Q&A with Dr Rhian Milton-Cole: Building better rehabilitation pathways for all

7 May 2025

Rhian, can you tell us a bit about your background and current role?

I’m a physiotherapist by background, currently working at Whipps Cross Hospital within Barts Health NHS Trust as an orthopaedic physiotherapist. As of a few weeks ago, I’ve stepped into a new role as a Senior Clinical Research Fellow with the Bone and Joint Health group, which means I now split my time evenly, 50 per cent research and 50 per cent clinical work.

Before this, I’d been working with the Bone and Joint Health team as a postdoc since January 2024. So, although this new post is recent, I’ve been part of the team for over a year and have already had the opportunity to contribute to significant research projects. The new structure of my role now gives me the capacity to expand and establish my own research programme, which I’m really excited about.

What research projects are you currently working on?

I’m currently leading three key areas of work. Two of these are new research grants that we have been awarded.

The first is funded by the Chartered Society of Physiotherapy Charitable Trust, and focuses on developing a core outcome set for vertebral fractures. It’s an 18-month project that I’ll be starting shortly, and it’s especially meaningful to me as it was my first successful grant as lead.

The second is my first NIHR Research for Patient Benefit (RfPB) grant, which supports the development of a rehabilitation intervention for people with fragility fractures and co-existing depressive symptoms. That project also runs for 18 months and directly follows on from my PhD, which explored depression in people recovering from hip fractures, particularly through a rehabilitation lens. We want to build something practical and impactful that can support this overlooked group in their recovery.

In parallel, I’m beginning to design my own longer-term research programme, which is still taking shape. It will continue to focus on people with fragility fractures, but I’ll be looking more closely at how underrepresented groups experience rehabilitation and recovery. My PhD focused on mental health as a form of underrepresentation, but I’m also interested in other underserved communities, such as people from different ethnic backgrounds, those with lower socioeconomic status, and those facing cultural or linguistic barriers. I’m also considering exploring pain management as part of this work, particularly in relation to how it’s experienced and treated across different communities.

Are there specific issues facing East London that you aim to address?

Definitely. East London is central to the work we’re doing. The populations we serve, particularly in Tower Hamlets and Newham, experience high levels of social deprivation, ethnic diversity, and linguistic diversity, with many residents not speaking English as a first language.

We also know that people from ethnic minority backgrounds and lower socioeconomic groups are consistently underrepresented in health research, even though they are often most affected by the conditions we study. Many face barriers to accessing both research and healthcare, whether that’s due to language, cultural differences, time, or lack of trust in institutions.

For both of my current research projects, we’ve built inclusivity into the design from the start. That includes allocating funding for translation and transcription, so we can translate interviews and study documents into other languages. We’re trying to address the accessibility gap; if we don’t include these communities in our research, we risk developing interventions that aren’t relevant or effective for them.

The broader issue is that we often generate health research based on narrow populations and then apply that research universally. That’s neither fair nor effective. Our goal is to make sure our research reflects the people it's meant to help, both locally in East London and nationally, given how diverse the UK is.

What role does patient and public involvement (PPI) play in your work?

PPI is integral to my current projects. Each has a PPI lead, someone with lived experience of the relevant condition, who was involved from the moment we started developing the grant applications. Their feedback shaped the design, and they’ll continue to play a central role throughout.

We’ve also built in regular engagement with PPI groups at all stages, from planning and analysis to dissemination. This isn’t just a tick-box exercise. We want our partners to be true collaborators. That’s why we’ve costed in resources for training, so PPI members can, for example, chair meetings or co-present at conferences.

We’ve also included funding for PPI members to attend and speak at conferences alongside researchers, not just at community-facing events, but also in academic and professional settings. Often, we speak about patients to professionals, but we rarely include those patients in those conversations. We want to change that.

What have been your key successes so far?

I’d say the two grants I’ve been awarded are my biggest achievements to date. I’d only been in my postdoctoral role for around 10 months when I secured both the CSPCT and NIHR grants, which was a real surprise and a huge milestone in my career.

Being named lead investigator so early in my post-PhD journey, and on nationally competitive funding streams, was both validating and exciting. It’s given me the confidence to begin shaping my own research direction and building a team around it.

What difference will the new Centre for Bone and Joint Health make?

Becoming a Centre is a big step forward. We’ve always been ambitious as a group, but Centre status brings greater visibility, resources, and infrastructure. For me personally, it comes at exactly the right time, I’m beginning to build my own research programme and team, and the Centre structure supports that growth.

It also allows us to create more opportunities for others. I see this as part of a much bigger ambition, not just to do good research, but to grow the next generation of researchers, including those from underrepresented professional backgrounds like allied health.

There’s been real momentum in the team over the past couple of years. It’s exciting to be part of something that’s growing exponentially, with a clear vision of where it’s going.

How has Barts Charity helped make this work possible?

Barts Charity has been crucial in making roles like mine possible. I’m both a clinician and a researcher, and for allied health professionals such as physios, occupational therapists, speech and language therapists, and dietitians, there isn’t a clear or structured clinical academic career path like there is for doctors or nurses.

This new post was created, in part, with funding from Barts Charity (Barts Charity funded the Precision Medicine Academy), along with the Barts Biomedical Research Centre, Queen Mary University of London and Barts Health NHS Trust. Without that support, posts like mine wouldn’t exist.

Beyond individual roles, Barts Charity also supports broader research activity like PPI engagement. It’s helped us access more resources, more flexibility, and more opportunities to grow. That’s not just good for us as researchers, it’s good for the communities we’re here to serve.