In episode 247 I'm joined by Professor Nadine Foster, physical therapist and research lead at Keele University in Staffordshire, England. On part one she shares her journey, discussion on randomized control trial research and some important papers from which you'll be sure to benefit. This week on MCF!
Nadine is an NIHR Professor of Musculoskeletal Health in Primary Care at Keele University and the Director of Keele Clinical Trials Unit. She leads the Musculoskeletal Health and Pain research programme within the Arthritis Research UK Primary Care Centre in the Research Institute of Primary Care and Health Sciences and is an NIHR Senior Investigator. Her research focuses on the commonest musculoskeletal pain conditions, including low back pain and osteoarthritis and whilst her research programme utilises many research methods she has a particular interest in developing, testing and implementing treatments and services for patients with musculoskeletal pain. She has led or collaborated on more than 19 randomised trials, with funding support from Arthritis Research UK, the Medical Research Council and the National Institute for Health Research (NIHR). She leads an NIHR Programme Grant for Applied Research on stratified primary care for patients with musculoskeletal pain (STarT MSK) and an NIHR Health Technology Assessment (HTA) funded trial testing stratified care for patients consulting in primary care with sciatica (SCOPiC). Nadine is the lead NIHR training advocate for physiotherapy and President of the Society of Back Pain Research. She chairs the NIHR Research for Patient Benefit funding panel in the West Midlands, and has previously served on HTA funding committees and the Arthritis Research UK Pain Clinical Studies Group. She has over 180 peer reviewed publications, supervised 14 PhD students and contributed to over £35 million in research funding.
Nadine Foster is a physical therapist working in England and has worked at Keele University in UK for 18 years. Currently she is the lead clinician in the research department in the musculoskeletal department. She is working with a large multi-disciplinary team on different MSK problems but her primary focus is on low back pain.
Nadine graduated from University of Ulster, Ireland and even during her undergraduate program there was a strong focus on research for the students. She also had exposure to good clinical research at one of the teaching institutes in Belfast which sowed the early seeds of research in her mind. One of her mentors showed her the possibility of being funded for her PhD and after consulting different clinical colleagues and receiving differing opinions, Nadine decided to apply and completed her Phd with research focused on low back pain. She has been involved in 19 clinical trials with all being focused on improving clinical care of musculoskeletal patients. Recently she is also involved in understanding tele health and direct practice.
Skepticism for RCTs
Randomized Controlled Trials have been largely developed from agricultural and plant based research. Applying that to health-care goes against the notion of considering every individual as unique. She also agrees that over a period of time there has been a lot of poor quality research for which she has been an active voice against. Her hopes are that as we understand what good research is the quality will improve. A good quality RCT though has the potential to give us a method that is least likely to mislead us in terms of research studies.
Current Work and Contributions
A group of multi disciplinary authors from around the world worked together to publish papers in Lancet Journal about the global problem of back pain. These papers talk about the epidemiology, prevalence, the rise in disability secondary to back pain and evidence based practice for management of low back pain patients. Despite more research, there is still a lot of discrepancy in treatment interventions with the USA leading in invasive treatment approaches. Their research paper also summarizes ideas to improve management of low back pain. One of the methods is called Changing Care Pathways; and it is about matching the patients with the right clinician from the early onset. It showcases why it is important to get the right care early in the episode so as to avoid over medicalizing the condition.