Paul Campbell

Keele University · School of Medicine

Painful musculoskeletal conditions are common in older adults, however pain identification, assessment, and management are reported to be suboptimal for people with dementia. Adequate pain management is an integral aspect of care for people with dementia to prevent or delay negative outcomes, such as behavioural and psychological changes, emergency...

A significant proportion of children/adolescents report Chronic Widespread Pain (CWP), but little is known about clinically relevant CWP or what factors lead to onset in this population. Objectives were to report the primary care consultation prevalence of CWP, and investigate risk factors associated with onset. A validated algorithm for identifyin...

People of South Asian (SA) origin have a higher prevalence of dementia compared with the United Kingdom (UK) population as a whole. Little is known about how family carers of SA origin perceive dementia, manage access to dementia services, and how plans and preparations are made for end-of-life for loved ones with dementia. This qualitative study a...

Health literacy (HL), defined as the ability of an individual to understand and appraise health information to make informed decisions on their health, helps maintain and improve one’s health and thus reduce the use of healthcare services. There is a recognised global effort to address insufficient HL in early life and understand how HL develops. T...

The introduction of Integrated Care Systems (ICS) in England aimed to increase joint planning and delivery of health and social care, and other services, to better meet the needs of local communities. There is an associated duty to undertake collaborative research across ICS partners to inform this new integrated approach, which might be challengin...

Background: Dementia is a global health concern affecting an estimated 115.4 million people worldwide. Dementia has become a specific research priority in low- and middle-income countries (LMIC), due to the general rise in prevalence associated with increased longevity and demographic transition. 66% of people with dementia live in LMIC; however, a...

Background Usual primary care for patients with musculoskeletal pain varies widely and treatment outcomes are suboptimal. Stratified care involves targeting treatments according to patient subgroups, in the hope of maximising treatment benefit and reducing potential harm or unnecessary interventions. This programme developed a new prognostic strati...

Objectives To assess the feasibility of linking and comparing markers of dementia-related health recorded in primary care electronic health records (EHR) to assessments of cognitive function undertaken in a specialist dementia service. Methods One thousand patients in a UK secondary care specialist dementia service were invited to take part. Prima...

Objectives The aim of this study was to describe and compare health economic outcomes (healthcare utilisation, costs, work outcomes and health-related quality of life (EQ-5D-5L)) in patients classified into different risk subgroups by the Keele STarT MSK Tool. Methods Data on healthcare utilisation, costs and EQ-5D-5L were collected from a healthc...

Objective Rheumatoid arthritis (RA) is an autoimmune, inflammatory, systemic condition that requires specific drug treatment to suppress disease activity and prevent joint deformity. To manage the ongoing symptoms of joint pain and fatigue patients are encouraged to engage in self-management activities. People with RA have an increased incidence of...

Objective: People with inflammatory arthritis have an increased incidence of serious illness and mortality, placing them at risk of poor outcomes from coronavirus disease 2019 (COVID-19). This study explored patients' perceptions of risk from COVID-19 over a longitudinal period of the pandemic. Methods: Fifteen adults with inflammatory arthritis...

This longitudinal interview study with 15 people with RA highlights that the main impact of the pandemic appeared to be on emotional wellbeing brought about by fear of COVID-19, later compounded by lack of social interaction. In this small study, participants’ physical health was reported to be stable and participants were able to use self-manageme...

Background/Aims The COVID-19 pandemic led to the widespread adoption of remote consultations. Whilst remote consultations offer many potential advantages to patients and healthcare services, they are unlikely to be suitable for all. Guidance encourages clinicians to consider patient preferences when choosing face-to-face vs remote consultations. Ho...

Background Guidance for choosing face-to-face vs remote consultations (RCs) encourages clinicians to consider patient preferences, however, little is known about acceptability of, and preferences for RCs, particularly amongst patients with musculoskeletal conditions. This study aimed to explore the acceptability of, and preferences for, RC among pa...

Evidence-based practice (EBP) has been promoted within social work/social care, with emerging evidence of benefit to practitioners and service users. Advocates argue that EBP enables practitioners to have the skills to interpret and evaluate evidence and be actively involved in research. This project aimed to evaluate awareness, experience/skills a...

The COVID-19 pandemic signalled a radical shift in health and social care services globally. In UK, many of the people with existing social care needs were identified as 'clinically vulnerable' to COVID-19. Those at greatest risk were encouraged to adhere to additional public health measures that inadvertently exacerbated social disadvantages. Soci...

Adolescent musculoskeletal pain is common and is associated with musculoskeletal pain in adulthood. Psychological symptoms, also common in adolescence, have been shown to be associated with musculoskeletal pain, but the current evidence is mixed and may be dependent on effect modifiers. This study investigated whether adolescents with psychological...

Background Patients with musculoskeletal pain in different body sites share common prognostic factors. Using prognosis to stratify and treatment match can be clinically and cost-effective. We aimed to refine and validate the Keele STarT MSK tool for prognostic stratification of musculoskeletal pain patients. Methods Tool refinement and validity wa...

Background: As a result of the global rise in life expectancy, dementia has become a major global health concern; it is considered to be one of the most burdensome conditions of later life. Despite 66% of older adults with dementia living in Low-and-Middle Income countries (LMIC), only 10% of dementia research has been conducted in these countries...

Background The objectives were to assess the feasibility and validity of using markers of dementia‐related health as indicators of dementia progression in primary care, by assessing the frequency they are recorded and by testing the hypothesis they are associated with recognised outcomes of dementia. The markers, in 13 domains, were derived previou...

Our knowledge of the prevalence, impact, and outcomes of chronic pain in the general population is predominantly based on studies over relatively short periods of time. The aim of this study was to identify and describe trajectories of chronic pain status over a period of 21 years. Self-reported population data (n=1858) from five timepoints were an...

Introduction: The benefits of family-based interventions for patients with musculoskeletal pain have been previously shown in individual randomised controlled trials (RCTs), but no systematic review has summarised their effects. Materials and methods: A systematic review was conducted to assess the effectiveness of family-based interventions on...

Adults with sleep problems are at higher risk for onset of musculoskeletal pain, but the evidence is less clear for children. This prospective cohort study investigated whether children with sleep problems are at higher risk for onset of musculoskeletal pain and explored whether sex is a modifier of this association. In a prospective cohort study o...

Objectives: Identifying routinely recorded markers of poor health in patients with dementia may help treatment decisions and evaluation of earlier outcomes in research. Our objective was to determine whether a set of credible markers of dementia-related health could be identified from primary care electronic health records (EHR). Methods: The study...

Background Painful conditions are common in older adults, including people with dementia. The symptoms associated with dementia (for example, diminished language capacity, memory impairment, and behavioural changes), however, may lead to the suboptimal identification, assessment, and management of pain. Research has yet to qualitatively explore pai...

Low health literacy is an issue with high prevalence in the UK and internationally. It has a social gradient with higher prevalence in lower social groups and is linked with higher rates of long-term health conditions, lower self-rated health, and greater difficulty self-managing long-term health conditions. Improved medical services and practition...

This commentary review collates and evaluates current review and meta-analysis evidence on the association between exercise and depression. Collectively this evidence demonstrates a clear and robust effect of depressive symptom reduction as a result of exercise, and this effect is shown to be particularly stronger in populations with greater severi...

This commentary review evaluates current review and meta-analysis evidence on the association between exercise and depression. Collectively this evidence demonstrates a clear and robust effect of depressive symptom reduction as a result of exercise, and this effect is shown to be particularly stronger in populations with greater severity of depress...

Background: Population-based studies show that sleep problems and psychological symptoms may increase the risk of musculoskeletal pain onset in children / adolescents. However, there is no evidence of these associations within primary care settings, where interventions can take place. This study investigated whether children / adolescents who cons...

Dementia is a global health concern affecting an estimated 115.4 million people worldwide. Dementia has become a specific research priority in low and middle-income countries, due to the general rise in prevalence associated with increased longevity. 66% of people with dementia live in developing countries, however at present, only 10% of research...

Background: People with low health literacy (HL) are at increased risk of poor health outcomes, and receive less benefit from healthcare services. However, healthcare practitioners can effectively adapt healthcare information if they are aware of their patients' HL. Measurements are available to assess HL levels but may not be practical for use wi...

Background: Musculoskeletal (MSK) pain represents a considerable worldwide healthcare burden. This study aimed to gain consensus from practitioners who work with MSK pain patients, on the most appropriate primary care treatment options for subgroups of patients based on prognostic risk of persistent disabling pain. Agreement was sought on treatmen...

Background Chronic widespread pain (CWP) is common (population prevalence of approximately 10%) and has a significant impact on the individual, healthcare, and society. Currently little is known about the actual course of CWP over time, in particular the pathways to the development and maintenance of CWP. One useful way to understand these pathways...

Objectives To describe the current literature on pain assessment and pain treatment for community‐dwelling people with dementia. Method A comprehensive systematic search of the literature with narrative synthesis was conducted. Eight major bibliographic databases were searched in October 2018. Titles, abstracts, and full‐text articles were sequent...

Musculoskeletal conditions are a major cause of ill health and disability. Inadequate health literacy may partly explain why musculoskeletal self-management programs are not effective for some patients. This study prospectively evaluated the impact of patients' health literacy level on their musculoskeletal pain and physical function (PF) following...

Background: During adolescence, prevalence of pain and health risk factors such as smoking, alcohol use and poor mental health all rise sharply. The aim of this study was to describe the relationship between back pain and health risk factors in adolescents. Methods: Cross-sectional data from the Healthy Schools Healthy Futures study, and the Aus...

Objectives Test a method of identifying, recruiting and collecting data from children and adolescents who consult their general practitioner about a musculoskeletal condition. Design Prospective cohort feasibility study. Setting 13 general practices in West Midlands of England. Participants Patients aged 8–19 years who consult their general prac...

Abstract : Dementia is a research priority in developing countries due to the worldwide rise in prevalence. Evidence demonstrates differences in the views and perceptions about dementia among people in developed and developing countries, such differences may indicate the need for different approaches to health care and management of dementia. The...

Background During adolescence, prevalence of pain and health risk factors such as smoking, alcohol use, and poor mental health rise sharply. While these risk factors and mental health are accepted public health concerns, the same is not true for pain. The aim of this study was to describe the relationship between back pain and health risk factors i...

In this issue you will find a paper by Holden et al.: “Pain during adolescence can be grouped into four pain classes with distinct profiles: a study on a cohort of 2953 adolescents”. (Holden et al., 2018)

Low back pain (LBP) is a major health challenge globally. Research has identified common trajectories of pain over time. We aimed to investigate whether trajectories described in one primary care cohort can be confirmed in another, and to determine the prognostic value of factors collected 5 years prior to the identification of the trajectory. The...

Low back pain (LBP) is common, impacts on the individual and society, and is a major health concern. Psychological consequences of LBP, such as depression, are significant barriers to recovery, but mechanisms for the development of depression are less well understood. One potential mechanism is the individual’s health locus of control (HLoC), that...

Synopsis Accurate, reliable, and timely assessment of pain is critical for effective management of musculoskeletal pain conditions. The assessment of pain in infants, children, and adolescents with and without cognitive impairment can be particularly challenging for clinicians for a number of reasons, including factors related to: the consultation...

Chronic pain is common and creates significant burden to the individual and society. Emerging research has shown the influence of the family environment on pain outcomes. However it is not clear what shared factors between family members associate with chronic pain. This study aimed to investigate the family level contribution to an individual's ch...

Researchers have identified trajectories of pain derived using statistical techniques on longitudinal data. These trajectories have potential to be of use clinically but the repeated data collection required is currently impractical for such situations. Our aim was to investigate the validity of a self-report (Visual Trajectories Questionnaire-Pain...

Background and aims Adults with sleep problems are at higher risk for musculoskeletal pain, but the evidence is less clear for children and adolescents. This may be due to potential effect modifiers, which have biological and behavioural plausibility (e.g. gender, screen time use). This study aims to investigate the association between sleep proble...

Background and aims Musculoskeletal pain is a major burden on society. Adults with psychological morbidity are at higher risk for musculoskeletal pain onset, but little is known about this relationship in adolescents. We tested whether adolescents with psychological and behavioural problems (internalizing symptoms: emotional symptoms, peer problems...

Background Knee problems are common in children and adolescents. Despite this, little is known about the epidemiology of knee problems in children and adolescents who consult in general practice. The aim of this study was to describe consultations by children and adolescents about knee problems in general practice, and examine patterns of patient p...

Study objectives Musculoskeletal pain is a major burden on society. Adults with sleep problems are at higher risk for musculoskeletal pain onset, but there is no evidence for this relationship in children and adolescents. This study aimed to systematically review prospective studies on the risk for musculoskeletal pain onset in children and adolesc...

Background Depression and anxiety are common and have a significant impact on the individual and wider society. One theory proposed to explain a heightened risk for depression and anxiety is affective concordance in couples (e.g. influence of shared mood states, shared health beliefs). Whilst research has shown concordance for severe psychiatric il...

Low back pain (LBP) is very common; lifetime prevalence is high with estimates of 50% to 70%, and up to half the people with LBP will seek some form of healthcare. Global burden of disease findings show that back pain is the leading cause of disability adjusted life years (DALYs) in Western Europe and Australia, and is ranked 6th of the top 25 dise...

Sleep problems are common in people with low back pain (LBP), however the mechanisms on how sleep influences pain are complex. To date there is a lack of prospective research on the timings and the development of sleep problems in those who have LBP, such information would be useful to identify individuals at risk of poor outcome. Aims are to inves...

The aim of this systematic review is to describe dementia research in Sri Lanka. This information will inform on dementia prevalence, person with dementia and caregiver characteristics, and available dementia care models in Sri Lanka. The following specific objectives were developed in order to achieve the main aim of this review 1. To map the publ...

Objectives: To summarise the evidence for generic prognostic factors across a range of musculoskeletal (MSK) conditions. Setting: primary care. Methods and outcomes: Comprehensive systematic literature review. MEDLINE, CINAHL, PsychINFO and EMBASE were searched for prospective cohort studies, based in primary care (search period—inception to Dece...

Introduction This year marks the tenth anniversary of the National Institute for Health Research (NIHR) and the School for Primary Care Research (SPCR). To mark this milestone, we review the impact of patient and public involvement (PPI) in SPCR-funded research studies led by Keele since 2006. Methods Using data from a SPCR funded study of the cos...

Musculoskeletal conditions represent a considerable burden worldwide, and are predominantly managed in primary care. Evidence suggests that many musculoskeletal conditions share similar prognostic factors. Systematically assessing patient’s prognosis and matching treatments based on prognostic subgroups (stratified care) has been shown to be both c...

Identification of patient characteristics influencing treatment outcomes is a top low back pain (LBP) research priority. Results from the STarT Back trial support the effectiveness of prognostic stratified care for LBP compared with current best care, however, patient characteristics associated with treatment response have not yet been explored. Th...

Background Musculoskeletal pain is the leading cause of years lived with disability globally. There is evidence of a link between experiences of musculoskeletal pain in childhood and musculoskeletal pain in adulthood. Therefore, it is important to find the factors underlying the onset of musculoskeletal pain in children, who may be at risk of muscu...

Table S1. Influence of affective contagion, shared health behaviours, shared deprivation and age on male musculoskeletal pain consultation.

Background and aims Low back pain (LBP) is common, and is a major health concern. Psychological consequences of LBP, such as depression, are significant barriers to recovery, but mechanisms for the development of depression are less well understood. One potential mechanism is the individuals’ Health Locus of Control (HLOC), i.e. perception of the l...

Musculoskeletal pain conditions are common and create substantial burden for the individual and society. While research has shown concordance between couples for risk of some diseases, e.g. heart disease or diabetes, little information is available on such effects for musculoskeletal pain conditions. Our aims were to investigate the presence of con...

One theoretical model suggests that the pathway from pain to depression is through the disruption of social and relationship function. This study sought to test this hypothesis by considering the mediating effect of sexual functioning on the association between pain intensity and depressive symptoms in sexually active patients with chronic low back...

Background: Substantial research describes the impact of chronic pain conditions on families. However much less is known about concordance (i.e. shared risk) of chronic pain between family members. The aim of this study is to determine whether the presence of chronic pain in one family member is associated with chronic pain in another family member...

Background and Aims Research has shown illness concordance between couples for some conditions (hypertension, allergies, depression, peptic ulcers, heart disease) but not others (e.g. diabetes, stroke). To date little information exists on concordance between couples for musculoskeletal conditions. The aim of this study is to determine whether a pr...

To investigate associations of pain intensity in those with long-term back pain, with their partners' rating of key constructs of relationship quality: cohesion (activities together), consensus (affection, sexual relations), satisfaction (conflict, regrets). Self-report questionnaires on relationship quality (partner-rated), depression (partner-rat...

To describe long-term trajectories of back pain. Monthly data collection for 6 months at 7-year follow-up of participants in a prospective cohort study. Primary care practices in Staffordshire, UK. 228 people consulting their general practitioners with back pain, on whom information on 6-month back pain trajectories had been collected during 2001-2...

Background / Purpose: To investigate whether partners (wives, husbands) of those with a musculoskeletal condition are also more likely to consult for a musculoskeletal condition. Main conclusion: Patients were more likely have a consultation for a musculoskeletal condition if their partner had also consulted for a musculoskeletal condition eve...

One theoretical model suggests a pathway between pain and the development of depression through sleep problems. Here, we prospectively test the hypothesis that incident sleep problems, in those with persistent pain, increase risk of new onset probable depression, and investigate the role of "pain that interferes with daily life" (pain interference)...

Social factors are widely acknowledged in behavioural models of pain and pain management, but incorporating these factors into general medical consultations for low back pain (LBP) can be challenging. While there is no compelling evidence that social factors contribute to LBP onset, these factors have been shown to influence functional limitation a...

Back pain is common and many people experience long-term problems, yet little is known about what prognostic factors predict long-term outcomes. This study's objective was to determine which factors predict short- and long-term outcomes in primary care consulters with low back pain (LBP). Analysis was carried out on 488 patients who had consulted t...

The biopsychosocial model is increasingly accepted in low back pain (LBP) research and clinical practice. In order to assess the role of psychological factors in the development and persistence of pain, a wide array of measures has been developed. Yet there is likely to be considerable conceptual overlap between such measures, and consequently a la...

Background: Depression is identified as a risk factor for dementia. Little research has been carried out on the importance of anxiety, despite strong evidence of co-morbidity with depression. Objective: To examine the association of anxiety and depression with future dementia diagnosis. Methods: This case-control study was set in the Consultat...

Purpose To examine the influence of employment social support type (e.g. co-worker, supervisor, general support) on risk of occurrence of low back pain, and prognosis (e.g. recovery, return to work status) for those who have low back pain. Methods Systematic search of seven databases (MEDLINE, Embase, PsychINFO, CINAHL, IBSS, AMED and BNI) for pro...

In light of the ambiguity of meanings attributed to the concept of stoicism we critically explore its use as a label to explain and describe health and illness behaviour, juxtaposing the often negative portrayals of contemporary stoicism against its classical and philosophical origins. By reflecting critically on the term 'stoicism', its applicatio...

The objectives of this study were to investigate the associations of key constructs of relationship quality (cohesion, consensus, and satisfaction) and perceived partner responses to pain behavior (e.g., solicitous and negative responses) with the outcomes of pain and disability in those with long-term low back pain, and to explore the role of the...

Spinal pain is very common and has considerable consequences for the individual (e.g. loss of employment, disability) as well as increased health care costs. It is now widely accepted that biological, psychological and social factors impact on spinal pain outcomes. The majority of research on social factors has been employment related, with little...

Objectives Caregiver burden is a key measure in caregiver research and is frequently used as a baseline measure in intervention studies. Previous research has found numerous factors associated with caregiver burden such as the relationship quality between carer and patient, the patient’s cognitive ability, behavioural and psychological symptoms di...