Log in
Treating stroke consumes 5% of the NHS budget. Government objectives for improving stroke rehabilitation have driven our important advances in aiding recovery of movement and independence. We have developed and evaluated innovative technologies and directly ensured translation into clinical practice and home use. Over 2,500 therapists have received training in functional electrical stimulation (FES) in the UK and abroad. Our research into FES and upper-limb robot therapy has attracted great media attention, as well as international clinical and commercial success. FES is now incorporated into National Institute of Health and Care Excellence (NICE) and Royal College of Physicians (RCP) Stroke Guidelines. We have demonstrated successful adoption of technologies in practice (the main UK commercial provider reports 16,000 sales of FES devices), and we have published evidence for their continued use.
Lower-limb amputation (LLA) is associated with significant mobility, quality-of-life (QoL) and socioeconomic burdens. Research undertaken at the University of Hull relates to the early rehabilitation of amputees and their risk of falling. The research has influenced practice nationally and internationally by prompting clinicians to use these evidence-based recommendations for muscle strengthening and balance training and has informed policy at national levels. It inspired the British Association of Chartered Physiotherapists in Amputee Rehabilitation (BACPAR), to implement standardised recommendations in the BACPAR Toolbox of Outcome Measures in prosthetic rehabilitation. The findings of the Hull Early walking aid for rehabilitation of transtibial Amputees — Randomised controlled Trial (HEART) study, the first RCT comparing the biomechanics and clinical outcomes of early gait re-training with different Early Walking Aids (EWA), has made a significant impact on current healthcare practice and guidelines.
Research evaluating a pilot service for people who had had a stroke showed that there was a lack of support to help them return to work, insufficient attention to individual needs and that their ability to reintegrate into the community was poor. Post-stroke conditions cost the UK economy £7 billion annually. The research findings have made a distinct and material contribution to refocusing services in Wales and England towards helping patients fit back into society after a stroke. Three out of ten services established in 2005/2006 in Wales and the original service continue, and have informed the development of further services in England. These services support patients to return to work and make other lasting improvements to their lives.
The Orthotic Research & Locomotor Assessment Unit (ORLAU) (http://www.rjah.nhs.uk/ORLAU) has run multidisciplinary services to improve the function and lifestyle of severely disabled patients since 1975. New specialist clinical services have been established, based on research and development activity. The effectiveness of these services has been the subject of further investigations. Work has focused on the development of novel technology (in gait analysis and orthotics) and increasing understanding of human movement. Conditions treated include cerebral palsy, spinal cord injury, neuromuscular disorders, arthritis and stroke. Technological developments have led to licencing within the commercial sector. ORLAU has also contributed to the development of national and international clinical education and guidelines.
Research by the University of Nottingham's Division of Rehabilitation and Ageing has informed the effective implementation of evidence-based Early Supported Discharge (ESD) and community services for stroke survivors. The findings of an international consensus on the implementation of ESD have played a significant role in shaping local, regional, national and international service specifications. Qualitative and implementation studies have helped to shape better working practices between acute and community stroke services, including joint decision-making on who should be eligible for ESD and ensuring that services derive the full benefits of robust and relevant data capture.
This case study examines the long-term and ongoing relationship between an industrial collaborator (Chas A Blatchford & Sons Ltd) and researchers at the University of Roehampton. This systematic programme of biomechanical research on how prostheses perform in activities other than walking has had two significant outcomes. Firstly, this work has significantly improved prosthetic design, with four new prosthetic designs marketed worldwide. Secondly, it has increased awareness of — and importantly increased engagement with - exercise therapy for amputees among healthcare professionals (prosthetists and physiotherapists) and amputees themselves. This research has reached a wider audience including amputee charities and healthcare professionals, with whom we focus on mobility and movement rather than the prostheses.
Our research has had a direct influence on policy makers', commissioners' and practitioners' understanding of the value of peer led self-help groups and the potential of citizen/service user researchers for driving service improvements grounded in lived experience. That impact is reflected in:
Powell's work focuses on outcomes after traumatic brain injury. In 1995 she established an innovative community-based multidisciplinary neurorehabilitation service — the Outreach Team — and evaluated it via a randomised controlled trial. The positive findings have informed policy and service developments internationally. In parallel, she developed a new outcome instrument [the BICRO] to evaluate psychosocial functioning; this is now used by clinicians in 10+ countries. The BICRO informed the subsequent development and validation of a cross-cultural instrument for assessing quality of life after brain injury [the QOLIBRI]; Powell was a member of the Steering Group which directed the complex international collaborative QOLIBRI project. The QOLIBRI is now available in many languages, and has been fully validated in six. There are 400+ registered users in over 35 countries, more than 200 being clinical service providers; it is a formally recommended tool for public health services in Finland and the US; and it is being used as an outcome measure in numerous treatment evaluations and prospective studies worldwide.