Our research aims to understand the determinants of health and well-being, to understand patterns of health service use, and to develop and evaluate interventions to optimise health and well-being.
We have research areas focused on specific health conditions, such as neurodegenerative disorders including dementia, life-changing acute events such as stroke and brain injury, and long-term conditions such as musculoskeletal conditions and chronic lung disease.
We have researchers specialising in methodologies such as development of complex interventions, inclusive research, and implementation science. We also explore primary prevention and promotion of good health, through a focus on particular behaviours or environments that can be modified to protect health.
Explore our current research activity detailed below.
Acceptance and Commitment Therapy (ACT) for family carers of people with dementia
In many countries, family members are essential in caring for people with dementia and establishing effective evidence-based psychological support that can help them manage challenging situations is critically important. This study aims to test the feasibility of Acceptance and Commitment Therapy (ACT) with dementia carers. ACT helps carers to explore what is truly important and meaningful to them in their life and engage in activities that serve their valued ends. ACT also helps individuals to use mindfulness skills as an effective way to deal with psychological barriers they encounter as they attempt to pursue their personal life goals.
Co-design of a roadworks ramp to ensure accessibility for people with disabilities
Roadworks can be particularly challenging for people who are D/deaf or disabled to navigate. The existing roadworks ramps have been identified as being problematic for this section of the community. Melba Swintex co-designed a new ramp (The Right Ramp) with a panel of people with disabilities that addressed most of the concerns about the traditional ramp. This project worked with panel of people with disability to ensure this new ramp was accessible to people with a range of disabilities.
Cognitive Function and Ageing II Dementia Diagnosis Study
The process of dementia diagnosis is often delayed, protracted or complicated and a significant proportion of people do not appear to receive diagnosis. Understanding the factors underlying this using robust research data could help us improve people’s access to timely diagnosis. In order to determine the true prevalence of dementia or correlates of dementia not known to primary care it is necessary for diagnoses made in primary care to be linked to independent and objective dementia diagnoses at the patient level.
Community Involvement in Palliative and End of Life Care
Community engagement is vital to the future of hospice care. This project seeks to build on current palliative and end of life care infrastructure by utilizing additional support from non-clinicians. Hospices of the future could become community hubs responsible for orchestrating localized home support services for people approaching the end of life and their families. This is likely to extend their reach and impact. Currently, there is an absence of mutually agreed procedural policies to safeguard people receiving palliative and end of life care. Policies derived from structured task and risk analyses will benefit stakeholders, develop social capital, empower volunteers, and also benefit expenditure in the acute sector.
Dementia Carer Resilience and Social Support Study
The CARIS study explores perceptions of social support and opportunities for resilience that social support from dementia cafes and dementia friendly community activities may bring for dementia carers. It aims to further the research which examines the relationship between carer resilience, social support, subjective wellbeing, psychological health and complexity of care.
The Dementia Research and Care Clinic
This transdiagnostic study involves neurodegenerative conditions, which have varying structural changes in the brain but overlapping cognitive and behavioural changes. A comprehensive assessment package, including neuropsychological measures, collection of blood, urine and stool samples, and brain imaging, will generate data to inform key research questions, while providing research participants and their care professionals with clinical feedback. The newly gained knowledge from this study will lead to improved diagnostic accuracy, even in the early stages, which will increase the efficacy of new disease modifying therapies.
Empowering self-help groups for caregivers of children with disabilities in Kenya
Since 2015 we have set-up self-help groups for caregivers of children with disabilities in Kenya. Caregivers come together in shared enterprises of economic empowerment, peer support, and shared problem-solving. We have established proof of concept and developed a set of practical guidelines that are being trialled by our partners in the CBR Africa network. The follow up study started in 2018.
The research questions are:
- What impacts are associated with self-help groups for caregivers of children with disabilities?
- What is the uptake of the self-help group guidelines in other regions of Africa and how are they being used?
Feasibility randomised controlled trial of a smoking cessation smartphone app that delivers ‘context aware’ behavioural support in real time
We have developed, refined and piloted a theory-guided smartphone app (Quit Sense, formally known as Q Sense) that provides support to help smokers manage environmental cues to smoke as they arise. The app identifies high-risk situations using a learning tool and location sensing and represents a new type of behavioural intervention called a Just-In-Time Adaptive Intervention (JITAI). Two pilot studies have shown that Quit Sense can provide ‘in the moment’ support to smokers, including lapse prevention strategies, and that this is engaged with and is acceptable. This next phase of its evaluation is to undertake a feasibility randomised controlled trial (RCT) to inform a definitive effectiveness RCT. We will undertake a two arm RCT allocating 160 smokers recruited online to a ‘usual care’ arm (link to NHS SmokeFree website) or a ‘usual care’ plus Quit Sense arm.
How Should Hand Swelling Be Treated?
The treatment of hand swelling is a constant challenge for therapists where the objective is to reduce the swelling quickly and effectively in order to focus therapy on more functionally related goals, such as return to work and usual activity. There is no consensus on what is the most effective method of treating hand swelling after trauma or surgery. With the introduction of novel therapeutic techniques and modalities to treat swelling there is a need to assess the efficacy of these when compared to standard treatment.
Identifying the character of anxiety in Parkinson's and how people with Parkinson's manage it
A project to develop an understanding of the anxiety that is experienced by many people with Parkinson’s Disease (PwP), including an initial survey of the character of anxiety in Parkinson's, followed up by another survey to identify the range and preferences for therapies used to manage anxiety. This will allow us to develop an informed conceptualisation of anxiety in Parkinson’s, which will in turn inform the development of a Parkinson's-specific form of psychotherapy for anxiety.
The Impact of Hand Nerve Disorders Scale
Trauma and compression to the nerves of the hand results in paralysis and a loss of sensory feedback. Given the importance of good hand function for everyday functions nerve disorders can have a devastating impact on a person’s quality of life. Patient reported outcome measures or PROMs, provide a means for evaluating this impact. They aim to capture how a person functions or feels in relation to a health condition, coming directly from the patient without any interpretation from another person. The assessment of patient reported outcomes is now advocated for many health conditions and there is a consensus that they play an important role in clinical practice and research. There are currently no PROMs available specifically for people with a range of hand nerve conditions. To address this need the Impact of HaND Nerve Disorders Scale or I-HaND Scale, was developed.
The I-HaND study addresses the following questions:
- What is the lived experience of a person with a hand nerve disorder?
- What should be the content of a new patient-reported outcome measure for hand nerve disorders?
- How relevant and acceptable to patients is the newly developed I-HaND?
- How reliable, valid and responsive is the I-HaND?
Implementing PPI in an NHS Research Programme
There is increasing evidence that involving patients and the public can improve research in several ways, such as in recruiting people to take part in research, in making research procedures pre-ethically sensitive, and in making research more useful to a wider variety of people. However, for PPI to happen, different groups of people need to work together. The aim of IMPRESS is to find out how Patient and Public Involvement is being used within projects that are part of the CLAHRC East of England research programme.
Improving carer support in COPD (CSNAT-COPD)
COPD is a major cause of morbidity and mortality. Informal carers (family members/friends) play a key role in supporting patients, but with considerable impact on their well-being. The Carer Support Needs Assessment Tool (CSNAT) is an evidence-based validated tool for identifying carer support needs in clinical practice, underpinning a person-centred approach to carer support (the CSNAT Approach). However, the tool was developed in end-of-life hospice care, predominantly in cancer rather than non-malignant long-term conditions such as COPD. This project adapts CSNAT for COPD carers using evidence from a systematic review of COPD carer support needs and carer focus groups.
Learning about Breathlessness programme
Breathlessness is a distressing, disabling and common symptom of advanced disease. For informal carers (family members/friends who help and support patients) it causes anxiety, isolation, and helplessness. Informal carers lack knowledge and confidence in supporting patients with breathlessness.
The Learning about Breathlessness Study programme (LaB) aims to develop and test an intervention to help carers learn about breathlessness in life-limiting disease: to increase their knowledge and confidence. LaB1 identified topics carers wanted to learn about and how. Building on LaB1, LaB2 is working with carers, patients, healthcare professionals to produce and test the web-based intervention.
OptiMine: Optimizing the mining of electronic health record data to increase uptake of cancer prevention digital interventions
Smoking and drinking alcohol at risky levels are associated with cancer later on in life. In England, 15% of adults (17% men and 13% women) smoke cigarettes, and 24% of adults (31% men and 16% women) drink alcohol at risky levels (>14 units per week. There are services to help people quit smoking and reduce their alcohol consumption, but barriers to accessing these include time to travel and sensitivity of disclosing their smoking or alcohol consumption. As an alternative, there are digital programmes either online or through mobile phones that support people to quit smoking and reduce their alcohol consumption. But not many people know about these programmes and even fewer take advantage of them.
Patient beliefs and expectations of physiotherapy predict recovery from shoulder pain
Our study included 1,030 people attending physiotherapy for the treatment of shoulder pain. We collected information on 71 patient characteristics and clinical examination findings during the patient’s first physiotherapy appointment. Three factors were important in predicting outcome 6 months later. As expected, high baseline pain and disability predicted high levels at 6 months. But high pain self-efficacy could change this to a better outcome. In addition, people with shoulder pain who expect physiotherapy to help them were likely to have a better recovery than those who expect only minimal or no improvement. These should be a target for treatment.
Physical Activity Following Hip and Knee Replacement
Our team have undertaken a series of studies investigating firstly the degree of physical activity after hip or knee replacement and secondly what factors may influence why someone is (or is not) physically active following a hip or knee replacement. This is important as physical activity can have a significant beneficial effect on an individual’s health and well-being as well as on society as whole.
Practical management of cognitive and neuropsychiatric symptoms in MND – development of the MiNDToolkit
Historically MND has been regarded a disease involving mainly motor symptoms, with muscle wasting leading to loss of mobility, respiratory difficulties and swallowing problems. However, growing evidence is emerging of cognitive and behavioural difficulties which exist alongside motor problems. Epidemiological findings show that 35% of MND patients also experience cognitive difficulties, leading to problems with planning and decision making. A further 50-75% of patients also experience behavioural difficulties (depending on which assessment used), such as apathy, disinhibition and loss of empathy. Finally, about 15% present with a dual diagnosis of MND with frontotemporal dementia (MNDFTD). Research in MND and FTD have shown that cognitive, and particularly behavioural symptoms, have a significant impact on patient management, prognosis and carer levels of strain. Whilst clear, evidence-based guidelines for the management of motor symptoms are well established, there is presently no consensus on how best to support patients (and their carers) who are experiencing additional cognitive and behavioural symptoms.
Predicting Response To Treatment In Carpal Tunnel Syndrome
Carpal tunnel syndrome (CTS) is a common condition of the hands in which the median nerve is squeezed where it passes through the wrist. Typical symptoms of CTS include pain, aching, tingling and numbness in the thumb and fingers and waking at night. It frequently affects both hands and can result in difficulties with everyday activities, work and leisure.
Treatment options include splints and steroid injections for mild to moderate symptoms of CTS and surgical decompression for moderate to severe CTS. It is thought that a number of factors affect how well patients respond to different treatments. At present, however, there is insufficient research evidence to be able to predict what treatment is likely to work in which patients.
This large-scale observational study will follow-up over 700 patients newly diagnosed with CTS over 18 to 24 months. Information on clinical symptoms, general physical and emotional health, treatments received and treatment outcomes will be used to identify what factors predict a good response to treatment and to establish the costs of CTS to the individual, NHS and Society.
Key research questions
- What is the course and progression of CTS in treated and untreated patients over 18-24 months from diagnosis?
- What are the baseline clinical, psychological and sociodemographic predictors for response to treatment by steroid injection and surgical decompression?
- What are the costs of CTS to the individual, the NHS and society over a period of 18-24 months?
- What are the predictors of costs of CTS?
Promoting staff wellbeing in UK NHS Ambulance personnel - what works and how can we do better?
NHS ambulance service personnel are at risk of poor physical and mental wellbeing, and may have a greater risk of occupational suicide than the general population. The factors which influence this are poorly understood, as are interventions aimed at modifying these risks. It is important to recognise where occupation-specific risks can be modified in personal, cultural and job-specific areas (for example trauma), and within an individual organisation. This national project will map how Trusts are currently supporting staff and identify areas for priority action.
Qualitative exploration of the experiences of Centre 81's services for people with disabilities
Centre 81 in Great Yarmouth provides innovative and co-created social care for adults with physical, sensory and other disabilities including those with complex health and/or social needs including associated learning disabilities. It aims not to provide services “to” users but facilitate access to activities created “with” users. Users of Centre 81 are reported to have: greater resilience in physical and mental health; better coping strategies; reduced loneliness and isolation; improved confidence, participation, and quality of life. This study will qualitatively evaluate the perceptions of users on the impact of services offered at Centre 81.
Shoulder to Shoulder: Walk and Talk. Cancer prevention in vulnerable women
Cancer disproportionately affects disadvantaged people. Health literacy is recognised as critical in cancer prevention, but we lack understanding of how to promote health with disadvantaged people. Health walks are a popular public health intervention with proven health benefits but often not tailored to disadvantaged people. In this research we are working with disadvantaged women in the justice system who have set up a walking group as a support group. Our aim is to develop a cancer prevention programme to use on the walks. This is a unique way of promoting health that has not been tried before.
Shoulder Pain: Predicting response to physiotherapy treatment
Physiotherapy is a common point of referral for many people with musculoskeletal shoulder pain. Although effective for many, not all people will benefit. This study identified which patient characteristics and baseline measures, commonly assessed at the first physiotherapy appointment, are associated with outcome six months later.
1,030 people attending physiotherapy for the treatment of musculoskeletal shoulder pain across the East of England were included in the study. We collected information on 71 patient characteristics and clinical examination findings.
A number of factors were associated with outcome. The most important predictor of outcome was the person’s pain and disability at the first appointment - higher levels were associated with higher levels six months later. However, high pain self-efficacy and a high expectation of recovery could change this to a better outcome. Pain self-efficacy is a person’s confidence in their ability to do things despite their pain.
Sleep and Brain Research Unit
We spend nearly one-third of our life asleep, which has a profound effect on our bodily functions ranging from the way our genes become expressed, through various physiological processes including cardiovascular function, metabolism and immunity to the way our brain works.
Sleep affects our body and brain ranging from the very core of our biological existence, the way our genes work through multiple physiological processes involving immunity, cardio-metabolic and neural functions to ultimately modulating our emotional well-being and cognition including attention, memory and behaviour control.
The Sleep and Brain Research Unit (SBRU) aims to host state of the art research in order to improve our understanding of the significance of sleep in brain health throughout the life-span and drive changes in evidence based practice targeting the prevention, treatment and care of patients with brain health conditions.
SleepSmart for patient safety: improving sleep, fatigue and wellbeing outcomes amongst ambulance staff
The changing pace of pre-hospital emergency care means there is very little down time between jobs and missed shift breaks and late finishes are the new normal. Fatigue on the job and poor sleep quality increases the risk for a range of adverse patient, staff, and organisational outcomes, including patient care quality and safety, and staff mental health and burnout. We are conducting the first UK research study to estimate the magnitude of sleep problems and fatigue at work in ambulance staff, the association with patient safety outcomes, and explore what staff and ambulance services are currently doing to support healthy sleep.
Understanding Personal Care interactions in Severe Dementia
People with dementia develop high needs for assistance with their personal care and in the later stages can be reluctant to receive support with these daily tasks. Refusals of care can leave carers in a difficult position, since they are difficult to manage and can lead to serious consequences. The Pro-CARE study aims to:
- Determine the factors influencing refusals of care in care home and family settings
- Explore how family carers and care-home staff provide assistance with personal care to people in the later stages of dementia
- Create a training intervention to add to informal and formal carer skills
UndersTanding the distinct challenges for Nurses in Care Homes: LeaRnIng from CoVid-19 to support resiliencE and mental wellbeing (THRIVE)
THRIVE aims to understand Nursing and Midwifery Council (NMC)-registered nurses’ experiences of working in care homes for older people during the COVID-19 pandemic, how this impacted on resilience, mental health and wellbeing, and to collaboratively develop theory-informed approaches for ongoing and future support in this professional group.
Understanding the needs of dementia family carers
Many people with dementia living in the community are supported by unpaid family caregivers, saving the UK economy 11 billion pounds a year in health and social care costs. Although caring for a loved one is often accompanied by positive experiences, it can also be challenging at times. The wellbeing of carers is very important and this study aims to find out which carer- and patient-related factors influence this and how we can best support carer wellbeing. The study will also examine patterns of formal and informal support use among carers of people with mild, moderate, and severe dementia.
Understanding and Managing Everyday Task Performance in Dementia
The study’s overall aim is to determine intrinsic and extrinsic factors that affect functional disability at different stages of dementia. By doing so, we want to identify modifiable factors in order to develop and test a novel therapeutic approach which will minimise functional impairment and improve both patient care and family carer wellbeing.