Health and Community Research Showcase

This one day celebration and cultivation of the world-class and leading health research taking place across the University was showcased through lectures, and delivered through interactive workshops and networking sessions.

Lead researchers provided an insight into the vast portfolio through six key morning lectures. 

These included eye and vision sciences; developing complex interventions in justice health; rehabilitation and neurological research; creative and participatory approaches, such as using food-based events in working with vulnerable groups; and the use of technology in improving both health and social care, and global health research.

A facilitated workshop fostered the promotion of future cross- and interdisciplinary research projects amongst researchers from all areas of the University.

An evening session followed, in which key stakeholders were invited from the NIHR, CRN, NHS to join us for a keynote lecture followed by a showcase of the breadth of NIHR sponsored clinical research at the University of Plymouth undertaken by all levels of healthcare professionals.

Abstracts

Eye and vision research in Plymouth: from lab to clinic, and back

Professor Paul Artes

Researchers in the Eye and Vision group work on a large spectrum of issues, from fundamental question to clinically applied problems. With a health system that is stretched to breaking point, there is a need to re-think where how we can best care for patients with eye problems, many of which are chronic. Much of our research is just about that – from the design of better vision tests to the prevention of myopia. Most of our research is highly interdisciplinary, and there are many opportunities for collaboration. The aim of this talk is to showcase some of these opportunities, and to help make them happen.

Developing complex interventions in justice health: what you can achieve with time and a wide range of dedicated people

• Dr Cath Quinn, Dr Lynne Callaghan and Tom Thompson
  

In developing complex interventions we have to take into account the complexity of the people we are working with and the systems that they, and we, are operating within. Justice involved populations can have a range of health and social needs which often do not fit within the systems of main stream services. Services, particularly health and justice, can be operating within different systems which present barriers to working together to meet the needs of an individual in an integrated and person centred way. 

We will demonstrate how, over time, we have developed a series of research projects which have begun to address the health needs of justice involved populations. We will highlight the time, resources and range of skills that have been required and give illustrative examples of who was involved, the challenges faced and how it feels to finally see improved care being delivered to real people. We will also showcase the crucial importance of involving people with lived experience of the topic of interest not only to comment on your work, but to critique, challenge and potentially disrupt it.

Working together to develop capacity and capability for research, innovation and evidence-based practice in NHS Trusts: the clinical school model

• Professor Ruth Endacott (Director, University of Plymouth Clinical School and Professor of Critical Care Nursing, Monash University, Melbourne) and Frazer Underwood’s (Consultant Nurse – Older People/Associate Chief Nurse Honorary Clinical Fellow, University of Plymouth)

Nurses and midwives are creative problem solvers, developing ways of changing healthcare practice from the smallest detail of care to whole new healthcare models. However, our work with local health services has identified the urgent need to (i) capture improvements in patient and family outcomes, (ii) ensure that existing evidence is used to best effect and (iii) increase the amount of nursing and midwifery led research. 

We have sought to address this, in partnership with local health services, by establishing Clinical Schools, which are Professorial-led centres, in five of our local NHS Trusts. In this presentation we will illustrate how the clinical schools are engaging with nurses, midwives and allied health professionals to challenge current thinking, try out new ideas and develop a growing academic portfolio of work involving patients and focusing on improving care and patient outcomes. We will provide examples of local, national and international initiatives led by the clinical schools.

Rehabilitation research: from lab to community and back

• Professor Jenny Freeman and Professor Jon Marsden 
  

This session will provide a taster of the research we undertake within the Rehabilitation Research Group. This group, which is sited within the Institute of Health and Community, involves multi-professional researchers at a local, national and international level. It embraces research, across the breadth of the translational spectrum, from investigating the underlying mechanisms of disability to clinical trials and evaluation of service delivery. Our research draws on expertise in the areas of pathophysiology, behavioural science and the design and evaluation of complex health care interventions. This breadth of research is achieved by our resolve to ensure that it is collaborative at its heart, and takes a ground up approach informed by the views of patients and clinicians. This enables it to extend from the laboratory to the community and back. We will provide examples of work from across this spectrum, demonstrating how we work to ensure our research has impact on clinical practice and the broader community.

Creative and collaborative approaches to research

• Dr Julie Parsons and Dr Clare Pettinger
  

Over the last four years, Dr Clare Pettinger and Dr Julie Parsons have worked both collaboratively and individually on research projects that have drawn upon creative/arts-based and participatory approaches to working with vulnerable and/or marginalised groups. This includes the Plymouth-based ESRC Festival of Social Science participatory food events (annually run 2015-17), and more recently a research residential at Girton College, Cambridge University, funded by the Independent Social Research Foundation (ISRF) in August 2017, entitled 'Mapping the transformative potential of participatory styles of research with vulnerable and/or marginalised groups'*. 

The former involved capturing data using creative methods during participatory food events with harder to reach service users**. The focus of the latter was an exploration of creative/arts-based and ‘participatory’ approaches to research (not to be confused with ‘participatory action research’ PAR), in the context of a resurgence in interest in participatory approaches, particularly in health research, partly motivated by an explicit requirement by funding bodies (in the UK at least) for public and patient involvement (PPI). In this presentation, we reflect upon the benefits of developing collaborative rather than participatory approaches, that draws upon creative/arts-based methods that emphasises the importance of democracy, equality, flexibility and reflexivity. We refer to research that makes use of photo-dialogue, photo-elicitation, collage, ‘zine’ making, music, song-writing and i-poems.

* https://collaborations-in-research.org/

** https://issuu.com/issrplymuni/docs/falm__3_

The past, present and future of digital healthcare research

• Professor Ray Jones and Dr Arunangsu Chatterjee 
  

This will be a presentation on the eHealth Productivity and Innovation in Cornwall and the Isles of Scilly project. The eHealth and Technology research group is focused on the impact and implementation of eHealth, on patients' use of the internet, and online collaborative learning between patients and professionals.

NIHR Abstracts

Investigating the prevalence of anxiety and depression in people living with patellofemoral pain in the UK

James Wride, Specialist Musculoskeletal Physiotherapist, Royal Devon and Exeter NHS Foundation Trust

Background: Patellofemoral pain is a common knee condition causing pain around or behind the kneecap which is exacerbated by certain activities. It is commonly found in younger and more active people. Traditionally it has been viewed as a self-limiting condition. Recent research proves this is not the case. In many other conditions, it has been shown that anxiety and depression negatively affect both the treatability, and duration of, conditions. It is unclear how prevalent anxiety and depression are in patellofemoral pain. 

AIM: To identify the prevalence of anxiety and depression in people experiencing patellofemoral pain in the UK.

Design and methods: A cross-sectional online survey design was utilised. Four hundred participants with self-reported symptoms of patellofemoral pain, based on accepted criteria, were recruited from a wide variety of online sources. The survey recorded demographic information, the Hospital Anxiety and Depression Scale and the Anterior Knee Pain Scale. 

Results: Half (49.5%; n=198) of respondents were classified as experiencing anxiety and 20.8% (n=83) as experiencing depression. A small statistically significant negative correlation was found between increased severity of patellofemoral symptoms and increased levels of anxiety and depression. 

Conclusions: Anxiety and depression are more common in people living with patellofemoral pain than the general population. The study suggests a link between increased symptoms and more severe psychological symptoms, but no causal link can be drawn. This is the first study to investigate this in the UK and highlights the need for further investigation to determine if anxiety and depression affects treatment outcomes in patellofemoral pain.

Biography: James is a Specialist Musculoskeletal Physiotherapist working for the Royal Devon and Exeter NHS Foundation Trust. He has a special interest in lower limb injuries and rehabilitation, with an interest in patellofemoral pain. He is an NIHR trainee having recently completed a funded Masters in Clinical Research at the University of Plymouth. James’ research focuses on the psychological aspects of musculoskeletal conditions and how these can affect treatment outcomes and quality of life. 

INSTEP - Insoles to Ease Pressure

Richard Collings, NIHR Clinical Doctoral Researcher, University of Plymouth

Background: As a common long-term complication, diabetic foot disease is associated with impaired quality of life, high direct and indirect treatment costs and high rates of mortality. Reducing plantar foot pressures is one crucial aspect of optimising healing potential and preventing foot ulceration, particularly in neuropathic feet absent of protective sensation, where plantar loads and tissue stress are increased. Therapeutic footwear and insoles are utilised to reduce plantar pressures. However, their effectiveness is variable and often evaluated by the high risk strategy of observing foot health and tissue integrity over time with frequent service provision and manufacturing delays. 

Research design and methods: A mixed methods feasibility double-blinded multicentre randomised controlled trial with subjects randomised to wear either an insole designed by in-shoe plantar pressure measurement technology (n=38) or a standard cushioned insole (n=38) over 3 sites (Torbay, Exeter, Solent). 

Benefits: The results of this study will inform the design of a large scale multi-centred RCT to examine the clinical and cost effectiveness of the in-shoe pressure analysis designed insole. It will aim to provide an innovative service to the diabetic population in an attempt reduce the incidence of ulcer occurrence/re-occurrence making significant savings, both financial and in quality of life for patients and the NHS. It will provide a reliable model that can be utilised by other foot protection services within the national arena.

Biography: Graduating from the University of Plymouth in 2007 with a BSc (Hons) Podiatry, Richard undertook an MSc in Clinical Podiatric Biomechanics in 2013 at Stafford University. Richard started his PhD in April 2016 with a prestigious NIHR Clinical Doctoral Fellowship. His research is looking at incorporating an instant insole solution into NHS practice for ulcer prevention in people with diabetes. He currently works part-time on his PhD and part time in the NHS in his role as a Team Lead Podiatrist, specialising in Musculoskeletal disorders. Richard has been a member of the Balance Enhancement and Ulcer Prevention (BEUP) collaborative for the last four years and as part of the Rehabilitation team for the School for Health Professions.

The HAPPI study: Developing and testing a Nurse lead intervention for older people with frailty

Helen Lyndon, Nurse Consultant Older People/ NIHR Clinical Academic Doctoral Research Fellow, University of Plymouth

AIM: This mixed methods feasibility study aims to develop, implement and test a nurse-led Holistic Assessment and care Planning in Partnership Intervention (HAPPI) and to determine important parameters for the design of a definitive randomised controlled trial (RCT).

Design methods: The study has three work packages.

WP1: A three-round Delphi study will gain consensus from an expert stakeholder group on the components of the intervention and existing skills and knowledge deficits. Using this data, the components will be mapped to patient needs using the best available evidence to ascertain those which may be feasible in terms of clinical outcomes. A procedure guide for the intervention will be developed with an accompanying training package. The procedure guide will be tested for practicability in clinical practice and further refined by a stakeholder group.

WP 2: A feasibility cluster RCT will be conducted to gather process, resource, management and scientific data to inform the design of a future definitive trial. The proposed outcome measures will be related to adverse effects of frailty, which have been confirmed by PPI consultations and the literature. Outcomes will be measured at baseline, 6 and 12 months.

WP3: An embedded qualitative study will explore experiences of patients and carers who participated in the study and nurses carrying out the intervention. This will identify methodological issues such as recruitment and retention and any enablers and barriers which may impede the definitive RCT.

Biography: Helen has worked as a district nurse, nurse leader, community matron, nurse practitioner and nurse consultant in primary/community care settings. She set up services for older people in the Cornwall including Hospital-at-Home, Community Matrons and Telehealth. In 2016 she completed a two-year secondment to NHS England as Clinical Lead for Frailty. In April 2017, Helen was awarded a NIHR/HEE Clinical Academic Doctoral Research Fellowship. Helen’s PhD study with the University of Plymouth aims to develop and test an assessment and care planning intervention for frail older in primary care.

Keynote speaker biography

Professor Anne-Maree Keenan BAppSc (Pod), MAppSc, PhD, FFPM RCPS (Glasg)

Anne-Maree left Sydney and moved to Leeds in 2002 where she was employed as a Research Fellow in the Academic Unit of Rheumatology at the University of Leeds. 

Anne-Maree leads a successful portfolio of musculoskeletal research with a focus on foot pain and osteoarthritis. 

Anne-Maree is the Training Lead for the BRC and Deputy Chair for the NIHR Infrastructure Training Forum which oversee medical, clinical and non-clinical research training across the NIHR Infrastructure. 

Anne-Maree is the Lead Advocate for Podiatry for NIHR and co-founder of the Leeds Female Leaders Network.

Biographies

Professor Paul Artes

Paul Artes is Professor of Eye and Vision Sciences at the University of Plymouth. Having qualified as an optometrist in 1997 (Bradford University, Manchester Royal Eye Hospital) he completed a PhD (University of Manchester, 2001) and a two-year postdoctoral fellowship (Dalhousie University, Halifax, Nova Scotia, Canada, 2003). He has held faculty positions at Dalhousie and at Manchester University, and visiting positions at SUNY (USA) and Lausanne (Switzerland). His work focuses mainly on glaucoma and the visual field, but he also has a deep interest in how clinicians use tests to monitor patients with chronic eye diseases.

Dr Cath Quinn

Dr Cath Quinn is a Senior Research Fellow within the Community and Primary Care Research Group at the University of Plymouth Faculty of of Medicine and Dentistry. Cath has recently taken over the leadership of the Developing and Evaluating Complex Interventions (DEIC) group in the Institute of Health and Community (IHC). She is primarily interested in the mental health and wellbeing of socially marginalised groups, particularly justice involved populations. She uses her qualitative methodological skills to add value and understanding to intervention development and process evaluations of complex intervention trials. Current projects include: ‘Engager’ which is developing and evaluating a collaborative care intervention for offenders with common mental health problems, near to and after release; and ‘STRENGTHEN’ which is improving health for those under community supervision, with the support of a Health Trainer. Cath is also a National Institute for Health Research (NIHR) Programme Grants for Applied Research (PGfAR) qualitative methodologist panel member and an Associate Editor for the journal Pilot and Feasibility Studies.

Dr Lynne Callaghan

Dr Lynne Callaghan is a Senior Research Fellow at the University of Plymouth Faculty of Medicine and Dentistry working on a number of projects in the interface of health/mental health and criminal justice services as well as domestic and sexual violence. Her current projects include a pilot randomised controlled trial of a health trainer intervention for men and women under community supervision (Strengthen), and the development of an integrated service for individuals with mental health needs who come into contact with the police. Lynne also worked on the Engager 2 intervention for men with common mental health problems toward the end of their sentences, through the gate and into the community during the pilot trial, both as a researcher and intervention practitioner. Lynne has a particular interest in the early diversion of individuals with mental health needs from the criminal justice system and has worked on both a case-linkage study to examine police/mental health service inter-agency management and an evaluation of a street triage intervention for people in mental health crisis.

Tom Thompson

Tom Thompson is a Research Fellow at the University of Plymouth Faculty of Medicine and Dentistry working across a range of projects focused on complex health behaviour change interventions. He is currently the Principal Investigator for a large NIHR Research for Patient Benefit funded mixed methods systematic review of physical activity and the prevention, reduction, and treatment of alcohol and substance use. He also has broad experience delivering, designing, and evaluating motivational interventions to address health behaviours with marginalised groups. He is currently the intervention lead on a multi-centre Trial of physical Activity assisted Reduction of Smoking (TARS) and for a pilot randomised controlled trial of a health trainer led intervention for men and women under community supervision (STRENGTHEN). Within STRENGTHEN, Tom led the intervention development to work with the complex needs of the target population and services they interact with, and supervises a team of practitioners who deliver the intervention across Plymouth and Manchester.

Frazer Underwood

Frazer Underwood holds the position, at Royal Cornwall Hospital NHS Trust, of Consultant Nurse for Older People and is Associate Chief Nurse. He has passionately progressed a clinical nursing and academic career in rehabilitation nursing and older peoples care. His current role balances a clinical commitment to new inpatient frailty assessment and support services in the trust, alongside a range of senior corporate leadership roles that includes: leading the trust’s patient and family experience team; he is clinical and strategic lead for dementia care at the trust; and he heads up the progressive work of the trust’s Clinical School programme in partnership with the University's School of Nursing and Midwifery.

Frazer has an honorary appointment as Clinical Fellow with the University of Plymouth and following a regional academic internship award, he is now a PhD candidate studying part time with the University. His research is exploring the meaning and understanding of ‘confidence’ in older people living with frailty and the implications for practice. Frazer is currently joint vice-chair of the British Geriatric Society’s Nurses and Allied Health Professionals Council.

Professor Jenny Freeman

Jenny Freeman is a Professor in Physiotherapy and Rehabilitation within the Faculty of Health and Human Sciences at the University of Plymouth. Her research programme in MS centres on the development and evaluation of complex rehabilitation interventions; reflecting the priority given by health services to providing evidence-based management. A key focus is on the rehabilitation of impaired mobility and balance. Her research is grounded on her longstanding clinical expertise in neurological physiotherapy, for which she has an ongoing clinical commitment.

Dr Julie Parsons

Julie Parsons is an Associate Professor in Sociology. She has recently completed an Independent Social Research Foundation (ISRF) mid-career fellowship, working on a Photographic electronic Narrative (PeN) project with trainees on placement at a ‘prisoner’ resettlement scheme. This followed a Sociology of Health and Illness (SHI) Foundation Mildred Blaxter post-doctoral fellowship, exploring commensality. Her book Gender, Class and Food, Families, Bodies and Health (Palgrave MacMillan 2015), was shortlisted for the Foundation of Health and Illness (FHI) book prize in 2016. She is convener of the British Sociological Association (BSA) Food Study Group and member of the BSA Auto/Biography study group.

Dr Clare Pettinger

Dr Clare Pettinger RD RNutr (Public Health) is a lecturer in Public Health Dietetics in the School of Health Professionals, University of Plymouth. Her current research includes the use of creative participatory methods to address food poverty/justice and issues of social sustainability. The 'Food as a Lifestyle Motivator' (FLM) project has gained momentum (originally funded by ISSR/IHC but has more recently received funding via a British Academy/Leverhulme small grant). The project has included three successful ESRC Festival of Social Science events in (Nov 2015, 2016 and 2017) and has recently produced a short ‘media impact piece’ at the Totnes Transition Town Film festival. Creative collaboration and public engagement are core aspects to the FLM project as it moves forward – this will be showcased at the research event.

Research team: Drs Clare Pettinger, Julie Parsons, Lyndsey Withers and Richard Ayres; Ms Carole Sutton; Mr Andrew Whiteford, Miranda Cunningham; (Gia Daprano) Lin Adams; and Professor Gayle Letherby.

Professor Ray Jones

Ray Jones has been Professor of Health Informatics at the University of Plymouth since 2002, previously being Senior Lecturer in Public Health at Glasgow University. He leads a programme of research focused mainly on the implementation and evaluation of eHealth. In particular, he currently leads a £2.7m three-year project called eHealth Productivity and Innovation in Cornwall and the Isles of Scilly.

He has run and taught a Masters in Health Informatics, research methods in a Masters in Public Health, taught digital professionalism to undergraduate nurses, and supervised many PhDs. He comes from a background of public health (elected as Fellow of Faculty of Public Health in 2001) and informatics (his PhD in 1984 was the development and evaluation of a clinical information system for diabetes). Other current projects include care robots for older people, work with care homes using video calls, studies of how to address e-health inequalities, and tailored information for women with breast cancer.

Dr Arunangsu Chatterjee

Arunangsu Chatterjee is an Associate Professor in the Peninsula Schools of Medicine and Dentistry (PU PSMD). He is the Director for Technology Enhanced Learning & Distance Learning within PU PSMD, provides strategic leadership for the provision of evidence-based, innovative and effective TEL to Medical and Dental (clinical) education programmes. He leads the research theme of Games and Simulation in PedRIO. He is a Co-PI with Professor Ray Jones in the £2.7m three-year project called eHealth Productivity and Innovation in Cornwall and the Isles of Scilly and increasingly developing a programme of research focused mainly on the implementation and evaluation of eHealth. He is a core member of the Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA) research group and steering group member of the Global Health Collaborative. He has run and taught a Masters in Health Informatics, research methods, taught research ethics to undergraduate clinical cohorts, and supervising number of PhDs.