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PhD candidate Susan Ward is researching symptomatic hypermobility in children

Having graduated from Trinity College in 2001 with a BSc in Physiotherapy, Susan worked in both Scotland and New Zealand, completing post-graduate training in Clinical Physiotherapy and Acupuncture. She returned to Ireland in 2006 to work in the newly formed Rheumatology Team in Our Lady’s Children’s Hospital in Crumlin, as it was then known. Dr Orla Killeen was the first Paediatric Rheumatologist in Ireland managing children and young people with inflammatory conditions (such as Juvenile Arthritis) as well as non-inflammatory conditions, most of these presenting with joint hypermobility-related symptoms. Susan developed her clinical role in Rheumatology before becoming a Clinical Tutor in Children’s Health Ireland (CHI) at Crumlin.

Susan is just six months into her doctoral studies, and her PhD focuses on hypermobility in children and young people. Her studies are funded by a fellowship from the National Children’s Research Centre (NCRC), and she is supervised by Dr Sara Dockrell (Discipline of Physiotherapy) and Dr Emma MacDermott (Consultant Paediatric Rheumatologist, Children’s Health Ireland at Crumlin). Susan has two co-principal investigators; Dr Janet Deane (NIHR Clinical Lecturer and AHP Research and Innovation Lead) from the University of Manchester and Manchester University NHS Foundation Trust and Dr Jane Simmonds, Associate Professor from Great Ormond Street Institute of Child Health, University College London. We spoke to Susan about her PhD and how she sees her work impacting clinical practice.

Can you describe your research topic?

I am studying children and young people with joint hypermobility-related disorders. Joint hypermobility is the term used to describe the capability that a joint has to move beyond normal limits. It is also known as joint laxity or double-jointedness. Children are more hypermobile than adults, and for most children this causes no problem. Joint hypermobility may actually be advantageous in some sports like gymnastics or swimming. However, some children and young people complain of pain in multiple joints and muscles, frequently worse towards the end of the day following activity. They may complain of fatigue or difficulties with functional tasks which can limit their ability to participate in daily activities (such as attending school or doing sport and physical activity). Symptoms often extend beyond the musculoskeletal system into the gastrointestinal, cardiovascular, urogenital and psychological domains. Exploring this range of symptoms in children and young people is an important part of my research to help us to understand the full impact of this condition on quality of life. This varied pattern of symptoms can present a challenge in terms of diagnosis and treatment. The medical terms used to describe these conditions has changed over time which can be confusing to children, to their families, as well as to clinicians. We currently use the term ‘symptomatic hypermobility’.

How do you see your work impacting healthcare in the future?

I hope that my work will further the knowledge and understanding of this condition. Currently, there is no consensus about how to effectively manage children and young people with joint hypermobility-related conditions. Physiotherapists often play a fundamental role in management. Ultimately, we hope that children and young people will have a better patient journey from diagnosis to treatment. As part of my studies, I plan to develop a decision-making tool that could be used in a patient pathway for the management of symptomatic hypermobility.

Did you always want to pursue a research career?

I always wanted to pursue clinical research at some point in my career. During my role as Clinical Tutor, I began to further explore the process of critical thinking and questioning clinical practice with students on placement. It was at this point that I decided to use my clinical experience and interest in the area of symptomatic hypermobility to develop my research question. My clinical colleagues, and research team, helped to guide me along the path from clinician to clinical academic.

What do you enjoy most about your studies, and would you recommend the academic life to young student and undergraduates?

I am working full time on my PhD and feel very privileged to be in this position, thanks to the National Children’s Research Centre, (NCRC), my funding body. The NCRC have been in existence for more than 50 years and has been funded since its inception by the Children’s Health Foundation Crumlin. I enjoy having the time to focus exclusively on this project, about which I am very passionate. I enjoy the variety of my new role; using statistics, reviewing the evidence base, learning to navigate various IT software, organising online meetings with my team, managing timelines and deadlines, and taking on a new research role in the clinical setting where I will be starting data collection soon.

What are your plans for the future?

Following my PhD, I will look forward to returning to my clinical role in CHI, Crumlin. As a research active health professional, I hope to encourage others to engage in meaningful research in their own clinical areas of expertise. I also hope to further develop this project, developing and testing our clinical tool, to make a meaningful impact with patients and their families

When you are not working on your PhD studies, where could we find you?

I love to swim in the sea and admit to being a Covid-19 sea swimming convert, as it has provided some much-needed escapism during this past year!