Summary of the impact

Our research has produced a paradigm shift in the primary care management for back pain, by expanding traditional diagnostic approaches to attending to physical and psychosocial factors shown to influence future outcome (`prognosis'). We have developed screening tools (freely available, widely accessed, translated and adopted), to distinguish groups at low or high risk of long-term disability, and developed primary care interventions tailored to these groups. Through improved clinical outcomes and cost-effectiveness, we have changed back care at national and international levels, evidenced by inclusion in official guidelines, into training of health professionals, adoption by spine and pain services, and active engagement of health care commissioners, clinicians and educators.

Summary of the impact

A high quality clinical trial, systematic reviews and meta-analyses performed by a team at Brunel University have directly informed key international clinical practice guidelines, policies and on the management of low back pain and neuropathic pain and have been cited by users (NHS Trusts: Addenbrookes) in response to such guidelines. In this way our research is directly informing clinical practice.

Summary of the impact

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.

Summary of the impact

McCluskey and Burton at the University of Huddersfield's Centre for Health and Social Care Research (CHSCR) have made significant contributions to bringing about a cultural shift in how back pain is viewed and treated. Our research has underpinned a new approach which replaces rest and reliance on healthcare with activity, positive attitudes and remaining at, or returning early to, work as the preferred responses to back pain. We have demonstrated that prompt recovery from back pain and continued work participation can best be addressed from a biopsychosocial perspective. Innovative interventions aimed at overcoming biopsychosocial obstacles have been based on evidence from our research which shows that key stakeholders, including individuals, employers, healthcare practitioners and members of the wider society, need to work together in order to support the occupational rehabilitation of people living with back pain.

Summary of the impact

Adolescents (and their families) in the UK and around the world are now better able to cope with chronic pain because of the unique work carried out at the University of Bath Centre for Pain Research (BCPR), directed by Professor Christopher Eccleston.

The BCPR produced the first multidimensional `one-stop' tool to assess the impact of pain on children's lives, which has now been adopted in at least 12 countries. Pioneering treatments from Bath have influenced therapeutic approaches worldwide.

The Bath team also manage the evidence base for chronic pain, giving access through the Cochrane Library, advising internationally on clinical service development and improvement.

Summary of the impact

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.

Summary of the impact

We have developed the first ever physiotherapy guidelines (2008-) for contracted (frozen) shoulder (CFS). CFS is painful and disabling, affects c.9% of the UK working-age population,¹ and costs the NHS > £13.5 million annually.² Appropriate physiotherapy could improve outcomes and reduce costs by up to £2,000 per case.^b

Endorsed by the Chartered Society of Physiotherapy (CSP), the guidelines have generated great interest and already influenced practice and will improve the quality and cost-effectiveness of clinical management, as well as patients' experiences. They will also provide a better framework for research into the condition and, as a `live', electronic document, will evolve with future research.

Summary of the impact

Osteoarthritis affects 8.5 million people in the United Kingdom, accounting for a third of all years lived with disability. Our research has provided commissioners and third-sector organisations with accurate estimates of the size of the problem, policy-makers with evidence on groups at particularly high-risk, and clinicians with original evidence on better approaches to assessing and managing osteoarthritis in patients presenting to primary care. These key insights have supported advances in public health and health care policy debate, changes in legislation, and improvements in the quality of patient care through training and new national, European, and global guidelines for health professionals.

Summary of the impact

The Glasgow Composite Measure Pain Scale (CMPS) has provided the first validated pain questionnaire for the rapid assessment of acute pain in dogs in surgical and clinical settings. Developed by the University of Glasgow School of Veterinary Medicine, the scale aids clinical decisions on appropriate pain relief intervention and has been freely downloaded by over 3,000 clinical users since its launch in 2008. In addition, it has been used extensively by veterinary healthcare companies to successfully obtain regulatory approval for analgesic drugs and in marketing support materials. The University of Glasgow researchers have been instrumental in developing international pain guidelines with the World Small Animal Veterinary Association, which represent more than 180,000 veterinarians worldwide, and has thereby promoted awareness of pain management in companion animals.

Summary of the impact

Around half of older people, aged 65 and over, experience persistent pain; it can be isolating and seriously affect quality of life. This research, much of it done by service users, has produced tools and information for older people themselves, and for the professionals who work with them, to correctly assess and treat chronic pain. It is setting national standards, being adopted by the key national charities and NHS pain clinics, and garnering international interest. Specifically the work has:

• had a direct impact on older adults by helping them to develop and implement strategies to manage their own pain, using self-help materials;
• indirectly helped assessment and management of pain in older people by improving the knowledge and skills of health care professionals through education, new national guidelines and the use of new technologies.