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Cerebral Palsy in the British Orthopaedic Surgery Surveillance Study

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  • Full or part time
    Mr T Theologis
    Assoc Prof D Perry
  • Application Deadline
    No more applications being accepted
  • Funded PhD Project (European/UK Students Only)
    Funded PhD Project (European/UK Students Only)

About This PhD Project

Project Description

A national prospective cohort study on the effects of Single Event Multi-Level Surgery on gait and function in children with diplegic cerebral palsy
Funded by Action Medical Research Project Grant Reference: GN2721

Cerebral Palsy (CP) is the most common serious physical disability in childhood and affects muscle control and movement. Single-event multi-level surgery (SEMLS) aims to correct lower limb deformities through a single operation and rehabilitation. However, the effectiveness is unclear and there are considerable variations in practice. This proposal was driven by parental concerns over the variation of practice and quality standards.

We will collect data nationally on all children undergoing SEMLS for one year. We will use an already established network, the “BOSS study”, which has proven effectiveness in collecting information on other orthopaedic conditions of childhood. We will assess the outcomes (patient and surgeon reported) of treatment at one and two years after surgery. Understanding the efficacy of SEMLS will refine patient selection criteria and surgical/rehabilitation techniques that work best for particular groups of patients.
Overall, this work will provide the first prospective evidence base for best surgical practice in this challenging and under-researched area. The findings of this project are essential to guide the development of future clinical trials in this field.

This study was recently prioritised as one of the top-10 research priorities in children’s orthopaedics in a Delphi consensus amongst BSCOS members. This research was also prioritised as number 3 at a recent James Lind Alliance Priority Setting Partnership on paediatric lower limb surgery.

The DPhil student is expected to lead on the data collection and analysis and the write up of the results. The project is affiliated with Wolfson College (https://www.wolfson.ox.ac.uk/). College and University fees and research costs are covered by the project but the Applicant will be required to cover their own stipend/salary for living costs.

Supervisors:
Tim Theologis [https://www.ndorms.ox.ac.uk/team/tim-theologis]

Dan Perry [https://www.ndorms.ox.ac.uk/team/daniel-perry]

The Research Team:

Tim Theologis has extensive clinical and research experience in CP and SEMLS. He is currently UK Lead for an international multi-centre (9 UK centres) prospective cohort study on the management of hip displacement in CP and has led the recent James Lind Alliance project in paediatric orthopaedics. Nicky Thompson contributes her experience in clinical gait analysis and in a previous RCT in CP. Julie Stebbins contributes her expertise in gait analysis data management and her links with the Clinical Movement Analysis Society-UK, which is important in terms of recruitment and data collection. Dan Perry contributes his expertise of having successfully organised the first prospective multi-centre study in paediatric orthopaedics in the UK, the BOSS Study. James Wright has an internationally renowned research record and contributes his experience in designing and organising clinical research. David Beards offers his expertise in organising clinical research and the support of the Oxford Clinical Trials Unit (OCTRU). Mrs Birks provides expert statistical support.

Training

The Botnar Research Centre plays host to the University of Oxford's Institute of Musculoskeletal Sciences, which enables and encourages research and education into the causes of musculoskeletal disease and their treatment. Training will be provided in techniques including analysis of gait and motor function data, understanding of the assessment and clinical management of cerebral palsy and the conducting of clinical trials.
A core curriculum of lectures will be taken in the first term to provide a solid foundation in a broad range of subjects including musculoskeletal biology, inflammation, epigenetics, translational immunology, data analysis and the microbiome.
Students will attend regular seminars within the department and those relevant in the wider University.
Students will be expected to present data regularly in the departmental PGR seminars, the ROAM group [https://www.ndorms.ox.ac.uk/research-groups/roam] and to attend external conferences to present their research globally.
Students will also have the opportunity to work closely with the Surgical Interventions Trials Unit – SITU [https://www.ndorms.ox.ac.uk/situ].
Students will have access to various courses run by the Medical Sciences Division Skills Training Team and other departments. All students are required to attend a 2 - day Statistical and Experimental Design course at NDORMS.

How to Apply

It is recommended that, in the first instance, you contact the relevant supervisors or the Graduate Studies Officer, Sam Burnell ([Email Address Removed]), who will be able to advise you of the essential requirements.
Interested applicants should have or expect to obtain a first or upper second-class BSc degree or equivalent, and will also need to provide evidence of English language competence (if applicable). The application guide and form is found online and the DPhil or MSc by research will commence in October 2019.
For further information, please visit:
http://www.ox.ac.uk/admissions/graduate/applying-to-oxford.

References

1. BOSS website: British Orthopaedic Surveillance System. Available from: http:/www.boss.surgery

2. Predictors affecting outcome after single-event multilevel surgery in children with cerebral palsy: a systematic review.
Edwards TA, Theologis T, Wright J.
Dev Med Child Neurol. 2018 Dec;60(12):1201-1208. doi: 10.1111/dmcn.13981. Epub 2018 Aug 2.

3. Multilevel Surgery for Children With Cerebral Palsy: A Meta-analysis.
Amirmudin NA, Lavelle G, Theologis T, Thompson N, Ryan JM.
Pediatrics. 2019 Apr;143(4). pii: e20183390. doi: 10.1542/peds.2018-3390. Review.
PMID: 30918016

4. The use of minimally invasive techniques in multi-level surgery for children with cerebral palsy: preliminary results.
Thompson N, Stebbins J, Seniorou M, Wainwright AM, Newham DJ, Theologis TN.
J Bone Joint Surg Br. 2010 Oct;92(10):1442-8. doi: 10.1302/0301-620X.92B10.24307.
PMID: 20884985



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