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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.
The Pain Research Group (PRG) is a research team within the Centre for Health and Social Care Research (CHSCR). The PRG's research programme in chronic pain management encompasses a range of robust methodological approaches to achieve better patient outcomes with local, national and international impact. The PRG has adopted a dual approach to investigating the treatment of chronic pain, incorporating psychological factors with the application of neuromodulation techniques. This has led to significant improvements in patient outcomes and patient satisfaction surveys demonstrate excellent, positive results. The research has had significant influence on clinical practice at national level, underpinning recommendations for best practice issued by the British Pain Society in relation to spinal cord stimulation and intrathecal drug therapy. It has also contributed to NICE's clinical guidelines on the implementation of spinal cord stimulation and influenced clinical decision making through the NHS evidence database. At an international level, our research has contributed to three sets of guidelines issued by the Polyanalgesic Consensus Conference: inflammatory mass, intrathecal drug therapy for chronic pain and recommendations for reducing mortality and morbidity of intrathecal drug therapy. The reduction of morbidity and mortality in intrathecal drug therapy is of particular significance as the reduction of harm and unnecessary complications in healthcare is of high concern to healthcare organisations worldwide.
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.
The key driver for this research is to provide clinicians with robust tools that they can use to evaluate, treat and therefore improve the clinical outcome in their patients. Our research has assisted the development of the evidence base of many clinical treatments and assessment tools. This has led to the design and development of new rehabilitation products and medical devices in partnership with both large companies and small to medium sized enterprises. The core impact of this work has been improvements in patient care and quality of life by improving the efficacy and effectiveness in these areas with a particular focus on the advancement of conservative management and lower limb rehabilitation.
Timmis' collaborative research group (straddling four major institutions) focuses on healthcare delivery as it affects cardiovascular outcomes. The group's research in patients with suspected angina has delivered four key impacts:
a. National implementation and validation of rapid access chest pain clinics in hospitals in England and Wales — a model that has been replicated widely in other countries;
b. Paradigm change in diagnostic testing that has informed national guidelines;
c. Identification of inequity in access to healthcare and healthcare decisions that has informed national guidelines; and
d. New research to restore equitable management of patients with suspected angina.
In this case study we describe an interrelated collection of impacts on healthcare in the NHS; these are summarised in the Table below.
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 rehabilitation method 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 healthcare professionals 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.
Research carried out by the SESRC has resulted in the development of three novel devices that improve foot and lower limb circulation. These have been commercialised by Actegy Health Ltd.
Since 2008, impact arising from this research includes,
Research by Ichiyama and colleagues has resulted in humans with severe spinal cord injury (SCI) recovering standing and stepping, combined with other major health benefits including restoration of urinary continence, bowel movements and sexual function. Specifically, Ichiyama and collaborators used a combination of epidural electrical stimulation of the spinal cord, pharmacological agents and rehabilitation training to enable animals with severe spinal injuries to walk again. This work was the necessary foundation for translation to humans with severe spinal injuries. The publicity surrounding these landmark clinical studies stimulated charitable donations and commercial investment in this new field.
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".