Dr Joanna Diong
2009 Grant recipient
Dr Joanna Diong is a physiotherapist and early career researcher with broad interests in mechanics of human movement and clinical epidemiology. She completed her PhD in 2012 on the incidence and mechanisms of contracture (loss of joint range of motion) after spinal cord injury. She is now a Lecturer in musculoskeletal anatomy at Sydney Medical School and Honorary Research Fellow at Neuroscience Research Australia (NeuRA).
Research areas and findings
It is thought that many people will develop contracture after spinal cord injury or stroke, but there are few data to support this and contracture is difficult to prevent or treat. During her PhD, Joanna was awarded a $10,000 Physiotherapy Research Foundation Tagged Jill Nosworthy Research Grant to conduct a large prospective cohort study on the incidence and predictors of contracture after acute spinal cord injury. Together with her supervisors Professor Rob Herbert and Associate Professor Lisa Harvey, she collected and analysed data on joint range of motion and potential clinical predictors from 92 consecutive patients with acute spinal cord injury who were admitted to the two main spinal units of NSW. Participants were assessed within one month after injury and one year later. The data subsequently provided the first robust estimates that the risk of contracture after acute spinal cord injury is high (over 60% of people will develop at least one joint contracture at one year), but it is difficult to identify those at risk of contracture within one month after injury.
Achievements with grant money
To calculate robust estimates of risk of disease, studies on prognosis need to recruit and assess a representative cohort of participants soon after the diagnosis of the condition and achieve good follow-up in subsequent assessments. Participants in the cohort needed to be followed-up in their homes at one year after injury and many lived outside of the greater Sydney metropolitan area. Funds from the PRF Tagged Grant supported both investigator transport to regional areas and a research assistant to help with part of the data collection. Consequently, follow-up (92% of participants) was achieved in a cohort representative of people who sustain an acute spinal cord injury.
Research impact on physiotherapy
Physiotherapists can now be certain that contracture is a common complication after spinal cord injury. It is commonly thought that clinical information such as age, pain, or the presence or absence of spasticity can identify those at risk of contracture. However this study showed that these and other potential clinical predictors are not useful at predicting those at risk of developing contracture after spinal cord injury. Further work is needed to understand the mechanisms of how contracture develops and what can be done to prevent or treat contracture.
Important areas for development in physiotherapy
Joanna believes that further investigation into the mechanisms of impaired motor and sensory function in neurological conditions would provide more insight into how or why secondary complications such as contracture occur. Impairments in the upper limb after stroke and spinal cord injury also tend to persist. More robust information is needed on strategies to provide best practice in rehabilitation of the upper limb in people who have neurological conditions.