Research Interests

People with chronic (lasting > 3 months) musculoskeletal – and particularly LBP – commonly have poor health outcomes and persisting symptoms. This is largely because musculoskeletal pain is a complex condition where a single treatment approach may not achieve optimal outcomes for all patients.  Individualised treatment based on the biopsychosocial model is most likely to be effective at targeting the biological (pathoanatomical, impairment, neurophysiological), psychosocial and social barriers to recovery.  However, few treatment protocols have been published in regard to individualised treatment informed by all the factors in this model.

We undertake multi-centre randomised controlled trials in order to establish novel individualised treatment, as well as other studies designed to generate an understanding of the mechanism of treatments effect. Our research improves identification of prognostic factors, the understanding of disease processes, behaviour change in patients/practitioners, and clinical decision making. This ultimately enables health professionals to provide more effective individualised treatments for patients with musculoskeletal and LBP.

Research Team 

We are a multidisciplinary research team who are inspired to develop a world-class research program on chronic pain, and in particular LBP. 

Clinical Researchers

• A/Prof Jon Ford (Clinical and Managing Director)

• Dr Luke Surkitt (APA Pain Physiotherapist)

• Dr Aston Wan (Specialist Pain Physician)

• Advance Healthcare clinical practitioners (https://www.advancehealthcare.com.au/practitioners )

• PhD students (Aidan Rich, Matt Richards, Mohini Shah, Musa Sani Danazumi, Rashid Vid)

Research assistants

• Dr Shane Pritchard

• Kerryn Dunn

• Meagan Vermass

• Priscilla Martin

• Rosie Muleta

• Lachlan Robinson

Our Collaborators

• Dr Andrew Hahne (La Trobe University)

• Prof Nicholas Taylor (La Trobe University)

• Dr Paul O’Halloran (La Trobe University)

• Dr Alix Mellor (Monash University)

• Prof Paul Hodges (University of Queensland)

• Prof Jill Cook (La Trobe University)

• Prof Kavitha Raja (JSS University, Academy of Higher Education & Research, India)

• Prof Linda van Dillen (Washington University in St. Louis, USA)

• Dr Marianne Matthias (Indiana University–Purdue University Indianapolis)

• Dr Katherine Brain (University of Newcastle)

• Dr Melinda Rak (Clinical Psychologist)

Research Themes

Research at Advance Healthcare encompasses four treatment disciplines: physiotherapy; psychology; dietetics and multi-disciplinary pain management.  We undertake clinical trials using cross-disciplinary approaches and a focus on five themes.

Theme #1:        Clinical and healthcare outcomes of individualised physiotherapy for LBP

The Specific Treatment of Problems of the Spine (STOPS) trial is the first randomised controlled trial showing moderate to large effects favouring individualised physiotherapy. Clinically important improvements in pain and disability, when compared to guideline-based treatment as well as cost effectiveness were demonstrated. Theme #1 involves replicating the original STOPS trial in further studies in Australia and overseas.

Theme #2:        Brain activity changes in people with LBP undergoing individualised physiotherapy

In order to understand the long-term benefits and overall impact that individualised physiotherapy exerts upon patients with LBP, we will use functional magnetic resonance imaging (fMRI) to evaluate changes in brain activity in people with LBP receiving the STOPS approach compared to usual care. Brain MRI is one of the most widely used modalities for the study of pain, and functional MRI (fMRI) allows for an indirect measurement of brain activity by tracking changes in blood oxygenation levels.

Theme #3:        Motor control training in people with nociceptive and/or neuropathic pain

This project will evaluate the effectiveness of motor control training targeting posture, movement and muscle activation on people with nociceptive and/or neuropathic dominant LBP who are undergoing multi-disciplinary pain management compared to pain management alone.

Theme #4:         Motivational interviewing and peer support in people with nociplastic pain

This project will evaluate the effectiveness of motivational interviewing (provided by psychologists and physiotherapists) and peer support (provided by patient “graduates” from the pain management program) on people with nociplastic dominant pain undergoing multi-disciplinary pain management compared to pain management alone. 

Theme #5:        Improving Pain Healthcare Service via ePPOC

We are a participating healthcare service of the Electronic Persistent Pain Outcomes Collaboration (ePPOC), an Australasian initiative that aims to improve the quality of care and outcomes for people who experience chronic pain. Standardised information about patients and their treatment is collected using a specialised software called epiCentre (ePPOC Patient Information Centre). Through participating in this nation-wide program, we are able to perform regular measurement of practice and healthcare quality in order to achieve ongoing service improvement.

Queries

For queries regarding our research programs or if you are interested in collaborating, please contact Shane Pritchard through spritchard@advancehealthcare.com.au.

Research Outcomes and Impact

Research Publications

(Full text research paper available from http://www.stops.physio/our-research )  

1. Liew, B. X. W., J. J. Ford, M. Scutari and A. J. Hahne (2021). How does individualised physiotherapy work for people with low back pain? A Bayesian Network analysis using randomised controlled trial data. PLoS One, 16(10). doi:10.1371/journal.pone.0258515

2. Ford, J. J., S. E. Bower, I. Ford, M. M. de Mello, S. R. Carneiro, A. P. Balasundaram and A. J. Hahne (2020). Effects of specific muscle activation for low back pain on activity limitation, pain, work participation, or recurrence: A systematic review. Musculoskeletal Science and Practice, 50: 102276. (Impact Factor 1.911 – June 2019)

3. Ford, J. J., Kaddour, O., Gonzales, M., Page, P., & Hahne, A. J. (2020). Clinical features as predictors of histologically confirmed inflammation in patients with lumbar disc herniation with associated radiculopathy. BMC Musculoskeletal Disorders, 21(1), 567. doi:10.1186/s12891-020-03590-x (Impact Factor 2.002 – June 2018)

4. Teychenne, M., Miller, C., Ford, J., Hahne, A., Main, L., Rantalainen, T., . . . Belavy, D. (2020). Randomized Trial of General Strength and Conditioning Versus Motor Control and Manual Therapy for Chronic Low Back Pain on Physical and Self-Report Outcome. Journal of Clinical Medicine, 9, 1726. (Impact Factor 5.583 – June 2018)

5. Ford, J. J., Kaddour, O., Page, P., Richards, M. C., McMeeken, J. M., & Hahne, A. J. (2020). A multivariate prognostic model for pain and activity limitation in people undergoing lumbar discectomy. British Journal of Neurosurgery, 1-7. doi:10.1080/02688697.2020.1742288 (Impact Factor 1.481 – June 2018)

6. Owen, P. J., Miller, C. T., Rantalainen, T., Simson, K. J., Connell, D., Hahne, A. J., . . . Belavy, D. L. (2020). Exercise for the intervertebral disc: a 6-month randomised controlled trial in chronic low back pain. European Spine Journal. doi:10.1007/s00586-020-06379-7 (Impact Factor 1.368 – June 2018)

7. Ford J, Hahne A, Surkitt L, Chan A, Richards M. The Evolving Case Supporting Individualised Physiotherapy for Low Back Pain. Journal of Clinical Medicine. 2019;8(9). (Impact Factor 5.583 – June 2018)

8. Teychennel, M, Lamb, K.E, Main, L, Miller, C, Hahne, A, Ford, J, Rosenbaum, S, Belavy, D (2019).  General strength and conditioning versus motor control with manual therapy for improving depressive symptoms in chronic low back pain: a randomised feasibility trial.  PLOS ONE (Impact Factor 2.776 – June 2018)

9. Ford, J. J., Slater, S. L., Richards, M. C., Surkitt, L. D., Chan, A. Y. P., Taylor, N. F., & Hahne, A. J. (2018). Individualised manual therapy plus guideline-based advice versus advice alone for people with clinical features of lumbar zygapophyseal joint pain: A randomised controlled trial. Physiotherapy. doi:10.1016/j.physio.2018.07.008 (Impact Factor 2.534 – June 2018)

10. Ford, J. J., Hahne, A. J., Surkitt, L. D., Chan, A. Y. P., Richards, M. C., Slater, S. L., . . . Taylor, N. F. (2018). STOPS trial versus Costa et al: a more accurate analysis. Br J Sports Med. doi:10.1136/bjsports-2017-098821 (Impact Factor 7.867 – July 2018)

11. Ford, J. J., Richards, M. C., Surkitt, L. D., Chan, A. Y. P., Slater, S. L., Taylor, N. F., & Hahne, A. J. (2018). Development of a Multivariate Prognostic Model for Pain and Activity Limitation in People With Low Back Disorders Receiving Physiotherapy. Arch Phys Med Rehabil. doi:10.1016/j.apmr.2018.04.026

12. Warby, S. A., Ford, J. J., Hahne, A. J., Watson, L., Balster, S., Lenssen, R., & Pizzari, T. (2018). Comparison of 2 Exercise Rehabilitation Programs for Multidirectional Instability of the Glenohumeral Joint: A Randomized Controlled Trial. Am J Sports Med, 46(1), 87-97. doi:10.1177/0363546517734508. (Impact Factor – 5.673 – July 2017)

13. Simson, K. J., Miller, C. T., Ford, J., Hahne, A., Main, L., Rantalainen, T., . . . Belavy, D. L. (2017). Optimising conservative management of chronic low back pain: study protocol for a randomised controlled trial. Trials, 18(1), 184. doi:10.1186/s13063-017-1913-8

14. Chan, A. Y., Ford, J. J., Surkitt, L. D., Richards, M. C., Slater, S. L., Davidson, M., & Hahne, A. J. (2016). Individualised functional restoration plus guideline-based advice vs advice alone for non-reducible discogenic low back pain: a randomised controlled trial. Physiotherapy. doi:10.1016/j.physio.2016.08.001

15. Warby, S. A., Watson, L., Ford, J. J., Hahne, A. J., & Pizzari, T. (2017). Multidirectional instability of the glenohumeral joint: Etiology, classification, assessment, and management. J Hand Ther, 30(2), 175-181. doi:10.1016/j.jht.2017.03.005

16. Hahne, A. J., Ford, J. J., Richards, M. C., Surkitt, L. D., Chan, A. Y., Slater, S. L., & Taylor, N. F. (2017). Who Benefits Most from Individualized Physiotherapy or Advice for Low Back Disorders? A Pre-Planned Effect Modifier Analysis of a Randomized Controlled Trial. Spine (Phila Pa 1976). doi:10.1097/brs.0000000000002148

17. Hahne, A. J., Ford, J. J., Surkitt, L. D., Richards, M. C., Chan, A. Y., Slater, S. L., & Taylor, N. F. (2017). Individualized Physical Therapy Is Cost-Effective Compared With Guideline-Based Advice for People With Low Back Disorders. Spine (Phila Pa 1976), 42(3), E169-E176. doi:10.1097/BRS.0000000000001734

18. Hahne, A. J., Ford, J. J., Hinman, R. S., Richards, M. C., Surkitt, L. D., Chan, A. Y., . . . Taylor, N. F. (2017). Individualized functional restoration as an adjunct to advice for lumbar disc herniation with associated radiculopathy. A preplanned subgroup analysis of a randomized controlled trial. Spine J, 17(3), 346-359. doi:10.1016/j.spinee.2016.10.004

19. Surkitt, L. D., Ford, J. J., Chan, A. Y. P., Richards, M. C., Slater, S. L., Pizzari, T., & Hahne, A. J. (2016). Effects of individualised directional preference management versus advice for reducible discogenic pain: A pre-planned secondary analysis of a randomised controlled trial. Manual Therapy, 25, 69-80. doi:10.1016/j.math.2016.06.002

20. Warby, S. A., Ford, J. J., Hahne, A. J., Watson, L., Balster, S., Lenssen, R., & Pizzari, T. (2016). Effect of exercise-based management on multidirectional instability of the glenohumeral joint: a pilot randomised controlled trial protocol. BMJ Open, 6(9), e013083. doi:10.1136/bmjopen-2016-013083

21. Ford, J. J., Hahne, A. J., Surkitt, L. D., Chan, A. Y., Richards, M. C., Slater, S. L., . . . Taylor, N. F. (2015). Individualised physiotherapy as an adjunct to guideline-based advice for low back disorders in primary care: a randomised controlled trial. Br J Sports Med. doi:10.1136/bjsports-2015-095058. (Impact Factor 7.867 – July 2018)

22. Freitag, J., Ford, J., Bates, D., Boyd, R., Hahne, A., Wang, Y., . . . Shah, K. (2015). Adipose derived mesenchymal stem cell therapy in the treatment of isolated knee chondral lesions: design of a randomised controlled pilot study comparing arthroscopic microfracture versus arthroscopic microfracture combined with postoperative mesenchymal stem cell injections. BMJ Open, 5(12). doi:10.1136/bmjopen-2015-009332. (Impact Factor 2.271 – December 2014) 

23. Warby, S. A., Pizzari, T., Ford, J. J., Hahne, A. J., & Watson, L. (2016). Exercise-based management versus surgery for multidirectional instability of the glenohumeral joint: a systematic review. Br J Sports Med, 50(18), 1115-1123. doi:10.1136/bjsports-2015-094970. (Impact Factor 5.025 – December 2014)

24. Warby, S. A., Pizzari, T., Ford, J. J., Hahne, A. J., & Watson, L. (2014). The effect of exercise-based management for multidirectional instability of the glenohumeral joint: a systematic review. J Shoulder Elbow Surg, 23(1), 128-142. doi:10.1016/j.jse.2013.08.006. (Impact Factor 2.69 – December 2014)

25. Chan, A. Y., Ford, J. J., McMeeken, J. M., & Wilde, V. E. (2013). Preliminary evidence for the features of non-reducible discogenic low back pain: survey of an international physiotherapy expert panel with the Delphi technique. Physiotherapy, 99, 212-220. doi:10.1016/j.physio.2012.09.007. (Impact Factor 1.57 – July 2013)

26. Ford, J. J., & Hahne, A. J. (2013a). Complexity in the physiotherapy management of low back disorders: clinical and research implications. Manual Therapy, 18, 438–442. doi:10.1016/j.math.2013.01.007. (Impact Factor 2.24 – July 2013)

27. Ford, J. J., & Hahne, A. J. (2013b). Pathoanatomy and classification of low back disorders. Manual Therapy, 18(2), 165-168. doi:10.1016/j.math.2012.05.007. (Impact Factor 2.24 – July 2013)

28. Ford, J. J., Hahne, A. J., Chan, A. Y. P., & Surkitt, L. D. (2012). A classification and treatment protocol for low back disorders. Part 3: functional restoration for intervertebral disc related disorders. Phys Ther Rev, 17(1), 55-75.

29. Ford, J. J., Richards, M. J., & Hahne, A. J. (2012). A classification and treatment protocol for low back disorders. Part 4: functional restoration for low back disorders associated with multifactorial persistent pain. Phys Ther Rev, 17(5), 322-334.

30. Slater, S. L., Ford, J. J., Richards, M. C., Taylor, N. F., Surkitt, L. D., & Hahne, A. J. (2012). The effectiveness of sub-group specific manual therapy for low back pain: a systematic review. Manual Therapy, 17(3), 201-212. doi:10.1016/j.math.2012.01.006

31. Surkitt, L. D., Ford, J. J., Hahne, A. J., Pizzari, T., & McMeeken, J. M. (2012). Efficacy of directional preference management for low back pain: a systematic review. Physical Therapy, 92(5), 652-665. doi:10.2522/ptj.20100251. (Impact Factor 2.78 – July 2013).

32. Richards, M. C., Ford, J. J., Slater, S. L., Hahne, A. J., Surkitt, L. D., Davidson, M., & McMeeken, J. M. (2012). The effectiveness of physiotherapy functional restoration for post-acute low back pain: a systematic review. Manual Therapy, 18(1), 4-25. doi:10.1016/j.math.2012.06.005. (Impact Factor 2.24 – July 2013)

33. Ford, J. J., Surkitt, L. D., & Hahne, A. J. (2011). A classification and treatment protocol for low back disorders. Part 2: directional preference management for reducible discogenic pain. Phys Ther Rev, 16(6), 423-437.

34. Ford, J. J., Thompson, S. L., & Hahne, A. J. (2011). A classification and treatment protocol for low back disorders. Part 1: specific manual therapy. Phys Ther Rev, 16(3), 168-177.

35. Hahne, A., Ford, J. J., Hinman, R., Taylor, N. F., Surkitt, L., Walters, A., & McMeeken, J. (2010). Outcomes and adverse events from physiotherapy functional restoration for lumbar disc herniation with associated radiculopathy. Disability and Rehabilitation, Early Online, 1-11. (Impact Factor 1.54 – July 2013).

36. Hahne, A. J., Ford, J. J., Surkitt, L. D., Richards, M. C., Chan, A. Y., Thompson, S. L., . . . Taylor, N. F. (2011). Specific treatment of problems of the spine (STOPS): design of a randomised controlled trial comparing specific physiotherapy versus advice for people with subacute low back disorders. BMC Musculoskelet Disord, 12, 104. doi:10.1186/1471-2474-12-104. (Impact Factor 1.89 – July 2013)

37. Hahne, A. J., Ford, J. J., & McMeeken, J. M. (2010). Conservative management of lumbar disc herniation with associated radiculopathy: a systematic review. Spine, 35(11), E488-E504 (Impact Factor 2.16 – July 2013). 

38. Ford, J., Story, I., & McMeeken, J. (2009). The test retest reliability and concurrent validity of the Subjective Complaints Questionnaire for low back pain. Manual Therapy, 14 283-291.

39. Stanhope M and Ford JJ.  Practical implementation of treatment guidelines in a workers’ compensation environment: A new approach.  The Journal of the International Association of Industrial Accidents Boards and Commissions 2008;45:207-223.

40. Heymans, M., Ford, J., McMeeken, J., Chan, A., de Vet, H., & van Mechelen, W. (2007). Exploring the contribution of patient-reported and clinician based variables for the prediction of low back work status. Journal of Occupational Rehabilitation, 17, 383–397 (IF 1.644)

41. Wilde, V., Ford, J., & McMeeken, J. (2007). Indicators of lumbar zygapophyseal joint pain: survey of an expert panel with the Delphi Technique. Physical Therapy, 87(10), 1348–1361.

42. Ford, J., Story, I., O’Sullivan, P., & McMeeken, J. (2007). Classification systems for low back pain: a review of the methodology for development and validation. Physical Therapy Reviews, 12, 33-42.

43. Stanhope M, Ford JJ.  The critical role of evidence-based decision support systems to deliver the intended benefits of treatment guidelines in workers’ compensation.  The Journal of the International Association of Industrial Accidents Boards and Commissions 2006; Autumn:35-60. 

44. Ford JJ.  Pathological and psychosocial considerations in massage of the lumbar spine.  Journal of the Australian Association Massage Therapists 2007;Spring:14-18.

45. Hahne, A., & Ford, J. (2006). Functional restoration for a chronic lumbar disk extrusion with associated radiculopathy. Physical Therapy, 86(12), 1668-1680.

46. Ford, J., & Bennell, K. (2000). Effectiveness of a physiotherapy functional restoration programme compared to patient-selected treatment on chronic compensable low back pain Moving in on occupational injury. Oxford: Butterworth-Heinemann.