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Since 1998 the University of Leeds has developed the Leeds Foot and Ankle STudies in Rheumatology (FASTER) programme — to drive improvements in UK musculoskeletal foot care services. Results from FASTER clinical trials and a national survey of podiatry services directly informed NICE guidelines on foot care in arthritis. FASTER's research also provided key evidence for a national consensus on standards of care and aided a shift in the treatment paradigm for foot care in arthritis patients. These standards and NICE recommendations are included in the latest Royal College of GPs curriculum. They have also informed government policies on commissioning for podiatry services throughout England. Since the inception of the FASTER programme independent reports suggest that access to foot health services for people with rheumatoid arthritis has increased from less than 50% immediately prior to FASTER, to nearly 80% of patients today.
Quality of life for people with rheumatoid arthritis (RA) has improved, responding to their stated major priority for help with fatigue. Their self-management of fatigue has improved using our cognitive-behavioural therapy intervention. Over 30,000 patients and healthcare professionals a year request our resulting self-management booklet, distributed via Arthritis Research UK.
This group's research spearheaded a new international patient/professional consensus that fatigue must be measured in all clinical trials. Along with the Bristol RA Fatigue scales, which we developed (translated into 35 languages) this has helped to place fatigue at the centre of drug development by changing the way the pharmaceutical industry performs multi-national drug trials.
Nursing management has now improved demonstrably. Fatigue evaluation and intervention have now been recommended in national guidelines.
Research at Sheffield has changed UK and international clinical guidelines for the treatment of post-traumatic stress disorder and has ensured that more appropriate treatments target people who have been traumatised. The Sheffield studies revealed the limitations and ineffectiveness of a commonly adopted clinical approach reliant on psycho-education and self-help. These studies concluded, on the basis of three randomised control trials of self-help provision, that despite the provision of information being valued by patients, it had no direct effect on relieving symptoms or enhancing quality of life or functioning. These research findings have directly contributed to good practice guidance for public health, disaster management and relief, and responding to terrorism and conflict.
Rheumatoid arthritis (RA) is a common destructive joint disease, causing pain and swelling, affecting 1 in 100 people. Work conducted by the University of Birmingham's Rheumatology Research Group has shown that early diagnosis is important, as the first few months represent a critical therapeutic window during which treatment can significantly improve health outcomes, increasing the chances of achieving disease remission and reducing the rate of progressive joint damage. The group have demonstrated that there are significant delays in patients making initial contact with their GP, which leads to delays in referral to a Rheumatologist and starting treatment; this situation has been shown to be worse in patients of South Asian origin. The outcome of the work has been incorporated into national policy documents and clinical guidance material and has underpinned a patient focused campaign to raise awareness of the disease and the need for early diagnosis.
It is widely acknowledged that increasing physical activity (PA) levels within `hard-to-reach' groups is challenging. Researchers in the School have addressed these challenges resulting in impacts in two recognized `hard-to-reach' groups: ethnic minority communities and patients who are at risk of disease onset and/or are suffering from diminished quality of life/disability due to chronic disease. In the former, our research has demonstrated how to make PA accessible and appropriate; in the latter, in addition, we have increased physical activity levels. In both examples, our research has changed professional training and/or standards.
Research into primary care insomnia by the Community and Health Research Unit (CaHRU) has led to broad improvements in healthcare provision for insomnia, improved patient quality of life, informed national/international policy and practice in insomnia care and impacted directly on health professional practice and insomnia sufferers, initially in Lincolnshire spreading across the UK and internationally from 2008 to 2011. Direct effects on practice include changes in sleep management and reduced hypnotic prescribing through seminars, workshops, conferences and e-learning developed by the team; inclusion in UK policy, practitioner information, training materials and guidance on hypnotics has led to greater professional and public awareness of sleep management internationally.
The Enabling Self-management and Coping with Arthritis Pain through Exercise (ESCAPE) intervention, refined at UWE Bristol, has led to reduced pain and increased function in people with osteoarthritis (OA). These benefits follow a brief exercise and self-management intervention based on developing self-efficacy, facilitated by a physiotherapist in primary care. This intervention is cited within the NICE guidelines, and has been adopted at sites across the NHS as an evidence-based, clinically effective and cost-effective intervention. The intervention is within the NICE cost-effectiveness threshold for investment and has resulted in savings in healthcare budgets. It has also achieved Quality, Innovation, Productivity and Prevention (QIPP) status — an evidence-based, peer reviewed case study evaluated on quality improvements, savings, evidence and ease of implementation, thus providing a resource for staff and commissioning bodies charged with making quality improvements and savings within the NHS.
Dr Lina Gega's research has been instrumental to the development and take-up of computerised Cognitive Behavioural Therapy (cCBT) and other technology-mediated interventions for common mental health problems in the UK and internationally. Gega's adjunct on-line methods form a key foundation for the training of professionals to support cCBT, and the National Institute for Health and Care Excellence (NICE) guidelines now include cCBT for first line intervention for common mental health problems. These developments have resulted in a greater patient reach for cCBT internationally, with resultant decreases in waiting time for patients (with associated economic benefit) and improved outcomes.
University of Aberdeen research has directly impacted on clinical practice with regard to the treatment of varicose veins. The University's Health Services Research Unit (HSRU) developed and validated the Aberdeen Varicose Vein Questionnaire (AVVQ), which allows patients to self-assess the severity of their varicose veins. Current national and international guidelines now recommend that as part of the assessment of outcome for patients with varicose veins, patients' self-assessment of their veins be routinely undertaken — with the AVVQ the most commonly recommended measure. The Department of Health in England also mandated the use of the AVVQ and all patients in England are now required to complete the AVVQ before and after treatment. Results from these questionnaires are being used by individual NHS providers to assess the quality of their care, to improve their services, and for planning and commissioning of services nationwide.
The claimed impact, as defined by REF guidance, therefore includes impact upon public policy and services; practitioners and professional services and health and welfare.
Long term conditions are leading causes of death and disability. Over 80% of care for people with long term conditions is self-management. In 2001, the Chief Medical Officer concluded, from evidence from the US and from Barlow and Turner's pioneering research in the UK, that the NHS should provide support for self-management through programmes such as the Expert Patient Programme. Turner and McHattie have developed self-management programmes (e.g. the Help to Overcome Problems Effectively: HOPE Programme) which have been taken up by local, national and international providers. These programmes have impacted positively on patient-reported outcome measures such as pain, fatigue and depression. They are cost-effective and produce a social return on investment.