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University of East Anglia

UOA 12 - Allied Health Professions and Studies

RA5a: Research environment and esteem

1.     Introduction

The interdisciplinary Allied Health Professions and Studies (AHP) Research Groups within the Faculty of Health (FoH) at the University of East Anglia (UEA) focus on the development and evaluation of interventions to enable individuals to perform everyday functional activity (e.g. walk, communicate) and participate in social roles (e.g. paid employment, parenting). The overall aim is to provide evidence-based interventions to enable lifelong health and wellbeing through restoring, maximizing and managing functional activity. Research systematically investigates complex rehabilitation interventions using the framework recommended by the Medical Research Council (Campbell BMJ 2000;321: 694-696) and the WHO International Classification of Functioning, Disability and Health (ICF). Thus AHP research activity encompasses the bio-psycho-social nature of health interventions and the need to conduct robust clinical trials. The research framework used is illustrated in Table 1 where letters A-O indicate categories of research activity. Robust studies are undertaken to establish the scientific rationale for interventions, proof-of-principle of interventions and to develop reliable and valid measures of the aims of interventions (studies in categories A to I) as a basis for randomised clinical trials (studies in categories J-O). Examples in this RA5 text are placed in this research framework by referring to categories of research (e.g. categories ABD) and referenced to RA2 by the output identification tag (e.g. Pomeroy 2).

Table 1. Illustration of framework for AHP research groups at UEA

MRC Framework for Design and Evaluation Of Complex Interventions to Improve Health

  Theoretical
(preclinical)
Modelling
(Phase I)
 Exploratory
(Phase II)
Definitive
(Phase III)

 Pragmatic
(Phase IV)

Bio A D G J M
Psycho B E H K N
Social C F I L O

 

2.     Overview of AHP Research Groups

The research framework (Table 1) informs all three Groups: Neuro-musculoskeletal Rehabilitation (lead Pomeroy); Health Communities (leads Poland and Hartley); and Education and Communication in Health Practice (leads Hartley and Richardson). Pomeroy and Hartley have been appointed to Chairs within the last two years recruited from St George’s and Institute of Child Health, London respectively. Collaborations between Groups and across the FoH are enabled through the research environment (section 3). For example, Song (submitted to UoA7) uses expertise in systematic reviews and meta-analysis to strengthen all Groups’ research. External collaboration, national and international, characterises the AHP research programme (sections 2 and 5). Key partnerships with users of research, such as NHS, and, locally, PPIRES (a voluntary organisation for Public and Patient Involvement in Research linking FoH, local NHS Trusts and local communities), are well-established (details section 3.3). Currently live research grants to projects involving AHP staff total £2M, with £3M awarded across the RAE period.

2.1     Neuro-musculoskeletal Rehabilitation
Core members: Pomeroy, Jerosch-Herold, Chester, Stephenson. Others include Song (submitted to UoA7)

Research is integrated with the FoH Chronic Disease and Rehabilitation theme (section 3) and focuses on therapies to restore movement control and functional ability after the onset of impairment resulting from pathology or injury. Musculo-skeletal techniques for respiratory care will be developed in the future. Their AHP share of funding secured since 2001 totals £758K. At St George’s Pomeroy secured over £1.2M (2001-2007).

The main emphasis has been on necessary precursors to clinical trials including:
a. the identification of well-defined interventions with biological credibility;
    research synthesis of clinical and experimental studies has identified the need to concentrate on interventions with biological plausibility to enhance motor recovery after stroke (e.g. Pomeroy 2; Table 1 Category A);
    testing clinical opinion about established yet under-evaluated practice has contested the assumption that different physiotherapists will deliver a well-defined intervention in the same way (Chester 3) and that self-propulsion of a wheelchair with the non-paretic hand and foot results in increased abnormality of postural control after stroke (Pomeroy 3);
    describing precisely, for the first time, interventions within conventional, yet under-evaluated, treatment provided by therapists for people after stroke (Pomeroy 1; Table 1 Categories DE). This work has provided a novel methodology and demonstrated the diversity of interventions hidden by the label “physical therapy” and the need to describe therapy in sufficient detail to enable replication and clinical use of research findings;
b. development of valid, reliable measures of the aims of interventions (Table 1 Category D);
    measures of hand sensation for use in evaluation of “natural” and therapy-enhanced recovery after nerve injury and repair (Jerosch-Herold 1-4);
    isokinetic dynamometry provides a reliable measure of plantarflexion torque after rupture of the Achilles tendon (Chester 2);
    a two or three factor solution is most appropriate for the Toronto Alexithymia Scale (Stephenson 1, Table 1 Category D).

The results of these and other preliminary studies have informed the design of current and recently completed Phase I studies and clinical trials. For example:
    Phase II and III trials evaluating the effects of functional strength training, a novel intervention, on motor recovery after stroke (Pomeroy, funded by The Wellcome Trust, £87K, and Health Foundation, £287K, Table 1 Categories GHJK);
    Phase I trial of the most appropriate dose of defined physical therapy to enhance motor recovery after stroke (Pomeroy, funded by Stroke Association £156K). This is a pioneering prospective dose-finding study of physical therapy after stroke (Table 1 Categories DEGH) ;
    Jerosch-Herold has gained Action Medical Research funding (£174K) to investigate the effectiveness of splinting after surgery for Dupuytren's Disease (2007-2010);
    innovative translational research, in collaboration with Ward (UCL), which combines clinical investigation and neuro-imaging to generate hypotheses about how specific therapies influence brain reorganisation and how particular brain damage might predict response to specific therapies (Pomeroy funded by Stroke Association, Table 1 Category D);
    Song (submitted to UOA7), together with Jerosch-Herold is now extending the methodological focus on theoretical bases of interventions to the area of research synthesis in carpal tunnel syndrome.

2.2     Health Communities
Core members: Drachler (cross-referred to UoA6), Hartley and Poland. Also Stewart (category B).

This Group is integrated with the FoH Policy and Decision-making and Mental Health themes (section 3). Research is focused on the development and evaluation of health policies with, within and for communities. Their AHP share of funding secured since 2001 totals £959K. At UCL Hartley secured over £1.2M.

Emphasis has been on identifying needs of disabled people and their families in income-poor countries to inform rehabilitation strategies. For example theoretical and Phase I studies have:
    developed the theoretical understanding needed to inform the policies and planning of services for people with communication disabilities (Hartley 1, Table 1 Categories EF);
    highlighted, through studies on the ‘treatment gap’ for children with epilepsy in Kenya (Hartley 2, Table 1 Categories BC), the importance of engaging with the service choices of families which will include traditional, educational, and religious as well as medical services;
    developed innovative methods of identifying blind children through the ‘Key Informant Method’ (KIM) in Bangladesh (Hartley 3);
    developed methodologies to examine comparative indicators of health inequalities in Brazilian and other populations (Drachler 2, 4, Table 1 Categories ABC);
    shown that approximately 50% of people seeking assistance from community based rehabilitation services in Uganda had a communication difficulty. This finding added more detail to the UNICEF estimate that 80% of people with a disability worldwide have no access to rehabilitation services (Hartley Afr J Special; Educational Needs 1998;13: 11-19), Table 1 Categories EF).

This body of work has:
    contributed to the WHO recommendation for the development of community-based rehabilitation (CBR) (Hartley 4, Table 1 Categories BCEF);
    supported evaluations of the effectiveness of health promotion interventions including oral health care, healthy eating and breast feeding with families in Brazil (Drachler 2-4, Table 1 Categories JL).

Research has also focused on:
    innovative studies which have conceptualised older peoples' understandings of communities’ social capital and health (Poland 4 in collaboration with Blaxter (Bristol ex UEA), Table 1 Categories BC);
    ongoing ESRC-funded studies of congruence in formal and informal support in dementia care which used findings from a previous DH HTA-funded, £643K RCT of the effectiveness and costs of befriending for carers of people with dementia (Poland 3, Table 1 Categories JKL);
    relationships between health and lifestyles, including community diet interventions with colleagues at the Institute of Food Research (Lambert, Scarpello, Rowe). This work has included a RCT of the effectiveness of an occupational therapy-led lifestyle treatment of panic disorder (Poland 2, Table 1 Categories K L - NHS research £35K with £183K research fellowship);
    a community-based RCT of occupational therapy (DH funded, £156K) which compared the clinical effects and cost effectiveness of initial assessment of older people. A key finding was that assessment by occupational therapists and social workers was comparable for outcomes for older people (Poland 1, in collaboration with Stewart, Table 1 Categories HIJ).

2.3     Education and Communication in Health Practice
Core members: Henwood (Category B), Horton, Richardson, Spalding, Stephenson. Also Bunning, McAllister (cross-referred to UoA58), Raschka (cross-referred to UoA58)

This Group is an integral part of the FoH Education and Learning and Evidence Based Practice research themes (section 3). Research focuses on identification of influences, including communication, on the development and attainment of practice-related knowledge and evaluating educational strategies which manipulate identified influences. Their AHP share of funding secured since 2001 totals £288K.

Key achievements since 2001 have been:
    identification of concepts of developing practice knowledge (Higgs, Richardson, Arbrant Dahlgren, Eds, 2004, Developing Practice Knowledge for Health Professionals. ISBN 07506 5429 5): Table 1 Categories ABC);
    recognition of variations in learning influences on the development of professional identity in a longitudinal cohort study of therapy students (Richardson 4 with the Karolinska Institute, Table 1 Categories DEF);
    production of the scientific foundation through preliminary studies for the £4.5M ESRC Timescapes Network from longitudinal studies (Henwood ESRC and NHS funded) of gender and identities underlying contraception and parenthood choices of younger adults;
    recognition of the influence of interactions, values and attitudes, on healthcare (Richardson 1, Table 1 Categories HI);
    identification of the effectiveness of self-reflective experiential learning for acquiring speech and language therapy skills (Horton 4, Table 1 Categories EFI);
    highlighting the impact of bilingualism on educational settings in the UK and in European and Asian societies (Raschka 1, 3, Table 1 Categories EF).

Ongoing research is:
    supporting the inclusion of different client groups in health care and education (Table 1 Categories CF) e.g. people with learning disabilities (Table 1 Category H) or communication difficulties (Table 1 Categories EFI) (Bunning 1-4, Horton 1,2);
    investigating the innovative use of information technology to help people with multiple and profound learning disabilities (Bunning, ESRC-funded UEA/UEL study: Table 1 Categories HIKL);
    beginning evaluation of empowerment of patients through the development of patient-centred pre-operative education (Spalding 2, 3, Table 1 Categories HI);
    exploring the identification, prevalence and listener perceptions of speech disfluency (McAllister 1,2,4, Table 1 Categories BCE).

3.    Research Environment: 2001-2007

AHP research at UEA has international standing as evidenced by the recent professorial appointments of Hartley in Communication and Health (2006) and Pomeroy in Neurorehabilitation, (2007). Vigorous AHP research capacity development has capitalised on the initiation and development of the FoH since the last RAE (2001) which has co-located AHP with two other Schools namely: Medicine, Health Policy and Practice; and Nursing and Midwifery. Consistent cross-School strengths have been further consolidated into FoH research themes:
• Chronic Disease and Rehabilitation;
• Evidence Based Practice;
• Mental Health;
• Education and Learning;
• Policy and Decision Making;
• Infection and Immunity.
This submission to UoA12 is one of six in RAE 2008 involving staff of the FoH at UEA.

3.1     Promoting, sustaining and developing a research culture
Strategic research direction and integration is provided by the FoH Research Committee chaired by the Associate Dean for Research (Harvey UoA 7) with membership including the University's Pro-Vice-Chancellor for Research and Knowledge Transfer and the research theme leaders.  This structure ensures convergence between Faculty and University research strategy, implementation and assessment, cross-pollinates research skills across the different professions in the FoH and has created innovative teams of researchers. Thus there is a coherent proactive research culture throughout the FoH. The FoH is part of a highly research-intensive campus University, actively drawing on the University’s membership of the Norwich Research Park, including the Institute of Food Research and the Norfolk and Norwich University Hospital Trust (NNUH). The close academic partnership with the NHS is evidenced by partnership boards, strong links with the local NHS R&D Consortium (East Norfolk and Waveney), joint appointments with the NHS (e.g. Chester) and the recently established Norfolk and Suffolk Comprehensive Local Research Network at the NNUH. Research Governance procedures ensure that ethical and NHS R&D approval is obtained for all appropriate studies before subject recruitment begins.

Across the FoH a culture of research success is supported by:
a. appointment of research leaders with 13 Chairs appointed including Hartley and Pomeroy in AHP and 2 internal promotions since 2001 (Table 2). A further 2 have been appointed to start in early 2008;
b. extensive investment in research facilities including:
    a £400K Stroke and Rehabilitation Research Laboratory (StaRLab, predominantly biomechanics and neurophysiology, 2007);
    a £100K communications laboratory to support communications research (2003);
    a £3.5M Clinical Research Trials Unit for clinical and health services research (2007);
    a £16.5M Biomedical Research Centre offering state-of-art facilities to support translational rehabilitation research (2005).
c. same-site access to appropriate expertise in methodology (quantitative and qualitative), statistics and health-related sciences;
d. five full-time technician posts (providing infrastructure) with further funding agreed for an additional (research) technician for the new StaRLab;
e. an integrated programme of research mentoring from lead FoH researchers;
f. specialist support from a Faculty Research Office (closely linked to the NHS Consortium Research Office) to seek external resources including those for research training and project development.

3.2     Development of AHP research environment since 2001
FoH research culture and strategic investment has enabled substantial growth and development in AHP research capacity since the 2001 RAE e.g:
a. Investing HEFCE Capability Funding (£152K p.a) in:
    key research appointments including four Readers (e.g. external appointment of Song -submitted to UoA7);
    supporting PhD students and Postdoctoral Fellows (section 3.2.2);
    Research Office support (section 3.1f).
b. Strengthening research leadership with UEA New Professorial Initiative Funding to appoint two new external Chairs: Hartley and Pomeroy.

In addition, early career researchers have been encouraged (e.g. Raschka). Table 2 summarises AHP research capacity development from 2001 to 2007.

Table 2. Summary of development of AHP research capacity since RAE 2001

  2001 2007 %Change
Number of Chairs* 0 2  
Number of Readers* 0 4  
Number of AHP academic staff with doctorates 2 22 1000%
Number of PGR students (Category A staff) 4 19 375%
Number of grant principal investigators* 5 19 280%

Note: * indicates cumulative, all other rows provide annual figures.

 

3.2.1     Research funding 2001-2007
Since 2001, external research-related grants involving AHP have been secured with a total value of over £3M (with a spend to date of £1.1M - see RA4), mostly in interdisciplinary collaborations with well-established research partners across the FoH and external institutions. In addition, whilst employed in other universities Hartley and Pomeroy each secured over £1.2M. Between 2001 and 2007, 19 AHP researchers have held grants as principal investigators. Sources of funding include: Wellcome Trust (Hartley, Pomeroy); ESRC (Bunning, Poland); Stroke Association (Pomeroy); Health Foundation (Pomeroy); DH (Cross, Hartley, Poland) and UNESCO and the Department of International Development (Hartley). As RA4 shows, research spend increased 64% between 2001/2 and 2005/6 and this was consolidated in 2006/7. Research spend is set to increase further with recently secured grants (e.g. splinting Dupuytren’s Disease 2007/10, MATREX trial 2005/9).

3.2.2     Research students 2001-2007
Recruitment and graduation of research students has increased from 2001-2007 with 312 recruited in total across the FoH 2001-2007, 34 of whom have been recruited to AHP equating to 26.75 FTEs in RA3b. Of these, 27 equating to 19.75 FTEs are PhD students supervised by Category A staff. The balance are Clinical Psychology Doctorate students, supervised by Category B staff. During the period, 32 research degrees were awarded, equating to 25.5 research degrees by submitted staff in RA3a. 11 of these are PhD awards, 14 are Clinical Psychology Doctorates and 0.5 is an MD. Clinical Psychology Doctoral students are required to submit a 40,000 word thesis for viva voce examination. Pomeroy, in partnership with St George’s University London (SGUL) and Keele University, has supervised 5 PhD students since 2001. Richardson has supervised a student in partnership with Karolinska Institute, Sweden.  All research students benefit from Transitions, UEA’s generic skills development programme for research postgraduates which complements and enhances subject-specific research skills training provided by the Schools and Faculties.

PGR studentship funding sources include:
a. UEA investment (7.25 full-time studentships);
b. AHP funds with NHS partner funding (three studentships with James Paget Hospital and Great Yarmouth Primary Care Trust);
c. HEFCE Capability together with charitable trust-funding (one PhD studentship);
d. Pomeroy’s ongoing partnership with St George’s and Southampton University has generated two studentships recently (Stroke Association and Dunhill Trust Fellowships);
e. international bursaries include three Iranian students (1.5 FTEs in RA3b) who graduated 2001-2005) and from 2005, two students from Thailand.

This funding profile illustrates the successful construction of research partnerships with NHS organisations and AHP dedication to enhancing research capacity.

3.3     Collaboration with other research groups and research user community
AHP Groups collaborate with other research groups and integrate with: the clinical and professional needs of therapists and health-promoting professionals, the organisations in which they work and the services they deliver. The majority of studies and trials have been developed in cooperation with members of the research user community including public health and social care services, voluntary groups, health professional special interest groups and PPIRES. Examples include:
a. Hartley:
• with Poland, user involvement in health and social care research, including community-based rehabilitation (CBR)-related links with Toronto and Cape Town Universities;
• directs the Community Based Rehabilitation Africa Network (CAN) generating research involving members from 25 countries and representatives from ILO, UNICEF and WHO (www.afri-can.org).

b. Pomeroy:
• initiated and led the first-ever UK Stroke Research Network Stroke Rehabilitation Translational Research Workshop to begin development of a basic/clinical science research programme;
• with Ward (UCL) and Hunter (Keele) secured funding for the first-ever prospective dose-finding study for a physical therapy intervention to enhance motor recovery after stroke.

c. Poland:
• with Harvey (UoA7), occupational therapy-led lifestyle treatment of panic disorder involved collaboration with Community Health Trusts;
• with Charlesworth (UCL), Mental Health Trusts and Primary Care Trusts, the NIHR-funded £2M UCL-led SHIELD programme to trial innovative forms of community support in dementia care.

d. Bunning and Horton:
• with CONNECT (a user-focused voluntary organisation), enabled close working links between academic, clinical and user groups in communication disabilities.

e. Drachler:
• with Action for ME (a user-focused voluntary organisation) enabling close working links between academic and user groups addressing the complex needs of people with chronic fatigue syndrome.

f. Richardson:
• with Karolinska Institute, Sweden, on the socialisation of therapy students and newly-qualified practitioners.

3.4     Policy to increase AHP research capacity and activity
The comprehensive policy provides specific support as appropriate for research active staff and a programme for developing research capacity and generating early career researchers. Activities include:
a. arranging research/teaching balance to allow staff weekly research time, with key researchers given more time;
b. giving study leave to meet research training needs identified as contributing to AHP Groups within the FoH Research themes (section 3);
c. supporting any staff without research degrees to gain research experience and, if appropriate, to register for a doctorate.

Through this policy we now have 22 AHP staff with doctorates (Table 2) with another PhD completion due in 2007. Three more are developing PhD study plans.

AHP early academic career development has been enabled through the above policy and:
a. new appointments of staff who have already been awarded their PhD;
b. the provision of 9 Lecturer/Practitioner posts as secondments from the NHS – including five with UEA investment.

4.    Impact of research

Examples of impact include:
a. immediate impact on healthcare policy and practice e.g.
    marked increase in coverage of CBR for African communities with Ugandan studies finding an increase from 2% in 2001 to 37% in 2006 (Hartley).
b. incorporation of findings from UEA AHP research into clinical guidelines e.g.:
    Royal College of Physicians National Clinical Guidelines for Stroke (Pomeroy).
c. contributions to the production of research-based Clinical Guidelines made by members of the Group e.g.
    International Society for Prosthetics and Orthotics Guidelines on the Orthotic Management of Stroke Patients (Pomeroy).
d. research-based contributions to key texts to inform practice e.g.
    an edited book series with Springer-Verlag for occupational therapists in German-speaking countries (Jerosch-Herold);
    textbook chapters on exploratory methodologies to explore therapist workplace culture and practices: ethnography in therapist professional development (Richardson) and a biographic-hermeneutic approach in mental health practice narratives (Poland, Finlay (Ed) 2006, Qualitative Research for Allied Health Professionals. Whurr. Publishing - now Wiley).

The Group’s research impact will increase as collaborations develop further and as definitive and pragmatic trials are undertaken (Table 1 Categories J-O). For example:
e. international multi-methods epidemiological and health services research into chronic fatigue syndrome, linking researchers (Brazil and UK) and clinicians (James Paget Hospital, Kelling Hospital). This team recently gained the largest amount of National Lottery-funding awarded for health research to date (Drachler);
f. the results of a recently-completed (Health Foundation-funded) definitive trial of functional strength training early after stroke will have a direct impact on clinical practice. The poster reporting this trial’s findings at the 2007 European Stroke Conference gained a distinction (Pomeroy).

5.     Research strategy 2008-2013
The key objectives of the research strategy (2008-2013) are:
a.
    to continue to build the evidence-base for rehabilitation through using the research framework (Table 1);
b.
    to continue strengthening Groups’ ability to address: a) national/international health research priorities including those identified by UK Research Councils, the NHS R&D Programme and EU Commission; and b) international health programmes especially those relating to multidisciplinary rehabilitation pathways.

It has two integrated components: undertaking high quality research within Research Groups (section 5.1) and reinforcing the research environment (section 5.2).

5.1     Strategy for research activity
Findings of preliminary studies, in progress and recently completed, will inform design of clinical trials (Table 1 Categories J to O). Funding will be sought from sources including the HTA Clinical Trials Programme, NIHR Programmes and Research Councils. Definitive study findings are expected to enhance impact on users of research (sections 3.3 and 4). Undertaking multi-centre clinical trials will further strengthen participation in the UKCRN networks (e.g. Pomeroy, section 6.3). Thus we plan to further raise quality and quantity of external funding by building on existing research partnerships.

5.1.1     Neuro-musculoskeletal Rehabilitation strategy
Two complementary strands will be:
a. undertaking trials of the effectiveness of well-characterised therapy shown to have proof of concept, be feasible in the clinical setting and have some indication of effectiveness (Table 1 Categories JKMN). A current example is Jerosch-Herold with a trial of the effects of post- surgical excision splinting in Dupuytren's Disease (see section 2.1);
b. developing translational stroke rehabilitation research by using the interventions being evaluated in clinical trials as probes to investigate the underlying bio-psycho mechanisms of natural and therapy-enhanced recovery alongside identification of prognostic bio-indicators of recovery (Table 1 Categories ABDE).

5.1.2     Health Communities strategy
Two important directions will be:
a. Governance in emerging health interventions. We will extend CBR research networks in Africa to Asia and Latin America (Hartley). Other practice changes already under study in the UK include user-centred health care and rehabilitation in forensic settings (Poland) (Table 1 Categories EFHI);
b. Individual and community enablement in health will, for example:
    build on Poland’s research into befriending for carers of people with dementia (already supported by ESRC funding and more recently, with NE London Mental Health Trust, £2M NIHR funding);
    undertake research synthesis to further develop PhD studies underway investigating complex interventions such as psycho-social rehabilitation (Hartley, Poland and Song (UoA 7));
    examine health inequalities and multi-professional service organisation in HIV/AIDS and Chronic Fatigue Syndrome (Drachler, Table 1 Categories D-IKL).

5.1.3     Education and Communication in Health Practice strategy
Research will focus on:
a. Changing working practices for client centred care through comparative studies of decision-making in practice and professional development (Richardson). Future work into the communication of scientific messages will use participatory mixed-methodological approaches developed by Hartley, Bunning and Horton to build on theoretical understanding of communication (Table 1 Categories EFHI);
b. The epistemology of practice programme will:
    undertake longitudinal international studies of influences on continuing professional development in therapists (Richardson, Table 1 Categories GHIKL);
    explore the practice potential of assistive technologies for users with profound learning and/or physical disabilities (Bunning and Horton);
    describe the SLT contribution to stroke rehabilitation building on Pomeroy’s development of physiotherapy treatment schedules and Hartley’s work on development of CBR (Bunning, Horton).

5.2     Reinforcing the research environment
The already-favourable research environment will be enhanced in 2008 by integration of current FoH themes (section 3) into three Research Institutes:
    Education in Health;
    Health and Social Sciences;
    Biomedical and Clinical Sciences.

These Institutes will further consolidate research strengths in AHP Groups of Neuro-musculoskeletal Rehabilitation (Biomedical and Clinical Sciences), Health Communities (Health and Social Sciences) and Education and Communication in Health Practice (Education in Health). Collaboration will be enhanced with researchers in the FoH-wide Medical Statistics, Health Economics and Clinical Trials Units. We will build on existing success in generating and undertaking research of national/international importance e.g.
    MATREX trial (HTA funded) investigating the effectiveness and cost utility of manual chest therapy in Chronic Obstructive Pulmonary Disease (Pomeroy, Cross, Harvey);
    clinical trial of the effects of post-surgical excision splinting in Dupuytren's Disease (Jerosch-Herold, Shepstone);
    clinical trial, BECCA, of the cost-effectiveness of befriending for carers of people with dementia (Poland, Reynolds, Mugford);
    investigation of effective communication strategies in professional undergraduate and postgraduate education, including inter-disciplinary education (Richardson, Leinster, Lindqvist).

In addition, investment in two new Chairs (Pomeroy, 2007, Potter, 2006) and stroke and rehabilitation research infrastructure (STaRLab, Research Technician, Research Assistant, 2007) has already resulted in a workpackage within a collaborative application to the EU to investigate continuity of care after stroke.

Each Group will continue to realise research strategy (sections 5.1.1-5.1.3) through existing policy (section 3.4). Expected funding growth will increase PhD completions, research active staff and post-doctoral researchers.

To enhance research leadership we will:
a. seek funds for further senior appointments to strengthen Research Groups. Areas for appointments over the next 5 years will be biomechanics/neurophysiology (Neuro-musculoskeletal Rehabilitation), community health policy (Health Communities) and communication in health settings (Education and Communication in Health Practice);
b. invest in career development for existing Senior Lecturers/Readers to prepare them for applying for a Chair within the next five years through:
    strategic leadership courses;
    initiation of external mentorship schemes (modelled on Academy of Medical Sciences mentorship programmes);
    seeking funding for placements with international research groups and international Visiting Professors to UEA.

6.     Key Esteem Indicators

6.1     Journal Editorships/National Clinical Guidelines/Grant Awarding Bodies
Examples:
    Hartley: (Editorial Board) Pro-Fono Brazil;
    Jerosch-Herold: (Editorial Board) British Journal of Hand Therapy;
    Pomeroy: (Associate Editor) Physiotherapy; Advances in Physiotherapy; International Society of Prosthetics and Orthotics Consensus Guidelines on Orthotic Management of Stroke Patients (2003); Stroke Association Research Awards Committee (2005-2008); Northern Ireland Recognised Research Groups Call (2005-6);
    Richardson: (Editor) Advances in Physiotherapy; (Associate Editor) Physiotherapy.

6.2     Invited presentations/keynote addresses at national and international conferences
Including:
    Hartley: Kyambogo University, Uganda (2005); International Centre for Rehabilitation Science, Toronto University, Canada (2006). University of Cape Town, South Africa (2007);
    Jerosch-Herold: Congresses of the European Federation of Societies for Hand Therapy (2002, 2004); Congress of Scandinavian Society for Surgery of the Hand, Copenhagen (2004) 2nd Three-Country Congress, Swiss, German and French Societies for Hand Therapy (2004);
    Poland: Health Development Agency conference on Social Capital and Health (2002); national colloquia and symposia on qualitative and collaborative research with communities (2003, 2006);
    Pomeroy: Dutch Royal Society of Physiotherapy Congress (2003); European Geriatric Medicine Conference (2003); 12th Mic Ostyn Guest Lecturer Univ Leuven Belgium (2002); European Congress of Physical and Rehabilitation Medicine (2002);
    Richardson: European Congress of Physiotherapy Education, 2004. Chair of the 2003 Symposium on Qualitative Research at the 14th Congress of World Federation Physical Therapists, Barcelona. Panel on ethics in research (WCPT 15th).

6.3     National/International Research Strategy and Public Service
AHP staff serve on the Boards of over 40 national/international organisations, including:
    Hartley: Adviser to the World Health Organisation (WHO) on Disability and Rehabilitation; WHO panel on International Guidelines in CBR; Co-Editor of WHO World Report on Disability and Rehabilitation; Honorary Senior Lecturer in Disability at Kyambogo University, Uganda;
    Pomeroy: initiated and led 1st UK Stroke Rehabilitation Translational Research Workshop for the UKSRN (March 2007); UKCRN Experimental Medicine Working Group (2007); EU Framework 7 Developmental Workshop on robotics in stroke rehabilitation (2007); International Neuroimaging and Stroke Recovery Group (2004, 2005, 2006); Academy Medical Sciences Report on Neurorehabilitation (2004); Advisor to MRC Strategy Development Group (2002-2004);
    Poland: National Committee for Association for Research in the Voluntary and Community Sector; Home Office Active Communities Unit evaluator of commissioned research on befriending and mentoring;
    Richardson: the first Foreign adjunct Professor of Physiotherapy at the Karolinska Institute, Sweden.