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UOA 12B - Allied Health Professions and Studies: Allied Health Professions

University of Brighton

RA5a: Research environment and esteem

1.0        INTRODUCTION

1.1        The research in this submission is concerned with musculoskeletal dysfunction and with wellbeing, health and occupation within clinical and community settings. Activities also include the investigation of applied pedagogic strategies for health professionals in Higher Education and practice settings. Significant achievements in these areas have included, for example, the first study to identify reduced longitudinal excursion of the median nerve in patients with carpal tunnel syndrome and the origination of the use of kinematic modelling in spine motion analysis. Innovative occupational science research has advanced theories underpinning occupational therapy. Other research has provided insight into the lived experiences of chronic pain sufferers in old age. Studies have recently demonstrated how the application of problem-based pedagogic strategies for student health professionals significantly enriches learning. In-depth studies of learning in critical care settings have identified support and supervisory models that demonstrably enhance learning. Our research profile has attracted a number of full-time overseas research students from Nigeria, Jordan, Malaysia and the Gaza Strip who have been fully sponsored by external scholarships.

1.2        We have a wide range of collaborators in the UK and abroad including those developed through founding membership of a specialist European musculoskeletal research collaboration (COBRA). This initiative involves five European universities and independent researchers from Portugal, Finland and Spain, and is currently developing plans for European-wide collaborative research, joint grant submissions, PhD student exchanges and capacity building. Its focus will be initially on spinal dysfunction. The research environment is home to two research networks: the National Physiotherapy Research Network (NPRN) and the National Council for Osteopathic Research (NCOR). In addition we provide the ‘expertise of a high profile, experienced researcher, to act as an advocate at a strategic level’ for the Chartered Society of Physiotherapy(CSP). 

 

Key research indicators:

2001

2007

% increase

Income/expenditure per FTE 

23,359

98,343

321%

Publications – peer-reviewed journals

55

183

232%

Keynote addresses/invited lectures

21

105

400%

Conference presentations (peer-reviewed)

64

200

212%

Research students completions 

5

12.51

150%

Research student registrations in each year

20

40

100%

 

2.0        RESEARCH STRUCTURE 

Research is led by Professor Moore (HoR), Head of the Clinical Research Centre for Health Professions (CRC). The three research groups in this submission are:-

(i)      musculoskeletal; 

(ii)     wellbeing, health and occupation (WHO); and

(iii)    applied pedagogy within clinical and HE contexts. 

The first of these is a well-established focus of research and the last two have been established and developed during the census period. Capability Funding since 2003 has underpinned development in these groups through the appointment of four research officers and two research administrators to support research activities and by the provision of seed-funding for emergent research.

2.1        Musculoskeletal research 

2.1.1     Research foci within this group include the biomechanics of the spine and lower extremities, and the effects of ageing and pathologies on the musculoskeletal system. The group comprises 6 category A staff including 1 early career researcher (Hashmi (EC), Lee, Moore, Otter, Petty and Trew) and 5 senior clinicians whose combined expertise covers biomedical engineering (Lee and John Evans – visiting professor); analysis of human movement and function, including ultrasound imaging (Lee, Moore, Otter, Petty andTrew); soft tissue viability (Hashmi and Otter); clinical examination and management of musculoskeletal dysfunction (Hashmi, Moore, and Petty); outcome measurement in musculoskeletal dysfunction (Moore and Otter) and standardised data collection (Moore and Leach). Research is conducted in laboratory and clinical settings.

2.1.2     Main achievements of this group include: the production of new scientific evidence demonstrating that functional ankle instability is not associated with deficits in evertor strength but  with reduced eccentric invertor strength, having significant implications for rehabilitation programmes [Lee,1]; development of a novel biomechanical model for predicting spine motion which allows spinal movement to be investigated using skin sensor information without the use of radiation, which has significant implications in clinical situations such as spine motion analysis during pregnancy [Lee,2]; the use of a new kinematic analysis method to examine spine and hip motion coordination which has significantly increased our understanding of the impact of low back pain on everyday activities [Lee,3]; creation of an extensive lumbar spine movement normative database to assist the work of researchers and clinicians, to assist the work of clinicians and researchers in assessing spinal dysfunction and recovery [Moore,2]; new work has challenged the orthodox clinical belief concerning the late onset of passive resistance in spinal and peripheral joint accessory movement which has implications for manual therapy practice [Petty,2]; the first study to provide normative data on lower limb muscle strength and physical activity levels in healthy pre-retirement individuals highlighting the need for the introduction of effective health promotion interventions for individuals approaching retirement [Trew,3]; identification of a decreased degree of plasticity in the epidermis of patients with type 2 diabetes in comparison with a control group of normal patients, with results suggesting that alterations in the glycation of plantar epidermal proteins may constitute additional aggravators of ulceration in patients with type 2 diabetes [Hashmi,1]; identification of significant increases in temporal parameters of plantar pressures which may be characteristic of rheumatoid feet having implications for the evaluation of podiatric interventions in this group of patients [Otter,4]; clinical trial findings that establish the efficacy of a programme of spinal stabilisations in the management of chronic low back pain [Moore,1]; and verification of the hypothesis that median nerve longitudinal excursion is reduced in a significant number of patients with carpal tunnel syndrome [Moore,3].

2.1.3     Current work involves the novel use of mixed-method approaches to clinical studies of musculoskeletal dysfunction which aim to improve understanding of the impact and significance of examination and treatment techniques. For example, new research into the physiotherapy management of post-irradiation nasopharyngeal carcinoma patients has led to the integration of a new approach to care in three hospitals in Hong Kong (Lee and Moore). Other work includes: investigations of the effect of ageing on the biomechanical properties of the lumbar spine muscles; the biomechanical neurophysiological effects of lumbar mobilisations; patients’ perspectives of acute low back pain and its management, and neck–eye movement coordination in normal subjects and chronic neck pain sufferers. Recently completed PhD work includes biomechanical modelling of the sub-talar joint (Trew and Birch) and the biochemical effects of the application of lumbar stabilisation exercises in patients with chronic low back pain (Moore and Sokunbi). 

2.2        Wellbeing, health and occupation

2.2.1     Areas of expertise and research foci include: occupational science (Sadlo); age and ageing with a focus on chronic pain in older people (Sofaer-Bennett and Moore); Epidemiology in cancer care (Leach), patient management in Osteopathy (Leach); and posture and mobility (Mandy). The group includes 5 category A staff (Leach, Mandy, Moore, Sadlo and Sofaer-Bennett), and representatives from the health, sports science, medicine, nursing, social sciences, voluntary agencies and the community.

2.2.2     Main Achievements of the group include: fundamental research on flow theory and mindfulness which advances theories underpinning occupational science and occupational therapy practice [Sadlo,4]; the first epidemiological study to investigate breast cancer survival in South Asian women in the UK which found higher than average survival, attributed to genetics, low alcohol consumption or access to high– quality care, and stimulated further research in the UK and the US [Leach,2]; a multi disciplinary collaboration which conducted an innovative analysis and record-linkage of multiple primary cancers within an extensive cancer registry database, suggesting to the international research community that there are further genes to be identified which raise the risk of breast cancer [Leach,1]; collaborative work, funded by the DOH, has led to the production and refinement of a modified one-handed wheelchair for stroke users which increases ease of mobility and decreases users’ energy expenditure [Mandy,4]; and work developing new perspectives on the lived experiences of older chronic pain sufferers has highlighted issues of stigma, social isolation and loss faced by patients in chronic pain and has important messages for professionals involved in treating patients in this situation [Sofaer-Bennett,1,2,3,4].

2.3        Applied pedagogic research

2.3.1     Expertise and research foci include problem-based learning (PBL) (Sadlo); teaching, learning and assessment in the practice-based setting (Cross, Scholes and Sadlo). The group reflects strongly our philosophy that research should not only be carried out into subject areas supporting health disciplines, but also be translated into the methods of teaching and learning used in these areas. The group includes 3 category A staff (Cross, Scholes and Sadlo), representatives from the University of Brighton’s (UoB) Centre for Learning and Teaching and Visiting Professor John Richardson (OU). 

2.3.2     Main achievements of the group include: innovative work which has shown that in comparison with subject–based curricula, problem-based curricula significantly enhance health professions students’ quality of learning [Sadlo,2,3]; research addressing values and assumptions underlying learning and assessment in health practice settings from both learner and educator perspectives which are significant for international HEIs (e.g., Broom ,J., 2007) and practice–based educators [Cross,1,2,3,4] – this research has recently been integrated into a new textbook The Practice Based Educator (Cross et al. 2006) praised by the Higher Education Academy as ‘exemplary’; other practice-based learning research which has investigated the use of portfolios as an adjunct to clinical learning in the workplace and has given a strong indication that portfolios must match learning outcomes and professional practice assessment [Scholes,1,4]; and an in-depth investigation of clinical learning in critical care settings which has identified different models of support and supervision appropriate for this area of practice and put forward strategies to enhance learning opportunities within this setting [Scholes,2] – this output has underpinned competency frameworks for critical care nursing in three HEIs in the UK and has fuelled two Critical Care Network work-based learning programmes.

3.0        PROMOTING AND DEVELOPING RESEARCH

3.1        Research networks 

Moore chairs the National Physiotherapy Research Network and the National Council for Osteopathic Research. Each network is supported by a full-time research officer in regular contact with 20 regional research hubs (in the case of NPRN) and 8 hubs (in the case of NCOR). The hubs bring together experienced researchers with clinicians interested in increasing their knowledge of and participation in research and evidence-based activities. Both networks host training events for new researchers within the clinical setting on topics such as: obtaining research funding, publication and peer review. NPRN is managed through close cooperation between the CSP, Kings College London, Southampton and Keele universities. NCOR involves close collaboration between all the UK osteopathic educational institutions, the British Osteopathic Association and General Osteopathic Council (GOC).

3.2        Capacity building

The environment hosts the South East regional research hub of the NPRN, which has a strong musculoskeletal focus and runs seminars and training programmes every three months for approximately 45 clinicians, active in musculoskeletal research or audit. The meetings are organised in order to transfer new research findings of key researchers and doctoral students to clinicians. These multidisciplinary meetings have resulted in several projects being undertaken by new researchers (clinical and academic) in collaboration with more experienced research staff, e.g., a national standardised data collection project for hydrotherapy. Other research knowledge is transferred to local and regional community networks of research users in Acute and Primary Care Hospital Trusts via research hub activities and to voluntary agencies, including Help the Aged and Age Concern through the co-option of representatives onto project planning and steering groups. These types of activity have led to a number of projects involving clinicians (e.g., Musculoskeletal outcome measure validation) and community partners (e.g., Activity Buddies Project involving intergenerational activities between older people and students aimed at promoting health and wellbeing). 

4.0        RESEARCH CULTURE AND INFRASTRUCTURE

We have a systematic approach to research development and management and are committed to optimal staff engagement in research and scholarly activities. Our philosophy is to support research which underpins practice and informs best-practice developments in educational policy, both within HE and practice-based settings.

A Research Strategy Committee is chaired by the HoR and consists of senior research staff including research group leaders and the Head of School. This committee directs research strategy and developments, and oversees the research grant scheme, support for staff, grant submissions and research student admissions. It reports to the School Board, the Faculty of Health’s Research Strategy Committee and the University Research Strategy Committee, for annual monitoring.

All staff and research students are allocated to one of our three research groups in which research is planned and nurtured. The CRC team provides regular capacity-building activities for academic staff in the form of seminars, lectures and other events, e.g., publication surgeries and journal clubs and writing away-days. New researchers are offered mentorship from an experienced researcher and all CRC staff offer guidance and support to academic staff as needed. We also provide research support for the research community that includes: a web-based international directory of problem-based learning data set up by Sadlo; and an NCOR website which carries useful information for new Osteopathic researchers.

4.1        Resources

The CRC occupies dedicated facilities, providing an excellent multidisciplinary working environment for researchers and research students. Our well-equipped clinical biomechanics laboratory is a fundamental resource for the musculoskeletal research strand. SRIF monies of £200,000 allocated in 2003 enabled us to enhance significantly our laboratory holdings, i.e., upgrade the existing VICON system and purchase two new force platforms, a vibrameter, pressure algometers, two new ultrasound imaging devices, new motion capturing devices using inertial and magnetic technologies and a new data acquisition and analysis system. A new technical workshop close to the laboratory has just been acquired and a new technician recently appointed.

 

 

4.2        Research students

We offer both PhD and Professional Doctorate Programmes. The UoB was the first to offer named Professional Doctorate routes in Physiotherapy, Occupational Therapy and Podiatry. Current registrations are: 19 PhDs and 31 Professional Doctorates. Currently two of our PhD students are in receipt of external scholarship funding. An internal research scholarship was offered within the last 18 months and awarded on a peer-review basis subject to competitive interview. All UoB research student programmes operate within a rigorous but supportive quality assurance framework which complies with the QAA’s code of practice. 

To ensure that appropriate methodological/subject expertise is available for students engaging in cross-disciplinary work, 18 of our doctoral students receive joint supervision with other UoAs. This is reflected in the FTE student allocation figures in the RA3a and RA3b.

5.0        RESEARCH ETHICS AND GOVERNANCE

The UoB has a comprehensive three-tier (school, faculty and university) research ethics and governance system screening both NHS and university-based protocols. The system was introduced in 2005.

6.0        NATIONAL GUIDELINE DEVELOPMENT

Moore led the development of the CSP’s clinical guidelines for the physiotherapy management of Whiplash Associated Disorder (Moore et al., 2005).       

7.0        RELATIONSHIPS WITH RESEARCH USERS AND THEIR INVOLVEMENT IN RESEARCH

We involve research users and, where appropriate, research participants in steering groups for funded projects and in project dissemination conferences. The Professional Doctorate Programme is designed to enhance research in practice, enabling students to explore issues of key importance to patients, clinicians and managers within the health service. Through our research networks we engage clinicians in evidence which underpins practice and research activities. Close links with local charities and professional bodies enable research findings to be disseminated directly to those who have commissioned our work. Our research groups, particularly the Wellbeing, Health and Occupation group, include user representatives from the local community and national charities. The musculoskeletal group now has representation from clinicians from five major NHS Trusts in the South of England. Our pedagogic group involves research users through our web-based international directory of PBL.

8.0        FUNDING

8.1        Most of our research income is from UK-based charities, UK government bodies, e.g., the Department of Health and other sources. We also receive funding from UK industries. A proportion of our funding has emanated from professional bodies, for example, the GOC and CSP for the development and support of NCOR and NPRN. As a result of her standing in the field, Moore has been commissioned to carry out standardised data collection projects for the Private Physiotherapy Education Foundation (PPEF) and the GOC. She has also recently been approached by the Department of Health to undertake further work on standardised data collection for the Allied Health Professions at national level. 

8.2        A small amount of university central funding has been provided (23K), enabling the development of several research initiatives in partnership with local older people’s community. This has led to the development of an ‘activity buddy system’ facilitating intergenerational activities between university students and older people. 

9.0        STAFFING POLICY

In order to facilitate staff engagement with research in addition to standard procedures, the following elements are in place: strategic staff recruitment to complement research groupings; strategic planning of grant applications supported by the professorial staff and by the UoB’s central research support unit; small grant scheme available for early career researchers to pump-prime early research work (this scheme awarded 12 grants – 50K in total – in the last three years on a peer-reviewed competitive basis modelled on best practice used by Research Councils). Staff are encouraged to undertake a doctoral programme. Seven staff completed their PhDs in this RAE period and 10 staff are registered for doctoral programmes; A mentorship scheme for early career researchers includes a new research buddy system and writing away-days to support publication activities.

10.0      RESEARCH STRATEGY

10.1      2001–08 evaluation

10.1.1   In 2003 we modified our research objectives in response to the award of Capability Funding. We have fulfilled the objectives set out at that time. Key research indicators are set out on page 1. We have more than quadrupled our research income in this period. We have brought into the university £1.7 million research funding in the census period. We have sustained the number of staff engaged in research and increased the number of early career researchers to 6 whose development we shall support over the next few years. Laboratory-based research has been enhanced through the strategic appointment of Lee, Professor of Clinical Biomechanics. We have increased the number of registered supervisors to 17.

10.2      2007-12 objectives and activities. 

10.2.1   We shall capitalise on the available expertise and infrastructure investment achieved during the RAE period. We shall continue to develop our strengths in research related to the mechanics of, and influences on, spinal pain, ageing and lower limb musculoskeletal problems by increasing the quality and number of research outputs, increasing the number of grant submissions and by the appointment of a post-doctoral fellow in this area. We aim to make a further technical appointment in 2008. We shall focus on the relationship between osteoporosis, exercise and function. We shall develop further understanding of the musculoskeletal patients’ experiences of treatment and the therapeutic encounter. In addition we shall enhance our profile in standardised data collection in musculoskeletal settings by strategic dissemination of findings from our current funded projects. There will be a growing user perspective focus within the musculoskeletal strand, and mixed methods will become the norm in our clinically applied research. We shall expand some of our musculoskeletal work through collaboration with the faculty of Art and Design in developing an Art and Health strand of research. The pedagogic strand will focus on the impact of problem-based learning on health professional learner groups; work-based learning and teaching; and learning experiences in higher education and work-based settings. The WHO group will continue to focus on occupational science, specifically flow and mindfulness in therapeutic and everyday activities. Multidisciplinary action research will aim at improving the quality of life for older people through the use of intergenerational activities. 

10.2.2   In order to achieve our aims we shall offer ongoing peer support, guidance and expert mentorship to early career researchers. There will be strategic division of funding to support growth of the specified research directions within each of the research groups. This will be managed through the school’s research strategy committee. We shall undertake strategic recruitment of high-calibre post-doctoral fellows and PhD students from the health professions as well as from the disciplines of bio-engineering and social sciences. We shall target strategically specific research grant initiatives such as the Life Science interface of EPSRC, Art and Health DOH and the New Dynamics of Ageing initiative. We shall implement a revised research strategy from January 2008. The multidisciplinary nature of our groupings and our extensive external collaborations will position us favourably to target relevant grant initiatives. We are currently carrying out a re-appraisal of teaching curricula and staff workloads to ensure that all academic staff can actively engage in research on a regular basis. 

10.2.3   To ensure high-quality and timely outputs we shall instigate a regular programme of writing away–days facilitated by publishing experts. This will lead to further enhancement of our research income and our international standing. In addition, we shall seek funding internally and externally to support staff research engagement with collaborators from prestigious overseas universities.

10.2.4   Due to significant growth in both research staff and student numbers we shall be enlarging our dedicated research accommodation in the new year and implementing a new management system to oversee the research centres activities. 

11.0      COLLABORATIONS        

We have a number of external collaborations for research purposes at international, national and local levels. Examples include: COBRA, a collaboration of 5 European universities (UoB, Free University Amsterdam, Erasmus University Rotterdam, University of Ghent, Free University Brussels and University of Leuven) for research into low back pain (Moore); Karolinska Institute (Sweden) for occupational science research (Sadlo); Hong Kong Polytechnic University, University of Sydney and Queensland University – an international research network on sports and musculoskeletal sciences (Lee); collaborative links with Richardson (Open University) for work investigating students’ experiences of problem-based learning (Sadlo);  universities of Northampton, Glasgow and Sheffield for tissue viability and footwear research ; and with the Clinical Trials Unit at the University of York (Hashmi).

12.0      ESTEEM

12.1      Keynote research papers and invited addresses at major national/international conferences. There have been 62 invited keynote addresses including for example:

  • 14th World Congress of Physical Therapy, 2003, Barcelona (Moore);
  • 2nd International Conference in Movement Dysfunction, 2005, Edinburgh (Moore); 
  • Alan Walker Memorial Lecture, Annual CSP Congress, 2006, Birmingham (Moore);
  • Danske Fysioterapeuter Congress, 2006, Odense, Denmark (Moore);
  • Physiotherapy Biennial Conference, 2005, Chile (Petty);
  • International Manual Therapy Conference, 2005, Rome (Petty);
  • European PBL Network Conference, 2001, Rotterdam (Sadlo);
  • International Arts for Health Conference, 2007, Northampton (Sadlo); and
  • International BACCN, 1st Congress of the World Confederation of Critical Care Nurses, 2004, Cambridge (Scholes).

12.2      Impact of research on national/international practice development

Musculoskeletal standardised data collection for both the PPEF and GOC will have a direct impact on record keeping at national level (Moore). This work has already stimulated collaborative interests in both Korea and Australia. Sadlo’s problem-based learning research has influenced numbers of institutions world-wide and nationally through her international keynote addresses. Evaluation of nurse-education partnership influenced the NMC’s review of the assessment of practice in pre-registration nursing training in the UK (Scholes).

12.3      Honours or awards given in recognition of research

Honorary Research Associateship at the University of Sydney (Lee); Honorary Senior Research Fellowship at the University of Kent at Canterbury, Fellowship of the Chartered Society of Physiotherapy, Fellowship of the Manipulation Association of Chartered Physiotherapists (Moore); National Teaching Fellowship, 2007, awarded by the Higher Education Academy (Sadlo); and best research paper awarded at the 22nd Australasian Podiatry Conference 2007 and grant for $4,000 (EC R Hashmi).

12.4      Chairing or membership of committees related to research

Member of the Technical Committee in Biomechanics for the International Association of Science and Technology for Development (Lee); Research Director of the Executive Council of the British Naturopathic Association (Leach); European representative on the International Scientific Committee for the World Confederation of Physical Therapy (WCPT) 2007, Deputy chair of the Research for Patient Benefit Scheme Grants Awards Panel (South East) by invitation of the DOH, Invited member of the Primary Care Research Network (South East) Management Group 2007 (Moore); and member of the European Network for Occupational Therapy, International Adviser to PROBEL, a problem-based learning research project in Finland (Sadlo).

12.5      Service on or invitations to join Government national or international bodies or professional advisory bodies relevant to research

Member of the Prince of Wales Foundation for Integrated Health research group, member of NCOR (Leach); chair of NCOR, chair of the Core Executive of the National Physiotherapy Research Network (NPRN) (Moore); invited consultant to the Department of Health for standardised data collection work for AHPs (Moore). Secondment to the Chartered Society of Physiotherapy (0.2FTE) as research lead for the CSP from November 2007 (Moore); chair of the Rheumatic Podiatric Care Association (Otter); member of an Expert Panel for Review of International Competencies for Intensivists, member of the NMC Reference Group on assessment and curricula redesign for pre-registration nursing (Scholes). 

12.6      Editorial activities

Associate Editor for Physiotherapy Journal (Cross); Associate Editor for International Journal of Osteopathic Medicine (Leach); Associate Editor of International Journal of Physiotherapy, Theory and Practice, Member of the International Advisory Board for Manual Therapy Journal (Lee); Editorial Adviser for International Journal of Therapy and Rehabilitation (Mandy); Executive Editor of Manual Therapy Journal – 3rd in rehabilitation rankings (Moore); Member of the International Advisory Board for Manual Therapy Journal (Petty); Member of the Editorial Board for Education for Health, International Journal of Occupational Science and the Scandinavian Journal of Occupational Therapy (Sadlo); and Co-Editor of Nursing in Critical Care (Scholes).