Willmore, Elaine
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Biography
I am a physiotherapist with a background in Advanced Practice particularly centred around the management of people with complex shoulder problems and am a member of the Musculoskeletal Association of Chartered Physiotherapists (MACP) a recognised standard of excellence in musculoskeletal physiotherapy. I completed my MSc in Neuromusculoskeletal Physiotherapy in 2011 and was awarded the prestigious British Elbow and Shoulder Society (BESS) AHP Fellowship in 2017. I was also the AHP committee member for the (BESS) between 2017-2020. Having completed a NIHR Doctoral Bridging programme, I am currently undertaking my PhD. I have published several peer reviewed articles and book chapters in addition to conference presentations and I regularly review for several journals. I have been a local Principal Investigator or supported other to be first time PIs on four large NIHR studies and in 2018 I was awarded the GHNHSFT award for “outstanding contribution to research.”
As lead for Research and Development for Therapy at GHNSHFT I am keen to support others in their research development and provide opportunities for staff at all levels to build their research pillar of practice. I am a Council for Allied Health Professionals in Research (CAHPR) champion and lead the Gloucestershire AHP Research Group
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Publication Search Results
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Publication Frozen shoulder(Nature Research, 2022-09-08) Millar, Neal; Meakins, Adam; Struyf, Filip; Willmore, Elaine; Campbell, Abigail; Kirwan, Paul; Akbar, Moeed; Moore, Laura; Ronquillo, Jonathan; Murrell, George; Rodeo, Scott; Willmore, Elaine; Allied Health ProfessionalFrozen shoulder is a common debilitating disorder characterized by shoulder pain and progressive loss of shoulder movement. Frozen shoulder is frequently associated with other systemic conditions or occurs following periods of immobilization, and has a protracted clinical course, which can be frustrating for patients as well as health-care professionals. Frozen shoulder is characterized by fibroproliferative tissue fibrosis, whereby fibroblasts, producing predominantly type I and type III collagen, transform into myofibroblasts (a smooth muscle phenotype), which is accompanied by inflammation, neoangiogenesis and neoinnervation, resulting in shoulder capsular fibrotic contractures and the associated clinical stiffness. Diagnosis is heavily based on physical examination and can be difficult depending on the stage of disease or if concomitant shoulder pathology is present. Management consists of physiotherapy, therapeutic modalities such as steroid injections, anti-inflammatory medications, hydrodilation and surgical interventions; however, their effectiveness remains unclear. Facilitating translational science should aid in development of novel therapies to improve outcomes among individuals with this debilitating condition.Publication Rehabilitation following shoulder arthroscopic stabilisation surgery: A survey of UK practice(SAGE Publications, 2023-02-10) Maher, Natasha; Willmore, Elaine; Bateman, Marcus; Blacknall, James; Chester, Rachel; Horsley, Ian; Gibson, Jo; O' Sullivan, Joel; Jaggi, Anju; Willmore, Elaine; Allied Health ProfessionalBackground: Optimal rehabilitation following arthroscopic shoulder stabilisation for traumatic anterior instability is unknown. The purpose of this study was to establish current UK practice for this patient group. Methods: A self-administered online questionnaire was developed and distributed to UK surgeons and physiotherapists. Results: 138 responses were received. Routine immobilisation was reported in 79.7% of responses with a cross-body sling being the preferred position (63.4%). Duration of immobilisation and timescales to initiate movement were highly variable. Return to light work was advised when patients felt able (25.4%) or after 6 weeks (26.1%). 58.7% recommended waiting for 12 weeks to return to manual work. 56% recommended non-contact sport could be resumed after 12 weeks. For contact sport, recommendations varied from 6 weeks (3.8%) to 6 months (5.8%). Psychological readiness was the most frequently cited criteria for return to play (58.6%). Factors such as hyperlaxity (40.6%), age (32.6%) and kinesiophobia (28.3%) were not considered as relevant as reported quality of surgical fixation (50%). Conclusion: There is no clear consensus regarding optimal post-operative rehabilitation following arthroscopic shoulder stabilisation. Further work is required to establish high value, personalised pathways for this patient group.Publication CSP2023: 390 - “My Life” Group Evaluation: How a Co-produced Lifestyle Programme can support Individuals with Severe Mental Illness to live well(Elsevier, 2024-06-18) Dowdeswell, Nicola; Walker, Mark; Willmore, Elaine; Vidal, S; Bayliss, Nigel; MacFarland, Simon; Chidgey, Helen; Vincze, Andrea; Dowdeswell, Nicola; Walker, Mark; Willmore, Elaine; Vidal, S; Bayliss, Nigel; MacFarland, Simon; Chidgey, Helen; Vincze, Andrea; Allied Health Professional; Admin and Clerical; Patient and Community PartnersNo abstract availablePublication Rehabilitation guidelines following arthroscopic shoulder stabilisation surgery for traumatic instability - a Delphi consensus(Elsevier, 2024-05-16) Willmore, Elaine; Bateman, Marcus; Maher, Natasha; Chester, Rachel; O'Sullivan, Joel; Horsley, Ian; Blacknall, James; Gibson, Jo; Jaggi, Anju; Willmore, Elaine; Allied Health ProfessionalBackground: There is no consistent approach to rehabilitation following arthroscopic shoulder stabilisation surgery (ASSS) in the UK. The aim of this study was to agree a set of post-operative guidelines for clinical practice. Method: Expert stakeholders (surgeons, physiotherapists and patients) were identified via professional networks and patient involvement and engagements groups. A three-stage online Delphi study was undertaken. Consensus was defined by the OMERACT threshold of 70% agreement. Results: 11 surgeons, 22 physiotherapists and 4 patients participated. It was agreed patients should be routinely immobilised in a sling for up to 3 weeks but can discard earlier if able. During the immobilisation period, patients should move only within a defined "safe zone." Permitted functional activities include using cutlery, lifting a drink, slicing bread, using kitchen utensils, wiping a table, light dusting, pulling up clothing, washing/drying dishes. Closing car doors or draining saucepans should be avoided. Through range movements can commence after 4 weeks, resisted movements at 6 weeks. Patients can resume light work as they feel able and return to manual work after 12 weeks. Return to non-contact sports when functional markers for return to play are met was agreed. Return to contact sport is based on function & confidence after a minimum of 12 weeks. Additional factors to consider when determining rehabilitation progression: functional/physical milestones, patient's confidence and presence of kinesiophobia. The preferred outcome measure is the Oxford Instability Shoulder Score. Conclusion: This consensus provides expert recommendations for the development of rehabilitation guidelines following ASSS.Publication What is the optimum rehabilitation for patients who have undergone release procedures for frozen shoulder? A UK survey(Elsevier, 2021-01-13) Willmore, Elaine; McRobert, Cliona; Foy, Christopher; stratton, irene; van der Windt, Danielle; Willmore, Elaine; Foy, Christopher; Stratton, Irene; Additional Professional Scientific and Technical; Allied Health ProfessionalObjective: Despite usually being considered necessary, the rehabilitation regime that optimises outcomes for patients following release procedures for frozen shoulder has not been established and no accepted best practice guidelines currently exist. The purpose of this study was to gain insight into what physiotherapists considered best practice and factors they considered likely to affect patient outcome. Methods: A cross-sectional, self-administered online questionnaire was developed and distributed to UK based Physiotherapists, undergraduate students and support workers via email, social media and professional networks. Results: 260 eligible and fully completed surveys were received. Clear preference for early (within 72 h), frequent (2-3 times per week or weekly) and prolonged (greater than 6 weeks) treatment delivered in a 1:1 setting was expressed. 99% were highly likely/likely to advocate education and advice, range of movement exercises (99.6%), stretching (73.5%) and strengthening (61.9%). More passive modalities (manual therapy, massage, electrotherapy, acupuncture) were highly unlikely/unlikely to be used and lack of manual therapy and insufficient contact with a physiotherapist were the reasons deemed least likely to affect outcome. Most clinicians (89.2%) were likely to prescribe exercises that patients reported as painful but persistent pain and poor adherence by patients to exercises were the top reasons given for poor outcome along with psychological and psychosocial patient characteristics. Conclusion: Physiotherapists consistently advocate early, frequent, prolonged, 1:1 treatment following release procedures for frozen shoulder. Most patients are discharged whilst still experiencing symptoms, particularly pain. Further work is needed to establish high value pathways for this patient group.Publication Critical evidence synthesis on rehabilitation following arthroscopic shoulder stabilisation surgery for traumatic anterior instability: consensus recommendations for clinical practice and research – commissioned by the British Elbow & Shoulder Society(BMJ Publishing Group, 2025-10-23) Wong, Carl; Jaggi, Anju; Willmore, Elaine; Maher, Natasha; Bateman, Marcus; O'Sullivan, Joel; Blacknall, James; Horsley, Ian; Gibson, Jo; Rugg, Bradley; Chester, Rachel; Willmore, Elaine; Allied Health ProfessionalArthroscopic shoulder stabilisation surgery (ASSS) is a common procedure for treating anterior shoulder instability. Postoperative rehabilitation remains a crucial, but under-researched, aspect of patient recovery. Despite its importance, no comprehensive rehabilitation guideline based on robust clinical trials has emerged, leaving a gap in evidence-based practice.To address this, the British Elbow & Shoulder Society appointed the Allied Health Professional Clinical Guideline Group to review current practices and establish clinical guidance on rehabilitation. This evidence synthesis aims to provide a critical synthesis and discussion on rehabilitation following ASSS. The intended outcome is to highlight areas of uncertainty and make recommendations for clinical practice and further research.The development of this evidence synthesis followed a rigorous five-stage process: (1) systematic literature review, (2) UK national practice survey, (3) expert consensus (Delphi) study, (4) updated literature search and review and (5) synthesis of the previous four stages. Stages 1-3 have been published previously. This evidence synthesis comprised stages 4 and 5.10 key domains for postoperative rehabilitation from immediate postsurgery to return to normal function, including sports, were identified. This paper synthesises current knowledge and provides a platform for recommendations in clinical practice and future research. In particular, early shoulder movement was recommended during the 'immobilisation period', but confined to shoulder elevation up to 90°, anterior to the scapular plane, with neutral external rotation. Further high-quality primary research is needed to address uncertainties and expand the evidence base, thereby informing and challenging clinical practice.Publication Post-surgical physiotherapy in frozen shoulder: A review(SAGE Publications, 2020-10-27) Willmore, Elaine; Millar, Neal; van der Windt, Daniëlle; Willmore, Elaine; Allied Health ProfessionalDespite its prevalence, the optimal management of frozen shoulder is unclear. A range of conservative measures are often undertaken with varying degrees of success. In cases of severe and persistent symptoms, release procedures which could include any combination of manipulation under anaesthetic, arthroscopic capsular release or hydrodilatation are frequently offered, none of which has been shown to offer superior outcome over the others. When surgical release is performed a period of rehabilitation is normally recommended but no best practice guidelines exist resulting in considerable variations in practice which may or may not directly affect patient outcome. During this narrative review, we hypothesise that these differing responses to treatment (both conservative and surgical options) are potentially the result of different causal mechanisms for frozen shoulder and may also suggest that post-release rehabilitation may need to take this into account.