NMAHP Research Unit ebulletin Sep/Oct 2016
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INDEXing complex intervention development:

Unit seeks experienced researcher

INDEX logoAsthma action plans, pelvic floor muscle training, and a pre-hospital sepsis screening tool are just a few of the complex interventions researched by Unit staff. They are 'interventions' because they are used in a deliberate effort to make a difference to people's lives, and they are 'complex' because they have many interacting parts that work for different people in different ways. The importance of developing interventions well is increasingly recognised, with Pilot and Feasibility Studies (a sister journal to Trials) initiating a special series to encourage reporting, edited by the Unit's Pat Hoddinott. Our new INDEX (IdeNtifying and critiquing different approaches to Developing complEX interventions) study team will investigate the many ways researchers have gone about developing complex interventions, and use this knowledge to produce comprehensive guidance. We are looking for an experienced qualitative researcher to join this exciting project (closing date for applications 18th October).

The INDEX study is led by Alicia O'Cathain at ScHARR, University of Sheffield, with Pat and Eddie Duncan from the Unit as co-investigators, along with colleagues from the Universities of Bristol and Southampton. Pat explains, "Careful development and evaluation of complex interventions is crucial if we are to avoid wasting time and money on trials of interventions which are flawed or would never work in the real world. Up-to-date guidance will help researchers and funders improve their practice and decision making based on the best available evidence."

INDEX is funded by the Medical Research Council which last published a framework for developing complex interventions in 2008. The study has three stages, starting with a methodological review of approaches to intervention development in health, education and social research. This will be followed by a qualitative intervention study - led by University of Stirling - with people who have been involved in intervention development, and a consensus phase to identify core aspects of intervention development and inform implementation of the guidance.

In looking forward to the new Research Fellow joining the Unit team, Eddie says, "The successful applicant will be involved in developing and undertaking the qualitative part of the study, synthesising data, and conducting an eDelphi consensus study. Their disciplinary background is less important to us than their experience, personal qualities, and open-minded approach to research, and both Pat and I welcome informal enquiries." More information is available here until the closing date of 18th October.

Cochrane stroke database:

Unit reviews 'most accessed' of 2015

Alex PollockA systematic review is a way to summarise the best available research evidence on effectiveness of healthcare interventions for patients, family members and healthcare professionals. As the leading resource for systematic reviews in healthcare, high standards are expected of contributors to the Cochrane Database of Systematic Reviews. We were therefore delighted to hear that, in the field of stroke, the top three most accessed Cochrane reviews of 2015 were led by Unit researchers. These reviews of interventions to improve arm function, mobility and communication also made it into the top 50 most cited Cochrane reviews from the whole Cochrane Library, which has over 17,000 reviews. Reacting to the news, the Unit’s Alex Pollock (pictured) said, “We are all motivated by a passion for improving the lives of people who have had a stroke. The access statistics for these reviews suggests that our efforts to identify best evidence are informing the practice of rehabilitation professionals including occupational, physio and speech and language therapists.”

Alex, Sybil Farmer and Marian Brady led the overview ‘Interventions for improving upper limb function after stroke’. By identifying more than 74 systematic reviews useful to clinicians and policy makers, they provided one accessible, comprehensive document to support decision making. However, they noted that the evidence for interventions used routinely in practice is insufficient, and that more than half of people with impairments to their arm following a stroke still have problems many months or years later. This means there is an urgent need for high quality research of the most promising interventions. 

Alex was again involved with the second most accessed stroke review ‘Physical rehabilitation approaches for the recovery of function and mobility following stroke’, with colleagues this time including Pauline Campbell and Jacqui Morris. Their review suggested that physiotherapy which comprises well-chosen components from different approaches selected to suit an individual patient is more effective than physiotherapy confined to a single, named approach. 

Marian led the third most accessed stroke review, ‘Speech and language therapy for aphasia following stroke’, with Pauline also lending her expertise. This review concluded that speech and language therapy is effective compared with no therapy for improving communication, reading, writing and expressive language in people with aphasia, and that, for people in the early months after stroke, more therapy over a shorter period may be more beneficial than less intensive models. 

Unit staff have amassed considerable experience in reviewing complex rehabilitation interventions, and are making methodological advances (such as the MASK project with the University of Edinburgh). As a consequence, Alex and Cochrane co-authors at Glasgow Caledonian University are in discussion with the International Journal of Stroke about a paper on systematic reviews. Alex has also just attended, by invitation, an exploratory meeting in Italy relating to a proposed new Cochrane field focused on rehabilitation reviews. Hosted by the University of Brescia, it was attended by international experts in evidence based rehabilitation from 19 countries.

Joining perinatal mental health dots:

Call for action for mothers, babies and families

Helen CheyneAlthough maternal and infant mental health is a policy priority in Scotland, women with the most severe perinatal mental health disorders and their babies do not have equitable access to inpatient facilities where, together, they can get the help they need. The Unit’s Helen Cheyne (pictured) and Margaret Maxwell joined forces with a range of experts in perinatal and infant mental health to call for government action on this and other inadequate, fragmented and inequitable mental health services for mothers before their baby is born and in the year after. In ‘Joining the Dots’, the Templeton Expert Group highlighted the opportunity for the forthcoming 10-year vision for Mental Health in Scotland to ‘protect two generations at once’ through investment, consistent implementation of an existing national clinical guideline, better training, and robust longitudinal evaluation.

Perinatal mental illness has a significant impact on mothers, babies, fathers and other family members. Helen says, “Women have a right to be admitted with their babies for inpatient care when this is necessary, but there are insufficient places available. To tackle perinatal mental illness effectively, we need joined up services and clear pathways based on the best evidence of what is helpful. As we agreed in ‘Joining the Dots’, we can only understand what is helpful if we involve women and their families who have lived experience of perinatal mental illness in developing strategies. Margaret and I are therefore delighted to be working on projects with Maternal Mental Health Scotland Change Agents, a group of parents and health professionals challenging the stigma associated with maternal mental ill health.”

The Templeton Expert Group met on 4th May 2016. Their ten-part Call to Action is represented in the above infographic.

Yes we can:

Supporting allied health professions research

Jacqui MorrisNMAHP RU researchers who have a background in the allied health professions welcome opportunities to work collaboratively with AHP clinicians, and to help those who want to do research themselves understand and navigate the unfamiliar pathways. Physiotherapist Jacqui Morris (pictured) and speech and language therapist Avril Nicoll both participated in different ways in a recent symposium ‘AHP Research – Yes We Can!’ organised by the North of Scotland Council for Allied Health Professions Research. Founded in 2014 and supported by 12 AHP organisations, CAHPR has 23 hubs across the UK. They aim to strengthen AHP research through providing opportunities for learning, sharing, networking, collaboration and access to advice. 

Introducing the day, Jacqui used her experience as one of the first AHP clinical academics in Scotland to observe that allied health professionals often succeed in research despite rather than because of the system. With strategic support for this type of career still lacking, it can be a ‘lonely furrow’ demanding significant time and commitment. On the plus side, she said this offers an opportunity to ‘forge your own direction’ by pursuing burning, important and original research questions that are likely to have impact. Having been involved in national work to support clinical academic career options, Jacqui hopes that clinical academic pathways will become clearer. She did however emphasise that considering the two halves of the work as one role, with one set of objectives, enables those in clinical academic roles to work effectively between the NHS and the academic setting in a seamless way. Later in the day, Jacqui also led workshops on developing grant proposals.

Avril’s contribution came in the form of a 10 minute platform presentation about her qualitative study of practice change in speech and language therapy. As AHP research has traditionally focused on experimental methods, she took the opportunity to demonstrate the flexibility of qualitative research for making sense of the complexities of intervention and change in different contexts.

Early on in her PhD, Avril explored the topic of practice change with speech and language therapists around the world when she curated one of the first @WeSpeechies chats on Twitter. While she is looking forward to a follow-up once she has written up her thesis, the Unit’s Eddie Duncan is getting ready to host the first #OTalk Research Twitter chat. #OTalk is a weekly Twitter chat for discussion about topics relevant to occupational therapy. From October, the first chat of each month will have a theme around the role of research in day to day occupational therapy practice. Eddie, who has a background in occupational therapy, will host the chat at 8pm on Tuesday 4th October on the topic of developing evidence-based practice and practice-based evidence. 

The 2nd North of Scotland AHP Research Symposium was on Thursday 1st September 2016 at Perth Royal Infirmary. As well as local hub activity, CAHPR provides a range of top tips for budding researchers, including Running a Journal Club and Preparing a Scientific Poster.

Valuing cancer nursing:

RECaN systematic review underway

RECaN logoWhat is the value of cancer nursing? And how does this differ across Europe? In her plenary address to the International Conference on Cancer Nursing in Hong Kong, the Unit’s Mary Wells outlined the challenges and solutions for enhanced recognition of the nursing contribution to cancer care in Europe. She explained to delegates how the RECaN (Recognising European Cancer Nursing) project will be crucial in moving things forward. Mary says, “We know that cancer nurses make a difference to patient experiences, safety, quality of life and satisfaction with care, as well as being cost-effective. However, they provide vital physical and psychological support to patients whilst coping with increasingly heavy workloads and service development pressures in a context of limited resources and often limited recognition. Many European countries lack educational and professional frameworks for cancer nursing.  We need to address the large variation across Europe and ensure that policy makers understand what specialist cancer nurses can do when their contribution is recognised and supported.”

RECaN will unfold in three stages. The first is a systematic review to identify best evidence around the impact of cancer nursing on patient experiences and outcomes. In stage two, researchers will contrast four countries in Europe where nursing is at different stages of development to understand the influence of different contexts. At stage three, the European Oncology Nursing Society will work with people involved in oncology policy across Europe to find ways of supporting and promoting specialist cancer nursing, wherever nurses and patients are based.

Mary, Pauline Campbell and Claire Torrens are finalising preparations for the systematic review, which has been designed and will be conducted in collaboration with a large European consortium of academics, cancer nurses, and representatives from patient groups and charities. Ten key publication databases will be searched for relevant studies using randomised controlled trial and controlled before and after methods from 2000 to 2016. 

Pauline explains, “We’ve used the PICO (Population, Intervention, Comparison, Outcomes) formula to set out our review plan. This means we will include papers where the population is nurses working with people of any age group who have cancer. The studied intervention will be any delivered by a qualified nurse across the trajectory of the illness from prevention to end of life, excluding interventions which are only medication or surgery. The comparison to the nurse delivered intervention will be no intervention, standard or usual care, or intervention delivered by another healthcare professional, and the outcomes will be around quality of life indicators and cost effectiveness. This plan removes as much bias as possible from the study, which means we can be confident that our findings will offer the best available evidence for the value and impact of cancer nursing on patient experiences and outcomes.”

The International Conference on Cancer Nursing was held from 4th-7th September 2016 in Hong Kong. The RECaN systematic review protocol will be registered with PROSPERO. Mary Wells contributed to a recent feature on RECaN in the Nursing Standard.

Making a real world difference:

Bringing public services, research and QI together

Eighty five year old Mrs Wright has several health conditions, takes 14 daily medications and has to get to hospital appointments from her rural home. She would manage better if she had her ears syringed, but her volunteer befriending scheme was cut recently, and the care at home service is under pressure, so no-one has noticed. With health and social care integration underway in Scotland, Mrs Wright is just one example of why the worlds of public service, research and quality improvement need to find new ways of working together. NMAHP RU recently hosted a small consultation event so that representatives from each could stand back from their own perspectives to identify common interests, emerging problems, available methods, and possible next steps.

The event’s mix of presentations, focused discussion and group tasks generated agreement around working from problems rather than professional or organisational trenches, and building on what we know is working already. There is a need to balance rapid and long-term projects, and to use available data to understand different contexts rather than making assumptions about what is going on. It is also vital to focus on people (patients, families and staff) and good decision making at all levels. 

The Unit’s Acting Director Margaret Maxwell emphasised that scaling down the challenge and tackling real, concrete examples together is crucial, “otherwise our world of research will never have the impact we want to achieve.” Participants identified key questions to bring public service, research and quality improvement together. These included: What is the problem? What methods does this need? What level of rigour is required? Who is best placed and has the level of independence to do it? How good is good enough, and when do we know this? 

Event coordinator Jacqui Morris thanked speakers Brian Williams (problems and their properties), Rob Packham (the realities of integrating health and social care), Margaret Maxwell (strengths and limitations of research) and Kevin Rooney (strengths and limitations of improvement methods) and all participants for their contributions. She added, “Coming from a clinical academic background, I know a multidisciplinary approach is crucial, but that the way we use language and our different priorities are barriers to integrated working. What’s clear from today is that we don’t necessarily need new methods, but new ways of using them together. This event has helped us understand how we can do that, and I am looking forward to the next step.”

The NMAHP RU research consultation event on Thursday 15th September 2016 was attended by Jacqui Morris, Margaret Maxwell, Rob Packham, Eddie Duncan, Marian Brady, Brian Williams, Christine Owen, Kevin Rooney, Karen Anderson, Helen Cheyne, Mags McGuire, Gaylor Hoskins, Debbie Baldie, Karen Ritchie and Avril Nicoll.
Margaret MaxwellThe Nursing, Midwifery and Allied Health Professions Research Unit is based at the University of Stirling and Glasgow Caledonian University. Led by Acting Director Margaret Maxwell, Unit staff work with practitioners, researchers and NHS patients and carers to produce research that can inform and improve healthcare. A key aim of the Unit is to contribute to the development of researchers across the nursing, midwifery and allied health professions. Contact us for more information.
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