Keywords: Adherence; Exercise; Rehabilitation Purpose: Advice, education and exercise are the main management strategies for rotator cuff related shoulder pain (RCRSP) (Doiron-Cadrin et al., 2020) . Adherence to a physiotherapist-led home exercise programme (HEP) is believed to be an important predictor of treatment outcome (Pisters et al., 2010). Despite this, research suggests that 50–70% of patients are either non-adherent or only partially adherent to their HEP (Bassett 2003, Beinart et al., 2013). If exercise interventions are effective in the management of RCRSP then outcomes will depend on how well the interventions are adopted. Qualitative investigation may provide a deeper understanding of the experience and challenges of home exercise adherence that cannot be obtained from other methodologies. The aim of this qualitative study was to explore the experience of a sample of Posterior Shoulder Tightness (PoST) feasibility pilot trial participants adhering to a physiotherapist-led HEP. Methods: Participants who were recruited to the PoST trial after 4th October 2018 were eligible for inclusion into the qualitative study. The interviews took place between February 2019 and June 2020 and were conducted in person and over video platforms. This study employed a qualitative research design using semi-structured interviews and thematic analysis as the approach to data analysis. An inductive approach to data analysis was employed. Results: Six persons who had participated in the PoST feasibility pilot trial agreed to participate in the qualitative study. The average length of interviews was 42.5 min (range 37–54 min). Four interviews were conducted face-to-face and two were conducted over Zoom. The coding framework generated three superordinate themes and 11 subthemes. The first theme, 'belief landscape', included beliefs relating to 'outcome expectation', 'self-identity', 'pain-induced disuse' and 'fear of making it worse'. The second theme, 'types of motivation', described the different types of motivation present over the course of the treatment episode including 'logical reasoning', 'escape from pain and disability', 'emotions, impulses and habits', and 'new knowledge and realisations'. The third theme, 'individualizing care', described the 'relationship with the physiotherapist', 'building confidence' and 'tailoring interventions'. Conclusion(s): Understanding the beliefs of persons receiving care is important in order to guide treatment and to enable physiotherapists to individualise support. Persons reported several types of motivation, many of which were external and key to early engagement. Some persons stopped the exercises as soon as the pain was gone, for others it was a catalyst for initiating recreational exercise. The relationship with the physiotherapist was a very important factor influencing exercise adherence. Individuals wanted a physiotherapist they felt comfortable with and trusted. They wanted reassurance that they were performing their exercises correctly. They both wanted clear guidance and structure in their programme, and also to have flexibility and to be able to integrate exercises into daily activities. Impact: These findings highlight the importance of understanding the complexity of HEP adherence, the diverse nature of individual requirements within a physiotherapy consultation, and the vital role of the therapeutic relationship in promoting HEP adherence. Funding acknowledgements: Kevin Hall was funded by a National Institute for Health Research (NIHR), Clinical Doctoral Research Fellowship (CDRF) award for this research project (CDRF-2014-05-003). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Keywords: Rehabilitation; Shoulder; Exercise Purpose: Posterior shoulder tightness (PST) has been described as a physical impairment and target for intervention in the management of shoulder pain and disability in both sporting (Wilk et al., 2011) and non-sporting populations (Land et al., 2017). PST intervention is included in the treatment algorithms in the management of rotator cuff related shoulder pain (RCRSP) (Ellenbecker and Cools 2010) and as a component of the exercise interventions in RCTs (Keene et al., 2019). Despite these recommendations there are many uncertainties relating to the role of PST in shoulder pain and the impact of treatment of PST on shoulder pain and disability. The aim of this feasibility pilot trial was to evaluate areas of uncertainty relating to the design of a definitive RCT to investigate the effectiveness of treating PST, specifically the acceptability of the interventions, incidence of PST in RCRSP, recruitment rate and the parameters required to calculate sample size in the definitive RCT. Methods: A randomised, controlled, double blind (patient and assessor), parallel group, feasibility pilot trial with 1:1 allocation ratio. Participants (18-years or over) with a clinical diagnosis of RCRSP and PST were recruited from the surgical and physiotherapy treatment pathways. Participants were randomised to receive PST interventions or sham PST interventions. Both groups received the same exercise rehabilitation and behaviour change interventions over a 14-week duration with outcome assessment at 7 and 14 weeks with 26 and 52-week follow-up. Outcome measures included the shoulder pain and disability index (SPADI) and clinical assessment measures of PST. Results: Forty-nine individuals (N = 49) were randomised over a 33-month period at a rate of 1.4 patients per month. At 14-weeks there was a 41-point and 44-point reduction in SPADI scores in the intervention and sham groups respectively, achieving the progression criteria of minimum within group change. There was a reduction in PST in both groups; 61-degrees and 57-degrees in the intervention and sham groups respectively. Attrition rates of 14% and adherence rates of 79–83% were reported across both groups at 14-weeks, achieving the intervention acceptability criteria for progression. Using the PoST trial SPADI characteristics a target sample size of 65 per group (N = 130) was estimated for the definitive RCT. Conclusion(s): The PoST feasibility pilot trial was successful in addressing all the primary objectives. Interventions were safe and acceptable, generating large within group changes in SPADI scores and measures of PST in both groups. The results of this pilot trial suggest that a full scale definitive RCT is not viable under the pilot study conditions due to the predicted recruitment rate and target. It would be possible to generate faster recruitment through the addition of more centres, however the trial would need to be piloted at these centres first. Impact: The PoST trial reports positive effects for the combined effect of exercise and behaviour change interventions, generating large within group changes in pain and disability in both groups. The large observed reductions in SPADI and measures of PST in both groups provide support for the questioning of the direction of causal relationship between PST and shoulder pain. Funding acknowledgements: Kevin Hall was funded by a National Institute for Health Research (NIHR), Clinical Doctoral Research Fellowship (CDRF) award for this research project (CDRF-2014-05-003). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

This chapter sets out to describe the current context of research in the clinical setting and summarises what has led to an increase in clinically based research. It explores the relationship between research, evidence-based practice, audit and evaluation. The chapter describes the concept of a research-focused clinical culture is developed, and includes the implications of this development for clinicians, their managers and those taking up new consultant therapist roles. Masters level courses have also been accessed by those who have not necessarily achieved degree level qualifications during their initial education and training period, but who had proved that they were academically capable of masters level work by other means. Academic readiness for research in the clinical setting has been emerging as the call for evidence-based practice in healthcare has become louder. Research has been defined as any activity undertaken to increase knowledge'.

Purpose: Physiotherapists' record patient's clinical examination data on a routine basis however, the consistency of the records and breadth of data recorded may be subject to considerable variation between individuals. Online standardised data collection (SDC) systems, if carried out rigorously, offers clinicians an excellent opportunity to show how efficient, timely and equitable their services are. Physio First (the Organisation for Chartered Physiotherapists in Private Practice in the UK) provides its members with the opportunity to participate in an online SDC project for patients with musculoskeletal (MSK) conditions. The purpose being to provide Physio First and its practitioners with detailed information about current practice, patient demographics and outcome of care within MSK physiotherapy private practices in the UK.

Purpose: Limited research exists on the possible association between duration of symptoms prior to commencing treatment and reported outcomes in musculoskeletal (MSK) physiotherapy. The purpose of this study was to evaluate the effect that duration of symptoms (DOS) has on the outcomes of patients attending physiotherapy treatment for a MSK condition in a private physiotherapy practice. Comparisons were made between patients who had their symptoms for 6 weeks or less versus patients who had had their symptoms for more than 6 weeks.

Clinicians are becoming increasingly aware of the need to be able to demonstrate and account for the delivery and quality of their clinical services. Online standardised data collection systems can be used by clinicians to gather this information in a robust and accessible way. Physio First (the Organisation for Chartered Physiotherapists in Private Practice) have commissioned several data collection projects in the UK.

Relevance: Research shows that the expectations a patient brings to treatment have important influences on the clinical relationship, experiences of treatment, the treatment process, outcomes and satisfaction with care. This influence means that patients' expectations are important for physiotherapists, service providers and researchers to take into account in approaches to care and treatment evaluations. Research highlights the need for a better understanding of expectations of physiotherapy treatment for musculoskeletal problems to enable more effective, high quality and cost-beneficial care.

Relevance: Clinicians are becoming increasingly aware of the need to be able to demonstrate and account for the delivery and quality of their clinical services. Online standardised data collection systems, if carried out rigorously, can be used by clinicians to gather this information in a robust and accessible way. The standardised data collection system used in this project was developed following a number of different phases including identifying relevant criteria for inclusion, piloting the tool through a number of pilot studies and the development of an electronic database.

Background: This study was developed from a collaboration between a musculoskeletal therapist and researcher, a fine artist, a media specialist and an engineer. All the team had an interest in Chronic Low Back Pain from a range of perspectives and shared a range of skills and knowledge which had never before been combined and utilised in this area of study. In context, Chronic Low Back Pain is an invisible problem that affects 80% of the UK population at some time in their lives. It is however a largely misunderstood which is an issue that individuals who experience it sometimes have difficulty communicating. Purpose: The purpose of the study was to capture participants' meaningful experiences of Chronic Low back pain in everyday life focusing on a personal significant walk. The aim of the project was to produce a series of visualisations with each of the participants which would enhance health professionals and members of the Publics understanding of the difficulties faced by individuals with chronic Low back pain. Methods: Twelve participants with Chronic Low Back Pain chose a walk of personal significance to them, either Positive or negative. Demographic data were collected at the start of the process as well as details regarding the extent and position of their pain.Prior to their walk Inertial sensors were attached to their Lumbar spine (L1-S1)and a head mounted video camera was fitted to their forehead to capture a video of their walk. Pain levels were monitored every 2 minutes during their 20 minute walk and qualitative data were collected prior to, during and after their walk using a range of approaches. Results: Using the data gathered, visual representationsof each of the significant walks have been co-produced by the researchers and the participants. Key elements of the video footage and data have been selectedand combined in a seriesof audio visual exhibitions. Each participant used their own movement data to manipulate special effects applied to the original video footage and data was synchronised to create hybrid footage that the participant felt represented their personal experience. Conclusion: Low Back Pain is a complex issue that creates significant personal challenges for those affected. This combined arts science and health approach to this work has demonstrated a range of outcomes that may be helpful in building a range of visualisations of a range of Musculoskeletal conditions. Implications: These very personal and valid expressions of Chronic Low Back Pain syndromes are now available for exhibition purposes. More public knowledge of the impact of Chronic Low Back Pain on individuals who experience the problem could create a greater understanding of the challenges faced by these people. The outcomes of the project will also be useful for teaching purposes in relation to health professional students. The more understanding members of the public and health professionals have of the personal impact of chronic low back pain the more likely it is that individuals with back pain will meet with more positive understanding from their family their friends and their colleagues. Funding acknowledgements: This Project was funded by The Welcome Trust in the UK Ethics approval: The research project was approved by the Un iversity of Brighton,Faculty of Health's Ethic and Governance committee Disclosure of interest: None Declared Keywords: Art and Health, Chronic low back pain, Patient experiences

A move towards self-management is central to health strategy around chronic low back pain, but its concept and meaning for those involved are poorly understood. In the reported study, four distinct and shared viewpoints on self-management were identified among people with pain and healthcare providers using Q methodology. Each construes self-management in a distinctive manner and articulates a different vision of change. Identification of similarities and differences among the viewpoints holds potential for enhancing communication between patients and healthcare providers and for better understanding the complexities of self-management in practice.

Background: The exploration of opinions, attitudes, experiences and other perspectives of interest are important areas of research in physiotherapy to enhance understandings of many issues. These interests are often explored using approaches such as survey, questionnaire and Delphi studies, or qualitative strategies involving interview, focus group or diary methods, and increasingly through mixed method approaches. Q-Methodology offers a valuable research alternative being increasingly applied in health fields to explore issues of a subjective nature. Q-Methodology involves entwined qualitative and quantitative approaches, combining the strengths and insights each brings to enhance understanding of issues of a subjective nature.

Background: Identifying psychosocial risk factors in patients with low back pain has become an important focus to help prevent persistent pain and disability. Catastrophising is seen as displays of magnification, rumination and helplessness which have become considered as obstacles to recovery and linked with poor outcomes. There has been increasing encouragement to adopt a more psychologically informed practice. This aims to improve the identification of psychological risk factors, such as catastrophising, to support more skilled assessment and achieve better outcomes by applying psychologically targeted interventions.

Background: A common treatment used by physiotherapists for patients with low back pain is mobilisation. The aim of applying mobilisation treatment is to increase range of movement and reduce pain and stiffness. Therapists choose a specific dose of mobilisation for each patient, which includes a decision on the duration of applied force, commonly up to 3 minutes. Little research has been done to determine the effects of different durations of treatment. There is tentative evidence that increased duration beyond 3 minutes leads to a decrease in pain.