Adulthood

Plymouth Institute of Health and Care Research (PIHR) undertake extensive research on health risk factors, including obesity, alcohol misuse, smoking, lack of exercise and poor mental health. We have developed and evaluated physical activity interventions with randomised control trials for a range of conditions including obesity, hypertension, type two diabetes, falls prevention, COPD, alcohol misuse, depression and nicotine addiction. 

We work with very vulnerable populations, including offenders under community supervision, people with bi-polar disorder, people experiencing homelessness and disadvantaged people experiencing issues such as poor dental health; and excel in the evaluation of community-based interventions. 

With respect to the management of adult chronic disease, highlights of our research include diabetic foot protection, the detection, assessment and management of Parkinson’s disease, stroke rehabilitation and avoiding avoidable hospital admissions. We have been at the forefront of efforts to improve the recognition of obesity as an important and treatable clinical problem.

Health risk factors

Our public health cross-cutting theme brings together researchers, clinicians, practitioners and expertise in systematic reviews, epidemiological studies, the design and evaluation of complex interventions and service evaluation to deliver improved health and social care for patient and public benefit.

One strand of this focuses on Health and behaviour change (led by Adrian Taylor) and includes NIHR-funded trials such as e-coachER, a web-based coaching/exercise referral scheme for patients with chronic physical and mental health conditions; TARS, a trial to assess the effectiveness of new physical activity support to help smokers who want to reduce but not quit; and Strengthen which aims to improve health for those under community supervision, with the support of a Health Trainer. Taylor co-founded and is Editor in Chief of Mental Health & Physical Activity, in international and multi-disciplinary journal in this field.  

Pinkney leads a large programme of obesity research, including the origins of weight gain and obesity, impact on health, diabetes, development of effective prevention strategies and treatment interventions. Trials in this area include PROGROUP (ImPROving GROUP treatment for people with severe obesity) (Pinkney, Swancutt), an NIHR funded, multicentre national study. 

Lloyd and Pinkney have used personal narratives of obesity to elevate the views of service users and explore the relationship between subjective illness models and motivation to engage in treatment in people referred to tier three weight management services.

Our Hepatology research group explores the implications of alcohol misuse (Dhanda), obesity (Sheridan) and viral hepatitis (Cramp) for liver health. Other areas of expertise with respect to health risk factors include respiratory health (Rupert Jones), with research on exposure to particulate pollution, especially in the developing World; and oral health inequality and public health promotion (Nasser, Thompson, Witton, Paisi).

Cancer

As well as investigating the underlying mechanisms by which cancers are initiated and propagate (Frontiers in Discovery Science), our researchers are involved in the development of new approaches for the early diagnosis, screening, treatment and prevention of a variety of cancers and understanding the impact and effectiveness of frontline treatments on practice.

Highlights include the identification of biomarkers which will help predict patient response to treatment (Hanemann, Hutchinson); novel therapeutics for lymphoma (Hutchinson); and the prevention and treatment of oral and skin cancers (Bing Hu).

Diabetes

In addition to our Earlybird research, which identifies childhood and adolescent risk factors for adult diabetes, we have a strong focus on the impact of obesity on people with diabetes and other endocrine conditions, and developing new approaches to treatment (Pinkney).

Research supporting the evidence based management of people with diabetes is an important focus of the Rehabilitation Research Group. The Balance Enhancement and Ulcer Prevention (BEUP) group is an academic/NHS multidisciplinary collaboration, which aims to translate the results from our published research to influence and inform everyday clinical practice with respect to diabetes and neuropathy.

Applying specialist knowledge of diabetic foot self-care and education and ulcer prevention and management with focus onfoot pressure analysis, orthotic design and balance problems the team is developing and testing a battery of interventions to make walking safer for people with diabetes.

Highlights in applied research include an automated 3D-printed insole, a novel balance enhancement insole and a clinical trial testing pressure data guided insoles (Paton, Marsden, Collings).

Mental health and wellbeing

Led by Richard Byng, the Mental Health Group is researching mental health in a range of community-based settings.

Recent project include Partners 2, an NIHR funded Programme aiming to help primary care and community based mental health services work more closely together by developing a system of collaborative care based in GP surgeries for people with schizophrenia and bipolar disorder; and Engager which developed ways of organising care for men with common mental health problems as they approached being released from prison (Byng, Callaghan, Quinn, Rybczynska-Bunt).

The group has been working alongside key stakeholders to shape and define services to better fit the needs of ex-offenders, such as Street Triage and the Neighbourhood Liaison and Diversion intervention, services that aim to divert people away from the Criminal Justice System (Callaghan, Hazeldine).

Mental health problems often include and/or are exacerbated by problems of substance use. Work in this area include PHASED, a study examining research on physical activity in relation to alcohol and substance use disorders (Thompson) and Flourish in Nature, a project supporting alcohol and drug use recovery through volunteer opportunities in natural environments (Thompson).

Lloyd and Close are also investigating the role of online gaming and gambling behaviours and the impact of these on wellbeing the UK adult population. This work has also included a targeted ‘lock down’ survey to measure the impact of COVID-19 restrictions on this behaviour.

Andrade is testing the use of Functional imagery training to reduce alcohol-related harm; while ongoing research takes place across the faculty into new and inventive forms of psychological intervention to target mental health difficulties (Whalley, Sharpe, Lloyd, Norman).

Metabolic Health

Dysfunctional metabolism is associated with medical disorders across the life course. Nutrition and lifestyle establish an appropriate energy balance that is crucial for metabolic health. When this energy balance is disturbed, chronic diseases may arise that affect people from cradle to grave (Pinkney, Hosking, Sheridan). Patients with acute critical illnesses are affected too, as metabolic health correlates directly with disease prognosis (Martin).

Our current work in these areas falls under a broad Metabolic Health Research umbrella that also covers nutrition (Rees, Redfern), diet (Hickson, Bescos) and exercise (Breese). Crossing the boundary to Frontiers in Discovery Science, our clinical and physiological work informs, and is informed by, fundamental research into the biochemical basis of metabolic and other diseases (Affourtit, Carré).


Multiple sclerosis

We host internationally renowned research in the field of MS. Hobart has led several clinical studies/trials into the assessment and treatment of MS and the design, testing and validation of patient outcome scales for clinical application. The MS scales are among a limited number contained in the United States Food and Drugs Administration (FDA) compendium of Clinical Outcomes Assessments.

Combining pathophysiology, behavioural science and health care practice, our Rehabilitation Research Group also conducts a range of research on MS.

Trials evaluating the effectiveness of whole-care packages and targeted interventions include Standing Up in Multiple Sclerosis, a multi-centre randomised controlled study to assess the effectiveness of a home-based self-management standing frame programme in people with progressive MS (Freeman) and Balance Right in Multiple Sclerosis (BRiMS), a guided self-management programme to reduce falls and improve quality of life, balance and mobility (Gunn, Freeman).

Gunn has investigated risk factors associated with falls in people with MS and co-developed a falls management intervention (Endacott, Marsden, Freeman); while Grose has explored the confidante relationship in people with MS.

Long-term health conditions

Bacon and Hyland have conducted extensive studies looking at the long term physical and psychosocial impact of fibromyalgia, while Norman has looked at psychosocial functioning in those with pituitary conditions and adults with a range of visible differences. This work has included the development of an online intervention to address the appearance-related psychosocial impact of living with visible difference.

More recent studies have looked at the health-related impact of COVID-19 and its impact on overall mental health among a range of individuals with existing long-term health conditions (Bacon).

Lloyd is working with the University of Gothenburg in a European wide project to develop the knowledge base and partner network to enhance person centred care for people with long-term conditions (SELFIE, SUSTAIN, COST CARES). This has involved the development of measures and implementation tools that have been adopted internationally and across Europe and translated into more than six different languages. Lloyd and Close are also working with Swedish colleagues (Dencker, Roselund; GPCC) to develop the first computer adapted test to measure peoples’ experiences of person centred long-term condition care.