Defence Medical Rehabilitation Center

Epsom, United Kingdom

Defence Medical Rehabilitation Center

Epsom, United Kingdom

Time filter

Source Type

Bennett A.N.,Chapel Allerton Hospital | Bennett A.N.,Defence Medical Rehabilitation Center | Rehman A.,American Hospital Dubai | Hensor E.M.A.,Chapel Allerton Hospital | And 3 more authors.
Annals of the Rheumatic Diseases | Year: 2010

Background: Fatty changes at vertebral corners have been reported on MRI in ankylosing spondylitis but the distribution or specificity of these lesions to early axial spondyloarthropathy (axial-SpA) has not been determined. Objective: To assess the diagnostic utility of fatty Romanus lesions (FRLs) for axial-SpA in a population with chronic back pain. Methods: Axial-skeleton TI SE and fat-suppressed MRI were performed on 174 patients with back pain and 11 controls. MRI lesions including FRLs were scored blind. An imaging diagnosis was given on MRI findings alone and compared with the 'gold standard' treating doctor's diagnosis. Results: Twenty-nine patients had FRLs: 31% (20/64) of patients with spondyloarthropathy, 13% (6/45) with degenerative arthritis, 4% (2/45) with spinal malignancy, 5% (1/20) with 'other' diagnoses; none of 11 normal subjects had FRLs. The majority of the FRLs in SpA 60% (135/226) were present in the thoracic spine. The diagnostic utility of FRLs for SpA (likelihood ratio (LR) = 4.7) was significantly (p<0.05) greater than for other diagnoses and increased further (LR = 12.6, p<0.05) when more than five FRLs were present. Of note 5/20 (25%) patients with SpA with FRLs had no diagnostic bone-oedema lesions on fat-suppressed MRI, suggesting that FRLs may be useful diagnostically in axial-SpA. Conclusion: This study defines the FRL as a diagnostic imaging feature of axial-SpA, which may be useful where inflammatory changes are absent on fat-suppression MRI and where radiography is normal.


House C.,Institute of Naval Medicine | Reece M.A.,Defence Medical Rehabilitation Center | De Sa D.R.,Institute of Naval Medicine
Military Medicine | Year: 2013

This study was undertaken to determine whether the incidence of lower limb overuse injuries (LLOIs) sustained during Royal Marine training could be reduced by issuing the recruits with shock-absorbing insoles (SAIs) to wear in their military boots. This was a retrospective longitudinal trial conducted in two phases. Injury data from 1, 416 recruits issued with standard Saran insoles and 1, 338 recruits issued with SAI were compared. The recruits in the two groups were of similar height, body mass, and aerobic fitness and followed the same training course. The incidence of LLOI sustained by the recruits was lower (p < 0.05) in the SAI Group (19.0%) compared to the Saran Insole Group (31.7%). The incidences of lower limb stress fractures, tibial periostitis, tenosynovitis of foot, achilles tendonopathy, other tendonopathy and anterior knee pain were lower (p < 0.05) in the SAI Group. Tibial stress fracture incidence was lower (p < 0.05) in the SAI Group but metatarsal and femoral stress fracture incidences were the same for the two insole groups. Thus, issuing SAIs to military recruits undertaking a sustained, arduous physical training program with a high incidence of LLOI would provide a beneficial reduction in the incidence of LLOI.


Sinha S.,St Georges Vascular Institute | Houghton J.,Defence Medical Rehabilitation Center | Holt P.J.,St Georges Vascular Institute | Thompson M.M.,St Georges Vascular Institute | And 2 more authors.
Journal of Vascular Surgery | Year: 2012

Popliteal entrapment syndrome (PES) is a rare but important cause of intermittent claudication in young people. Controversy exists about optimal strategies for diagnosis and management, particularly for variants such as functional popliteal entrapment. The aim of this review was to systematically catalog the published English-language literature on PES and to determine if evidence-based guidelines for management could be formulated. An electronic search using the MEDLINE, EMBASE, Cochrane Library, AMED, and CINAHL databases was performed to identify articles about PES published from 1947 to December 2010. The systematic review conformed to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement standards. Prospective studies and retrospective case series with more than five patients with arterial, venous, nerve, and combined neurovascular entrapment were analyzed on a study-by-study narrative basis. The search identified 291 articles, and 44 were included. Of these, 30 studies were on popliteal artery entrapment syndrome (PAES). No relationship was found between duration of symptoms and the presence of irreversible arterial injury. Each study used a median of three diagnostic tests (range, 1-6). Arteriography was used in 28 of 30 studies to diagnose PAES, with an estimated mean sensitivity of 97% (range, 85%-100%). Twenty-three studies described arterial reconstructive procedures, with a median failure rate of 27.5% (range, 0%-83%). The proportion of patients asymptomatic after surgery was reported in only 12 of 30 studies, with a median value of 77% (range, 70%-100%). A large volume of predominantly retrospective clinical data exists on PES. A subset of studies describe a significant failure rate after surgery, but study quality is insufficient to derive robust conclusions allowing recommendation of any one particular diagnostic modality or operative procedure over another. Improvements in management of this condition are unlikely to result from publication of further retrospective case series, and clinicians should concentrate on prospectively collected data with predefined inclusion criteria, outcome measures, follow-up protocols, and transparent standardized reporting criteria. © 2012 Society for Vascular Surgery.


Bond S.J.,Defence Medical Rehabilitation Center | Soundy A.,University of Birmingham
Journal of the Royal Army Medical Corps | Year: 2012

Background: There is a high prevalence of Lower Back Pain (LBP) within military populations. Physiotherapeutic management has a primary role for patient care, but there is a need to establish the most effective management. Civilian physiotherapists provide the majority of clinical provision throughout the Defence Medical Rehabilitation Programme for British Armed Forces personnel. To date no study has been carried out looking at their perceptions and beliefs with regards to management of non-specific LBP and the potential impact this had on the delivery of rehabilitation across Defence. Methods: This mixed methods exploratory study aimed to explore the potential complexities surrounding the decision making process with regards to management of non-specific LBP using semi-structured interviews with 14 MOD civilian physiotherapists. All interviews were transcribed verbatim. The transcribed data was then subjected to a categorical content analysis. Results: The analysis of the interview data revealed four interrelated themes that influence civilian physiotherapists in their management of back pain in military personnel: the military environment, integration of military procedures, physiotherapist treatment approach and communication. Discussion: This paper highlights the value civilian physiotherapists place on experience when managing non-specific LBP. This experience however was gained through 'patient mileage' rather than integration of best evidence into practice. Several problems were identified in patient management including specific types of patients and their expectations and the importance of the right communication between Health Care Professionals, but also with patients.


Kristensen J.,Defence Medical Rehabilitation Center
Journal of the Royal Army Medical Corps | Year: 2013

Introduction Exercise-based rehabilitation programmes have formed the cornerstone of the treatment currently delivered at the Defence Medical Rehabilitation Centre (DMRC) based at Headley Court.Increased operational activity in recent years has meant a concomitant increase in the pressure on Defence rehabilitation resources and a greater need for effective rehabilitation strategies. The aim of this research was to assess the effects of exercisebased rehabilitation on energy expenditure and body composition. Methods A group of nine male volunteers (30±2.4 years) serving with the Armed Forces and suffering from a variety of musculoskeletal lower limb injuries underwent 17 days of exercise-based rehabilitation. Total daily energy expenditure (TEE) was assessed using a portable combined heart rate monitor/accelerometer (Actiheart).Changes in body composition were assessed using dual energy x-ray absorptiometry (DEXA). Results MeanTEE over the entire admission period was 2915±53 kcal/day with no significant difference in TEE observed between training week 1 (W1) and 2 (W2). However, a strong trend towards increased TEE in W1 was observed (p=0.06). No significant change was observed in fat mass (FM), lean body mass (LBM) or body-fat percentage despite the exercise-based rehabilitation programme. Conclusions These results suggest that 17 days of exercise- based rehabilitation is insufficient to observe significant changes in body composition, despite high energy expenditure.


Camp S.J.,Royal National Orthopaedic Hospital | Camp S.J.,Charing Cross Hospital | Birch R.,Royal National Orthopaedic Hospital | Birch R.,Defence Medical Rehabilitation Center
Journal of Bone and Joint Surgery - Series B | Year: 2011

The integrity of the spinal accessory nerve is fundamental to thoracoscapular function and essential for scapulohumeral rhythm. This nerve is vulnerable along its superficial course. This study assessed the delay in diagnosis and referral for management of damage to this nerve, clarified its anatomical course and function, and documented the results of repair. From examination of our records, 111 patients with lesions of the spinal accessory nerve were treated between 1984 and 2007. In 89 patients (80.2%) the damage was iatropathic. Recognition and referral were seldom made by the surgeon responsible for the injury, leading to a marked delay in instituting treatment. Most referrals were made for painful loss of shoulder function. The clinical diagnosis is straightforward. There is a characteristic downward and lateral displacement of the scapula, with narrowing of the inferior scapulohumeral angle and loss of function, with pain commonly present. In all, 80 nerves were explored and 65 were repaired. The course of the spinal accessory nerve in relation to the sternocleidomastoid muscle was constant, with branches from the cervical plexus rarely conveying motor fibres. Damage to the nerve was predominantly posterior to this muscle. Despite the delay, the results of repair were surprising, with early relief of pain, implying a neuropathic source, which preceded generally good recovery of muscle function. ©2011 British Editorial Society of Bone and Joint Surgery.


Bennett A.N.,Defence Medical Rehabilitation Center | Marzo-Ortega H.,University of Leeds | Rehman A.,American Hospital Dubai | Emery P.,University of Leeds | McGonagle D.,University of Leeds
Rheumatology | Year: 2010

In the past decade, fat-suppression MRI techniques have been increasingly used for the assessment of axial-SpA. Indeed, newly proposed classification criteria have suggested the inclusion of fat-suppression MRI for the evaluation of the SI joint in inflammatory back pain (IBP) of suspected axial-SpA. However, recent data on the whole spine have identified certain MRI spinal lesions to be highly diagnostic of axial-SpA; that the SI joint can be spared in axial-SpA; and that IBP may originate in the lumbar spine rather than SI joint. Therefore, it is proposed that MRI of the whole spine and not just the SI joint should now become a routine part of the assessment of axial-SpA. Not only is spinal MRI of great diagnostic utility in axial-SpA but there is also increasing evidence to suggest that it can play a significant role in the management, in particular directing anti-TNF therapy in AS, and also it may be prognostically useful in axial-SpA. With the wider availability, improving technology and falling cost of MRI, and the difficulty that clinical assessment of axial-SpA poses, especially in early disease, there is now a strong case for the use of whole-spine MRI in the diagnosis and management of axial-SpA. © The Author 2010. Published by Oxford University Press on behalf of the British Society for Rheumatology.


Marzo-Ortega H.,University of Leeds | McGonagle D.,University of Leeds | Bennett A.N.,Defence Medical Rehabilitation Center
Current Opinion in Rheumatology | Year: 2010

Purpose of review: The study of the early involvement of the axial skeleton has dominated the research map in spondyloarthritides (SpA) in recent months. MRI remains the imaging method of choice to visualize the sacroiliac joint and spine as recognized by the new classification criteria for axial SpA. This review synthesises the most recently published data and offers a critical appraisal of findings. Recent findings: MRI studies of inflammatory back pain of short duration have identified disease starting simultaneously in the lumbar spine and sacroiliac joints in a proportion of patients and confirm MRI as a reliable measure to assess efficacy of biologic agents in early axial SpA. The new Assessment of SpondyloArthritis International Society classification criteria can be applied in the presence and absence of radiographic abnormalities of the sacroiliac joints. Imaging studies of the spine have confirmed the diagnostic utility of spinal MRI in SpA and have described highly specific lesions such as inflammatory vertebral and posterior element lesions or the postinflammatory fatty Romanus lesions. Summary: MRI in axial SpA is the most rapidly expanding area of translational research in SpA. The publication of the new Assessment of SpondyloArthritis International Society classification criteria for axial SpA heralds a new era for the identification of early disease and mirrors the existing use of MRI in clinical practice for the evaluation of inflammatory back pain. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Birch R.,Defence Medical Rehabilitation Center
Journal of Hand Surgery: European Volume | Year: 2015

While it is widely accepted that cases of traumatic injury to the brachial plexus benefit from early surgical exploration and repair, with results deteriorating with long delays, policies vary regarding the exact timing of intervention. This is one of a pair of review articles considering the clinical issues, investigations, and surgical factors relating to management of injuries to the supraclavicular brachial plexus, as well evidence from experimental work and clinical outcomes. In this article Professor Birch argues for early exploration of the brachial plexus as the optimum both to delineate the pathology and undertake reconstructive surgery. © The British Society for Surgery of the Hand.


Aydin S.Z.,Istanbul Medeniyet University | Maksymowych W.P.,University of Alberta | Bennett A.N.,Defence Medical Rehabilitation Center | Bennett A.N.,Guys And St Thomas Foundation Trust | And 3 more authors.
Annals of the Rheumatic Diseases | Year: 2012

Background: The new Assessment of SpondyloArthritis international Society (ASAS) criteria classify axial spondyloarthritis (SpA) into human leucocyte antigen-B27 and/or imaging-based arms. To aid implementation, ASAS has proposed a definition of a positive MRI for active sacroiliitis. Objective: The authors aimed to test the diagnostic and predictive value of the ASAS criteria and definition of a 'positive' MRI. Methods: Baseline MRI scans on 29 patients with early inflammatory back pain and 18 controls were read independently by four experienced rheumatologists. Both arms of the criteria were tested against a 'gold standard' of physician diagnosis of SpA. MRI abnormalities were assessed according to a global assessment of MRI and the ASAS definition. Sensitivity, specificity and likelihood ratios for individual and concordant reader data were calculated for axial SpA diagnosis at baseline and the development of radiographic sacroiliitis, fulfilling the modified New York criteria at 8 years. Results: All patients were classified as having axial SpA, with more patients fulfilling the imaging arm (83%, n=24/29) than the human leucocyte antigen B27 arm (62%, n=18/29). Concordant reader data showed that the baseline MRI had high diagnostic utility for SpA according to global assessment (sensitivity/ specificity: 66%/94%, LR+ (positive likelihood ratio) 11.8, LR-(negative likelihood ratio) 0.4) and ASAS definition (sensitivity/specificity: 79%/89%, LR+ 7.1, LR-0.2). Likewise, a positive baseline MRI had 100% sensitivity for subsequent radiographic sacroiliitis by either assessment, although specificity was lower (56% for global assessment and 33% for ASAS definition). Conclusion: Both arms of the ASAS criteria have good diagnostic utility in early SpA, although they are of limited value for the prediction of radiographic progression. This may be due to the definition of a positive MRI for sacroiliitis that lacks specificity at baseline.

Loading Defence Medical Rehabilitation Center collaborators
Loading Defence Medical Rehabilitation Center collaborators