The first guidelines for physios to support those with spinal cord injuries
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Digital health technology trial for chronic pain patients
Our researchers supporting the musculoskeletal health of astronauts
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Northern Sydney Local Health District
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MESSAGE FROM THE ACADEMIC DIRECTOR
As we approach the mid-point of the year, it’s a good opportunity to reflect on our progress this year, and the impact we’re having on healthcare across the local, national and global landscape. Our researchers are making significant inroads, directly broadening our understanding of health conditions and diseases, and providing crucial data for better and more informed models of care. As you read through this newsletter, you’ll gain an insight into some of our current collaborative research projects from our basic science through to our translational work. For example, our researchers have developed the first national guidelines for physiotherapists supporting people with spinal cord injuries. We’re working to ensure more consistency in treatments for osteoarthritis, and our teams are driving clinical trials into chronic pain, and bone health treatments for women, post menopause. As we expand our clinical trial capacity, it was encouraging to attend the recent events to mark International Clinical Trials day. We have a large number of researchers involved in clinical trials, and I would like to acknowledge their efforts to establish new treatments and lift the standard of care we all receive. For me personally it has been a busy time, travelling internationally and within Australia to progress our collaborative, multidisciplinary MuscleMap research around the age-related composition of skeletal muscles using Artificial Intelligence. It’s envisaged that the advances we are making will support the
development of a new high-tech space suit and inform health and performance guidelines for astronauts before, during and after spaceflight. Closer to home, a transition is taking place across the priority research area leadership teams. New chairs and co-chairs are being progressively recruited to the three committees, with an emphasis on building on the gains achieved in recent years. There is not expected to be a change across the research enabler committee leadership teams at this time. The changes are inline with the terms of reference for the committee appointments and permits an opportunity to thank the previous co-chairs for their leadership to drive and achieve research-strategy aligned initiatives. As part of the transition, iterative planning sessions are being co-ordinated to commence in late July for Kolling researchers and our joint venture partners to report on what has been achieved with our current 5-year research strategy and a co-designed focus on the next 5-year strategy. I am pleased to confirm planning is already underway for the 2024 Kolling Research Symposium. This year’s event will be held on November 14th at the Northside Conference Centre in Crows Nest, with the theme centred on wellbeing. The symposium will feature an invited keynote speaker as well as a collection of early to mid-career researchers, and will provide an opportunity to showcase the Kolling’s recent research achievements.
We continue to work closely with the NORTH Foundation team to investigate further philanthropic opportunities and partners. I’m pleased to report a new Trust and Foundations Officer at the NORTH Foundation has been appointed to actively engage with the Kolling Institute. The NORTH Foundation is also supporting a series of information- based events like the recent Meniere’s Disease seminar and the Musculoskeletal Showcase to further engage potential donors. I would like to thank the NORTH Foundation team for their ongoing efforts to raise vital funding and I would encourage our researchers to reach out if they have questions. I would like to acknowledge the remarkable contribution of Professor Michael Cousins AO who died recently. Michael was a trailblazer in anaesthesia and pain medicine, and a mentor to many at the Kolling Institute. He was instrumental in the establishment of the Kolling’s Pain Management Research Institute. This multidisciplinary centre, named in his honour, is internationally regarded for its clinical care, teaching and research. I would like to honour his extraordinary influence on so many clinician researchers and the care offered today. Professor James Elliott
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KOLLINGNEWS | JUNE 2024
Professor Lisa Harvey in the RNSH rehabilitation gym
Kolling Institute researchers instrumental in Australian first guidelines
It has taken three years and many hours of careful work, but two researchers from the John Walsh Centre for Rehabilitation Research have developed the first clinical practice guidelines for physiotherapists to inform the care of people with life-changing spinal cord injuries. Physiotherapy is a key part of rehabilitation for people with a spinal cord injury, but until now, there has been no nationally consistent advice based on the best available evidence. The guidelines were driven by A/Professor Joanne Glinsky and Professor Lisa Harvey, who worked with a team of physiotherapists, researchers, and people with a spinal cord injury across Australia and New Zealand. Professor Harvey said the recommendations provide up-to- date information on the most effective physiotherapy management.
and the support from organisations throughout Australia including the Transport Accident Commission, the National Insurance Scheme Queensland and the Lifetime Support Authority. “Their support for this important piece of work was critical to our success. We are tremendously grateful they shared our vision to create these first Australian recommendations.” The guidelines can be viewed at www.SCIPTguide.org
“Importantly, they are based on a rigorous evaluation of the available evidence, taking into account the opinions of clinical experts and people with a spinal cord injury,” she said. “We started the process by identifying over 100 clinical questions of importance to physiotherapists and those living with an injury, and each question was ultimately answered by way of an evidenced- based recommendation or a consensus statement.” A/Professor Glinsky said we followed a very detailed and rigorous process with many meetings, discussions and reviews of the evidence. It is this process that should give people confidence in the recommendations of the guidelines,” she said. Professor Harvey added that the work was only possible with the initial financial support from icare in NSW,
Professor Lisa Harvey and A Professor Joanne Glinsky
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Kolling researchers help astronauts tackle the health challenges of spaceflight
As the National Aeronautics and Space Administration (NASA) progresses its ambitious Artemis spaceflight program, Australian researchers including the Kolling Institute’s Academic Director Professor James Elliott will tap into their scientific expertise to offer support. Professor Elliott attended a recent event at NASA’s Johnson Space Centre in Texas, which brought together leading clinicians and scientists from around the world to discuss ways to reduce the spine injuries experienced by astronauts. This group is exposed to a range of musculoskeletal conditions including spinal pain and muscle challenges due to the lack of gravity when in space. Professor Elliott said we know that physical changes to the spine during spaceflight predispose astronauts to symptomatic spine pain and nearly 50 per cent of cases presenting to NASA’s musculoskeletal care team involve spine pain. “The risk of spine pain during and after spaceflight raises operational issues and concerns for the long- term spine health of astronauts and others going into space,” he said. “We are looking forward to sharing our expertise to help reduce injury,
“The program is generating a reference dataset of muscle composition across the lifespan to help diagnose pathology, gauge the effectiveness of interventions, and develop new health outcome measures. “We are using the latest AI technology to revolutionise the measurement of skeletal muscles. “The normative data sets, developed by the MuscleMap program, could be used to compare data sets from the astronauts, so that when astronauts return from outer space, and they’ve experienced zero gravity exposure, you will be able to see what’s happened to their muscle system and what has changed to their skeletal muscle composition.
“The MuscleMap program could be an assessment tool to help improve their pain and performance when they’re in space, when they get home, and in preparation for future missions. “We are very excited to be involved with this cutting-edge research which we hope will directly support astronauts and their long-term health.” Professor Elliott has also welcomed the chance to collaborate with innovator Metakosmos as it pioneers the development of a next-generation space suit. The company is working to revolutionise human spaceflight technology, while also advancing terrestrial based health, performance and wellbeing. It is set to leverage the progress of the MuscleMap program.
and improve the health and performance of astronauts.
“NASA has expressed an interest in our MuscleMap program, which is a revolutionary technique to assess whole-body skeletal muscle composition using high-resolution MRI. “More than 50 clinicians and researchers are now contributing to our program representing physics, engineering, oncology, radiology and many more specialties.
Professor James Elliott
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KOLLINGNEWS | JUNE 2024
Professor Gemma Figtree has completed the prestigious Boston Marathon
Running for game-changing research Less than two years after a breast cancer diagnosis, Professor Gemma Figtree has completed the prestigious Boston Marathon while raising
exercise for cancer patients from reductions in recurrence, improved mental health and a reduction in the side effects of chemotherapy.” Gemma is tremendously thankful to her donors who helped her raise more than $30,000. “Philanthropic funding is so important as it often supports early to mid-career researchers or early stage ideas, where there may not necessarily be all the data to succeed with a highly competitive national funding grant. It can be a crucial component in advancing medical research.” Gemma hopes there will also be further philanthropic funds for her own research program into heart disease and the rise in cases of coronary artery disease and heart attack in patients without the traditional risk factors, like blood pressure, diabetes, high cholesterol and smoking. “I’m sure we can learn from some of our cancer colleagues about the drugs that can target specific biological pathways that are driving an individual’s susceptibility or resilience to common disease.
“This could be particularly relevant for heart disease, with 25 per cent of heart attack patients developing ticking time bomb coronary plaque without the traditional risk factors. “We are developing new biomarkers in the blood to help detect early coronary artery plaque before a heart attack, enabling all patients to benefit from effective treatments. These markers are designed to be integrated into clinical pathways that take a stepwise approach to imaging using advanced CT coronary angiography. “This would have a game changing impact on reducing heart attacks –because, if we can detect the disease, we can treat it.” Imaging of coronary plaque also has an important role in providing a new pathway for novel drugs to prevent heart attack. Gemma is leading an international consortium CAD Frontiers to advocate for CT coronary angiography measures of coronary plaque to be measured as endpoints in clinical trials. This would dramatically reduce the cost and time required to develop much needed new coronary artery drugs without reducing the rigor.
significant funds for cancer research. Gemma crossed the finish line in a sub four hour time as part of the talented team running for the internationally renowned Dana Farber Cancer Institute. Gemma ran her first marathon just after completing six months of chemotherapy in 2022, so to be accepted into the Boston event was a remarkable achievement. “I was really excited to have the opportunity to run in the marathon, but it was particularly an honour to run for the Dana Farber Cancer Institute,” she said. “For me to come through chemotherapy, and then qualify to run Boston was a major milestone in itself, and then to be able to run for one of the world’s best cancer research institute’s fundraising teams, was a perfect combination. “Running was a crucial part of my recovery, and there’s now increasing evidence around the benefits of
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Digital technology to support those with long-standing pain
Researchers based at the Kolling Institute have launched a clinical trial using digital health technology to help those with chronic pain reduce their use of opioids. Chief investigator and leading pain specialist at Royal North Shore Hospital Professor Paul Glare said many people with chronic pain are
using opioid medications long- term, but research shows that in many cases, these medications are doing more harm than good. “We know that reducing the use of opioids not only minimises harm, but also leads to improvements in pain and quality of life,” he said. Professor Glare said many people who have
“The aim of this study is to see if we can provide more support via their mobile phone to make tapering easier. “The clinical trial follows a pilot study which showed that patients’ confidence to reduce their reliance on opioids improved when they received text messages. “It also found their pain reduced, and their mood and functioning was better. “We are now enrolling participants in a randomised control trial to test if the intervention leads to a greater reduction of their opioid dose.” You can join the study from anywhere in Australia where you have access to a phone network and the internet. If you would like to participate go to Support4Pain Study
been on long term opioids for pain find reducing their dose a daunting prospect, and unfortunately, many of them don’t have much social support either. As part of the clinical trial, participants will watch a video about pain and opioids and receive text messages,
Professor Paul Glare
while their opioid medication dose is reduced under the supervision of the prescribing doctor.
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Dr Jillian Eyles
Research helping the community tap into the best osteoarthritis care
While a large share of the community experiences osteoarthritis, many people are not receiving the latest, evidenced- based care leaving them with poorer and more painful outcomes. Health and government bodies are working to address the shortfall, investing resources to increase awareness of high-value care. As part of this national approach, Kolling Institute researcher and physiotherapist Dr Jillian Eyles has received a prestigious $660,000 NHMRC investigator grant to promote best-practice osteoarthritis care. Dr Eyles said we know that the first-line approach for osteoarthritis involves non-surgical treatments based on education, self- management, exercise and weight control. “This approach works well for many people and is consistently recommended by the clinical
guidelines, and yet 64 per cent of people with osteoarthritis are not offered these treatments,” she said. “We can see there are many barriers to delivering the best care from a lack of knowledge and skills of health professionals to traditional referral pathways. “There is an urgent need to reduce the use of treatments that are not recommended such as unnecessary surgical procedures, and we will be working with surgeons to gain a better understanding around the existing pathways. “As part of this grant, we will also be looking at new ways to educate and train the health workforce to deliver best-evidence care, and we’ll be working to improve the uptake of programs which offer best-evidence models of care. “This will involve phasing-out low-value osteoarthritis treatments which should no longer be used.
“A large amount of research has made considerable progress in recent years, and its crucial that this new advice and understanding of the joint disease is broadly incorporated into both the hospital and community settings. “More than eight per cent of the total population of Australia live with osteoarthritis, so it’s important everyone has good access to the best available advice and treatment.”
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Research to improve postmenopausal women’s bone and muscle health
Kolling Institute researchers Dr Shejil Kumar and Professor Rory Clifton-Bligh have embarked on a pioneering study to enhance bone health in postmenopausal women. Titled “ Combining Osteoanabolic Pharmacotherapy with Osteogenic Exercise in Postmenopausal Women with Osteoporosis and Osteopenia ”, the ROLEX-DUO study is set to recruit 100 women aged 50 and above. Dr. Kumar said the research will assess the effectiveness of combining exercise and medication to improve bone and muscle health. “We know that exercise has benefits on bone and muscle health, and there are effective treatments available to strengthen bones,” he said.
“However, what we don’t know is whether combining exercise plus medication at the same time can lead to even greater improvements in bone and muscle health than treating with either alone.” The study will utilise a medication that has been shown to increase bone density and reduce fracture risk in previous international studies. Participants will be randomly assigned to different treatment groups, including a supervised group class focusing on weightbearing exercises and a home-based exercise program concentrating on mobility and balance. “We are investigating if this combination is more effective and could change the way we treat and prevent osteoporosis going forward,” Dr Kumar said.
Postmenopausal women between the ages of 50 and 80 are encouraged to participate, as they are at high risk of poor bone health. The study aims to assess how different combinations of treatment improve bone density, muscle strength, body composition, physical function and risk of falls.
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KOLLINGNEWS | JUNE 2024
New research challenges the link between the weather and joint pain
Many people believe there is a connection between the weather and joint or muscle pain, but a team of researchers from the Kolling Institute and the University of Sydney say their latest study has found there is no link between the two. Lead author Professor Manuela Ferreira said there is a longstanding belief that changes in weather conditions, such as rain or temperature variations, can trigger or worsen muscle and joint pain, but based on their analyses, they have found the weather has no direct influence on the most common musculoskeletal conditions. “We looked at data from over 15,000 people from seven different countries,” she said.
“Together, these people reported over 28,000 episodes of pain, mostly back pain, knee or hip osteoarthritis. We also included people with rheumatoid arthritis and gout. “We then looked at the frequency of those pain reports in different types of weather, hot, cold, humid, dry, rainy and found no difference. “In other words, people do not experience more pain or pain flares when it is hot, or cold, or humid or raining suggesting there is no direct link between the weather and joint or muscle pain. “The only exception was gout where we found hot and dry weather can increase the risk of a flare in people with gout.” Professor Ferreira said the study highlights a wider issue that even
though more than a quarter of Australians are affected by a chronic musculoskeletal condition, there are still widespread misconceptions and limited treatment options. “Patients are often left to navigate and understand their medical condition without access to reliable information,” she said. “Our research has debunked a common myth, and we hope shifted attention to evidenced based care. “When seeking pain prevention and relief, both patients and clinicians should focus on how to best manage the condition, including weight management and exercises, and not let the weather influence any treatment.” The study has been published in Seminars in arthritis and rheumatism.
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Professor Chris Little
Our researchers making an impact on the world stage
Internationally respected investigator Professor Chris Little
“Since its inception 70 years ago, the US Orthopaedic Research Society has arguably become the pre-eminent international scientific society dedicated to musculoskeletal research,” he said. “I am therefore very honoured and humbled to have been nominated as an Orthopaedic Research Society Fellow. “Such personal accolades are really a reflection of the extraordinary members of the Raymond Purves Research Lab team that I’ve have the privilege of leading over the past 20 years. “Ultimately, it’s the work that they do to increase knowledge of the mechanisms of musculoskeletal disease to help develop new treatments, that is the most important thing.
“Societies like the Orthopaedic Research Society enable us to both disseminate what we learn in our research and learn from others around the world, so that together we can hopefully change the lives of patients.”
has been recognised for his remarkable contribution to orthopaedic research.
Infront of a large international audience in California, Professor Little was elected as a Fellow of the Orthopaedic Research Society for his exemplary service and leadership. The accolade acknowledges Chris’ achievement, expert knowledge and contribution to the society and the field of musculoskeletal research over more than 20 years. Fellows are recognised as thought leaders and serve as role models for those beginning their research journey. Chris has welcomed the honour.
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Strong research pipeline flags positive trend With an increasing focus on our research activity, the Royal North Shore Hospital Scientific Staff Council is keen to celebrate the efforts of some of our emerging leaders at the Kolling Institute.
Dr Carina Blaker
It has presented four awards recognising an outstanding commitment to research excellence. Kolling Institute musculoskeletal researchers Dylan Ashton and Dr Carina Blaker were joint winners of the best publication award for their paper which identified a broader range of possible tendon grafts for knee injuries. Carina also took out the outstanding early to mid-career researcher award in the basic science category, while fellow Kolling researcher A/Professor Rebecca Kozor clinched the outstanding clinical researcher award for her work using high resolution imaging to help diagnose and treat heart disease.
Dr Katherine Bates received the outstanding research student award for her work on the identification of new biomarkers and risk factors for heart disease. Chair of the Scientific Staff Council Dr Sumit Sahni said he was pleased to be able to present the awards to this impressive group. “A huge amount of important work goes on behind the scenes,” he said. “Many of our researchers are quietly making crucial progress with their research, and it’s wonderful to be able to recognise their remarkable efforts extending our understanding of particular conditions and lifting the standard of care we all receive. “The quality of nominations we received was particularly high, making the decisions difficult and highlighting the expertise we have on the Royal North Shore Hospital campus.”
Carina welcomed the announcement. “I was really honoured to receive the award recognising our research and I’m very grateful to the Scientific Staff Council for their ongoing support,” she said. “Our research is aimed at broadening our understanding of different tissues so that we can personalise treatment options. “We are increasingly seeing that a tailored approach will deliver a better individual fit and a better outcome for patients. “I hope this award helps to draw attention to the steady progress we’re making in this field. “We’re seeing an increasing number of knee injuries in Australia, with many the result of a sporting injury, so it’s important that clinicians are able to offer the very latest evidenced-based treatments for each patient.”
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