Cliffton Chan
The University of Sydney, Sydney Medical School, Faculty Member
Face‐to‐face pain management programs demonstrate positive clinical outcomes in the chronic pain population by improving pain intensity and attitudes, depression, and functional disability scores. The effects of this modality carried out... more
Face‐to‐face pain management programs demonstrate positive clinical outcomes in the chronic pain population by improving pain intensity and attitudes, depression, and functional disability scores. The effects of this modality carried out online is less known, particularly in subgroups of chronic pain. This systematic review assessed the effects of online pain management programs in chronic, widespread musculoskeletal conditions on pain measurements (intensity, interference, coping, and catastrophizing), health‐related quality of life, depression, and anxiety scores immediately post‐intervention. Five electronic databases (Embase, Medline, CINAHL, Scopus, and PEDro) were searched with 3546 studies identified. Eighteen randomized controlled trials fulfilled the inclusion criteria. Included studies had moderate methodological quality (using the Effective Public Health Practice Project (EPHPP) quality assessment tool) but high risk of bias (using the revised Cochrane risk‐of‐bias tool f...
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Importance: Heritable disorders of connective tissue (HDCTs) affect hand function and participation in daily activities for children and adolescents. Objective: To describe hand impairment and function and determine the extent to which... more
Importance: Heritable disorders of connective tissue (HDCTs) affect hand function and participation in daily activities for children and adolescents. Objective: To describe hand impairment and function and determine the extent to which hand impairment and function explain the variation in self-reported functional performance. Design: Cross-sectional observational study. Setting: Specialist tertiary hospital. Participants: Children and adolescents ages 8–18 yr with HDCTs (N = 73). Intervention: None. Outcomes and Measures: Hand function outcomes included grip strength (digital dynamometer), manipulation and dexterity (Functional Dexterity Test, Nine-Hole Peg Test), and fine motor skills (Bruininks–Oseretsky Test of Motor Proficiency). Upper limb hypermobility was assessed using the Upper Limb Hypermobility Assessment Tool. Hand pain and fatigue were recorded for a timed button test and 3- and 9-min handwriting tasks. Functional performance was measured using the Childhood Health Asse...
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The Lower Limb Assessment Score. This file contains the name, patient and therapist instructions and criteria for each of the 12 tests of the Lower Limb Assessment score as described by the original authors that developed this tool. (DOCX... more
The Lower Limb Assessment Score. This file contains the name, patient and therapist instructions and criteria for each of the 12 tests of the Lower Limb Assessment score as described by the original authors that developed this tool. (DOCX 17 kb)
Digital games are a common form of entertainment in modern society and are increasingly prevalent in health education. However, little research has been conducted into their use for delivering anatomy and histology education for health... more
Digital games are a common form of entertainment in modern society and are increasingly prevalent in health education. However, little research has been conducted into their use for delivering anatomy and histology education for health students. This is surprising considering the difficulty many health students have learning anatomy and histology. The study used a mixed methodology, consisting of a controlled trial and qualitative evaluation of learner attitudes towards the digital game. The trial stratified learners into two groups: a digital game group and a multiple-choice quiz group, for one semester. At the end of semester final examination results from the two groups were compared to see if the digital game was a comparable means of revising anatomy and histology subject matter. Additionally, an online survey and semi-structured interviews were used to explore student attitudes towards the digital game. Findings demonstrated that a digital game could be as effective as alterna...
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PURPOSE: To evaluate the effect of a purpose-designed exercise program on performance-related musculoskeletal disorders (PRMDs) and associated risk factors in a sample of professional orchestral musicians. METHODS: A 10-week exercise... more
PURPOSE: To evaluate the effect of a purpose-designed exercise program on performance-related musculoskeletal disorders (PRMDs) and associated risk factors in a sample of professional orchestral musicians. METHODS: A 10-week exercise program was made available to full-time musicians employed by the eight premier symphony orchestras of Australia. Questionnaires were administered before, immediately after (T1), and 6 months after interventions (T2) containing questions relating to change in frequency and severity of PRMDs, ratings of perceived exertion (RPE) during rehearsal, private practice, and performance, as well as nine performance-related factors. Participants were also asked to rate whether these performance-related factors affected their overall playing capacity during different playing situations. A comparative control group of musicians had no intervention and completed a modified questionnaire at the same time points. RESULTS: Exercise participants (n=30) reported a reduct...
Research Interests: Music, Occupational Health, Australia, Treatment Outcome, Exercise therapy, and 15 moreMedicine, Physical Therapy, Workplace, Humans, Chronic Disease, Female, Male, Young Adult, Posture, Clinical Sciences, Middle Aged, Adult, Occupational Diseases, Severity of Illness Index, and Musculoskeletal diseases
To determine the prevalence of Generalized Joint Hypermobility (GJH) and Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome-Hypermobility Type (JHS/EDS-HT) among dancers using established validated measures. Observational Cohort Study.... more
To determine the prevalence of Generalized Joint Hypermobility (GJH) and Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome-Hypermobility Type (JHS/EDS-HT) among dancers using established validated measures. Observational Cohort Study. Laboratory. 85 dancers from two dance institutions. GJH was determined using the Beighton score (cut-point ≥5/9) and the Lower Limb Assessment Scale (LLAS) (cut-point ≥7/12). Presence of JHS/EDS-HT was assessed using the Brighton and Villefranche criteria. Paired sample t-test was performed to compare LLAS side-to-side scores, and percentage disagreements calculated to determine differences between the two GJH and the two JHS/EDS-HT measures. 72% of dancers met the Beighton cut-point for GJH, while 38% and 42% met the LLAS cut-point on the left and right respectively. The proportion of dancers identified with GJH was different when assessed using the Beighton compared to the left and right LLAS (both p < 0.001), a disagreement of 48% and 46% respe...
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Physical inactivity is one of the key global health challenges as it is associated with adverse effects related to ageing, weight control, physical function, longevity, and quality of life. Dancing is a form of physical activity... more
Physical inactivity is one of the key global health challenges as it is associated with adverse effects related to ageing, weight control, physical function, longevity, and quality of life. Dancing is a form of physical activity associated with health benefits across the lifespan, even at amateur levels of participation. However, it is unclear whether dance interventions are equally as effective as other forms of physical activity. The aim was to systematically review the literature on the effectiveness of structured dance interventions, in comparison to structured exercise programmes, on physical health outcome measures. Seven databases were searched from earliest records to 4 August 2017. Studies investigating dance interventions lasting > 4 weeks that included physical health outcomes and had a structured exercise comparison group were included in the study. Screening and data extraction were performed by two reviewers, with all disagreements resolved by the primary author. Wh...
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Existing measures of generalized joint hypermobility do not include commonly affected upper limb joints. To evaluate the reliability of a novel clinically-applicable measure of upper limb joint mobility, its ability to discriminate... more
Existing measures of generalized joint hypermobility do not include commonly affected upper limb joints. To evaluate the reliability of a novel clinically-applicable measure of upper limb joint mobility, its ability to discriminate between varying extents of hypermobility, identify generalized joint hypermobility, and to establish a cut-point for hypermobility classification. Validation of a diagnostic tool. Participants were sought from three groups - healthy controls, likely and known hypermobiles, and assessed using the Upper Limb Hypermobility Assessment Tool (ULHAT), Beighton score and clinical opinion. Pearson's correlation coefficient examined individual group and whole cohort relationships between upper limb hypermobility, age, gender and ethnicity. MANOVA investigated between-group differences in ULHAT scores. Median interquartile ranges and ROC Curve analysis identified the cut-off score for identification of upper limb hypermobility. Percent agreement with clinical op...
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The Lower Limb Assessment Score (LLAS) has only been validated in a paediatric population. The aim of this study was to validate the use of the LLAS in an adult population by: i) evaluating its ability to discriminate between different... more
The Lower Limb Assessment Score (LLAS) has only been validated in a paediatric population. The aim of this study was to validate the use of the LLAS in an adult population by: i) evaluating its ability to discriminate between different extents of lower limb hypermobility, ii) establishing a cut-off score to identify lower limb hypermobility, and iii) determining if the LLAS is able to identify Generalised Joint Hypermobility (GJH). Participants were recruited across three groups representing varying degrees of hypermobility. They were assessed using the LLAS, Beighton score and clinical opinion. Pearson's correlation coefficient and MANOVA were used to assess between-group differences in the LLAS. The cut-off score was determined using median and inter-quartile ranges and the Receiver Operator Characteristic Curve. The ability of the LLAS to identify GJH was assessed using percent agreement with clinical opinion. One hundred twelve participants aged 18-40 years were recruited. T...
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BACKGROUND: Elite cello playing requires complex and refined motor control. Cellists are prone to right shoulder and thoracolumbar injuries. Research informing injury management of cellists and cello pedagogy is limited. The aims of this... more
BACKGROUND: Elite cello playing requires complex and refined motor control. Cellists are prone to right shoulder and thoracolumbar injuries. Research informing injury management of cellists and cello pedagogy is limited. The aims of this study were to quantify the torso, right shoulder, and elbow joint movement used by elite cellists while performing a fundamental playing task, a C major scale, under two volume conditions. METHODS: An eight degrees of freedom upper limb biomechanical model was applied to 3D motion capture data of the torso, upper arm, and forearm for 31 cellists with a mean experience of 19.4 yrs (SD 9.1). Two-factor ANOVA compared the joint positions between the four cello strings and two volume conditions. FINDINGS: Significant (p<0.05) effects were found for either the string and/or volume conditions across all torso, shoulder, and elbow joint degrees of freedom. The torso was consistently positioned in left rotation from 5.0° (SD 5.6) at the beginning of the ...
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The video folders represent the mp4 and avi versions of videos that accompanied the thesis. The DVD itself may be accessed in the Rare Book Library at the University of Sydney Library - RBTH 3154.
Research Interests: Health Sciences, Education, Educational Measurement, Medicine, Learning, and 15 moreCurriculum, Anatomy, Humans, Female, Male, Feedback, Interactive Whiteboard Teaching, Curriculum and Pedagogy, Human Anatomy and Physiology Teaching Methodologies, Musculoskeletal Anatomy, Pilot Projects, Peer Teaching, Anatomy curriculum and teaching, Cohort Studies, and Engaged Enquiry
Postural dysfunction is reported to increase the likelihood of developing performance-related musculoskeletal disorders in musicians. Both Exercise Therapy and Alexander Technique (AT) use methods that are suggested to assist with... more
Postural dysfunction is reported to increase the likelihood of developing performance-related musculoskeletal disorders in musicians. Both Exercise Therapy and Alexander Technique (AT) use methods that are suggested to assist with improving posture. This study aims to investigate whether experienced observers were able to detect postural changes in professional orchestral musicians following a 10-week intervention program. 57 musicians volunteered for either a program of Exercise or AT. Standardized series of photographs were taken of each participant before and after participating in an intervention program. Photographs were then randomized by (i) before or after the intervention and (ii) intervention type. These were evaluated by five experienced musician health professionals and four specialist music educators who had additional training in AT or Body Mapping. Observers were asked to identify the better posture using anterior and lateral photographic views of each musician. All p...
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Research Interests: Music, Australia, Occupational Medicine, Humans, Female, and 12 moreFeasibility Studies, Male, Patient Compliance, Exercise, Middle Aged, Questionnaires, Adult, Public health systems and services research, Occupational Diseases, Video Recording, Severity of Illness Index, and Musculoskeletal diseases
Research Interests: Program Evaluation, Psychology, Music, Evidence Based Medicine, Injury Prevention, and 13 moreTreatment Outcome, Exercise therapy, Medicine, Humans, Female, Male, Middle Aged, Adult, Public health systems and services research, Reproducibility of Results, Pilot Projects, Occupational Diseases, and Occupational Injuries
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Some studies suggested that adolescent scoliotic dancers were more likely to sustain dance injuries than non-scoliotic dancers. This study aimed to investigate the association between scoliosis and dance injury among children and... more
Some studies suggested that adolescent scoliotic dancers were more likely to sustain dance injuries than non-scoliotic dancers. This study aimed to investigate the association between scoliosis and dance injury among children and adolescent recreational dancers. Identical web-based and paper-based questionnaires were distributed to children and adolescent recreational dancers to collect demographic information, dance experiences, history and location of dance injuries, as well as the frequency of dance injury in the last 12 months. The prevalence rates of the top three dance injury sites (lower back, knee, and ankles) were estimated. Associations between the presence of scoliosis and various dance injuries in the last 12 months were evaluated by multivariate logistic regression. Data from 704 respondents (644 females, 13.3 ± 2.4 years) was analyzed. Ninety-one respondents (12.9%) reported scoliosis and 11 respondents (1.6%) were wearing scoliosis braces. The 12-month prevalence rate...
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The primary aim of this study was to determine the association between generalized joint hypermobility (GJH), knee‐specific hypermobility (KSH) and self‐reported knee health in an Australian population. Secondary aims included elucidating... more
The primary aim of this study was to determine the association between generalized joint hypermobility (GJH), knee‐specific hypermobility (KSH) and self‐reported knee health in an Australian population. Secondary aims included elucidating ethnic/gender differences in GJH/KSH prevalence and knee health, and identifying KSH using a novel knee extension range of motion cut‐off method.
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Background: Students often strategically adopt surface approaches to learning anatomy in order to pass this necessarily content-heavy subject. The consequence of this approach, without understanding and contextualisation, limits transfer... more
Background: Students often strategically adopt surface approaches to learning anatomy in order to pass this necessarily content-heavy subject. The consequence of this approach, without understanding and contextualisation, limits transfer of anatomical knowledge to clinical applications. Encouraging deep approaches to learning is challenging in the current environment of lectures and laboratory-based practica. A novel interactive anatomy workshop was proposed in an attempt to address this issue. Methods: This workshop comprised of body painting, clay modelling, white-boarding and quizzes, and was undertaken by 66 health science students utilising their preferred learning styles. Performance was measured prior to the workshop at the mid-semester examination and after the workshop at the end-semester examination. Differences between mid-and end-semester performances were calculated and compared between workshop attendees and non-attendees. Baseline, post-workshop and follow-up surveys were administered to identify learning styles, goals for attendance, useful aspects of the workshop and self-confidence ratings. Results: Workshop attendees significantly improved their performance compared to non-attendees (p = 0.001) despite a difference at baseline (p = 0.05). Increased self-confidence was reported by the attendees (p < 0.001). To optimise their learning, 97 % of attendees reported utilising multi-modal learning styles. Five main goals for participating in the workshop included: understanding, strategic engagement, examination preparation, memorisation and increasing self-confidence. All attendees reported achieving these goals. The most useful components of the workshop were body painting and clay modelling. Conclusions: This interactive workshop improved attendees' examination performance and promoted engaged-enquiry and deeper learning. This tool accommodates varied learning styles and improves self-confidence, which may be a valuable supplement to traditional anatomy teaching.
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Research Interests: Program Evaluation, Psychology, Music, Evidence Based Medicine, Injury Prevention, and 12 moreTreatment Outcome, Exercise therapy, Humans, Female, Male, Middle Aged, Adult, Public health systems and services research, Reproducibility of Results, Pilot Projects, Occupational Diseases, and Occupational Injuries
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Postural dysfunction is reported to increase the likelihood of developing performance-related musculoskeletal disorders in musicians. Both Exercise Therapy and Alexander Technique (AT) use methods that are suggested to assist with... more
Postural dysfunction is reported to increase the likelihood of developing performance-related musculoskeletal disorders in musicians. Both Exercise Therapy and Alexander Technique (AT) use methods that are suggested to assist with improving posture. This study aims to investigate whether experienced observers were able to detect postural changes in professional orchestral musicians following a 10-week intervention program. 57 musicians volunteered for either a program of Exercise or AT. Standardized series of photographs were taken of each participant before and after participating in an intervention program. Photographs were then randomized by (i) before or after the intervention and (ii) intervention type. These were evaluated by five experienced musician health professionals and four specialist music educators who had additional training in AT or Body Mapping. Observers were asked to identify the better posture using anterior and lateral photographic views of each musician. All p...