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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.
Functional electrical stimulation (FES) to the ankle dorsi-flexors is an assistive technology that aims to counter foot drop, a common symptom in people with neurological impairment. Our research has facilitated a better understanding of the clinical potential of FES as a means to enhance walking capability and ultimately the quality of life of people with gait abnormalities associated with "dropped foot". The production and dissemination of this research has directly had an impacted on local NHS clinical treatment practice and NHS clinical service evaluation/re-design in support of self-managed care of people with long-term conditions such as Cerebral Palsy, Stroke, and Multiple Sclerosis.
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.
Many hand surgical units worldwide have routinely used night-time splints in all patients after Dupuytren's contracture fasciectomy and dermo-fasciectomy, despite the lack of robust evidence to support its use.
Jerosch-Herold's programme of research identified that routine night-time splinting for all patients after fasciectomy or dermo-fasciectomy surgical treatments for Dupuytren's contracture is not beneficial. This finding is changing clinical practice, and informing guidelines and policies in the UK, New Zealand and the USA. As a result, health care organisations are ceasing to prescribe routine night-time splinting. This reduces inconvenience and discomfort for patients, relieves pressure on services and generates financial savings, all whilst maintaining equally good clinical outcomes.
The reach of the research findings impact is high, as Dupuytren's contracture is a common disorder of people of Northern European ancestry which results in surgical interventions for thousands of people annually (13,000 pa in the UK alone).
The impact of this case study is the novel treatment of neurologically impaired individuals via vestibular stimulation, an emerging clinical therapy. The research has helped make people better, changed local clinical practice, and led to a commercial collaboration to produce a CE-marked (European Union safety compliant), home-based device that can be marketed and used across the world. The research has also raised awareness and understanding of neurological disease amongst healthcare practitioners and the general public.
Infection of patients with cystic fibrosis (CF) with the multidrug-resistant Nontuberculous mycobacteria (NTM), Mycobacterium abscessus, has rapidly increased over the past decade and currently affects 5-10% of CF patients worldwide. Our work has identified two possible mechanisms by which M. abscessus infection rates may be increasing: chronic azithromycin therapy may predispose individuals to infection through inhibition of autophagic-killing of mycobacteria; secondly, there is frequent person-to-person transmission of M. abscessus despite conventional infection control measures. This research has had a direct impact on how CF is treated, and has influenced infection control guidelines throughout the UK.
This case study illustrates the development of novel research materials designed to improve quality of life and performance in different populations. Impact has been achieved through the use of research findings in professional practice, formulation of health-related policies and in the development of new indicators of health and well-being. RCSEP research has been used by international and national health-service organisations (e.g., European League Against Rheumatism, Evidence NHS), industrial establishments (e.g., ArtEZ Conservatoire, Netherlands; Royal Ballet), national governing bodies (British Heart Foundation), and professional bodies (e.g., Dance UK, International Association of Dance Medicine & Science).
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.
Biocatalysts provide unique activities that facilitate chemical transformations that are simply not possible using abiotic methods. Northumbria University researchers with expertise in enzymes and biocatalysis have provided biocatalysis services to the pharmaceutical, fine chemical, food and biofuels industries through our business facing innovation unit Nzomics. This has generated significant contract research, collaboration and licence agreements to companies, including the pharmaceutical company GlaxoSmithKline and the services-led company Almac. Biocatalysts produced as a result of Northumbria University research and technology transfer are sold worldwide and benefit business through their use in research and development activities, such as the production of intermediates in drug synthesis.