In this case study we describe an interrelated collection of impacts
on healthcare in the NHS; these are summarised in the Table below.
King's College London (KCL) research has had substantial impact, through
making strong contributions to international and national guidelines which
recommend that pulmonary rehabilitation should be made available to all
appropriate people with COPD, including those who have had a recent
hospitalisation for an acute flare-up.
Recommendations citing our research include those published
internationally by a Cochrane Review and the Global Initiative for Chronic
Obstructive Lung Disease, and nationally in the UK by NICE and IMPRESS —
which provides clinical leadership to the NHS. These recommendations have
been taken up by the NHS and are also included in NHS Best Practice
Guidance (2012). The Department of Health (2010) estimated "widespread use
of pulmonary rehabilitation would bring substantial annual savings".
The modified shuttle test (MST), developed at the University of Ulster by
Professor Bradley and
colleagues, is an evidence-based exercise test that is having the
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 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.
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
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.
The research team at Bucks New University has provided the groundwork for
a number of applications to use cardiac power output as a novel functional
measurement in the clinical evaluation of patients with heart failure and
other related diseases. It involved validating the measure, assessing its
reliability and applying it to a group of patients with end-stage heart
failure. The success of this procedure is now evidenced by the number of
national and international clinical centres adopting cardiac power output
as a key functional measurement.
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.
Heaney's research at Queen's University Belfast on difficult-to-treat
asthma (or simply "difficult asthma"— DA) patients has led to changes in
clinical management guidelines and a drive to co-ordinate and commission
specialist services nationally for DA patients. It has also led to the
establishment of a UK Multi-centre National Clinical Network and Patient
Registry (Centres listed in Section 5). DA patients have persistent
symptoms and frequent exacerbations despite being on high dose asthma
therapy. DA patients (10% of the asthmatic population) have significant
morbidity and carry a high risk of asthma death. Their clinical assessment
has been optimised to ensure proper management of both their asthma and
non-asthma related conditions.
Up to 10% of stroke patients experience persistent hemispatial neglect, a
lack of perception of
space in one half of their visual field, despite their eyesight
functioning properly. University of
Glasgow researcher Dr. Monika Harvey has led the development of a vision
that was implemented by German stroke units (2011) and applied to over 60
stroke patients. In
July 2011 Harvey formulated content for an advanced training module called
`Vision after Stroke', a
Scottish Government supported online training resource for stroke
provided by the Stroke Training and Awareness Resources (STARs) Project.
In just eight months
since launch (December 2012) the module series has had 17 473 unique
visitors nationally and
internationally with `Vision after Stroke' the second most popular module
in Scotland. To date, 152
healthcare professionals have successfully completed the `Vision after
Stroke' module certificate.