Faculty of Medicine and Health Sciences

PhD Research

A number of PhD students are working on research projects to help us deepen our understanding of issues related to rehabilitation acoss injuries, patent experience and respiratory medicine to name a few.

Natalie Gray

Natalie Gray

Early mobilisation in spinal cord injury

A spinal cord injury or disease can cause a devastating range of symptoms and patients benefit from multidisciplinary rehabilitation to facilitate and support their recovery. Current practice within the UK utilise an initial period of immobilisation or bed rest with the aim of protecting the spine and facilitating healing. This immobilisation can continue for a number of weeks or months with the optimum time or conditions to commence movement unclear. With no established consensus, approaches vary both across the UK and internationally. There are growing doubts expressed by both patients and clinicians that prolonged immobilisation may lead to more risks than benefits. Natalie’s PhD research investigates early mobilisation in spinal cord injury.

Her research aims to explore the risks and benefits of early mobilisation. This will be completed through use of a systematic review of the literature, exploration of current practice, and working with expert teams around the UK and internationally through a consensus study. It is intended that this will lead to the creation of an evidence-based protocol for use within healthcare across the UK, guiding the timely initiation of mobilisation following spinal cord injury. 

Natalie says:

“Working with the NRC offers exciting opportunities to explore and deliver rehabilitation in new ways. The combination of expertise in clinical care, research and education offers opportunities to integrate and influence clinically relevant research and evidence-based rehabilitation. In addition, the NRC offers unique potential for extensive collaboration across specialties and disciplines within the UK and internationally, offering new ideas and learning opportunities."

Following her clinical work as a physiotherapist, her PhD offers a new challenge: “It is exciting to be able to investigate a clinically relevant question with the potential to influence future patient care. I look forward to broadening my skills and experience within research, as I move towards a clinical academic career.” she says. 

Meri Westlake

Meri Westlake


Meri Westlake is currently conducting her PhD on the deconditioning of patients to understand the factors involved in people becoming less able. Her research seeks to answer the question: “How do Healthcare Professionals Recognise and Respond to Deconditioning?”

It also aims to address the limited understanding of the term “hospital-acquired deconditioning” with the aim of building a framework for assessment and treatment purposes. 

Speaking about the NRC, Meri says:

The NRC alignment is really exciting because it’s a rare opportunity to be part of re-working how we think about rehabilitation and hospital-based care. I look forward to seeing how widely we can improve rehabilitation medicine and how it will be applied to patient groups in the future.

Hayley Carter

Hayley Carter

Patient management before knee ligament surgery

Hayley’s PhD research investigates the preoperative management of patients waiting for knee ligament (anterior cruciate ligament) surgery. The anterior cruciate ligament is the most commonly injured ligament in the knee. Surgery is currently standard treatment for anterior cruciate ligament tears but waiting times for surgery are long. In this waiting time, it is advised that patients undergo preoperative rehabilitation to help them prepare physically and mentally. However, current practice varies it is not known how best to treat patients.

After anterior cruciate ligament surgery, most patients aim to return to their pre-injury level of physical activity. However, recent research has shown that, at 1-year, only 24% of patients have been able to return. We hope that by helping patients better prepare before surgery, their outcomes before and after surgery will improve.

The aim of Hayley’s research is to develop a pre-operative treatment package. This will be completed by interviewing patients, developing the treatment package with clinicians, patients and therapy managers through a consensus study and then implementing the treatment package in clinical practice. It is intended that this will lead to a treatment, guiding best practice for patients with anterior cruciate ligament injuries waiting for surgery.

Hayley says,

“The NRC is an excellent facility, combining clinical practice with research, innovation, education and training. Communication between clinical practice and research is vital to ensure research is clinically relevant and the results of research are driven into practice. The NRC embodies the importance of this and will be a gold standard hub delivering ambitious, novel research and evidence-based rehabilitation”. The NRC Clinical and Academic Partnership (NCAP) brings together a ‘hub and spoke’ network of more than 20 universities across the country allowing exciting new collaborations between hundreds of rehabilitation researchers and clinicians. Hayley says “this partnership will be invaluable to make a difference. It will lead to improved patient care and outcomes, showcasing the value of rehabilitation”

Hayley Carter, Clinical Doctoral Research Fellow, NIHR302104 is funded by Health Education England (HEE) / NIHR for this research project.

The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR, NHS or the UK Department of Health and Social Care. 

Sarah MacCracken

Sarah McCracken

Nordic Walking for People with Parkinson’s Disease.

Understanding the impact, accessibility, and diversity of Nordic Walking in People with Parkinson’s disease after the Covid-19 pandemic.

Supervisors: Dr Vicky Booth, PI, Dr Frances Allen, Prof Pip Logan. University of Nottingham.

Sarah’s MPhil research investigates the impact and accessibility of Nordic Walking (NW) in People with Parkinson’s Disease (PD) following the Covid-19 lockdown. People with Parkinson’s struggled to access PD services during lockdown and became physically deconditioned and some experienced anxiety, fear of going out, isolation, sleep disturbance and low mood. Nordic Walking was one of the first activities to re-start after the pandemic as it is delivered outdoors in groups with an instructor who has clinical experience in this field. Current rehabilitation programmes for People with Parkinson’s are delivered indoors, in a gym or at home, by physio and occupational therapists. Nordic walking started in Finland in the 1930’s when cross country skiers used their poles for summer training. NW utilises 90% of skeletal muscles and previous studies suggest NW is useful for improving gait, balance and posture in the presence of PD. In a feasibility study in 2020, McCracken et al noted an increased walking speed over 10 metres, increased Timed up and go over 3 metres, improvements in mental health from exercising outside, healing balm effect and the group effect that enhanced motivation and perseverance.

Click here to read the British Journal of Neuroscience Nursing article: Exploring the benefits and barriers to Nordic walking in people with Parkinson's disease

The aim of Sarah’s study is to explore the motor (physical) and non-motor (psychological) impact of an 8-week programme of Nordic Walking for People with Parkinson’s Disease. This will be completed by a review of the literature to explore current practice, working in partnership with British Nordic walking and Parkinson’s UK. 40-60 participants will be recruited, and outcome measures will be recorded at week 0, week 8 and at month 6 and 9. Timed up and go, 10 metre and 20 metre walk test, Tragus and Berg balance (for some participants) will be recorded. The non-motor scale questionnaire will be completed at the same time points and field notes will be recorded. Three focus groups will be held during the recruitment phase, addressing this research question:

What are the characteristics and core components needed to implement Nordic Walking groups for People with Parkinson’s in a community rehabilitation setting?

Thematic analysis will assist in developing themes that will influence the role out of future Nordic walking rehabilitation programmes, facilitated by a clinician with Nordic walking instructor training, or a Nordic walking instructor with specific Parkinson’s experience and training. Sarah says:

“Working with the National Rehabilitation Centre provides an exciting opportunity to deliver innovative, evidence-based rehabilitation in a non-clinical, outdoor setting. In a post Covid world there is scope for safer rehabilitation programmes of Nordic walking, delivered by NW Instructors or clinicians with a breadth of skills and knowledge specific to Parkinson’s Disease. The NRC offers potential for extensive partnerships with key stakeholders including the NHS, Parkinson’s UK and British Nordic Walking."

Following 17 years as a Parkinson’s Nurse Specialist, and a total of 31 years nursing, her MPhil offers new challenges and opportunities:

“I’ve had the vision for this rehabilitation programme for several years since I started park run, Nordic walking and I’ve always had a passion for skiing. I feel uniquely placed to investigate this clinically relevant research question and, potentially, to drive forward changes in future patient care. I am enjoying the opportunity to develop my skills within research, as I explore a clinical academic career.”



Faculty of Medicine and Health Sciences

University of Nottingham
Medical School
Queen's Medical Centre
Nottingham, NG7 2UH

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