Portrait of Karthikeyan Muthumayandi

Karthikeyan Muthumayandi

Programme Director of Sports Therapy and Rehabilitation


Mr Karthikeyan Muthumayandi received a bachelor's degree in physiotherapy from the Tamil Nadu Dr.M.G.R medical University, India in 1998. After teaching biomechanics, sports therapy and rehabilitation in the Nanda Institute of Physiotherapy, he completed M.P.Th. in Physiotherapy from Jamia Hamdard University, New Delhi, India in 2002. He worked as senior physiotherapist in charge of Sports and Neuro-Musculoskeletal rehabilitation for two years in Apollo Hospital (world’s third largest group of corporate hospitals) New Delhi. He competed M.Phil from Northumbria University, Newcastle upon Tyne in 2010. He was working as research physiotherapist from 2004 before he joined the School of Sports and Exercise Sciences at the University of Kent in May 2014. He was appointed as honorary research associate in Institute of Cellular Medicine, Newcastle University.

Research interests

Karthik's  research interests are exploring the use of latest generation physical activity monitors in objective quantification of physical ambulatory behaviour in individual at macro (quantity-community ambulation) and micro level (quality-spatial and temporal gait parameters of gait) through machine learning approach. One of the objectives is to evaluate these technologies as tools to increase the physical ambulatory activity in an individual.

His other research interests are looking at the impact of obesity in patients with severe  osteoarthritis, exploring patients reported outcome in patients waiting for joint replacements, prediction of outcome through machine learning after surgery and also looking at gait pathologies in people with orthopaedic disorders.

In the future, he intends to explore the possibility of translating the objective quantification of physical ambulatory activity to clinical relevance. To explore new technologies and machine learning programming in sports evaluation


Karthikeyan's teaching focuses on clincial practice.



  • Poomsalood, S., Muthumayandi, K. and Hambly, K. (2019). Can stretch sensors measure knee range of motion in healthy adults?. Biomedical Human Kinetics [Online] 11:1-8. Available at: https://doi.org/10.2478/bhk-2019-0001.
    Study aim: There are currently limited methods available to access dynamic knee range of motion (ROM) during free-living activities. This type of method would be valuable for monitoring and progressing knee rehabilitation. Therefore, the aim of this study was to evaluate the functioning of stretch sensors for the measurement of knee ROM and to assess the level of the measurement error.
    Material and methods: Nine healthy participants were included in the study. Three stretch sensors (StretchSense?, Auckland, NZ) were attached on the participants’ right knees by Kinesiotape®. A Cybex dynamometer was used to standardise movement speed of the knee joint. Data was recorded through the StretchSense? BLE application. Knee angles were obtained from the video clips recorded during the testing and were analysed by MaxTraq® 2D motion analysis software. The knee angles were then synchronised with the sensor capacitance through R programme.
    Results: Seven out of the nine participants presented with high coefficient of determination (R2)
    (>0.98) and low root mean square error (RMSE) (<5°) between the sensor capacitance and knee angle. Two participants did not confirm good relationship between capacitance and knee angle as they presented high RMSE (>5°). The equations generated from these 7 participants’ data were used individually to predict knee angles.
    Conclusions: The stretch sensors can be used to measure knee ROM in healthy adults during a passive, non-weight-bearing movement with a clinically acceptable level of error. Further research is needed to establish the validity and reliability of the methodology under different conditions before considered within a clinical setting.
  • Mohammed, W., Pappous, A., Muthumayandi, K. and Sharma, D. (2018). The Effect of Mindfulness Meditation on Therapists’ Body-Awareness and Burnout in Different Forms of Practice. European Journal of Physiotherapy [Online]. Available at: https://doi.org/10.1080/21679169.2018.1452980.
    Objectives: The main aim of this study was to explore if mindfulness increase therapists’ (physiotherapists and sport therapists) body-awareness and if it can have an effect on reducing their burnout in the workplace. Additionally it was intended to gather evidence about which methods (face-to-face groups FFGs with an instructor or self-directed group SDG) of mindfulness meditation program (MMP) were more effective with therapists.
    Methods: Online tools such as websites, skype and online surveys were used with participants as part of the methodology. Seven measurements were used to assess the effect of mindfulness meditation on therapists after 4 week of formal and informal practise.
    Results: Our results showed that attention regulation, self-regulation and trusting in FFGs had significant improvement in pre and post meditation practise. Findings showed significant differences between groups for the FFGs. Particularly, our findings indicated a clear improvement in the acting with awareness, positive affect of mindfulness, emotional awareness and reduction in burnout. However, no changes were observed in stress.
    Conclusions: MMP has positively affected therapists, specifically in the FFGs. Therapists in the FFGs gained benefits from mindfulness to improve their body-awareness and less level of burnout at workplace. The benefits of the mindfulness programme were more significant when delivered in a face-to-face programme rather than in a self –directed way.
  • Singisetti, K., Muthumayandi, K., Abual-Rub, Z. and Weir, D. (2015). Navigation-assisted versus conventional total knee replacement: no difference in patient-reported outcome measures (PROMs) at 1 and 2 years. Archives of Orthopaedic and Trauma Surgery [Online] 135:1595-1601. Available at: http://www.dx.doi.org/10.1007/s00402-015-2314-7.
    Introduction: Navigation technique for total knee replacement has been shown to improve accuracy of prosthesis alignment in several studies. The purpose was to compare the patient-reported outcome measures in primary total knee replacement (TKR) using navigation versus conventional surgical technique at 1- and 2-year follow-up. Materials and methods: A retrospective review of prospectively collected patient-reported outcome data for 351 consecutively performed primary TKR was included in the study. The study group (N = 113) included patients who had Triathlon TKR using articular surface mounted (ASM Stryker®) navigation technique and control group (N = 238) included patients who had Triathlon TKR using conventional jig. In addition to the WOMAC (Western Ontario and McMaster University Osteoarthritis Index) and SF-36 (Medical Outcomes Trust Short Form-36), a short self-report questionnaire evaluating the level of satisfaction, quality of life and whether patients would undergo knee replacement again. Results: WOMAC: no significant difference between the groups was noted in mean WOMAC pain, function and stiffness scores at 1- and 2-year follow-up. SF-36: no significant difference between the groups was seen except in the physical function component of score at 1 year (p = 0.019). Navigation group mean 56.78 (CI 51.06–62.5) versus conventional group mean 48.34 (44.68–52.01) but this difference was not observed at 2-year follow-up. Conclusions: The overall patient-reported outcome scores improved after total knee replacement but appear to be comparable in both groups at 1- and 2-year follow-up.
  • Devalia, K., Ramaskandhan, J., Muthumayandi, K. and Siddique, M. (2015). Early results of a novel technique: Hindfoot fusion in talus osteonecrosis prior to ankle arthroplasty: A case series. The Foot [Online] 25:200-205. Available at: http://dx.doi.org/10.1016/j.foot.2015.07.001.

    The purpose of this study was to evaluate the clinical outcome of a two staged approach of subtalar arthrodesis followed by TAR for patients with ankle arthritis and AVN talus.


    Out of total 210 TARs performed at our institute; 7 patients underwent a two staged procedure between 2006 and 2010. All patients had over 3 years of follow up (except one). The clinical results were assessed using AOFAS, WOMAC, SF-36 and patient satisfaction scores.


    The mean follow up was 3 years. There was significant improvement in AOFAS and WOMAC (pain and stiffness) from pre-op to 3 years post-op (P < 0.05). SF 36 scores improved from pre-op to 3 years post-op for 6/8 domains. 5 patients were satisfied at 3 years for overall surgical outcomes, 4 were satisfied with pain relief. Radiological signs of talar subsidence were noted in 2 patients at year 1. This did not progress at 3 years and did not deteriorate clinical outcome.


    We recommend our two staged approach to deal with this difficult clinical problem. We believe this approach is safe for TAR surgery where talar vascularity and bone quality is questionable leading to reduced talar subsidence, ischaemic pain and improvement in longevity of TAR.
  • Mackie, A., Muthumayandi, K., Shirley, M., Deehan, D. and Gerrand, C. (2014). Association between body mass index change and outcome in the first year after total knee Arthroplasty. The Journal of Arthroplasty [Online] 30. Available at: http://dx.doi.org/10.1016/j.arth.2014.09.003.
    There is an association between obesity, osteoarthritis and total knee arthroplasty (TKA), but little is known about how postoperative weight change influences outcomes. Primary TKA patients were identified from an institutional arthroplasty registry. BMI and patient reported outcome measures (PROMs, specifically WOMAC and SF36) were recorded for 1545 patients preoperatively and up to 3 years postoperatively. Mixed effects modelling showed postoperative BMI change had no impact on postoperative WOMAC scores. However, weight gain over 10% had a negative impact on SF36 pain and functional scores although postoperative weight loss was not associated with improved PROMs. Men showed greater improvement in postoperative SF36 function and pain scores, whilst older patients were slower to improve. Postoperative weight gain has a negative association with SF36 pain and function.
  • Baker, P., Muthumayandi, K., Gerrand, C., Kleim, B., Bettinson, K. and Deehan, D. (2013). Influence of body mass index (BMI) on functional improvements at 3 years following total knee replacement: a retrospective cohort study. PloS one 8.

    The number of patients presenting for total knee replacement who are classified as obese is increasing. The functional benefits of performing TKR in these patients are unclear.


    To assess the influence pre-operative body mass index has upon knee specific function, general health status and patient satisfaction at 3 years following total knee replacement.


    Retrospective comparative cohort study using prospectively collected data from an institutional arthroplasty register.


    1367 patients were assessed using the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and Medical Outcomes Trust Short Form-36 (SF-36) scores supplemented by a validated measure of satisfaction pre-operatively and subsequently at 1,2 and 3 year post-operatively. Comparisons were made by dividing the cohort into 4 groups based on body mass index (BMI) 18.5–25.0 kg/m2 (n?=?253);>25.0–30.0 kg/m2 (n?=?559);>30.0?35.0 kg/m2 (n?=?373);>35.0 kg/m2 (n?=?182).


    Despite lower pre-operative, 1 and 3 year WOMAC and SF-36 scores patients with the highest BMIs >35.0 kg/m2 experienced similar improvements to patients with a ‘normal‘ BMI (18.5–25.0 kg/m2) at 1 year (Difference in WOMAC improvement?=?0.0 (95%CI ?5.2 to 5.2), p?=?1.00) and this improvement was sustained at up to 3 years (Difference in 1 year to 3 year improvement?=?2.2 (95%CI: ?2.1 to 6.5), p?=?1.00). This effect was also observed for the SF-36 mental and physical component scores. Despite equivalent functional improvements levels of satisfaction in the >35.0 kg/m2 group were lower than for any other BMI group (>35.0 kg/m2?=?84.6% satisfied versus 18.5–5.0 kg/m2?=?93.3% satisfied,p?=?0.01) as was the proportion of patients who stated they would have the operation again (>35.0 kg/m2?=?69.6% versus 18.5–25.0 kg/m2?=?82.2%,p?=?0.01).


    Obese and morbidly obese patients gain as much functional benefit from total knee replacement as patients with lesser body mass indexes. This benefit is maintained for up to 3 years following surgery. However, these patients are less satisfied with their knee replacement and almost a third would not have the operation again.
  • Malviya, A., Rushton, S., Foster, H., Ferris, C., Hanson, H., Muthumayandi, K. and Deehan, D. (2012). The relationships between adult juvenile idiopathic arthritis and employment. Arthritis & Rheumatism [Online] 64:3016-3024. Available at: http://www.dx.doi.org/10.1002/art.34499.
    The chronicity of juvenile idiopathic arthritis (JIA) into adulthood and attendant potential disability may adversely influence educational attainment and the ability to secure and maintain gainful employment. We undertook this study to investigate the effects of patient- and disease-specific factors on education and employment outcomes in a group of adult patients with JIA.
    We performed a cross-sectional study of 103 consecutive adults attending a JIA continuity clinic, and patients who consented completed questionnaires relating to educational achievement, employment status, and functional disability (the Health Assessment Questionnaire disability index [HAQ DI]), and, for those who were employed, the rheumatoid arthritis Work Instability Scale. We used the structural equation modeling technique to study key patient and disease variables for employment in adults with JIA.
    The median age of patients was 24 years (range 17-71 years) with median disease duration of 19 years (range 7-67 years). Functional disability (the mean HAQ DI score) was significantly lower in patients who were employed (P = 0.03) and in those with oligoarticular JIA (t = 2.29, P = 0.02). Educational achievement was not influenced by JIA subtype (F = 1.18, P = 0.33). Educational achievement measured by General Certificate of Secondary Education (GCSE) grades had a positive effect on the type of job achieved in later life (F = 11.63, P = 0.001), with greater success leading to more professional or managerial posts. In the complex structural equation model, job stability was influenced positively by educational achievement measured by GCSE grades and negatively by the HAQ DI score (t = 10.94, P = 6.36 × 10(-16) ).
    Educational attainment is key to successful employability and is influenced by functional disability rather than by JIA subtype. These findings have implications for choice of occupation and delivery of career advice to aid decision making by young people with JIA.
  • Lingard, E., Muthumayandi, K. and Holland, J. (2009). Comparison of patient-reported outcomes between hip resurfacing and total hip replacement. Journal of Bone & Joint Surgery, British Volume 91:1550-1554.
    This study compared the demographic, clinical and patient-reported outcomes after total
    hip replacement (THR) and Birmingham Hip Resurfacing (BHR) carried out by a single
    surgeon. Patients completed a questionnaire that included the WOMAC, SF-36 scores and
    comorbid medical conditions. Data were collected before operation and one year after. The
    outcome scores were adjusted for age, gender, comorbid conditions and, at one year, for the
    pre-operative scores. There were 214 patients with a THR and 132 with a BHR. Patients with
    a BHR were significantly younger (49 vs 67 years, p < 0.0001), more likely to be male (68% vs
    42% of THR, p < 0.0001) and had fewer comorbid conditions (1.3 vs 2.0, p < 0.0001). Before
    operation there was no difference in WOMAC and SF-36 scores, except for function, in which
    patients awaiting THR were worse than those awaiting a BHR.
    At one year patients with a BHR reported significantly better WOMAC pain scores (p =
    0.04) and in all SF-36 domains (p < 0.05). Patients undergoing BHR report a significantly
    greater improvement in general health compared with those with a THR.

Conference or workshop item

  • De Coninck, K., Hambly, K., Passfield, L., Dickinson, J. and Muthumayandi, K. (2015). Inter-observer agreement of thoracolumbar fascia morphology: an exploratory analysis of ultrasound images. In: Fourth International Fascia Research Congress. Elsevier, pp. 668-669. Available at: https://doi.org/10.1016/j.jbmt.2015.07.005.
    BACKGROUND: Ultrasound imaging (USI) has been shown to be a valid method to investigate the morphology of the thoracolumbar fascia (TLF) [1]. A USI-based study has demonstrated that the TLF of subjects with chronic lower back pain (LBP) is on average 25% thicker and more disorganised compared to a control group [1]. The aim of this study is to explore inter-observer agreement between a range of clinicians on (dis)organisation of TLF in ultrasound images. There are currently no validated methods for the evaluation of USI of TLF.
    METHODS: Design: an exploratory analysis using a fully crossed design of inter-observer agreement. This study was approved by the University of Kent’s School of Sport and Exercise Sciences Research and Ethics Committee (Prop. 163 – 2013). Participants: Thirty observers consisting of 21 (70%) Medical Doctors, 7 (23%) physiotherapists and 2 (6%) radiologists, with a combined total average of 13 years of clinical experience (± SD 9.4). 57% had no experience in USI, 36% had experience ranging from monthly to daily evaluations of USI, no observers had experience in evaluating USI of TLF. Protocol: A sub-set of thirty ultrasound scans of TLF were randomly selected from a data set of 308 scans of subjects with and without LBP (from a larger study conducted by the first author). All scans were anonymised and displayed on a desktop computer, or projected on a screen. All observers viewed and rated each of the 30 scans independently on a Likert-type scale from 1(very disorganised) to 10 (very organised). Inter-observer agreement was assessed using a two-way mixed, consistency, average measures intra-class correlation (ICC), the Cronbach’s Alpha, to assess consistency among observers. The Krippendorff’s Alpha (Kalpha) [2] reliability estimate was used to assess agreement.
    RESULTS: The resulting ICC was in the excellent range, ICC = 0.98, indicating that observers had a high degree of consistency, suggesting that (dis)organisation was rated similarly across observers. Observers without USI experience scored an ICC = 0.96, observers with USI experience scored an ICC = 0.95, again both in the excellent range. In this small cohort, experience in USI does not appear to impact on consistency. The Krippendorff’s ordinal alpha ? was .621, indicating a modest degree of agreement.
    CONCLUSIONS: The high ICC and modest Kalpha suggest that a minimal amount of measurement error was introduced by the independent observers, and therefore statistical power for subsequent analyses is not substantially reduced. This will allow for further analysis of USI images of TLF in terms of morphology and classification. This could ultimately, lead to a meaningful evaluation of treatments of TLF.


  • Meadows, S. and Muthumayandi, K. (2016). Report for Medway Community Healthcare Cardiac Rehabilitation Team (MCHCRT) November 2016. University of Kent.
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