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UOA 12 - Allied Health Professions and Studies

University of Teesside

RA5a: Research environment and esteem

Research Structure

The evolution of our research activity since RAE 2001 led to the establishment of the Research Institute for Health Sciences and Social Care. The Institute, directed by Summerbell, synchronises allied health research across three Research Centres – Food, Physical Activity, and Obesity, Rehabilitation Sciences, and Health and Social Evaluation.

The Institute has received substantial investment over the census period:
Capability funding/HEFCE R (including GR and CollR). Unit of Assessment (UoA) 12 received £1,547,180, which supported two administrators, fifteen research assistants, and nine lectureships (eight of whom are returned under Category A; Brown, Dixon, Ells, Flynn, Hanchard, Heslehurst, Moore, Zohoori).
The University Research Investment Fund, a strategic investment in 2004 targeting areas of research strength. UoA 12 received £219,157 to create two new posts for Category A-eligible staff (Batterham, Moore).
Science Research Infrastructure Fund (SRIF) allocations have been used strategically and awarded competitively. UoA 12 received £195k, which was invested in facilities and equipment for the Centre for Rehabilitation Sciences.
• UoA 12 received £58,686 from the University Research Fund (URF) - a pump-priming fund for new researchers established in 1998.
Staff Development Fund. UoA 12 received £59k over the period, which has funded five sabbaticals (half-time remission from teaching duties for half an academic year) for Young and Promising Researchers to facilitate timely completion of PhD programmes and journal articles, plus a small amount for external training courses or visiting fellowships. Two sabbaticals were awarded to Crawshaw, and one to Flynn, both of whom completed their doctoral studies within the census period and are returned as Category A.
• HEIF 2 pump-prime funding for the Centre for Health and Social Evaluation of £50k, which attracted matched funding from Middlesbrough Primary Care Trust (PCT) from 2006-2009.

The total investment in the support of research activity for UoA 12 over the period was £2,129,023.

Activities, achievements, and esteem indicators

1. Centre for Food, Physical Activity, and Obesity
The Centre is led by Summerbell and Batterham, and includes Brown, Ells, Heslehurst, Moore, and Zohoori, supported by 7 Research Assistants (3.4 FTE). We are a National Institute for Health and Clinical Excellence (NICE) Public Health Collaborating Centre on Obesity, and the World Cancer Research Fund (WCRF) Systematic Literature Review Centre on Obesity. Our research involves both systematic reviews (including Cochrane) and original investigations, and addresses the impact of a variety of antecedents and interventions on major chronic diseases. These studies include the influence of dietary fat intake on the prevention of cardiovascular disease (Summerbell, RA2 output 1; 92 citations to date in Web of Science); the influence of omega-3 fats on mortality, cardiovascular disease, and cancer incidence (Moore, RA2 output 1; 75 citations in Web of Science); and the effect of dietary advice or lifestyle and behavioural weight loss interventions on the management of type 2 diabetes in adults [Moore (PhD conferred in 2006), Brown]. Within this theme, in collaboration with the Universities of Bath and Bristol, Batterham is a co-investigator in a randomised trial of the effect of physical activity on pro- and anti-atherogenic inflammation in early Type 2 diabetes (British Heart Foundation; £117,440, held at Bath).

A primary research focus is the causes and consequences of overweight and obesity - including disability (Ells) and maternal obesity (Heslehurst) - and its prevention and management (Summerbell, Ells, Brown). Summerbell’s contributions focus on nutritional, dietary advice, physical activity, and surgical interventions. As a NICE Collaborating Centre, we have conducted a series of critical reviews forming the evidence base for the national guidance on the prevention, identification, assessment, and management of overweight and obesity in adults and children. (NICE, 2006. Brown made the major contribution to the development of this Clinical Guideline, returned in RA2.) Our Cochrane review of interventions for the prevention of obesity in children (Brown, RA2) has received 124 citations in Google Scholar. Heslehurst is driving a programme of work on maternal obesity incidence and consequences as part of her ongoing doctoral studies. As an early career researcher, she has published two papers in the British Journal of Obstetrics and Gynaecology (RA2). For her maternal obesity research, Heslehurst received the President’s Poster Award for the most outstanding research in the category at the 2006 International Congress on Obesity, plus the 2007 Student Researcher Award from the Association for the Study of Obesity.

As a WCRF collaborating centre, we received funding to systematically review the evidence for food, nutrition, and physical activity behaviours as ‘Determinants of Weight Gain, Overweight, and Obesity’. This work forms Chapter 8 of the WCRF/AICR (Association for International Cancer Research) second report on Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective (returned for Ells in RA2). In recognition of the Centre’s contribution, Summerbell was invited to present the report’s Body Fatness recommendation (‘be as lean as possible within the normal range of body weight’) at the launch conference at The Royal Society, London, in November 2007.

The recruitment of exercise science expertise has facilitated a focus on the assessment of free-living physical activity using multi-method approaches, including state-of-the-art synchronised heart rate and accelerometry (Batterham, RA2). This area complements the nutrition expertise and permits a broader, energy-balance related behaviours framework to guide our research. A current example of this approach is the ‘Effectiveness of a Community Challenge for Promoting Healthy Diets and Levels of Activity in Adults’, a complex intervention funded by the Food Standards Agency (FSA; £515,800, co-investigators Summerbell, Batterham, Kelly). Central to this conceptual framework is the development of a novel, computerised self-report tool - The Synchronised Nutrition and Activity Program (SNAPTM; Batterham, Ells, Moore, Summerbell). This research programme is embryonic, yet has already produced an output detailing the initial validation work in children (Moore, RA2). In recognition of the innovation and knowledge transfer potential of SNAPTM, Moore received a University of Teesside Enterprise Development Fund grant of £9,476 to refine the tool in preparation for the second phase of feasibility testing and full validation (in progress).

Closely connected to the above themes is research on the influence of body size and composition on exercise metabolism         (Batterham, RA2, outputs 1 and 2). This work broadens our focus on chronic diseases, as maximal metabolic rate is inversely related to the risk of several such conditions, including cardiovascular disease. In addition, our focus on behavioural risk factors has been extended with Zohoori's work on nutrition knowledge, and dietary intake of iron, water, and fluoride. Zohoori  has developed two protocols for the analysis of fluoride in biological samples that have been adopted internationally.

Interwoven with our primary research foci is a measurement and biostatistics theme led by Batterham. An example of this work is the development and evaluation of inferential approaches based on effect sizes and clinically important differences. This project evolved from a short-term research visit in 2003 to the laboratory of Professor William G. Hopkins (AUT, New Zealand) funded by the Royal Society. Subsequently, Batterham was invited to co-present a mini-symposium on ‘Clinical, Practical, or Mechanistic Significance versus Statistical Significance’, at the 51st Annual Meeting of the American College of Sports Medicine  (ACSM) in Indianapolis (2004). The associated output is an invited journal publication on magnitude-based inferences               (Batterham, RA2 output 3). This research has great potential to influence practice and, indeed, is forming part of international guidelines. Batterham was invited by the Editor-in-Chief of the official journal of the ACSM (Medicine and Science in Sports and Exercise) to join an ad hoc expert group charged with developing new guidelines for reporting research. The work on making meaningful inferences about effect sizes is central to the philosophy of these new guidelines, which are currently in review and are due to be published in 2008.

The standing of Centre researchers is recognised further by additional esteem indicators. Batterham is an Associate Editor for the Journal of Aging and Physical Activity and member of the Editorial Board for the International Journal of Sports Physiology and Performance. Batterham and Shucksmith (Centre for Health and Social Evaluation) are members of the North East Regional Funding Committee for the Research for Patient Benefit (RfPB) Programme  of the National Institute for Health Research (NIHR). Batterham is a Fellow of the ACSM and the Royal Statistical Society, Chair of the ACSM Biostatistics Interest Group, and has delivered three additional keynote communications at the ACSM Annual Meeting in 2003, 2004, and 2006. [1. Precise baseline measurements of strength and functional ability in older adults; associated output published in the Archives of Physical Medicine and Rehabilitation, 85:329-34, 2004. 2. Have we reached our Limit of (dis)Agreement for how best to assess test validity and method comparison? (This specific biostatistical expertise informs our development and evaluation work in physical activity measurement, outlined previously; Batterham, RA2 output 4; Moore, RA2 output 4). 3. Tradition and Innovation in Data Analysis].

Summerbell’s expertise is recognised internationally by invited presentations at prestigious meetings including: a Satellite Meeting (on Community Development, Geelong) to the 10th International Congress of Obesity (Sydney, 2006); a Satellite Meeting (on the Prevention of Childhood Obesity, Stockholm) to the annual conference of the International Society for Behavioural Nutrition and Physical Activity (Oslo, 2007); and a Cardiovascular Seminar entitled ‘Programs and Strategies for Tackling the Childhood Obesity Epidemic’ at the American Heart Association’s Scientific Sessions 2007 in Orlando, Florida (Population Science Track). She sits on the Editorial Board of the International Journal for Obesity, the British Journal of Nutrition, and the Journal of Human Nutrition and Dietetics. She is also a member of the World Health Organization (WHO) Expert Panel on Childhood Obesity, and the Deputy Chair of the Association for the Study of Obesity. Moore (alongside Summerbell) was an invited speaker at the meeting of the Nutrition Society (Glasgow, 2003): Searching the evidence: the clinically effective nutritionist. The associated output from this talk was published in the Society’s Proceedings (Moore, RA2). This example illustrates our emphasis on the synthesis of evidence and its translation into practice, an approach reflected in the systematic review conducted for the Food Standards Agency of the effect of nutrition, diet and dietary change on learning, education and performance of children (www.food.gov.uk/multimedia/pdfs/systemreview.pdf#page=1). (Summerbell was invited to present this review at both the House of Lords and Downing Street in 2006.)

With respect to informing international guidelines and policy, an important recent research activity has been assisting the WHO in the production of their global strategy on diet and physical activity. We informed this strategy by collating the evidence base for the prevention of obesity in children, and Summerbell presented this work at the WHO Expert Meeting on Childhood Obesity (A contribution to the implementation of the global strategy on diet, physical activity and health) at Kobe, Japan in 2005. We also contributed to one of the strategy’s interim outputs - ‘The Challenge of Obesity in the WHO European Region and the Strategies for Response’ (www.euro.who.int/document/E90711.pdf). We are currently working with the WHO Euro and HQ on the Nutrition Friendly Schools Initiative (NFSI), and are applying to become a WHO Collaborating Centre for Nutrition Friendly Schools. Summerbell was invited to deliver keynote presentations on the development of the NFSI at the ‘WHO Technical Consultation on the formulation of school policies for the prevention of obesity in childhood and adolescence’ in Florence, Italy, in 2006, and at the 34th Session of the United Nations Standing Committee on Nutrition in Rome, in 2007.

2. The Centre for Rehabilitation Sciences
The Centre for Rehabilitation Sciences (CRS) is directed by Martin, a Reader in Rehabilitation and Chair of the Scientific Committee of the Charitable Trust of the Chartered Society of Physiotherapy. The other core-funded researchers have specialities in physiotherapy, nursing, biomechanics, physiology, engineering and psychology and consist of one Professor          (Nabhani), two Readers (Hamilton, Spears), plus Baker, Campbell, Dixon, Hanchard, Handoll, and MacSween.

The CRS has a purpose built laboratory at the James Cook University Hospital in a collaboration with the South Tees Hospitals NHS Trust. Previous SRIF investment has furnished the laboratory with state-of-the-art research equipment (including a motion capture system and isokinetic dynamometer). The Centre also offers specialist mentoring and advice on rehabilitation research to academic staff and clinical and service colleagues. A prime example thereof is the successful work on amputee rehabilitation funded by the Health Foundation and carried out by Jane Cumming, a physiotherapist at James Cook, with supervision and mentoring from the CRS. The Centre is also the North East Hub of the National Physiotherapy Research Network, with Martin as facilitator. (MacSween performed this role for the North of Scotland hub before joining the CRS.)

The CRS has two established research strands - the rehabilitation of musculoskeletal conditions and rehabilitation technology. This structure provides a framework to organise and manage research strategically. At the same time there are clear links between the strands, offering the opportunity for synergies and joint working, a fundamental philosophy of the Centre. An emergent theme is neurological rehabilitation, which is developing along the same structure.

Rehabilitation of musculoskeletal conditions
Martin
leads this strand, supported by Campbell, Dixon, Hanchard, Handoll, and MacSween. (Work by Rome and Howe also featured herein.) The research activity is in line with government priorities as outlined in the Department of Health’s Musculoskeletal Services Framework. The underpinning model is the WHO International Classification of Functioning (ICF), Disability and Health with the work focusing variously on combinations of impairment, activity, and participation. It thus brings together basic research into underlying mechanisms and applied research, and features a range of quantitative and qualitative methods of inquiry. The strand has three distinct but complementary areas of activity: systematic reviews, measurement and assessment, and management.

Systematic reviews
Our expertise in this activity is recognised internationally, evidenced by the invitation to produce one of ten Cochrane reviews of diagnostic test accuracy (Hanchard, Handoll). This review, on tests of shoulder impingement, follows Hanchard’s work as the lead author of the Chartered Society of Physiotherapy’s national guidelines for the diagnosis, assessment, and management of subacromial impingement syndrome. The review protocol has been published in the Cochrane Library. (Hanchard NCA, Handoll HHG. Physical tests for shoulder impingements and local lesions of bursa, tendon or labrum that may accompany impingement [monograph on the Internet]. Chichester, UK: Wiley; 2007. Available from: http://www3.interscience.wiley.com/homepages/106568753/DTAP4.pdf). Handoll and Hanchard are editors of the Cochrane Bone, Joint, and Muscle Trauma Group (formerly the Musculoskeletal Injuries Group) and Handoll has produced and maintains a suite of Cochrane reviews on the management of musculoskeletal conditions. The reviews have made a substantial contribution to various evidence-based guidelines (e.g., the Scottish Intercollegiate Guidelines Network) and summaries.

The systematic reviews inform our ongoing work in the two research activities outlined below: measurement and assessment, and management. Martin, with colleagues in Scotland, has produced a Cochrane review into the management of Morton’s Neuroma, a painful foot condition, which formed the basis for a recently completed randomised trial into the management of this condition (Scottish Executive £77.4k, held by Queen Margaret University). Martin was part of a team commissioned by the Chartered Society of Physiotherapy that produced clinical guidelines, based on systematic reviews of the literature, on the management of low back pain using exercise and manual therapy.

A particular feature of the activity is building capacity and external relationships by including, as co-reviewers with experienced core staff, novice researchers in the University and NHS. For example, locally based physiotherapists were co-authors of a Cochrane review on post-reduction conservative management of anterior dislocation of the shoulder (Handoll, Hanchard), which received funding from the Physiotherapy Research Foundation [who also funded the Cochrane review on exercise for treating isolated anterior cruciate ligament injuries in adults (Dixon)].

Measurement and assessment
This activity features basic and applied research along with work on the perspectives of users and clinicians involved in the processes of measurement and assessment of musculoskeletal conditions. The achievement of a Department of Health Researcher Development Award (Hanchard, PhD conferred in 2007) reflects the quality of the research environment. This work was also funded by the Physiotherapy Research Foundation and Hanchard was awarded the Robert Williams prize for his presentation at the World Congress of Physical Therapy in 2003. Hanchard’s evaluation of the accuracy of ‘blind’ (unguided) injection techniques for the shoulder joint and subacromial bursa in cadavers led to the development of optimised practices with superior accuracy to other blind techniques.

Basic research on measuring the perception of pain with quantitative sensory testing (Martin) is linked with methods used in our research on the management of musculoskeletal conditions (Martin, MacSween). Specific work on incorporating sensory detection theory into quantitative sensory testing (Martin) has developed knowledge in this area that provides practical information for applied clinical testing. Basic interdisciplinary research, with the Electronics Department at the University of York (Dixon), is investigating novel methods for analysis of electromyographic (EMG) recordings and examining how EMG signals are impaired by changes due to ageing and muscle atrophy. Again, this basic research links with and informs the research activity on managing musculoskeletal conditions.

The research activity also features applied research into clinical measures. Studies on balance/ postural stability, movement and fitness (Dixon, Martin, MacSween, Rome) are supported by the laboratory facilities at our James Cook University Hospital site, enabling collaboration with clinicians. Ongoing studies of self-report measures of the impact of pain on function - impairment, activity and participation - (Martin) expand and complement the work on physical measures in line with the underpinning ICF model.

Our research activity also features work into service users’ and clinicians’ perspectives on the processes of clinical assessment (Martin). This expertise has been used to develop assessment strategies for colleagues in back pain and chronic pain services   (Martin).

Management
This activity features investigations of the effect of rehabilitation interventions supported by research into the nature of impairments and mechanisms underlying musculoskeletal conditions. The EMG studies of reflex and voluntary muscle activation in the lower limb (Dixon) led to a study of daily quadriceps activity profiles using portable electromyography, funded by the Physiotherapy Research Foundation. This work (awarded the Conference Prize for best paper at the 5th Staffordshire Clinical Biomechanics Conference; and a Runner-up prize in the Advances in Physiotherapy competition at the 14th International Congress of the World Confederation for Physical Therapy in 2003) continues with research into quadriceps muscle activation during physiotherapeutic exercise for the rehabilitation of anterior cruciate ligament injuries and patellofemoral pain syndrome    (Dixon). A PhD was conferred on Dixon in 2004.

Expertise in both muscle activity and postural stability combines in a programme of work on the effect of appliances for the foot in the management of musculoskeletal conditions (Dixon, Martin, Nabhani, Rome). Work on the impact of textured insoles on postural stability and muscle activity relating to reducing falls in older adults has been awarded a British Geriatrics Society/ Dunhill Trust Research Fellowship (Dixon, Martin, Rome).

The impact of pain is a particular feature of the research activity. (Martin is Vice-Chair of the British Pain Society’s Special Interest Group in Older People, and previously Chair of the Physiotherapy Pain Association North; part of the CSP Special Interest Group. He was also Co-Director of the Scottish Network for Chronic Pain Research. Martin is the rehabilitation section editor and Campbell, Dixon, and Rome sit on the Editorial Board of the Journal of Pain Management.) Campbell’s work on short-term memory deficits in people with low back pain examines a key psychological mechanism underpinning this condition. Martin’s work on interferential current for reducing pain highlighted problems with claims for the key mechanisms of this treatment, and thus advocated a simplified approach to its clinical use. MacSween has used similar investigative methods to study the role of placebo effects in the use of acupuncture. Trials on interventions for painful foot-related musculoskeletal problems run parallel to the research on footwear referred to above. This work includes the aforementioned randomised trial of the effect of steroid injection on pain and function in people with Morton’s Neuroma (Martin).

Again, the user perspective is a feature of our research activity in this area. Campbell’s work on people's beliefs about causes for their back pain provides an in-depth insight. (Campbell is a member of the NICE Technology Appraisals Committee.) A highlight of this work was an extensive qualitative study of people’s experiences of living with pain (Health Foundation, held by Queen Margaret University), which informed a module on chronic pain for the internationally acclaimed DIPEx website (Martin). Martin’s work also includes an investigation of the needs of people living with chronic pain in the community (£173.8k, National Lottery Charities Board to Queen Margaret University). This study led directly to the development of a community-based pain management support service within the voluntary sector (delivered by Pain Association Scotland) that has received international recognition. (In 2003, in recognition of his work by the user community, Martin accepted an invitation to become Chair of Pain Association Scotland. He has represented the Association on the Scottish Parliament’s Cross Party Group on Chronic Pain, of which he was a founder member and inaugural vice-convenor.)

Rehabilitation technology
This strand is led by Spears, an Associate Editor (Biomechanics) of the International Journal of Fitness, supported by MacSween and Nabhani. (Rome’s work featured in this area.) There are two distinct but complementary areas of activity: biomechanical evaluation of rehabilitation technology and development of rehabilitation technologies, reflecting the team’s expertise in engineering and biomechanics, along with clinical expertise in rehabilitation. It thus brings together basic and applied research, with a strong feature of innovative development and knowledge transfer that connects with government priorities for research and development in higher education.

Biomechanical evaluation of rehabilitation technology
The assessment of tissue mechanics through finite element analysis is a key feature. In collaboration with the University of Liverpool, software has been developed to assess the biomechanics of biological tissue and create 3-D anatomically detailed models based on medical imaging (Spears). In collaboration with the Technical University of Hamburg-Harburg, Germany and the A-O Davos Research Institute, Switzerland, Spears has created a virtual testing environment for the evaluation of non-cemented hip replacements. This work, funded by the German Research Council, simulated biological processes in response to trauma, and for the first time informed practice for optimising clinical success beyond the immediate postoperative period.

Related techniques have been applied to the rehabilitation of the lower limb such as investigations into optimal conditions for orthopaedic screw fixation in femoral neck fractures; the biomechanical evaluation of foot orthoses, mouthguards and cycle saddles (Spears); and for improving the outcomes of ankle arthrodesis operations (Nabhani). In work that has generated interest from implant manufacturers, finite element analysis was used to create 3D models of the 4th and 5th vertebrae revealing the distribution of stresses and informing knowledge about mechanical loading of the spine (Nabhani). This area links with positional magnetic resonance imaging work that has for the first time provided evidence for the validity of clinical assumptions concerning disc behaviour in functional posture (MacSween).

Finite element analysis is also used in the evaluation of hip protectors designed to reduce impact forces during falls (Nabhani). Nabhani has been appointed as Conference Chair for the forthcoming 19th International Conference on Flexible Automation and Intelligent Manufacturing (FAIM). He was a committee member of the 10th International Conference on Rehabilitation Robotics in 2007; a member of the ICMEEM Conference Committee of World Congress on Engineering in 2007; and chaired several sessions in the 2007 International Conference of Manufacturing Engineering. His international expertise extends into investigation of the impact properties of flooring and underlay materials to reduce hip fractures in older people (Nabhani, Knowledge Transfer Partnership).

Development of rehabilitation technology
In collaboration with clinical colleagues, work has been conducted on the development of new hip protectors to reduce cost and improve fit and usage to prevent injury in older people. This product is currently undergoing development by the NHS                  (Nabhani). The work required the design of a testing rig that has been adopted as standard equipment throughout Europe for performance evaluation of hip protectors. The rig has been commissioned, and a commercial service is available to manufacturers who wish to test their hip protectors using the standard apparatus and procedures. It will also be used in the ongoing development of legislation regarding testing and manufacture of hip protectors (Nabhani).

Similarly, knowledge acquired through the finite element analysis of the foot (Spears, Rome) is being exploited to inform design of the next generation of foot orthotics. A Knowledge Transfer Partnership (Nabhani) has commenced to improve orthotic design and address the impact of obesity on foot and ankle mechanics in chronic plantar heel pain. Another example of knowledge transfer is the CannyTrack Human Balance Monitor (patent 0609999.8), which uses computer modelling and new tracking technology to provide information on the function of the body’s balance system (Spears).

Neurological rehabilitation
This is an embryonic strand, led by Hamilton and supported by Baker, Finn, and Whittaker (née Ashton). Hamilton has completed a Cochrane systematic review on nutritional support of stroke patients. (Hamilton is Vice-Chair of the Royal College of Nursing Northern Regional Research Society and Chair of the R&D sub-committee, which is part of the National Stroke Nurses' Forum.) The research activity in measurement and assessment has begun through Baker’s validation of the use of accelerometers for home use by people with Parkinson’s disease (in collaboration with partners in the Netherlands and Belgium as part of a European Commission Framework 5 Programme). This work links with the measurement of free-living physical activity in the Centre for Food, Physical Activity, and Obesity (Batterham).

The furthest developed research activity within this emerging strand is in condition management. Hamilton has investigated physiotherapy management of lower limb function following stroke, which links with Finn’s collaborative work with local clinicians on the clinical effectiveness of weight-transference exercises in sitting in acute stroke patients. Whittaker’s work with people with Parkinson’s Disease using auditory cues to enhance gait links closely with that of Baker, investigating cueing as a therapeutic modality for improving function in people with Parkinson’s Disease.

As with the musculoskeletal rehabilitation theme, the perspective of health care professionals features in this strand through Hamilton’s continuing work. In recognition of her work on the RESCUE project, Baker is a regular speaker to Parkinson’s disease user support groups around the North East and has also spoken at two of their regional research meetings, disseminating research results to users and carers.

3. Centre for Health and Social Evaluation
The Centre for Health and Social Evaluation (CHASE), co-directed by Shucksmith and Hamilton, focuses on evaluation as a critical research tool in assessing the impact of health and health promotion interventions and improving the evidence base on which much health work is based. Shucksmith is also an associate director of the Edinburgh-based consortium Centre for Research on Families and Children.

The evaluation research incorporates the work of Crawshaw, Conway and van Wersch. During the census period, van Wersch was awarded a Personal Chair  and both Crawshaw and Conway successfully completed doctorates and are beginning to develop new research portfolios. Crawshaw is now reviews editor of the journal Critical Public Health. A team of Research Assistants (3.5 FTE) supports this core group. The Centre received core funding from Middlesbrough PCT (via Kelly), and also obtained early investment through HEIF start up funding. It is building on this base with income from local and national agencies. Shucksmith has led on the University of Teesside’s collaboration with other North East universities and the Strategic Health Authority in a consortium bid to the UK Clinical Research Collaboration (UKCRC) to establish a Public Health Centre of Excellence in the North East. This Centre will focus in large part, if successful, on evaluation as a tool in improving the evidence base for public health and subsequent translation of research into policy and practice.

Sociological and psychological approaches to health issues are dominant in this work, which stretches across clinical and community settings. With respect to the clinical area, van Wersch’s work with Eccles (Newcastle), evaluated the success of patient involvement in the development of evidence-based clinical guidelines. The evaluation group continues to pursue this interest in the involvement of health service users and lay people in the design and evaluation of interventions and services in a current seminar series being run by CHASE, Climbing the Participation Ladder. Other publications by van Wersch arise from evaluation work looking at patient satisfaction in a variety of clinical settings, for example, with breast reconstruction and preparation for gastrointestinal endoscopy and in relation to GUM clinic attendance.

With respect to evaluation of community level interventions, Shucksmith was involved in a number of national evaluation projects, including the independent evaluation of the National Health Demonstration project on sexual health, Healthy Respect. Publications report the evaluation but also reflect on the difficulty of demonstrating attributable effect to specific facets of a complex intervention. The publications of Shucksmith and colleagues focus, for instance, not just on identification of measurable health outcomes but on new ways of measuring the success of partnership working between agencies.

Crawshaw and Conway were involved in a major evaluation of another complex community-based intervention, Health Action Zones. Beyond the straightforward evaluation reports of that work, their published analyses focus on the governance of such initiatives, exploring how the reality of implementation can undermine the evidence-based goals and methods that generate them. In particular the notion of ‘community’ as a focus for large-scale health promotion approaches is examined critically.

A very specific site for community level interventions is the school. Shucksmith has undertaken a variety of projects evaluating schools as sites for both health surveillance and interventions. This work combines her interest across both health and education sectors [she was formerly a Board Member (1998-2001) of the Scottish Council for Research in Education; at that time a national independent representative organisation with core government funding]. Recent pilot work undertaken for the North East Public Health Observatory evaluated the roll out of the Government’s Body Mass Index (BMI) measurement programme in schools and is the precursor of a bid to the ESRC for a more sustained project with colleagues in Durham. Findings echo earlier work undertaken by Shucksmith and colleagues at the University of Aberdeen on schools as sites for promotion of young people’s mental health (funded by the Scottish Executive Education Department and the National Programme for Mental Health Improvement), as a consequence of which Shucksmith was invited to become part of an expert group on the ‘Evidence into Practice’ strand of mental health improvement for the Scottish Executive’s National Programme for Improving Mental Health and Wellbeing. Recently Shucksmith, along with Summerbell, Whittaker and other research colleagues, has undertaken a systematic review for NICE, looking at the effectiveness of targeted interventions to improve young people’s mental wellbeing in primary schools, which will form part of the evidence base for the production of new public health guidelines in 2008. An ESRC seminar series on this topic was recently awarded to Shucksmith and colleagues and will run in 2008 with seminars in Teesside (2), Southampton and Aberdeen.

Recent and ongoing work which picks up some of the same issues focuses around childhood immunisation, with project funding to date from NHS Health Scotland, Health Protection Scotland, and Middlesbrough PCT to evaluate professional roles and public reaction to MMR immunisation and to the introduction of HPV and HepB immunisation into school-based vaccination schedules.

The three centres are supported by a range of key staff operating within the Research Institute for Health Sciences and Social Care. At the Institute’s hub are the administrators (2.9 FTE), led by a Project Officer (Rowbotham) who assesses potential funding sources and manages pre- and post-award financial administration. The Institute has robust procedures in place regarding research governance, and these are reviewed on a regular basis in accordance with Department of Health and associated national guidelines. A Principal Lecturer for Research Governance (currently MacSween) was appointed to ensure that correct policy and practice is carefully adhered to in collaboration with local Research Ethics Committees. Additionally, there are two medical statisticians (Finn, Whittaker) and a research support methodologist (Flynn) working across Centre boundaries. Whittaker is Statistical Advisor to the Cochrane Ear, Nose and Throat Disorders and Cochrane Wounds groups, and the Statistical Editor of Sexual Health Matters. Flynn’s work is at the interface between researcher, patient, and clinician and relates to the translation of knowledge into practice. A PhD was conferred on Flynn in 2007.

The Institute infrastructure includes high-specification computer hardware, specialist software, and access to library and information systems specialists (including Moore) to facilitate our systematic reviews. Laboratory facilities in the Sport and Exercise Science subject area permit work that informs and underpins our fieldwork in the physical activity and exercise area. When conducting research involving members of the public as participants or end users, we adhere to the spirit of the INVOLVE guidelines (www.invo.org.uk). To reflect this philosophy and formalise existing policy, the School of Health and Social Care has produced a Service User and Carer Involvement Strategy.

Our research students enhance the research environment and culture. We have approximately one PhD completion per staff head count over the census period (discounting the seven early career researchers). The outputs and achievements of staff recently awarded a PhD illustrate the quality and rigour of our research training (e.g., RA2 output 2 for both Hanchard and Moore, derived from their doctoral studies). Heslehurst’s contributions as a current doctoral student, described previously, underscore this point. The University has allocated three PhD scholarships, awarded competitively, from January 2008 to the Centre for Food, Physical Activity, and Obesity.

Staffing Policy

Significant staffing changes have occurred since RAE 2001, with three researchers remaining (2.5 FTE; Summerbell, van Wersch, and Batterham; a Category A* leaver in 2001, returning in 2005). These changes relate primarily to a strategic emphasis on rehabilitation, obesity-related research, and evaluation. The most notable losses are Howe (now at HealthQWest) and Rome (until his recent appointment at AUT in New Zealand), both formerly Directors of the Centre for Rehabilitation Sciences, though these have not affected the focus of our research work. New appointments of established researchers              (Batterham, Hamilton, MacSween, Martin, Shucksmith, Zohoori) have significantly improved the strength and coherence of our research culture, as evidenced by our outputs and esteem indicators.

Underpinning our current and future research plans is the attraction and retention of the highest quality researchers and their continuing professional development, interfacing with the University’s Personal Development Review process. All bar two posts are permanent, with the aim to secure funding for their continuity. Researchers are appraised annually, and participate in a wide range of personal and professional development programmes, including external courses. Core Institute researchers are required to engage in a maximum of 6 hours per week of non-research duties. Support for staff and research students is co-ordinated by a University-wide Graduate Research School (GRS), established in 2005. Research staff members are assisted in the preparation of bids for earmarked research career development and financial support, for example, seed corn funding from the University Research Fund and sabbatical leave. Equally, Research Assistants are encouraged to participate in career development activities, and to apply for academic posts as they arise. This process contributes to the development and maintenance of a critical mass of research active staff.

A vibrant, co-operative research culture exists within the Institute. Researchers work closely on the interlocking research areas and benefit mutually from the interdisciplinary interactions. Since the last RAE, an informal research seminar programme has been initiated permitting an unfiltered discussion of our activities. This programme benefits all, but particularly early career researchers, and research assistants and students. All researchers have access to a peer mentor programme, to assist with all aspects of the research process, from study conception and design, through data collection, analysis, writing for publication and dissemination of findings, addressing referee’s comments appropriately, and applying for funding.

Research Strategy


Due to the high staff turnover, it was impossible to implement the limited plans advanced in 2001. The main objectives and activities in research over the next five years are outlined below for each of the three Centres.


In the Centre for Food, Physical Activity and Obesity we aim to consolidate our international reputation in obesity research, continuing our research and policy liaison with the WHO, NICE, WCRF, and the FSA. We shall maintain our focus on health inequalities, extending our funding targets to include the UK research councils and the European Commission Framework Programme. We have applied (and have been called to final interview) to become a NICE Centre for Public Health Excellence Collaborating Centre (led by Teesside) and a UKCRC Public Health Centre of Excellence (in a collaboration between the 5 North East universities, led by Newcastle).

A primary objective is the growth of the physical activity area. We shall continue to develop, refine, and validate tools to improve the accuracy and precision of measurement of physical activity, including the SNAPTM project, and motion sensor technologies. Presently, Batterham is a co-investigator in a 3-year trial of the effects of exercise and physical activity interventions on cardiovascular, bone, body composition, and motor skill outcomes in children (Neighbourhood Renewal Fund, Liverpool John Moores University). The initial output from the exploratory trial phase is in press in Pediatric Exercise Science.

In the Centre for Rehabilitation Sciences we aim to develop existing strengths through closer involvement with new technologies. For example, in collaboration with Aberdeen University, we have submitted a proposal to the New Dynamics of Aging programme to investigate the problems of chronic pain in older people (Martin). Our specific contribution is to investigate technological solutions to problems of function experienced by older people with chronic pain. To facilitate this work we have established an interdisciplinary group in virtual rehabilitation/ telerehabilitation, linking the expertise of the Centre with the University’s strength in digital innovation and design.

Our work in musculoskeletal rehabilitation advances with the award of £1.2m from the NIHR Health Technology Assessment Programme for a trial on the management of people recovering from humerus fractures (Handoll, Hamilton, in collaboration with York University and James Cook University Hospital). We have also been shortlisted by the RfPB programme for an exploratory trial of the benefits of exercise training in intensive care unit survivors, building on promising pilot work (Batterham, Martin; in collaboration with the James Cook University Hospital and the University of Leeds).

 

In the Centre for Health and Social Evaluation, we aim to develop access to national and international level evaluation activity via the anticipated UKCRC collaboration. (The Strategic Health Authority has expressed strong support for the consortium development of capacity in public health and translational research, and has indicated its willingness to support the initiative if the UKCRC bid is unsuccessful.) This work will focus on ways of using evaluation activity to develop evidence-informed practice and policy making. Shucksmith will lead on strands relating to knowledge translation and also play a major role in the area examining the growth in new professional roles to deliver public health/ health promotion. We anticipate that the collaborations developed through the ESRC seminar series on schools and mental health will lead to further joint bids in this area of work. The focus on schools as sites for public health/ health promotion intervention will also continue with a bid to ESRC for a larger project to examine the ramifications of the BMI surveillance programme.

A new growth area relates to end of life care, which is rapidly becoming a recognised part of the mainstream public health agenda. Conway will lead on this strand alongside Edwin Pugh, a visiting professor charged with leading the end of life care dimension of the Darzi review in the North East. This development will consolidate a small number of local evaluations already undertaken on different dimensions of palliative care and will be taken through into major bids to NIHR funding streams and to subsequent publications.