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Falls are a common (30-40% >65 year olds fall each year) and important age-related health problem costing the NHS and social care >£5.6m each day. University of Manchester research has contributed to reducing the burden of falls worldwide.
We demonstrated that falls are better predictors of fracture than bone mineral density. We developed an effective intervention, reducing falls amongst older people by 30%; identified barriers to service use, and approaches to increasing uptake and adherence; and developed a fear of falling instrument (FES-I), now translated into 30+ languages and widely used in clinical practice.
By 2012, 54% NHS Trusts used training programmes based on our research. It moulded service provision nationally and internationally, changing the emphasis of how falls prevention services are presented, from "reducing risk" to "improving/maintaining independence".
Schizophrenia affects 1 in 100 people, with costs to society of £12 billion in England alone. Prevalence is similar across the world, with two thirds of people experiencing relapses despite medical treatment. Researchers at the University of Manchester (UoM) pioneered and disseminated psychological interventions for schizophrenia and related mental health problems which have led to improved outcomes for patients and families (e.g. 20% improvement in symptoms over standard treatment). We have implemented and delivered our intervention protocols, outcome measures, treatment manuals, and training programmes (with over 200 training courses delivered across the UK, Europe, USA, Asia, Australia and Africa). The impact of the research has been commended nationally and internationally by professional bodies (e.g., British Psychological Society, American Association of Behavior Therapy).
The Visual Impairment Centre for Teaching and Research (VICTAR), which focuses on understanding and removing the barriers that prevent people with visual impairment accessing education, has been particularly effective in: securing legislative change for braille readers (e.g. the braille labelling of medication); influencing policy documents of NGOs involved in supporting people with visual impairment (by providing reliable and up to date statistics on employment, and the factors associated with employment); and influencing the professional training of teachers who support visually impaired pupils (by improving teacher reflection and systematic record keeping).
The most frequent surgical procedure undertaken in the NHS is cataract surgery and it improves vision and quality of life (QoL). In the 1990's there were long waiting times for cataract surgery with rationing most frequently restricting surgery on the 2nd eye. A randomised controlled trial undertaken at the University of Bristol (UoB) demonstrated clear QoL benefits from 2nd eye cataract surgery, followed by a population study quantifying population requirements for 1st and 2nd eye surgery and the surgical backlog. Government policy, announced in `Action on Cataracts — Good Practice Guidance, 2000', advised that the volume cataract surgery, including on the 2nd eye, should be increased. This policy ensured timely access to surgery becoming routine practice in the NHS, thus improving the lives of thousands of people. Second-eye surgery rates rose from ~25% of operations to 35-40%, with overall increases in operations for patients needing surgery (e.g. in England up from 201,682 operations in 1998-1999 to 332,625 in 2009-2010) and reduced waiting times. These improvements were sustained through to the end of the 2000's. The research has become highly relevant again as the NHS enters another period of constrained expenditure.
The Human Factors Group (HFG) has established an evidence base to inform the design, implementation and evaluation of risk communications in promoting safe behaviour. They have delineated a range of design, linguistic and personal variables that influence the effectiveness of risk communications, as well as identifying important demographic and psychological variables that affect personal safety, particularly in relation to driving. This evidence has been used to inform the development of road safety interventions and tools/guidelines for communication in civil emergencies. There has been impact at national and local government level, driving changes in policy and practice. Evidence has been integrated into the road safety policy and interventions of local government, and into government guidance on communicating during civil emergencies. Emergency preparedness documents for public use have been developed and validated. Our success at embedding research evidence into practice has received national and international recognition (e.g. Prince Michael International Road Safety Award, 2012; HM Government Emergency Preparedness Guidance - case study illustrating good practice; and a request for dissemination to World Health Organisation).
Impact: New business, intellectual property, employment and clinical diagnostic capability resulting from the invention, development, validation and manufacture of a peripheral vision-measuring device.
Significance: A new technology, Saccadic Vector Optokinetic Perimetry (SVOP) has been developed and commercialised. SVOP enables the testing of visual fields in patients who previously could not be tested. A spin-out company, i2eye Diagnostics Ltd., raised £900K to commercialise the technology, employs five people and has made sales internationally.
Beneficiaries: Commerce; ophthalmologists, opticians and optometrists; previously untestable patients.
Attribution: UoE team comprising Professor Bob Minns, Professor Brian Fleck, Dr Ian Murray and Dr Harry Brash are inventors on the granted patent for SVOP. The UoE BioQuarter commercialisation team formed the spin-out company and recruited the management team.
Reach: Worldwide: SVOP instruments are now in use in the US, EU and Australia. The technology is suitable for the 30% of patients worldwide whose visual field could previously not be measured.
Research carried out at the University of Southampton has led to the development of a new tool for detecting and managing malnutrition. The Malnutrition Universal Screening Tool (MUST) has been rolled out to more than 80% of hospitals and care homes in England and 98% in Scotland, is part of national health policy in Finland and the Netherlands, and has attracted interest internationally. The National Institute for Health and Clinical Excellence bases its current quality standard for nutritional support in adults on the MUST framework; only two NICE guidelines have saved the NHS more money. MUST has become an integral part of the UK's health policy framework, embedded in routine clinical care and supported by bodies responsible for clinical and care excellence. It is central to learning programmes on managing malnutrition.
Research carried out at the University of Aberdeen has directly resulted in a new therapy for stroke patients who have suffered partial sight loss. The sight rehabilitation device developed through the research has so far been used to treat around 300 UK stroke patients, who reported significant improvements in their quality of life. The therapy has been publicized by the UK Stroke Association and at national and international events. The research also led to commercial impacts through the creation of a spin-out company, Sight Science Ltd, which was later acquired by its only worldwide competitor, NovaVision Inc, protecting jobs and forging a long-term commercial partnership.
The specific impacts on commerce have been: substantial industrial investment in research and development, job creation and protection within UK industry, commercialisation of a new product, and long term partnership contract with industry with provisions for commercialisation of future products.
Coordination between the eyes is vital for children's visual and motor development, yet it often fails to develop properly. Horwood and Riddell's research has had important implications for the clinical management of binocular coordination, particularly for infant squint and childhood long-sightedness. They have demonstrated that most newborn infants (approximately 75%) have intermittent misalignment (i.e. sometimes point their eyes in different directions), but after 4 months of age only 3.25% continue to squint and it is only these children that require intervention. As a result, concerned parents have been advised appropriately and unnecessary appointments with GPs and specialists have been reduced. Horwood and Riddell's findings have also led to a substantial change in the management of long-sightedness, from which about 5% of children in the UK suffer (i.e. approximately 300,000 children between 5 and 14 years of age). Traditionally, children with long-sightedness have been provided with glasses that under-correct their vision. Our findings, however, have (i) demonstrated that some long-sighted children choose not to focus on near objects, and (ii) informed clinicians that full correction of focussing is often required to ensure clear vision, for instance, when reading. In both areas, Horwood and Riddell's research has led to changes in clinical guidelines, training, and practice and the advice given to concerned parents.
15m people have a stroke each year worldwide. In England alone, stroke generates direct care costs of £3bn and a wider economic burden of £8bn. Service users report high levels of unmet need in relation to cognitive dysfunction (e.g. concentration). Improving cognition was the number one priority agreed by users and providers (James Lind Alliance, Lancet Neurology 2012). Research led by the University of Manchester (UoM) underpins recommendations in several recent clinical guidelines for stroke management and rehabilitation in the UK and internationally. Our 2012 aphasia trial and qualitative study made key contributions to the recommendations in the recent NICE (2013) and Intercollegiate Stroke Working Party (2012) guidelines. UoM-led Cochrane reviews (e.g., neglect, apraxia, perception) have directly influenced recommendations in guidelines produced by the Scottish Intercollegiate Guidelines Network, the European Stroke Organization and the Australian National Stroke Foundation.