:
We produced eight descriptive case studies of selected reviews from the three teams. From these we identified key issues that shape the processes of scoping and question formulation for evidence synthesis. The issues were then discussed and lessons drawn.
Findings:
Across the eight diverse case studies we identified 14 recurrent issues that were important in shaping the scoping processes and formulating a review’s questions. These were ‘consultative issues’, relating to securing input from review commissioners, policy customers, experts, patients and other stakeholders: managing and deciding priorities; reconciling different priorities/perspectives; achieving buy-in and engagement; educating the end-user about synthesis processes and products, and; managing stakeholder expectations. There were ‘interface issues’ relating to the interaction between review team and potential review users: identifying the niche/gap and optimising value; assuring and balancing rigour/reliability/relevance, and; assuring transferability/applicability of study evidence to specific policy/service user contexts. There were also ‘technical issues’ associated with the methods and conduct of the review: choosing the method(s) of synthesis; balancing fixed versus fluid review questions/components/definitions; taking stock of what research already exists; Mapping vs Scoping vs Reviewing; scoping/relevance as a continuous process not just at initial stage, and; calibrating general versus specific and broad versus deep coverage of topics.
Limitations:
As a retrospective joint reflection by review teams on their experiences of scoping processes, this report is not based on prospectively collected research data. Also, our evaluations were not externally validated by, for example, policy and service evidence users or patients and the public.
Conclusions:
We have summarised our reflections on scoping from this programme of reviews as 14 common issues and 28 practical ‘lessons learned’. Effective scoping of rapid, responsive reviews extends beyond information exchange and technical procedures for specifying a ‘gap’ in the evidence. These considerations work alongside social processes, in particular the building of relationships and shared understanding between reviewers, research commissioners and potential review users that may be reflective of consultancy, negotiation, and co-production models of research and information use.
Funding:
Commissioned by the National Institute of Health Research Heath Services and Delivery Research programme as NIHR132708 (including work from Award IDs:. 16/47/11, 16/47/17, 16/47/22).
Abstract.
Parker K, Eddy S, Nunns M, Xiao Z, Ford T, Eldridge S, Ukoumunne O (In Press). Systematic review of the characteristics of school-based feasibility cluster randomised trials of interventions for improving the health of pupils in the United Kingdom. Pilot and Feasibility Studies
2023
Lear R, Metcalf B, Brailey G, Nunns M, Bond B, Hillsdon M, Pulsford R (2023). Associations of habitual physical activity and carotid-femoral pulse wave velocity; a systematic review and meta-analysis of observational studies.
PLoS One,
18(4).
Abstract:
Associations of habitual physical activity and carotid-femoral pulse wave velocity; a systematic review and meta-analysis of observational studies.
The aim of this review was to understand the association between habitual physical activity (hPA) and carotid-femoral pulse wave velocity (cfPWV) in an ostensibly healthy adult population. Searches were performed in MEDLINE Web of Science, SPORTDiscus and CINAHL databases published up to 01/01/2022 (PROSPERO, Registration No: CRD42017067159). Observational English-language studies assessing the relationship between cfPWV and hPA (measured via self-report or device-based measures) were considered for inclusion in a narrative synthesis. Studies were excluded if studying specific disease. Studies were further included in pooled analyses where a standardised association statistic for continuous hPA and cfPWV was available. 29 studies were included in narrative synthesis, of which 18 studies provided sufficient data for pooled analyses, totalling 15,573 participants. A weak, significant, negative correlation between hPA and cfPWV was observed; partial r = -0.08 95%CI [-0.15, -0.01]; P = 0.045. Heterogeneity was high (I2 = 94.5% P
Abstract.
Author URL.
Shaw E, Briscoe S, Orr N, Nunns M, Boddy K, Turner M, Thompson Coon J, Melendez-Torres GJ, Garside R (2023). Effectiveness of interventions to reduce carbon-emissions within secondary healthcare: Systematic review and narrative synthesis.
Briscoe S, Shaw E, Nunns M, Lawal H, Orr N, Thompson Coon J, Garside R, Melendez-Torres GJ (2023). Health inequalities were rarely considered in systematic reviews of risk factors for hearing loss: a cross-sectional analysis. Faculty of Health and Life Sciences Early Career Researcher Network Conference. 12th - 12th Jun 2023.
Abstract:
Health inequalities were rarely considered in systematic reviews of risk factors for hearing loss: a cross-sectional analysis
Abstract.
Shaw L, Nunns M, Briscoe S, Garside R, Turner M, Melendez-Torres GJ, Lawal HM, Coon JT (2023). Optimising the prescribing of drugs that may cause dependency: an evidence and gap map of systematic reviews.
J Health Serv Res PolicyAbstract:
Optimising the prescribing of drugs that may cause dependency: an evidence and gap map of systematic reviews.
OBJECTIVES: We set out to map the quantitative and qualitative systematic review evidence available to inform the optimal prescribing of drugs that can cause dependency (benzodiazepines, opioids, non-benzodiazepine hypnotics, gabapentinoids and antidepressants). We also consider how this evidence can be used to inform decision-making in the patient care pathway for each type of medication. METHODS: Eight bibliographic databases were searched for the period 2010 to 2020. All included reviews were initially appraised using four items from the Collaboration for Environmental Evidence Synthesis Assessment Tool, with reviews that scored well on all items proceeding to full quality appraisal. Key characteristics of the reviews were tabulated, and each review was incorporated into an evidence and gap map based on a patient care pathway. The care pathway was based upon an amalgamation of existing NICE guidelines and feedback from clinical and patient stakeholders. RESULTS: We identified 80 relevant reviews and displayed them in an evidence and gap map. The evidence included in these reviews was predominantly of low overall quality. Areas where systematic reviews have been conducted include barriers and facilitators to the deprescribing of drugs that may cause dependency, although we identified little evidence exploring the experiences or evaluations of specific interventions to promote deprescribing. All medications of interest, apart from gabapentinoids, were included in at least one review. CONCLUSIONS: the evidence and gap map provides an interactive resource to support (i) policy developers and service commissioners to use evidence in the development and delivery of services for people receiving a prescription of drugs that may cause dependency, where withdrawal of medication may be appropriate, (ii) the clinical decision-making of prescribers and (iii) the commissioning of further research. The map can also be used to inform the commissioning of further systematic reviews. To address the concerns regarding the quality of the existing evidence based raised in this report, future reviews should be conducted according to best-practice guidelines. Systematic reviews focusing on evaluating interventions to promote deprescribing would be particularly beneficial, as would reviews focusing on addressing the paucity of evidence regarding the deprescription of gabapentinoids.
Abstract.
Author URL.
Shaw E, Lawal H, Briscoe S, Garside R, Thompson Coon J, Liabo K, Turner M, Nunns M, Melendez-Torres GJ (2023). Patient, Carer and Family Experiences of Seeking. Redress and Reconciliation Following a Life-Changing Event: Systematic Review of Qualitative. Evidence.
Briscoe S, Shaw E, Nunns M, Lawal H, Orr N, Melendez-Torres GJ, Garside R, Thompson Coon J, Briscoe S (2023). Scoping and question refinement for systematic reviews commissioned by policy customers. Cochrane Colloquium. 4th - 6th Sep 2023.
Abstract:
Scoping and question refinement for systematic reviews commissioned by policy customers
Abstract.
Nunns M, Febrey S, Buckland J, Abbott R, Whear R, Bethel A, Shaw E, Boddy K, Thompson Coon J, Melendez-Torres GJ, et al (2023). What is the quantity, quality and scope of recent network meta-analyses evaluating the effectiveness of Glucagon-like peptide-1 receptor agonists for weight loss in obese adults? Protocol for a scoping review of network meta-analyses.
2022
Coon JT, Orr N, Shaw L, Hunt H, Garside R, Nunns M, Gröppel-Wegener A, Whear B (2022). Bursting out of our bubble: using creative techniques to communicate within the systematic review process and beyond.
Systematic Reviews,
11(1).
Abstract:
Bursting out of our bubble: using creative techniques to communicate within the systematic review process and beyond
Abstract
. Background
. Increasing pressure to publicise research findings and generate impact, alongside an expectation from funding bodies to go beyond publication within academic journals, has generated interest in alternative methods of science communication.
. Our aim is to describe our experience of using a variety of creative communication tools, reflect on their use in different situations, enhance learning and generate discussion within the systematic review community.
.
. Methods
. Over the last 5 years, we have explored several creative communication tools within the systematic review process and beyond to extend dissemination beyond traditional academic mechanisms.
. Central to our approach is the co-production of a communication plan with potential evidence users which facilitates (i) the identification of key messages for different audiences, (ii) discussion of appropriate tools to communicate key messages and (iii) exploration of avenues to share them. We aim to involve evidence users in the production of a variety of outputs for each research project cognisant of the many ways in which individuals engage with information.
.
. Results
. Our experience has allowed us to develop an understanding of the benefits and challenges of a wide range of creative communication tools. For example, board games can be a fun way of learning, may flatten power hierarchies between researchers and research users and enable sharing of large amounts of complex information in a thought provoking way, but they are time and resource intensive both to produce and to engage with. Conversely, social media shareable content can be quick and easy to produce and to engage with but limited in the depth and complexity of shareable information.
.
. Discussion
. It is widely recognised that most stakeholders do not have time to invest in reading large, complex documents; creative communication tools can be a used to improve accessibility of key messages. Furthermore, our experience has highlighted a range of additional benefits of embedding these techniques within our project processes e.g. opening up two-way conversations with end-users of research to discuss the implications of findings.
.
Abstract.
Ahuja L, Price A, Bramwell C, Briscoe S, Shaw L, Nunns M, O'Rourke G, Baron S, Anderson R (2022). Implementation of the Making Safeguarding Personal Approach to Strengths-based Adult Social Care: Systematic Review of Qualitative Research Evidence.
BRITISH JOURNAL OF SOCIAL WORK,
52(8), 4640-4663.
Author URL.
Briscoe S, Thompson Coon J, Melendez-Torres GJ, Abbott R, Shaw E, Nunns M, Garside R (2022).
Primary care clinicians’ perspectives on interacting with patients with gynaecological conditions or symptoms suggestive of gynaecological conditions: a scoping review of qualitative studies. National Institute for Health and Care Research (NIHR) Policy Research Programme.
Abstract:
Primary care clinicians’ perspectives on interacting with patients with gynaecological conditions or symptoms suggestive of gynaecological conditions: a scoping review of qualitative studies
Abstract.
Briscoe S, Thompson Coon J, Melendez-Torres GJ, Abbott R, Shaw E, Nunns M, Garside R (2022).
Primary care clinicians’ perspectives on interacting with patients with gynaecological conditions or symptoms suggestive of gynaecological conditions: a scoping review of qualitative studies.Abstract:
Primary care clinicians’ perspectives on interacting with patients with gynaecological conditions or symptoms suggestive of gynaecological conditions: a scoping review of qualitative studies
Abstract.
Shaw E, Nunns M, Spicer S, Lawal H, Briscoe S, Melendez-Torres GJ, Garside R, Liabo K, Thompson Coon J (2022).
What multi-disciplinary delivery models for Occupational Health services are effective for whom? an umbrella review. NIHR Policy Research Programme.
Abstract:
What multi-disciplinary delivery models for Occupational Health services are effective for whom? an umbrella review
Abstract.
2021
Parker K, Nunns M, Xiao Z, Ford T, Ukoumunne O (2021). Characteristics and practices of school-based cluster randomised controlled trials for improving health outcomes in pupils in the UK: a systematic review protocols. BMJ Open, 11
Shaw E, Nunns M, Briscoe S, Melendez-Torres GJ, Kneale D, McGrath J, Hemsley A, Lovegrove C, Thompson Coon J (2021). Impact of interventions to improve recovery of older adults following planned hospital admission on quality of life following discharge: linked evidence synthesis. Protocol.
Walker E, Shaw E, Nunns M, Moore D, Thompson Coon J (2021). No evidence synthesis about me without me: Involving young people in the conduct and dissemination of a complex evidence synthesis.
Health Expect,
24 Suppl 1(Suppl 1), 122-133.
Abstract:
No evidence synthesis about me without me: Involving young people in the conduct and dissemination of a complex evidence synthesis.
OBJECTIVES: to describe and reflect on the methods and influence of involvement of young people with lived experience within a complex evidence synthesis. STUDY DESIGN AND SETTING: Linked syntheses of quantitative and qualitative systematic reviews of evidence about interventions to improve the mental health of children and young people (CYP) with long-term physical conditions (LTCs). METHODS: Involvement was led by an experienced patient and public involvement in research lead. Young people with long-term physical conditions and mental health issues were invited to join a study-specific Children and Young People's Advisory Group (CYPAG). The CYPAG met face to face on four occasions during the project with individuals continuing to contribute to dissemination following report submission. RESULTS: Eight young people joined the CYPAG. Their views and experiences informed (a) a systematic review evaluating the effectiveness of interventions intended to improve the mental health of CYP with LTCs, (b) a systematic review exploring the experiences of interventions intended to improve the mental well-being of CYP with LTCs and (c) an overarching synthesis. The CYPAG greatly contributed to the team's understanding and appreciation of the wider context of the research. The young people found the experience of involvement empowering and felt they would use the knowledge they had gained about the research process in the future. CONCLUSION: Creating an environment that enabled meaningful engagement between the research team and the CYPAG had a beneficial influence on the young people themselves, as well as on the review process and the interpretation, presentation and dissemination of findings.
Abstract.
Author URL.
Thompson Coon J, Nunns M, Shaw E, Briscoe S, Liabo K, Garside R, Melendez-Torres GJ, turner M (2021).
Optimising prescribing of drugs to prevent CVD and drugs that cause dependency: an evidence-gap map.Abstract:
Optimising prescribing of drugs to prevent CVD and drugs that cause dependency: an evidence-gap map
Abstract.
Price A, Ahuja L, Bramwell C, Briscoe S, Shaw L, Nunns M, O’Rouke G, Baron S, Anderson R (2021). P90 Implementation of strategies for fostering strengths-based adult social work in the UK: a systematic review of research evidence. SSM Annual Scientific Meeting.
Briscoe S, Shaw E, Nunns M, Thompson Coon J, Melendez-Torres GJ, Garside R (2021). Primary care clinicians’ perspectives on interacting with patients with gynaecological conditions or symptoms suggestive of gynaecological conditions: Protocol for a scoping review.
Thompson G, Zhelev Z, Peters J, Khalid S, Briscoe S, Shaw L, Nunns M, Ludman S, Hyde C (2021). Symptom scores in the diagnosis of pediatric cow's milk protein allergy: a systematic review.
Pediatr Allergy Immunol,
32(7), 1497-1507.
Abstract:
Symptom scores in the diagnosis of pediatric cow's milk protein allergy: a systematic review.
BACKGROUND: Cow's milk protein allergy (CMPA) is an immune-mediated allergic response to proteins in milk that is common in infants. Broad CMPA symptoms make diagnosis a challenge, particularly in primary care. Symptom scores may improve a clinician's awareness of symptoms, indicating a need for further testing. This systematic review examined the development and evaluation of such symptom scores for use in infants. METHODS: CENTRAL, MEDLINE, EMBASE and CINAHL databases were searched from inception to 3 December 2019 (Updated 14 November 2020) for diagnostic accuracy studies, randomised controlled trials, observational studies, economic evaluations, qualitative studies and studies reporting development of the tools. Data were not suitable for meta-analysis due to clinical and methodological heterogeneity, so were narratively synthesised. RESULTS: We found two symptom scores evaluated in one and fourteen studies, respectively. Estimated sensitivity and specificity ranged from 37% to 98% and 38% to 93%. The evaluations of each tool were at high risk of bias or failed to address issues such as clinical and cost-effectiveness. CONCLUSIONS: Estimates of accuracy of symptom scores for CMPA offered so far should be interpreted cautiously. Rigorous, conflict-free research based on well-defined roles for the tools is urgently required.
Abstract.
Author URL.
Malik H, Appelboam A, Nunns M (2021). Ultrasound-directed reduction of distal radius fractures in adults: a systematic review.
Emergency Medicine Journal,
38(7), 537-542.
Abstract:
Ultrasound-directed reduction of distal radius fractures in adults: a systematic review
Objective to conduct a systematic review of the clinical literature to determine whether ultrasound can be used to improve the reduction of distal radius fractures in adults in the ED. Methodology a study protocol was registered on PROSPERO. EMBASE, PubMed/MEDLINE, the Cochrane Central Register of Controlled Trials and ClinicalTrials.gov of the US National Library of Medicine were searched for studies evaluating ultrasound-assisted distal radial fracture reductions in comparison with standard care. The primary outcome of interest was manipulation success rates, defined as the proportion of fracture manipulations resulting in acceptable anatomical alignment, with secondary outcome being subsequent surgical intervention rates in ultrasound and standard care group of patients. Results 248 were screened at title and abstract, and 10 studies were included for a narrative synthesis. The quality of this evidence is limited but suggests ultrasound is accurate in determining distal radius fracture reduction and may improve the quality of reduction compared with standard care. However, there is insufficient evidence to determine whether this affects the rate of subsequent surgical intervention or functional outcome. Conclusion There is a lack of evidence that using ultrasound in the closed reduction of distal radius fractures benefits patients. Properly conducted randomised controlled trials with patient-orientated outcomes are crucial to investigate this technology.
Abstract.
Shaw EH, Nunns M, Briscoe S, Ahuja L, Price A, Bethel A, Shaw N, Anderson R, Thompson Coon J (2021). What is the volume, diversity and nature of recent, robust evidence for the use of peer support in health and social care? Protocol for a systematic evidence map Version 2: 24th May 2021.
Abstract:
What is the volume, diversity and nature of recent, robust evidence for the use of peer support in health and social care? Protocol for a systematic evidence map Version 2: 24th May 2021
Evaluating the potential of peer support is receiving abundant attention. This is in response to the increasing financial pressures on NHS, which has led health and social care sector to realise the importance of enabling patients and carers to support themselves more effectively. While there is strong evidence on effectiveness and cost-effectiveness of peer support intervention, it is currently not clear how future research could contribute in better understanding peer support interventions. Also, limited synthesised literature is available on which method of delivery of peer support may be the most effective in achieving positive patient outcomes and in terms of costs incurred. Thus, we aim to systematically map the volume, diversity and nature of recent, robust evidence for the use of peer support interventions in health and social care. We will conduct the systematic mapping in two stages: in stage 1 we will map systematic reviews of peer support, and in stage 2 we will map randomised controlled trials and health economic studies of peer support interventions that have not been included in recent systematic reviews. We will search several databases: MEDLINE, PsycINFO, Social Policy and Practice, HMIC, CINAHL, ASSIA and the Campbell Library. Supplementary web searches will be conducted. Results will be limited to English language studies conducted in high-income countries. Stage 1 search will be date limited from 2015 to-date. The date cut-off for the stage 2 searches will be determined following the completion of stage 1. Eligible studies will be those that involve users of adult services with a defined health and/or social care need accessing peer support delivered in any format (such as face-to-face, online, group, individual, mixed modes etc.), delivered by paid or unpaid peer supporters. Any comparator will be eligible for inclusion and all outcomes are of interest. In stage 1 of the review, high quality, recently published systematic reviews that include comparative studies (RCTs, non-randomised controlled trials, controlled and uncontrolled before-and-after trials and interrupted time series designs) evaluating the effectiveness and/or cost-effectiveness of peer support interventions will be included. The quality of all systematic reviews identified as eligible at stage 1 will be appraised using the AMSTAR2 quality appraisal tool. At stage 2. We will use the Cochrane Risk of Bias (ROB) tool and the CHEC list for assessing risk of bias of RCTs and the quality of economic evaluations, respectively. Following data extraction using EPPI Reviewer 4, studies will be entered into an interactive evidence map to visually represent the distribution of evidence across health and social care domains. The map will have multiple layers, such that studies can be identified by population group, type of peer support and outcome. We expect that by conducting this review, we will be able to direct users to existing evidence, funders to existing gaps, and reviewers to pockets of evidence that could be reviewed to help decision making. It may also be possible to use the map to identify research questions that cut across settings, populations and interventions that would help us to understand how to use peer support interventions most effectively.
Abstract.
2020
Thompson G, Zhelev Z, Peters J, Khalid S, Briscoe S, Shaw L, Nunns M, Ludman S, Hyde C (2020). A comprehensive evaluation of symptom scores designed to inform the triage and diagnosis of cow’s milk protein allergy in children: a systematic review of the research evidence.
Coon JT, Orr N, Shaw E, Nunns M, Whear R (2020). BURSTING OUT OF OUR BUBBLE: USING CREATIVE TECHNIQUES TO COMMUNICATE RESEARCH FINDINGS.
Author URL.
Parker K, Eddy S, Nunns M, Xiao Z, Ford T, Eldridge S, Ukoumunne O (2020). Characteristics of school-based feasibility studies with a cluster randomised trial design: a systematic review. PROSPERO: International prospective register of systematic reviews
Nunns M, John JB, McGrath JS, Shaw L, Briscoe S, Thompson Coon J, Hemsley A, Lovegrove CJ, Thomas D, Mythen MG, et al (2020). Evaluating enhanced recovery after surgery: time to cover new ground and discover the missing patient voice.
Perioperative Medicine,
9(1).
Abstract:
Evaluating enhanced recovery after surgery: time to cover new ground and discover the missing patient voice
AbstractMulticomponent peri-operative interventions offer to accelerate patient recovery and improve cost-effectiveness. The recent National Institute of Health Research-commissioned evidence synthesis review by Nunns et al. considers the effectiveness and cost-effectiveness of all types of multicomponent interventions for older adults undergoing elective inpatient surgery. Enhanced recovery programmes (ERPs) were the most commonly evaluated intervention. An association between ERPs and decreased length of stay was observed, whilst complication rates and time to recovery were static or sometimes reduced. Important areas which lack research in the context of ERPs are patient-reported outcome measures, patients with complex needs and assessment of factors pertaining to successful ERP implementation. The next generation of ERP studies should seek to develop our understanding in these key areas.
Abstract.
Shaw E, Nunns M, Briscoe S, Anderson R, Thompson Coon J (2020). Evidence for specialist treatment of people with acquired brain injury in secure psychiatric services: systematic review and narrative synthesis., NIHR Health Services and Delivery Research Topic Report.
Briscoe S, Nunns M, Shaw L (2020). How do Cochrane authors conduct web searching to identify studies? Findings from a cross‐sectional sample of Cochrane Reviews.
Health Information & Libraries Journal,
37(4), 293-318.
Abstract:
How do Cochrane authors conduct web searching to identify studies? Findings from a cross‐sectional sample of Cochrane Reviews
AbstractBackgroundSearching the World Wide Web using search engines and websites can be conducted to identify studies for systematic reviews. When searching to support systematic reviews, the searcher faces challenges in using the basic search interfaces of most search engines and websites.ObjectivesTo describe and evaluate current practice of web searching in a cross‐sectional sample of Cochrane Reviews. The study also describes the stated aims of web searching, i.e. the identification of published or unpublished studies or both.MethodsA six‐month cross‐sectional sample of Cochrane Reviews was identified via the Cochrane Library. Reviews were inspected for detail about web searching. Findings were described and evaluated using a framework of key principles for web searching.Results423 Cochrane Reviews published August 2016–January 2017 were identified of which 61 (14%) reported web searching. Web searches were typically simplified versions of the bibliographic database search. Advanced and iterative approaches were not widely used. Google Search and Google Scholar were the most popular search engines. Most reports stated identification of grey literature as their aim.ConclusionBasic web search interfaces necessitate simple searches. However, there is scope to use more diverse search features and techniques and a greater variety of search engines.
Abstract.
Westwood CS, Fallowfield JL, Delves SK, Nunns M, Ogden HB, Layden JD (2020). Individual risk factors associated with exertional heat illness: a systematic review.
Experimental Physiology,
106(1), 191-199.
Abstract:
Individual risk factors associated with exertional heat illness: a systematic review
New FindingsWhat is the topic of this review?
Exertional heat illness (EHI) remains a persistent problem for athletes and individuals. This threat remains despite numerous athletic position statements and occupational guidance policies. This review explores primary evidence that demonstrates a direct association between ‘known’ risk factors and EHI.
What advances does it highlight?
Primary evidence to support ‘known’ risk factors associated with EHI is not comprehensive. Furthermore, it is not evident that single individual factors predispose individuals to greater risk. In fact, the evidence indicates that EHI can manifest in non‐hostile compensable environments when a combination of risk factors is prevalent.
AbstractDespite the widespread knowledge of exertional heat illness (EHI) and clear guidance for its prevention, the incidence of EHI remains high. We carried out a systematic review of available literature evaluating the scientific evidence underpinning the risk factors associated with EHI. Medline, PsycINFO, SportDiscus and Embase were searched from inception to January 2019 with no date limitation, with supplementary searches also being performed. Search terms included permutations of risk and heat illness, with only studies in English included. Study selection, data extraction and quality assessment, using the QUALSYST tool, were performed by two independent reviewers. of 8898 articles identified by the searches, 42 were included in the systematic review as primary evidence demonstrating a link between a risk factor and EHI. The quality scores ranged from 57.50 to 100%, and studies were generally considered to be of strong quality. The majority of risks attributable to EHI were categorized as those associated with lifestyle factors. The findings from the systematic review suggest complex manifestation of EHI through multiple risk factors rather than any one factor in isolation. Further research is needed to explore the accumulation of risk factors to help in development of effective preventative measures.
Abstract.
Shaw E, Nunns M, Briscoe S, Thompson Coon J, Melendez-Torres GJ, Garside R (2020). Optimal prescribing of drugs to prevent CVD and drugs that cause dependency: an evidence gap map.
Price A, Ahuja L, Bramwell C, Briscoe S, Shaw E, Nunns M, O'Rourke G, Baron S, Anderson R (2020). Research evidence on different strengths-based approaches within adult social work: a systematic review.
HS&DR Evidence Synthesis Centre Topic Report (peer-reviewed), 1-157.
Abstract:
Research evidence on different strengths-based approaches within adult social work: a systematic review
Background
A ‘strengths-based approach’ focusses on peoples’ goals and resources rather than their problems. Social care professionals and organisations are striving to practise in a strengths-based way and since the Care Act of 2014 it is an even stronger requirement. However, there are challenges in implementing strengths-based approaches into practise, and uncertainty remains about their effectiveness.
Objective
To summarise research evidence on the effectiveness and the implementation of different strengths-based approaches within adult social work in the UK.
Data sources
We searched seven databases: MEDLINE ALL, PsycINFO, Social Policy and Practice, HMIC, CINAHL, ASSIA and the Campbell Library. Supplementary web searches were conducted. No date or language limits were used.
Review methods
Eligible studies were about adults (≥18 years) being supported or assessed by social workers; or about initiatives involving adult social care teams. For the effectiveness question, outcomes could be directly related to people’s individual outcomes or outcomes at the level of families or communities. The Cochrane Effective Practice and Organisation of Care group’s Risk of Bias Tool was chosen to appraise the quality of effectiveness studies, and qualitative implementation studies were assessed using the Wallace criteria. Findings were tabulated and analysed using framework synthesis, based on the Consolidated Framework of Implementation Research (CFIR). Studies that were not synthesised were summarised descriptively.
Findings
Of 5,030 studies screened, none met our inclusion criteria for the effectiveness question. Fifteen qualitative or mixed methods studies met the criteria for the implementation question, six of which were assessed as ‘good quality’. Seven examined Making Safeguarding Personal (MSP) and the remaining eight studies examined Local Area Coordination, Solution Focused Therapy, Family Group Conferencing, Asset-based Community Development, Strengths-based with Relationship-based Approach, Asset-based approaches, and Motivational Interviewing.
Seven studies on Making Safeguarding Personal (MSP), were synthesised into the following themes of implementation factors: 1) MSP as an intervention: seen as initially demanding but with long-term advantages; required significant practice change; needed tailoring to local settings. 2) Culture and Settings: required broad cultural changes; ‘outward facing’ and smaller/specialist councils tended to find this easier. 3) Individual characteristics: enhancing the knowledge, skills and confidence of stakeholders in MSP facilitated delivery; depended on practitioner skill in engaging people being supported; and people’s willingness to engage. 4) Embedding and sustaining MSP: depended on strong leadership and active engagement at all levels; required extensive planning and shaping of safeguarding practice that was user-focussed.
For the remaining eight studies of seven strengths-based approaches, we provide a summary of their findings.
Limitations
Our findings are mainly limited by the lack of available evidence in the UK. Higher quality studies may have revealed richer explanations of implementation.
Conclusions
There is a lack of good quality research evidence evaluating the effectiveness or implementation of strengths-based approaches. The synthesis revealed a wide range of factors that enabled or inhibited successful implementation of Making Safeguarding Personal. These factors may have wider relevance for the implementation of other strengths-based models of social work practice.
Future work
Higher quality evaluations of different strengths-based social work models are required.
Study registration: PROSPERO CRD42020166870
Funding
Commissioned by the NIHR HS&DR programme as a review project (NIHR130867) within NIHR HS&DR programme, reference number 16/47/22.
Abstract.
Price A, Ahuja L, Bramwell C, Briscoe S, Shaw L, Nunns M, O'Rourke G, Baron S, Anderson R (2020). Research evidence on different strengths-based approaches within adult social work: a systematic review., NIHR.
Parker K, Nunns M, Xiao Z, Ford T, Ukoumunne OC (2020). Systematic review of the characteristics, design and analysis methods of school-based cluster randomised controlled trials for improving health outcomes in pupils in the UK. PROSPERO
John JB, Hemsley A, Nunns M, McGrath JS (2020). Time to make enhanced recovery after surgery the standard.
British Journal of Hospital Medicine,
81(3), 1-4.
Abstract:
Time to make enhanced recovery after surgery the standard
Multimodality perioperative interventions could accelerate patient recovery and improve cost-effectiveness. An evidence review found an association between enhanced recovery after surgery and decreased length of stay, while complications and recovery time were unchanged or reduced. More specialties should develop and implement enhanced recovery after surgery pathways.
Abstract.
Shaw E, Nunns M, Briscoe S, Thompson Coon J, Anderson R (2020). What is the evidence for the need for specialist treatment of people with acquired brain injury in secure psychiatric services? Protocol for a systematic review.
Thompson Coon J, Ahuja L, Price A, Bethel A, Shaw N, Anderson R (2020). What is the volume, diversity and nature of recent, robust evidence for the use of peer support in health and social care? Protocol for a systematic evidence map.
Abstract:
What is the volume, diversity and nature of recent, robust evidence for the use of peer support in health and social care? Protocol for a systematic evidence map
Evaluating the potential of peer support is receiving abundant attention. This is in response to the increasing financial pressures on NHS, which has led health and social care sector to realise the importance of enabling patients and carers to support themselves more effectively. While there is strong evidence on effectiveness and cost-effectiveness of peer support intervention, it is currently not clear how future research could contribute in better understanding peer support interventions. Also, limited synthesised literature is available on which method of delivery of peer support may be the most effective in achieving positive patient outcomes and in terms of costs incurred. Thus, we aim to systematically map the volume, diversity and nature of recent, robust evidence for the use of peer support interventions in health and social care. We will conduct the systematic mapping in two stages: in stage 1 we will map systematic reviews of peer support, and in stage 2 we will map randomised controlled trials and health economic studies of peer support interventions that have not been included in recent systematic reviews. We will search several databases: MEDLINE, PsycINFO, Social Policy and Practice, HMIC, CINAHL, ASSIA and the Campbell Library. Supplementary web searches will be conducted. Results will be limited to English language studies conducted in high-income countries. Stage 1 search will be date limited from 2015 to-date. The date cut-off for the stage 2 searches will be determined following the completion of stage 1. Eligible studies will be those that involve users of adult services with a defined health and/or social care need accessing peer support delivered in any format (such as face-to-face, online, group, individual, mixed modes etc.), delivered by paid or unpaid peer supporters. Any comparator will be eligible for inclusion and all outcomes are of interest. In stage 1 of the review, high quality, recently published systematic reviews that include comparative studies (RCTs, non-randomised controlled trials, controlled and uncontrolled before-and-after trials and interrupted time series designs) evaluating the effectiveness and/or cost-effectiveness of peer support interventions will be included. The quality of all systematic reviews identified as eligible at stage 1 will be appraised using the AMSTAR2 quality appraisal tool. At stage 2. We will use the Cochrane Risk of Bias (ROB) tool and the CHEC list for assessing risk of bias of RCTs and the quality of economic evaluations, respectively. Following data extraction using EPPI Reviewer 4, studies will be entered into an interactive evidence map to visually represent the distribution of evidence across health and social care domains. The map will have multiple layers, such that studies can be identified by population group, type of peer support and outcome. We expect that by conducting this review, we will be able to direct users to existing evidence, funders to existing gaps, and reviewers to pockets of evidence that could be reviewed to help decision making. It may also be possible to use the map to identify research questions that cut across settings, populations and interventions that would help us to understand how to use peer support interventions most effectively.
Abstract.
2019
Thompson Coon J, Gwernan‐Jones R, Garside R, Nunns M, Shaw L, Melendez‐Torres GJ, Moore D (2019). Developing methods for the overarching synthesis of quantitative and qualitative evidence: the interweave synthesis approach.
Research Synthesis Methods,
11(4), 507-521.
Abstract:
Developing methods for the overarching synthesis of quantitative and qualitative evidence: the interweave synthesis approach
The incorporation of evidence derived from multiple research designs into one single synthesis can enhance the utility of systematic reviews making them more worthwhile, useful, and insightful. Methodological guidance for mixed‐methods synthesis continues to emerge and evolve but broadly involves a sequential, parallel, or convergent approach according to the degree of independence between individual syntheses before they are combined.We present two case studies in which we used novel and innovative methods to draw together the findings from individual but related quantitative and qualitative syntheses to aid interpretation of the overall evidence base. Our approach moved beyond making a choice between parallel, sequential, or convergent methods to interweave the findings of individual reviews and offers three key innovations to mixed‐methods synthesis methods:
The use of intersubjective questions to understand the findings of the individual reviews through different lenses,
Immersion of key reviewers in the entirety of the evidence base, and
Commencing the process during the final stages of the synthesis of individual reviews, at a point where reviewers are developing an understanding of initial findings.
Underlying our approach is the process of exploration and identification of links between and across review findings, an approach that is fundamental to all evidence syntheses but usually occurs at the level of the study. Adapting existing methods for exploring and identifying patterns and links between and across studies to interweave the findings between and across reviews may prove valuable.
Abstract.
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 Dev,
45(6), 832-849.
Abstract:
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.
Abstract.
Author URL.
Nunns MPI, Shaw L, Briscoe S, Thompson Coon J, Hemsley A, McGrath JS, Lovegrove CJ, Thomas D, Anderson R (2019). Multicomponent hospital-led interventions to reduce hospital stay for older adults following elective surgery: a systematic review. Health Services and Delivery Research, 7(40), 1-178.
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
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.
Abstract.
Nunns M, Shaw L, Briscoe S, Thompson-Coon J, Hemsley A, McGrath JS, Lovegrove CJ, Thomas D, Anderson R (2019). REDUCING LENGTH OF HOSPITAL STAY FOR OLDER ELECTIVE SURGICAL INPATIENTS: FINDINGS OF a SYSTEMATIC REVIEW.
Author URL.
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
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.
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
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
2017
Muir D, Vat LE, Keller M, Bell T, Jørgensen CR, Eskildsen NB, Johnsen AT, Pandya-Wood R, Blackburn S, Day R, et al (2017). Abstracts from the NIHR INVOLVE Conference 2017. Research Involvement and Engagement, 3(Suppl 1).
Mayhew D, Nunns M, Moore D, Ford T (2017). Effectiveness of Non-Pharmacological Interventions to Reduce Procedural Anxiety in Children and Adolescents Undergoing Treatment for Cancer: a Systematic Review and Meta-Analysis. Pediatric Oncall, 14(4).
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
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.
Abstract.
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.
Abstract.
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
Abstract.
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.
Abstract.
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.
Abstract.
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.