Researcher Spotlight: Nadine Foster

13 Dec 2021

Each month we shine the spotlight on a researcher within the Faculty of Health and Behavioural Sciences.

This month we caught up with Professor Nadine Foster, Director of Research and Education at Surgical, Treatment and Rehabilitation Services (STARS), a specialist public health facility at the Herston Health Precinct. STARS is a partnership between Metro North Health and UQ.

Tell us briefly about yourself and what drew you to this field?

I have spent over 25 years in applied clinical research, in the fields of musculoskeletal pain, orthopaedics and rehabilitation. I am a physiotherapist from the UK, was previously at Keele University leading a team focused on research in Musculoskeletal Health and providing senior leadership in Randomised Clinical Trials as Director of the Keele Clinical Trials Unit.

I recently arrived in a new role here as Director of the STARS Education and Research Alliance. I was drawn to this role given the opportunity to establish a team in the hospital supporting all things education and research, taking forward research that addresses important clinical challenges and reducing uncertainty in clinical practice.

Tell us about your research and favourite aspect?

I am energised to see important clinical questions answered well, and if possible, definitively.

I really like leading or collaborating on research that reduces uncertainty for clinical practice and patients, as well as research that shows us how to make the most of limited healthcare resources.

My research has evidenced the role of rehabilitation for the most common musculoskeletal pain presentations, including low back pain, shoulder pain and knee osteoarthritis. I have led or collaborated on over 22 randomised trials testing treatments and new models of care (stratified care, stepped care, direct access models of care).

Since coming to Brisbane I have been experimenting with the NIHR-NHMRC collaborative trials funding scheme in particular, leveraging my collaborations across the UK and Australia. The first of these has recently been successful- the RAPSODI trial comparing two approaches to shoulder replacement surgery, two trials are now funded, one in the UK and one in Australia, and are about to commence.

What are your most significant research accomplishments?

The most significant is the paradigm changing evidence that prognostic stratified care for back pain is clinically effective & cost-saving (STarTBack tool validation, STarTBack trial, IMPaCT Back study). This model of stratified care for low back pain has been implemented in over 38 countries and more than five guidelines (eg. UK, Belgium, Germany, Netherlands, France).

I also contributed the first robust evidence that arthroscopic surgery is slightly more effective than rehabilitation for hip impingement but not cost-effective- at least in terms of a short-term time horizon. I led the development of the rehabilitation intervention and supported the 47 physiotherapists who delivered this in the randomised trial. Published in the Lancet, this trial was a PEDro winner in 2019.

Right now, a huge collaborative team is working with me to deliver the first international exercise and osteoarthritis trials individual patient data (IPD) meta-analysis, having been based on an update of my previous systematic review and meta-analysis. This will provide best evidence about the effects of exercise for lower limb osteoarthritis and bring new understanding about whether there are characteristics of patients that benefit more than others.

Have there been any defining moments in your research career?

Other than the first decision to step into research as a young physiotherapist and catching ‘the research bug’, my involvement in the leadership of the 2018 Lancet Low Back Pain Series can be seen as a defining moment in my research career.

I led one of the three papers in this landmark series and was one of six Steering Group Members leading the 31 authors worldwide, over a period of two years.

Through this, we contributed state-of-the-art knowledge about back pain prevention and treatment and called for action to reduce low value care. This work was covered in over 579 media sources in 41 countries; influenced WHO policy; and attracted over 20 invited plenaries.

What has been the impact of your research?

How to get the right affordable treatment to the right patient at the right time is a key healthcare challenge.

Focused on the world’s leading cause of disability- musculoskeleletal pain, my research has led to paradigm-changing discoveries and evidences clinical and cost effectiveness of new models of care on core outcomes.

It showed subgrouping and targeting treatment based on risk of poor outcomes is better for patients & health services (cost-saving) and can be implemented in practice. It also showed that integrating vocational interventions in health services is effective with high return-on-investment and it is possible to deliver faster access to affordable healthcare such as self-referral or telehealth.

My studies have driven enquiry within and beyond the field across 25 broad subject areas across 96 countries. Our model of stratified care for back pain (STarT Back) sparked over 12 trials worldwide, including in other fields such as arthritis and whiplash.

Clinically, my work has challenged one-size-fits-all approaches in musculoskeletal healthcare by evidencing new models of care, taken up in 50 policy documents across six countries, influencing guidelines, and transforming patient pathways.

What would you like to achieve with your research?

With the move to Australia from the UK, I want to add value to partnership working between UQ and Metro North Health, in STARS and more broadly through involvement in research across Metro North Health.

I want to bring high quality research opportunities to patients and clinicians, involve consumers in shaping the research we do, and continue to ensure we are addressing the most important clinical questions through research.

I want to develop and support an interprofessional team of people who work in partnership across our organisations to develop and test treatments and new models of care that maximise patient outcomes yet that can also be sustained and scaled in ways that ensure they are translated into practice.

What advice would you give to early career researchers?

Tenacity is probably the most important characteristic of successful researchers. I have learned a lot over the years about tenacity from my terriers (particularly fox terrriers!). Find out what you really want to do and be tenacious about pursuing it. I would also advise working with great people, not only great because they are the top experts in their field but also because they genuinely want to support you and will take the time to help you. Clinical research is a team sport!