Log in
It is important that valid outcome measures are used to assess clinical services and interventions to demonstrate that services are effective. Additionally, outcomes of interventions need to be meaningful to the patients reporting them, as this adds value to the outcome of trials over and above the statistically significant difference derived mathematically. Singh and colleagues explored the minimum clinically important difference of the incremental shuttle walking test for individuals with chronic respiratory disease. As a result of Singh's research, this threshold is now included in international guidelines for pulmonary rehabilitation and has also been introduced into research and practice among people attending cardiac rehabilitation over the last 5 years.
In this case study we describe an interrelated collection of impacts on healthcare in the NHS; these are summarised in the Table below.
The Physical Activity in Ageing, Rehabilitation and Health Research Group at Aberystwyth University has designed, implemented and evaluated rural Community Exercise Schemes (CESs), including GP referral of sub-clinical populations, and more specialised schemes, such as cardiac rehabilitation and falls prevention. This research has made a distinct and material contribution to the provision of CESs in the region by providing evidence to inform service planning and delivery, increase access to and engagement with services, improve health and influence professional standards, guidelines and training.
Prof Doherty's research is themed around `safe and effective exercise for patients with complex cardiac disease' where, until his leading research had been carried out, thousands of patients were denied access to such services. Prof Doherty implemented the first prospective randomised control trial (RCT) in this population which has: benefitted patients directly by enabling more programmes to offer rehabilitation to this group of patients; impacted on clinical guidance nationally and internationally; contributed to Department of Health policy; and influenced the public and clinical populations through the NHS, British Heart Foundation, Arrhythmia Alliance and professional clinical groups.
The Movement ABC-2 Test is internationally recognised as `the gold standard' for identifying children with motor difficulties. Prof Anna Barnett's revision and development has provided health and education professionals with a reliable assessment tool, improving the support for children and their families. This test is recommended in the latest European guidelines on Developmental Coordination Disorder (DCD) — a condition recognised as having a major impact on the lives of children — and has also been translated into several languages for global use. The parallel development of specific tests for handwriting (DASH and DASH17+) for children and adults has provided clinicians and teachers with the tools to help support students with their class work and written examinations.
Smith's research in Exercise Science focuses on exercise adherence and health enhancing physical activity (HEPA). Doherty's research looks at `safe and effective exercise for patients with complex cardiac disease' and implemented the first prospective Randomised Control Trial in this population. Smith and Doherty have collaborated on an RCT, on `Active York' and on a successful proposal to the BHF. Smith's work has had an impact on practitioners and professional services by shaping regulatory frameworks for `exercise on prescription' schemes. In health, Doherty's research has benefitted patients directly by enabling hundreds of programmes to offer rehabilitation to patients with complex cardiac disease and has impacted on national and international practice.
Research from the University of Nottingham on aminoglycoside antibiotics in cystic fibrosis (CF) has changed clinical practice and improved patient safety internationally. There are over 70,000 people with CF worldwide. Most require frequent and prolonged intravenous courses of aminoglycoside antibiotics (which can cause kidney damage) to treat chronic lung infection with Pseudomonas aeruginosa. This infection may lead to respiratory failure and death. Our research has influenced national and international guidelines, and changed practice, such that once-daily aminoglycosides (less toxic to the kidneys) are now used. We have also stopped the use of gentamicin, in favour of less toxic aminoglycosides.
This research into the effective management of exertion intensity, symptoms and pain in the treatment of cardiovascular and neuromuscular diseases has resulted in the setting of national and international standards for safe and effective education, training and professional practice.
Physical activity forms a core component in the prevention and rehabilitation of cardiovascular disease and in genetically acquired neuromuscular disorders. Physical activity benefits are linked to the volume — frequency, intensity and duration — of participation, which will bring about physiological and/or psychosocial improvements.
New therapies supported by clear evidence from clinical trials have resulted in outstanding improvements in survival and quality of life for people living with cystic fibrosis (CF). Elborn's clinical trials group has delivered a programme of crucial clinical trials which has impacted on clinical practice in CF. From 2009-2012 Elborn co-led a pivotal multicentre trial using Ivacaftor (Kalydeco TM), a transformative new drug which represents a paradigm shift as the first approved therapy that corrects the basic defect in CF. This therapy is an exemplar of personalised medicine and is prescribed for patients with the specific gene mutation in which this drug works.
Invasive pulmonary aspergillosis (IPA) is a frequently fatal disease of haematological malignancy patients, caused by fungi from the genus Aspergillus. Dr Christopher Thornton has developed and commercialised a novel point-of-care test for the diagnosis of IPA with an Aspergillus-specific monoclonal antibody (mAb) JF5 generated using hybridoma technology. Using this mAb, he has developed a lateral-flow device (LFD) for the rapid detection of Aspergillus antigen in human serum and bronchoalveolar lavage fluids (BALf) that signifies active infection. Commercial exploitation of the patented technology has been met through the establishment of a University of Exeter spin-out company, Isca Diagnostics Limited.