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We have developed the first ever evidence-based physiotherapy guidelines for the diagnosis, assessment and physiotherapy management of contracted frozen shoulder (CFS)—a condition which painfully restricts movement, affects up to 10% of working-age adults in a general UK population, and costs the NHS at least £13.5 million annually.
My clinical research focuses on exercise science and health research methodology. Since 2006 I have collaborated successfully with researchers at James Cook University Hospital, Middlesbrough, and more recently EHS Hospital, Morges, Switzerland. Our work spans two main themes; exercise testing and training studies in a variety of patient groups [1, 2], and industry-sponsored clinical trials in patients with chronic intractable pain. Our ultimate aim is to translate our research findings into real patient benefit.
Fluorides and oral health is a designated research area in HSCI. We collaborate with national and international centres to support the World Health Organisation’s international mandate and programme priorities. The following four examples give some insight into HSCI’s work, which has involved collaborations with other leaders in the field.
Self-management for people with chronic pain is a key research area within HSCI. Many people of all ages in the UK and beyond are living with chronic pain. Chronic pain can affect people’s physical and psychological health. It can make it hard for people to look after themselves and perform daily activities and work, and it can hinder people's social lives, employment and relationships.
Research utilisation and knowledge mobilisation in the commissioning and joint planning of interventions to reduce alcohol-related harms - a study in the co-creation of knowledge.
Across HSCI there is a strong research interest in systematic reviewing. This encompasses a large cross disciplinary and collaborative work programme, resulting in numerous high profile publications.*
This joint clinical project between James Cook University Hospital and Teesside University is examining ways to help patients with chronic lower back pain better understand their pain and issues around its causes.
The project will examine how pain neurophysiology education, a cognitive behavioural based intervention which aims to reduce pain and disability by explaining the biology of pain to the patient, can help patients to reconceptualise their understanding of pain and what is causing it. Since its development 10 years ago this intervention has grown in popularity with both therapists and patients alike and it is now widely used by physiotherapist's throughout the UK. By studying how patients take on the educational information and make sense of it we can consider ways to enhance the education to make it more effective for patients.
The 12 month project is being funded by the Physiotherapy Research Foundation with Richard King, Senior Specialist Physiotherapist in Chronic Pain at James Cook University Hospital's Pain Clinic, as the clinical lead alongside Victoria Robinson another senior physiotherapist at James Cook University Hospital and Dr Cormac Ryan and Professor Denis Martin, from Teesside University, providing academic support.
Team: Richard King (PI) James Cook University Hospital; Victoria Robinson James Cook University Hospital; Dr. Cormac Ryan; Professor Denis Martin.
This project forms part of a set of platform studies being undertaken by a collaborative group of researchers across a number of centres linked through their membership of the NIHR School for Public Health Research (SPHR). Researchers at Teesside who are part of the Fuse Public Health Centre of Excellence will join others at Bristol, UCL, London School of Hygiene and Tropical Medicine, Lancaster/Liverpool, Sheffield and the Peninsula Medical School in working on the foundations for the development of an intervention which will aim to tackle the combined risk behaviours of alcohol misuse and unsafe sexual behaviour in young people.
The preliminary work is funded by NIHR SPHR and will be carried out between February 2014 and January 2016. The Fuse/Teesside contribution will involve undertaking case studies in schools which are already involved in multi-component interventions of a similar sort to ascertain what is acceptable to young people and also what is tolerated by teachers and other service delivery personnel, all elements which build into an assessment of the feasibility of a new intervention and a critical test of the likelihood of it being employed with fidelity and then sustained.
Team: Professor Janet Shucksmith; Leanne Mohan
Nationally and globally, childhood immunisations have been highly effective in reducing the incidence of, and associated morbidity and mortality from, a range of infectious diseases. This study is an National Institute for Health Research (NIHR) Health Technology Assessment (HTA) funded study that is interested in the acceptability and effectiveness of the introduction of incentives (such as financial gains for immunising) and quasi-mandatory schemes (such as requiring a child to be vaccinated before school entry) to increase uptake of childhood immunisations. Researchers from Teesside University are undertaking this work in collaboration with colleagues from Newcastle University.
This is a current project and as such no reports are currently available. Please contact the research team for more information.
Team: Dr. Jean Adams (PI), Newcastle University; Professor Janet Shucksmith, Rebekah McNaughton, HSCI, Teesside University.
This new and innovative proposal cuts across two research institutes within Teesside University with the aim of developing a smartphone-based intervention to increase physical activity and reduce sedentary behaviour in schoolchildren living in Redcar and Cleveland. The project is funded by local School Sports Partnerships. The research team of Dr. Liane Azevedo and Professor Iain Spears is led by Professor Greg Atkinson. The project also cements collaboration with Professor Gareth Stratton (University of Swansea), Dr. Ruth Hunter (Queens University Belfast) and Dr. Luis Calmeiro (University of Abertay Dundee).
The project is directly relevant to the local community in that schoolchildren will be surveyed about smartphone use and their preferred styles of "App" delivery. Then the most appropriate smartphone-based intervention will be developed and tested for feasibility. The project will be divided into three stages, 1- Qualitative, focus group research to identify the preferred styles of smartphone App delivery, and 2 - the technological development of the Smartphone Apps themselves, and 3 - a 'usability test', using qualitative and quantitative techniques.
Team: Professor Greg Atkinson (PI), Dr Liane Azevedo, Professor Iain Spears, Teesside University; Professor Gareth Stratton, University of Swansea; Dr. Ruth Hunter, Queens University, Belfast; Dr. Luis Calmeiro, University of Abertay Dundee.
The Pain Garden is a project funded by Arthritis Research UK. The study, in partnership with a local design company (Animmersion.co.uk), involves the development and evaluation of a web-based application which uses people's responses to questions about pain to create an animation of a garden. The items in the garden relate to a specific part of the pain experience to provide a highly visual method of feedback to help people understand their condition.
Team: Professor Denis Martin (PI), Leigh Rooney, HSCI, Teesside University.
Evaluation of Change Your Mind about Young People (Tyneside MIND)
Researchers are undertaking an evaluation of Change Your Mind about Young People; a collaborative intervention delivered by Tyneside Mind, Changemakers and the Regional Youth Work United North East (RYWU-NE), funded by the Health and Social Care Volunteering Fund (Department of Health funding). The intervention involves recruiting volunteers aged 16-25 years to be trained to work with GPs to improve how they treat mental health issues in young people. These volunteers guide the GP practice through You're Welcome accreditation; the nationally recognised award for young people friendly health services (HM Government 2012, Department of Health 2011).
The overall aim of the evaluation is to identify and analyse the impact of Change Your Mind About Young People on:
The evaluation will be carried out from July 2013 to June 2015.
Team: Dr. Mandy Cheetham (PI); Professor Janet Shucksmith
Teesside University were commissioned by Middlesbrough Borough Council Public Health to carry out a second evaluation of the BMI care pathways for the management of maternal obesity implemented at South Tees Hospitals NHS Foundation Trust. Women who had been through the pathways during pregnancy, and were now in the postnatal phase were interviewed about their experiences during and after pregnancy. As a result of the evaluation changes to service design and provision are planned. Furthermore the research team have provided input the Middlesbrough Redcar and Cleveland task and finish group for maternal obesity, which feeds into local strategy development for maternal and infant health.
Team: Professor Janet Shucksmith (PI), Sarah Dinsdale, HSCI, Teesside University.
This evaluation of the Royal Society of Public Health (RSPH) level 2 training module 'Understanding health improvement' was commissioned by North East Strategic Health Authority as part of their commitment to the 'Making every contact count' agenda. The evaluation demonstrated that whilst overall respondents enjoyed the training and gained new knowledge, there was a need to vary the training to meet the needs of the wide range of participants, to offer practical approaches to enable participants to become more confident in approaching people and for the training to form part of a wider strategic approach within organisations.
Team: Professor Janet Shucksmith (PI), Sarit Carlebach, HSCI, Teesside University.
Teesside University have been commissioned to carry out an evaluation of the Macmillan (Cheshire) Living Well, Dying Well Public Health Programme (CLWDW). CLWDW represents an innovative, collaborative approach to public health which ensures that end of life issues are mainstreamed within the public health agenda. Through qualitative interviews with key individuals, as well as consideration of project documents, this evaluation aims to evaluate the contribution of the key roles and champions towards the objectives of the Macmillan (Cheshire) Living Well, Dying Well Public Health approach. A realist evaluation approach is being utilised. The results will be fed back to Macmillan and the CLWDW team to influence the future roll out of the programme.
Team: Professor Janet Shucksmith (PI), Deborah Hall, Sarit Carlebach, Sarah Dinsdale, Pat Watson, HSCI, Teesside University.
Oral health is central to healthy living, but dental disease remains a major public health problem in Teesside. To address this, the Tees Oral Health & Commissioning Strategy Plan recommended the implementation of evidence-based initiatives to improve oral health and reduce inequalities, including school tooth brushing and fluoride varnish and fissure sealant programmes (Tees Oral Health & Commissioning Strategy 2009-2014). HSCI's CHASE (Centre for Healthcare and Service Evaluation) has been commissioned by North Tees PCT to evaluate the introduction of fluoride varnishing in local schools, the key aim being to identify the facilitators and barriers to maximising consent rates for the programme.
A qualitative approach will be adopted to identify the processes used by local dental teams to engage schools in the fluoride varnish programme, the range of marketing activities undertaken and how this relates to pupil consent rates within the school. We will also look at how both the school and programme leads engage with parents in order to gain consent and therefore achieve maximum uptake for the programme.
Team: Sharon Hamilton, HSCI, Teesside University.
In 2012, the North East Ambulance Service (NEAS) approached us with a serious problem of high work absenteeism in operational ambulance personnel, due in large part to job-related musculoskeletal problems. The organisation wished to co-create an occupational fitness test to ensure that personnel are fit for work. This ongoing research project comprises needs analysis, test design, test validation, and roll out.
The needs analysis involved a mini-ethnography, with researchers riding on-board with the crews in multiple day and night shifts, collecting observational and objective data to characterise job demands. The research evidence is being co-produced by our unit and the NEAS (as the end user), including emergency care, urgent care, rapid response, patient transport services, bariatric care, occupational health, human resources, senior management, and union representatives. The initial planned impact is a change in employment policy to require operational ambulance personnel to meet a minimum threshold on the test to be considered fit for work. Additional impacts include the development and roll out of an exercise training intervention to a) prepare for the initial fitness test and b) to increase fitness before retaking the test in those staff members not meeting the required threshold.
Team: Dr. Matt Weston (PI), Professor Alan Batterham, Jonathon Taylor, Teesside University.
This project involved analysis of data from the British Social Attitudes and preparation of chapter for their publication looking at planning and discussing for end of life. The research showed that whilst older people are increasingly making their end of life wishes known, most people leave it too late to do this.
Team: Professor Janet Shucksmith (PI), Sarit Carlebach and Dr. Vicky Whittaker, HSCI, Teesside University.
There is an increasing body of evidence suggesting that sedentary behaviour can be associated with being overweight, hypertension, adverse metabolic markers and poorer mental health. We aim to perform a meta-analysis and meta-regression on the effect of sedentary behaviour interventions on BMI and other anthropometric indicators using child age and duration of follow-up as a moderator. This study is supported by Fuse and Teesside University internal fund. More detailed information of the protocol can be found here.
Team: Dr. Liane Azevedo (PI), Professor Greg Atkinson, Dr. Louisa Ells, Dr. Nazalie Iqbal, HSCI, Teesside University; Dr. Jonathan Ling, Dr. Istvan Soos, Sunderland University; Shannon Robalino, Newcastle University.
Funded by the NIHR School for Public Health Research this project evaluates the introduction and implementation of an enhanced programme for supporting pregnant women to stop smoking. The programme, called babyClear© is being introduced across the Northeast region. The evaluation is being carried out in collaboration with Newcastle University who are taking the lead and also completing the quantitative element, while Teesside University are responsible for the qualitative data collection and analysis.
Team: Professor Janet Shucksmith, Dr. Sharon Hamilton and Sue Jones HSCI, Teesside University; Dr. Ruth Bell (PI), Newcastle University.
This is an ongoing trial funded by the NIHR Research for Patient Benefit programme. We are exploring the feasibility of implementing short-term exercise 'prehabilitation' to improve fitness for surgery to repair an abdominal aortic aneurysm and hence improve surgical outcome. This study is part of our collaborative research programme with Professor Gerard Danjoux, a Visiting Professor from the Department of Academic Anaesthesia at James Cook University Hospital, Middlesbrough. The study is multicentre, involving academic and clinical partners from Sheffield, York, and Newcastle (Northumbria University). Our protocol for this trial has been published in BMJ Open and is freely available here.
Team: Professor Alan Batterham (PI), HSCI, Teesside University; Professor Gerard Danjoux, James Cook University Hospital.
This new study commencing recruitment early 2014 is supported by the Multiple Sclerosis Society in the UK. It builds on our previous study funded by the MS Society which showed wearing textured insoles for two weeks had some benefits to walking ability in people with MS. This exploratory randomised controlled trial of wearing insoles for 3 months will provide a more detailed investigation of whether textured insoles can be helpful for self-management in people with MS.
Team: Dr. John Dixon (PI), Professor Denis Martin, HSCI, Teesside University.
National complex regional pain syndrome (CRPS) guidelines identify the potential of Transcutaneous Electrical Nerve Stimulation (TENS) as a treatment. Theoretical evidence on mechanisms of pain and cortical body image disruption further suggests that TENS would be useful for CRPS. However, there is no RCT-level evidence to substantiate or refute such claims. Also, our discussions with clinicians have identified that CRPS patients are unlikely to tolerate having adhesive pads attached to the painful site. To overcome that practical barrier TENS could be applied through pads placed above the affected area, and as such, could be offered to patients for home-use. Therefore, to address the practical issues and the evidence gap this study aims to:
1. Develop a clinical protocol for TENS specifically for people with upper limb CRPS to use at home.
2. Assess recruitment rates/procedures, blinding procedures, outcome measures, and estimate effect-sizes in order to develop an RCT investigating the effectiveness of TENS for CRPS.
This feasibility study will incorporate a small-scale single-blind RCT combined with a qualitative study. 30 people with upper limb CRPS will be recruited from local NHS services and randomised to either TENS (n=15) or a placebo (n=15). Following one session of training from a physiotherapist, participants will use TENS or placebo at home for 3 weeks. Data will be collected on pain, function and body image at baseline, post treatment and 3 months follow-up. At three months follow-up, each participant will be invited to a one-to-one interview to give their opinion of the trial procedures and the interviews will be analysed thematically. (ISRCTN http://controlled-trials.com/ISRCTN48768534)
Team: Dr. Cormac Ryan, Professor Denis Martin, HSCI, Teesside University; Richard King, James Cook University Hospital; Victoria Robinson, James Cook University Hospital; Dr. David Punt, Birmingham University; Professor Mark Johnson, Leeds Metropolitan University; Professor Christian Gruneberg, University of Applied Sciences, Bochum; Professor Hubert Dinse, Rurh University Bochum.
StepJockey (www.stepjockey.com) is a new platform that has been developed with Small Business Research Initiative funding, with the aim of improving energy expenditure by mapping and labelling steps with 'calorie burn' information. The programme is grounded in behavioural economics and designed to help weight management by seamlessly building physical activity into everyday life by encouraging stair use. The programme uses crowdsourcing to build a database of calorie counts for different stair climbs and enables the user to label stairs with smart posters which display calorie rating, and QR tags to facilitate smart phone tracking via the associated app. Louisa Ells was advisor to the project team during the development of the programme and is now working with Alan Batterham to validate the algorithm StepJockey uses to calculate the energy expenditure associated with stair climbing.
This research is particularly important given the lack of recent, high quality studies measuring real-world energy expenditure for stair climbing. This study therefore aims to: 1) to measure the physical activity energy expenditure associated with climbing stairs in a representative sample of an urban population; 2) cross validate the existing StepJockey stair climbing equations for men and women; 3) adjust the existing algorithm as necessary, and integrate variables for basal metabolic rate and excess post-exercise oxygen consumption.
Team: Professor Alan Batterham (PI), Dr. Louisa Ells, Alison Innerd, HSCI, Teesside University.
This study, supported by a Career Development Grant from the United Kingdom Occupational Therapy Research Foundation, aims to capture individual perspectives on the role of occupation (including self-care, leisure, work, relationships and community participation) for people who seek asylum. People seeking asylum face practical and policy-based challenges which interfere with access to everyday occupations, fostering occupational deprivation. Limited research has been conducted to explore the impact of asylum on occupation, though evidence indicates a link between well-being and occupational opportunity, particularly in transition and post migration.
This study is informed by phenomenological principles, following the Heuristic approach of Clark Moustakas and aims to capture the individual experiences of ten people who have sought asylum in the United Kingdom within the past five years. It will explore individuals' experiences of occupation before leaving their home country, during the asylum process and (where relevant) after seeking asylum. It will reflect what provides support or creates barriers to undertaking their chosen occupations and explore the perceived impact of access to occupation during the asylum process.
Team: Claire Smith (PI), HSCI, Teesside University.
Lisa Arai was part of team evaluating a child obesity intervention. Findings will be used to inform programme design, especially in respect of groups of children who do not seem to benefit from such interventions at present.
View the study
Team: Dr. Lisa Arai, HSCI, Teesside University
This project aimed to evaluate the Family Voice initiative as a tool for improving nursing communications with family/carers of the dying patient in hospital. Inadequate symptom control unnecessary procedures and communication difficulties are common issues reported by carers of those nearing end of life in hospital. Half of complaints about NHS hospitals concerned care near death (Healthcare Commission 2007).
The Family Voice Initiative (FVI) offers a tool aiming to improve communications and care. Designed by a Palliative Care Nurse Consultant in North East England, FVI is used with family members/carers of patients on the Liverpool End of Life Care Pathway. The diary, completed by family members and kept by the bedside, guides carers through 6 questions: 4 evaluate patient comfort on essential palliative care elements - pain, nausea, calmness, ease of breathing; two questions relate to staff care towards the dying patient and the carer.
Team: Professor Janet Shucksmith (PI), Sarit Carlebach, Pat Watson, HSCI, Teesside University.
Most knowledge about fluoride retention in the body is derived from studies with healthy adults and laboratory animals, despite the first 24 months of life being a critical period for fluoride exposure regarding development of dental fluorosis in maxillary central incisors. This ongoing project, funded by the Organix Foundation, is aiming to measure total fluoride intake and excretion in pre-weaned infants living in fluoridated and non-fluoridated areas of North East England. From these measurements, body fluoride retention will be determined. These infants will subsequently be examined after weaning in order to investigate the trend in body fluoride retention rate at an early age when the risk of dental fluorosis is highest.
Team: Dr. Sharon Hamilton (PI), Sue Jones, Pat Watson, Dr. Nazalie Iqbal, Joan Olajide, HSCI, Teesside University.
This is an assessment of the impact of the end of life workforce development project to provide end of life care training to staff on bands 1 to 4 working in the independent sector across four PCT areas in the North East. The training provided included non-accredited and accredited components. The evaluation report recommended the continuation of this training, which was demonstrated to have several benefits: up-skilling social care staff, improving awareness and understanding of end of life care, and potentially reducing emergency admissions to hospital for end of life care. It additionally recommended provision of training to higher graded staff so as to develop a general culture of effective end of life care approaches in all care homes.
Team: Professor Janet Shucksmith (PI), Sarah Dinsdale, Pat Watson, HSCI, Teesside University.
Childhood obesity is an important public health problem and identifying effective preventive strategies remains a priority. Parents are central to the development of their child's health-related behaviours and play a key role in both the development and implementation of prevention strategies. However, many studies show that parents do not recognise when their child is overweight. Evidence indicates that parents tend to use how their children look compared with others, which given the current high prevalence of child overweight, means parents rely on extreme cases as a reference point which may have shifted their understanding of what 'overweight' means.
Addressing the difference between parents' perceptions and actual child weight status is important. If parents do not perceive their child as overweight they are unlikely to make appropriate changes to their child's lifestyle. However there is evidence that parents are more likely to make such changes if they perceive their child's weight as being a health problem. This multistage Medical Research Council study, led by Newcastle University in collaboration with Teesside University, UCL and NHS Choices, aims to address the need for improving strategies for informing parents about their child's weight status. It will develop and test tools to improve parents' ability to correctly assess their child's weight status, as well to increase their knowledge of the health consequences of childhood overweight. In stage 1, portable 3D body scanning technology will be used to obtain body scans from 800 children. These scans will be used to produce age and gender specific body image scales for Reception and Year 6 aged children (these are the ages of children going through the National Child Measurement Programme).
In stage 2, parents will be consulted extensively to further develop the body image scales as a method to improve parents' ability to recognise overweight in children and to develop supporting information to increase parental knowledge of the consequences of childhood overweight. Two methods of delivering the tool will be developed (paper based and web based). In stage 3, a feasibility study of the tool, supporting information, and the two methods of delivery will be conducted. Parents' views and experiences of the developed methods will be sought by conducting focus groups and the findings will be used to improve all aspects. Finally, in stage 4, a cluster randomised control trial will be conducted with 2040 families to test whether the tool is effective and which method of delivery is most effective in improving parental recognition of childhood overweight and understanding of its consequences.
Team: Dr. Louisa Ells, HSCI, Teesside University; Professor Ashley Adamson (PI), Newcastle University.
Fifty to eighty percent of older people experience persistent pain, so it is important that pre-registration health and social care education helps to prepare students for working with this specific service user group. Students need to understand and appreciate the older person's perspectives and experiences. This is difficult to achieve in time limited classroom and clinical placement environments. A key challenge is how to give students sufficient exposure to the lifelong day-to-day reality of living with a long-term condition.
The aim of this project, which was funded by the Higher Education Academy, was to create a Facebook Learning Object (FLO) for health and social care students to develop their understanding of, and empathy with, older people with persistent pain.
A FLO has been created which presents the experience of living with persistent pain in the form of a fictitious Facebook entries and interactions with "Facebook Friends" by an older person called Florence (FLO): http://hdl.handle.net/10949/18483. The Facebook storyline was written by a professional playwright using older people's accounts from previous research (EOPIC study - Engaging with Older People and their carers for the self-management of Chronic pain see more). The project involved four student researchers and a student-centred approach was taken to the development of the resource. Input was sought through focus groups/interviews with students from a range of different health and social care professions (Including physiotherapy, occupational therapy and nursing students) as well as older adults and employers. The information obtained strongly influenced the design of the learning object.
A provisional version of the learning object has been piloted with nine physiotherapy students at Teesside University showing evidence of enhanced positive attitudes towards older people. Feedback from stakeholders involved in the development has been positive indicating a high level of acceptability amongst students and initial piloting demonstrates proof of concept. It is envisaged that this novel learning object will enhance health and social care student education and ultimately enhance the well-being of future service users.
Team: Dr. Cormac Ryan (PI), Dr. Nick Harland, Professor Liz Holey, Professor Denis Martin, Leigh Rooney, Lorelle Dismore, Emma Bradburn, Teesside University; Professor Pat Schofield, Greenwich University; Professor Blair H Smith, Dundee University; Dr. Derek Jones, Professor Amanda Clarke, Northumbria University and Dr. Paul McNamee, Aberdeen University.
NHS Health Scotland commissioned a review of approaches, activities and resources currently being applied to support the delivery of sex and relationships education (SRE) in primary schools in Scotland. Following on from previous work relating to SRE in secondary schools (Teijlingen et al, 2007), and recommendations included in the Report of the Working Group on Sex Education in Scottish Schools (McCabe, 2000), findings from this study supported the implementation of Respect and Responsibility strategy in Scotland (Scottish Executive, 2005).
Team: Jennifer Sprat (PI), Dr. Kate Philip, University of Aberdeen, Professor Janet Shucksmith, Rebekah McNaughton, HSCI, Teesside University.
Early detection and treatment of oral cancer, when lesions are small and localised, is believed to be the most effective means to improve survival and reduce hospital costs and duration of treatment. Although it is important to improve the awareness of all sectors of society, it is more crucial to target those where the incidence of disease is high. In order to develop effective approaches to meet this goal, the attitudes and beliefs of individuals at high risk should be understood first and then this knowledge used to design an effective intervention that will facilitate early diagnosis. This study, funded by Stockton PCT, engaged with high risk groups, through focus group discussions, to identify knowledge and awareness of oral cancer signs and symptoms, and identify the factors which might contribute to improved screening uptake (Zohoori et al, 2012).
Team: Dr. Vida Zohoori (PI), HSCI, Teesside University.
In 2010 industrial dance mat systems were installed in state secondary schools in Middlesbrough and Redcar and Cleveland, to promote an innovative and engaging opportunity for physical activity in schools. We conducted an evaluation of this scheme in a controlled before and after study, funded by the Middlesbrough Primary Care Trust. The research team included Dr Liane Azevedo (Teesside University), Dr Jean Adams (Newcastle University), Dr Katie Haighton (Newcastle University), Dr Duika Burges Watson (Durham University) and Professor Alan Batterham (Teesside University).
Our findings suggested that the implementation of the dance mat scheme was associated with improvement in body mass index, body composition, some aspects of health-related quality of life and physical activity self-efficacy. However, the mechanisms of the alleged benefits are unclear.
Team: Professor Alan Batterham (PI), Dr. Liane Azevedo, HSCI, Teesside University; Dr. Jean Adams, Dr Catherine Haighton, Newcastle University; Dr. Duika Burges Watson, Durham University
Public health guidance emphasises the role of Health Care Professionals in providing information, advice and support for obese pregnant women. However, a number of barriers to providing the above are evident in the literature. The North East SHA commissioned Teesside University to carry out a regional study exploring midwivesâ€™ perceptions of their education and training requirements in relation to maternal obesity. Findings will help inform the development of education and training programmes.
A publication from this research can be found at:
Heslehurst, N., et al. (2012), Midwives perspectives of their training and education requirements in maternal obesity: A qualitative study. Midwifery, 29, (7), July 2013, 736-744.
Findings from the previous evaluation of the NHS Health Checks in Tees highlighted the need for a health economics analysis to assess the costs and benefits of providing NHS Health Checks in the Tees Valley as well as exploring patient compliance with medications and lifestyle advice once they had been identified as at risk of CVD. Findings from these studies have facilitated commissioning strategies for the programme.
There are no open access reports or publications currently available for this work. Please contact the research team for more information.
Team: Professor Janet Shucksmith (PI), Rebekah McNaughton, Sarah Dinsdale, HSCI, Teesside University; Jo Gray (Newcastle University).
This was an evaluation of the practical palliative care training module for GPs run by Teesside University, looking at the impact of the training on their practice. The evaluation showed that this was an effective distance learning model which received much positive feedback from participants. The learning had led to increased knowledge and confidence in this specialist area, and had become embedded in clinical practice with some GPs taking on a lead role in palliative care.
Team: Professor Janet Shucksmith (PI), Pat Watson, Sarit Carlebach, HSCI, Teesside University.
Teesside University were commissioned by the North East Public Health Observatory (NEPHO) to provide qualitative analysis of the County Durham Winter Maintenance Scheme. The quantitative impact report was produced by NEPHO.
The impact of the winter gritting in terms of improved access to healthcare services generally was limited. A disparity in this service between rural and urban areas was also identified alongside an increase in cancellations, 'did not attends' and in telephone consultations. There was no perceived increase or decrease in the number of accidents and falls.
A clear divide was identified as to the level and consistency of services. Also a lack of understanding of the variations in weather conditions across the area meant a slower response to conditions in some of the worst hit communities. There was a strong view that local knowledge should have been used to allocate priority areas and that the blanket approach adopted was not suitable for such a diverse area.
Findings have been used in the planning for future winter maintenance strategies within the local authority.
Team: Professor Janet Shucksmith (PI), Pat Watson, HSCI, Teesside University.
Engaging with Older People to develop and deliver Interventions for the self-management of Chronic pain (EOPIC) is a collaborative project funded by the cross-research council Lifelong Health and Wellbeing initiative. The project is led by the University of Dundee and along with Teesside University the other collaborators are the University of Greenwich, Northumbria University and Aberdeen University. The wide-ranging programme explores the issues in chronic pain in older people with a focus on providing help for self-management.
Team: Professor Denis Martin (PI), Lisa Anderson, Gemma Wilson, HSCI, Teesside University.
This HTA-funded systematic review and cost-effectiveness analysis into the management of primary frozen shoulder was undertaken with research colleagues from the York Centre for Reviews and Dissemination (CRD) and clinical colleagues from Middlesbrough, both primary and secondary care. The review included 32 studies including 28 RCTs, one of which incorporated a cost-utility analysis. Of the studies evaluating conservative interventions, those at least risk of bias found benefit from adding a steroid injection to home exercises, benefit from adding physiotherapy to a steroid injection, and no benefit from distension therapy.
Evidence for "watchful waiting", physical therapy, acupuncture and sodium hyaluronate injections was mostly based on single studies at some risk or high risk of bias, and was therefore inconclusive. Regarding non-conservative interventions, one of four studies evaluating manipulation under anaesthesia (MUA) was of satisfactory quality, and found no benefit from adding MUA to home exercises; while evidence for capsular release is based case series, and therefore inconclusive. There were large gaps in the evidence for the effectiveness and cost-effectiveness of all the interventions investigated.
Team: Dr. Nigel Hanchard, Laura Dennis, HSCI, Teesside University; Dr. Catriona McDaid (PI), E Maund, Dawn Craig, Sarah Suekarran, Aileen Neilson, Kath Wright, Dr. Gerry Richardson, Dr. Stephen Brealey University of York;, Lorna Goodchild, Professor A Rangan, James Cook University Hospital; Dr. James Robertson, Cambridge Medical Group, Middlesbrough.
In 2008, NHS Health Scotland began to develop indicators for use in creating a summary profile of children and young people's mental health. Most research is done 'on' children, rather than 'with' them. It is important to ensure that their views inform this work. This study involved a systematic review (search process followed by rigorous quality assessment and data synthesis) of both peer-reviewed and 'grey' literature.
The search process revealed a paucity of literature collected without undue adult influence. The review suggested that children view mental health holistically, that some factors can be viewed as simultaneously positive and negative, and that it is the accumulation of factors that has the most impact. Particular significance was attached by young people to social relationships, feeling 'normal', transitions and issues of control over aspects of their lives. The effect of these findings and of the consultation work with young people on the development of the indicators is examined. The findings have influenced the development of the framework of indicators in ways which are informed by young people's own mental health priorities.
Team: Professor Janet Shucksmith, (PI), Rebekah McNaughton, HSCI, Teesside University; Jenny Spratt, Dr. Kate Philip, University of Aberdeen.
Teesside University were commissioned by Families Talking to carry out an evaluation of the Parenting Shop Project, an initiative funded by the Department for Children, Schools and Families (DCSF) for two years (April 2009-Mar 2011) aimed at providing an integrated package of services for families experiencing family breakdown in the borough of Redcar & Cleveland.
This project was established at a time when major changes were occurring; a change of government and restrictions in funding had a major impact on activity within the local authority, which substantially reduced its own parenting provision.
This was a complex programme of work aimed at a specific target group, and a new venture for Families Talking. The "distance management" model was challenging, because whilst staff were experienced in service provision, few had previously developed projects. But the quality of services ultimately provided from the Parenting Shop Project was very high. Impacts included improved confidence, knowledge and understanding. It had also led to changes in the way parents related to their children, and how they addressed issues. The delivery phase of the Parenting Shop Project proved too short to allow for a more robust evaluation of the impacts of the activities on the clients. The evaluation highlighted a number of opportunities for future work.
Team: Professor Janet Shucksmith (PI), Pat Watson , HSCI, Teesside University.
Evidence from a Cochrane review shows that smoking cessation counselling delivered in acute hospital settings, combined with follow-up support on discharge, increases smoking cessation rates. This evidence, combined with behavioural change theories and findings from the Scottish experience of providing smoking cessation services in hospitals, informed the development of a model for a smoking cessation service in one acute hospital in England.
Our study provided an evaluation of the impact of the new service. A case study design incorporating a mixed methods approach was used. This comprised Local Stop Smoking Service datasets, user questionnaires (n=44), user telephone interviews (n=19), smoking cessation staff interviews (n=5) and hospital staff interviews (n=5). A total of 783 smokers were assessed by the service and set target quit dates. Of these, 215 had quit at four weeks. Further follow-up suggested the quit rate was much higher than the data had shown. Patients generally welcomed the service and found it appropriate. Two main themes emerged: 'pushes' towards and 'pulls' away from quitting smoking. These were mediated by the battle going on in the smoker's mind and were demonstrated outwardly by how ready they were to quit.
Team: Dr. Sharon Hamilton (PI), Susan Jones, HSCI, Teesside University.
Cardiovascular diseases (CVD) are a leading cause of death and disability worldwide. The reduction of CVD has become a priority in the United Kingdom with the Department of Health developing a CVD risk assessment, reduction and management programme - NHS Health Checks. The four Tees Primary Care Trusts commissioned researchers from Teesside University to provide evaluation of the Tees Vascular Assessment Programme alongside its implementation. Work was carried out to evaluate the roll out of the programme in community pharmacy, GP practices, workplaces and community settings. Findings from the evaluation aided the PCTs to make decisions about how to roll the programme forward into subsequent years and shape commissioning strategies.
A publication from the evaluation can be found here.
Team: Professor Janet Shucksmith (PI) and Rebekah McNaughton, HSCI, Teesside University.
Monitoring fluoride exposure in infancy is very important due to the potential bidirectional correlation between fluoride exposure and oral health (i.e. caries prevention and dental fluorosis).
This study, funded by the Organix Foundation, measured total daily fluoride intake of infants living in non-fluoridated and fluoridated areas in the UK, to provide current data on fluoride exposure in infancy that reflect current dietary practice. Findings of this study (Zohoori et al, 2014) confirmed the importance of estimation of total daily fluoride intake at both an individual and community level prior to any recommendations for fluoride use with the goals of maximising dental caries prevention while minimising risk of dental fluorosis.
Team: Dr. Vida Zohoori (PI), Dr. Narges Omid, HSCI, Teesside University.
This study was funded by the South Tees NHS Trust Small Grant Awards (co-funded by South Tees NHS Trust and Teesside University).
Teesside University carried out a mixed methods evaluation of the 3 maternal obesity pathways implemented at South Tees Hospitals NHS Foundation Trust. These pathways have been implemented due to the associated risks of maternal obesity to both the mother and infant, and the associated implications for healthcare. Furthermore pregnancy is associated with increased weight gain, and is often deemed an appropriate 'teachable moment' for weight management intervention. Pregnant women with a booking BMI more than 30 are commenced on one of these 3 pathways, depending on the severity of their BMI (BMI more than 30-34.9; BMI more than 35-39.9; BMI more than 40).
These care pathways incorporate antenatal, intrapartum, and postnatal clinical requirements relevant to the booking BMI, as well as a focus on weight management intervention. The experiences of pregnant women who were currently on the BMI pathways, and HCPs' awareness and experiences in relation to the pathways were considered. Compliance with the care pathway was also assessed via routinely collected data. Data from the three components were triangulated, and key findings were provided to South Tees Hospitals Foundation Trust to enhance service improvement.
Team: Dr. Nicola Helsehurst (PI), Sarah Dinsdale, HSCI, Teesside University.
The Public Health Practitioner (PHP) role was designed to augment primary care teams' implementation of the public health agenda in primary care. The new and innovative role was underpinned by the move to modernise healthcare roles and find creative solutions for addressing public health issues.
This study aimed to explore the PHP role as developed in one local PCT and identify which aspects worked best, for whom and in what circumstances. Furthermore, recommendations were made to inform future development of the role.
The key findings highlighted that stakeholders valued the role. However, in common with many new roles when first implemented, there was a lack of role clarity. The role appeared to be unclear for the PHPs themselves, senior managers, colleagues and for the people that they worked with. Many of the participants were unsure of the different aspects of the role that the PHP were charged with delivering and where the PHPs could assist in the development of public health capacity. The choice of job title contributed to this confusion as it implied a 'hands on' role.
Overall, the PHPs were a valued resource for those with whom they had worked. Within the context of competing priorities for health professionals, the PHPs played an important role in raising awareness of public health opportunities in GP practices.
Team: Dr. Sharon Hamilton (PI), Sarit Carlebach, HSCI, Teesside University.
The Compassionate Communities project aimed to explore the implementation of the North East's Charter: 'Compassion at the end of life', and examine the theoretical development of the compassionate community approach to end of life.
A sub-study explored the impact of Human Resources policies around compassionate leave through a survey of trades unions, professional organisations and the area's largest employers, followed by interviews exploring the operation of policies in practice.
Team: Professor Janet Shucksmith (PI); Deborah Hall, Elizabeth Paterson, Letty Mather, HSCI, Teesside University.
This was an evaluation of the spirituality module in the School of Health & Social Care at Teesside University. The evaluation showed that the module had been successful in providing an effective learning experience which improved both knowledge and skills in this area, although there were some minor concerns and some participants struggled with the academic content. These findings support the continuation of this module and its potential to attract a wider audience.
Team: Professor Janet Shucksmith (PI), Pat Watson, HSCI, Teesside University.
An analysis of questionnaires sent to GP practices regarding their involvement in end of life care pathways. The responses showed that there was a lack of uniformity of approach across Teesside, and that further training in this specialist area was warranted, with greater attention to the needs of carers.
Team: Professor Janet Shucksmith (PI), Sarit Carlebach, HSCI, Teesside University.
This was an evaluation of referral process for safeguarding in Middlesbrough, exploring the reasons why the referral rates were significantly higher compared to other geographical areas with similar levels of social issues. Various reasons for this were suggested together with recommendations to review methods of working and seek further comparison with 'statistical neighbour' councils which have lower referral rates.
Very little is known about the information needs of patients with Adolescent Idiopathic Scoliosis (AIS) and their families. Failure to fully address patients' and their families' health information requirements can lead to significant stress and anxiety.
This study was commissioned by the British Scoliosis Research Foundation to evaluate patients' information needs at the first point of diagnosis with (AIS).
A mixed methods approach was used and comprised a literature review, interviews conducted with patients at one Centre in the North East of England and supplemented by a national survey of UK clients with AIS, a survey of UK NHS Consultants, an analysis of information contained on websites recommended by UK surgeons to patients, and a content analysis of a sample of UK hospital materials currently provided to patients.
Parents and young people identified a need for additional information. It was clear that verbal information alone was not sufficient to address that need. The findings from our study also supported the need for access to information in the period between GP referral and the visit to the consultant. There is also a view that general posters and leaflets on scoliosis should be available at GP surgeries as a way of raising general awareness of the condition. Furthermore it was suggested that awareness of the condition should be improved within school environments. Young people also felt that some guidance on how to talk about their condition, and what it means, with their friends was important as many did not know how to do this. The opportunity to communicate with others suffering from AIS, listen to their experiences and to learn from each other was felt to be an important step forward in meeting the information needs of young people.
AIS is a life-changing diagnosis for young people and their families. Patients and families have a need for good quality information at the point of diagnosis so they are able to make informed choices about their treatment. Currently the quality and range of information needs to be strengthened.
Team: Dr. Josette Bettany-Saltikov (PI), Dr. Sharon Hamilton, Shaun Wellburn, Dr. Lisa Arai, HSCI, Teesside University.
It is widely accepted that most people, when the time comes, wish to be cared for and die at home. However, many deaths occur in acute hospitals in the UK even though most patients have no medical reason to be there at the end of their life. To address the issue, an NHS Trust in the north of England secured funding from Macmillan Cancer Support to introduce a new end of life discharge sister post and additional administration support. The key aim of the post was to support clinical teams to discharge patients who had reached the end of their lives and whose desire was to be cared for out of the acute hospital environment.
The aim of our study was to explore the impact the introduction of the new discharge sister role from the perspectives of professional staff and carers. Seven carers and 75 professional staff (hospital and community) were interviewed. The overarching finding was that for a safe, timely, end of life discharge to take place a large number of factors needed to be in place within a short, specific but unpredictable time point. The new discharge sister role played a major part in facilitating pathways through organisational systems that were delaying discharges. Our findings from the evaluation were fed-back to the commissioners and clinical staff who used them to make immediate and more long-term improvements to the service.
Team: Dr. Sharon Hamilton (PI), Sue Jones, Sarit Carlebach, HSCI, Teesside University.
A literature review was undertaken of the impact and value of providing community equipment to enable people with long term health needs to continue to live in their own homes. This showed that despite the fact that community equipment is an integral part of health care for many individuals, there has been very little research linking provision with pre-identified health outcomes.
There is however wider evidence that it has an important role to play in preventing falls, increasing independence at home, and creating a sense of safety and security; and that there may be shortcomings in the provision of the service and awareness of its existence amongst potential service users. Following on from this study an evaluation was undertaken of the Tees Community Equipment Service.
Team: Dr. Sharon Hamilton (PI), Sarit Carlebach, Adam Park, HSCI, Teesside University.
This controlled trial was conducted from 2008-2011 in collaboration with Professor Gerard Danjoux (a Visiting Professor here at Teesside from the Department of Academic Anaesthesia at James Cook University Hospital, Middlesbrough) and Dr Simon Howell from the University of Leeds. The work was funded by the NIHR Research for Patient Benefit programme. In survivors of critical illness, we showed that an 8-week supervised aerobic exercise training programme resulted in a clinically relevant improvement in physical fitness, accelerating the natural recovery process. This evidence has already been translated into a recommendation to patients attending the intensive care unit follow-up clinic to engage in exercise of this type to aid rehabilitation. The full report of this trial has recently been published in the British Journal of Anaesthesia.
Batterham AM, Bonner S, Wright J, Howell SJ, Hugill K, Danjoux G. (2014). Effect of supervised aerobic exercise rehabilitation on physical fitness and quality-of-life in survivors of critical illness: an exploratory minimized controlled trial (PIX study). British Journal of Anaesthesia (In Press). doi:10.1093/bja/aeu051.
Team: Professor Alan Batterham (PI), Professor Denis Martin, HSCI, Teesside University; Professor Gerard Danjoux, James Cook University Hospital; Dr. Simon Howell, University of Leeds.
Carrying out a secondary analysis of the Health Survey for England 2008 our group has identified that elderly people who have chronic muscle pain are at a significantly increased risk of having heart disease. Almost half of elderly people who had chronic musculoskeletal pain (CMP) also had cardiovascular disease (CVD).
Individuals aged over 65-years-old who have chronic musculoskeletal pain are 82% more likely to have cardiovascular problems than those who do not have CMP. This work was a collaboration between Teesside University and academics in Northern Ireland and America to look at a sample of over 5,300 adults aged over 45-years-old. The sample of people had participated in the Health Survey for England in 2008.
Our findings suggest that the appropriate management of chronic musculoskeletal pain should not simply be viewed as an intervention for chronic musculoskeletal pain in itself, but also a preventive strategy to reduce the risk of developing cardiovascular disease. Of those aged 65 and over, 32.5% reported having chronic musculoskeletal pain. And of these individuals almost half, 47%, had cardiovascular disease. This is compared with 28% having cardiovascular disease who did not have chronic musculoskeletal pain. Middle-aged adults, from 45-64-years-old, who had chronic musculoskeletal pain were also at an increased risk of developing cardiovascular disease, with 23% of those having CMP going on to develop CVP, compared with 14% who had not had CMP.
There are a number of reasons why there may be a link between CMP and CVD. For example Musculoskeletal pain can impair movement, leading to a less activity and more sedentary lifestyle. However, this study found that reduced physical activity and increased sedentary behaviour did not appear to explain the link. There are a number of other potential links including obesity which the group are currently now investigating.
Considering, on average, 10% of the world's population report chronic musculoskeletal pain, this study could have far reaching implications for cardiovascular disease prevention, giving support to previous calls for chronic musculoskeletal pain to be considered as a public health priority.
Ryan CG, McDonough S, Kirwan JP, Leveille S, Martin DJ. (E-Pub ahead of print) An investigation of association between chronic musculoskeletal pain and cardiovascular disease in the Health Survey for England (2008). European Journal of Pain, DOI: 10.1002/j.1532-2149.2013.00405.x
Team: Dr Cormac Ryan (PI); Professor Denis Martin; Professor John Kirwan, Cleveland Clinic Ohio, USA; Professor Suzanne Leveille, University of Massachusetts Boston, USA; Professor Suzanne McDonough, University of Ulster.
HSCI Professors Greg Atkinson and Alan Batterham have recently published a paradigm-changing paper in the journal "Vascular Medicine". The paper focussed on an indicator of endothelial function known as percentage flow-mediated dilation. Researchers measure the percentage change in diameter of the brachial artery in response to an induced increase in blood flow. But Alan and Greg have been the first researchers in the world to demonstrate that a percentage change statistic is not accurate for this measurement. Using the large dataset from the Multi-Ethnic Study of atherosclerosis, they showed how use of the percentage change can lead to inaccurate study conclusions.
They have presented, for the first time, a much more accurate way of quantifying the change in diameter, which calls on the principles of allometric (size) scaling. Alan and Greg have now been working on this topic for three years and have published more than 10 papers and letters, which are already highly cited.
Team: Professor Greg Atkinson, Professor Alan Batterham.
Professor Atkinson has researched the body clock for over 25 years and has now joined forces with Professor Gerry Danjoux who heads up the Sleep Medicine Unit at the James Cook University Hospital (JCUH).
The JCUH has a strong reputation for sleep medicine - the President of the British Sleep Society, Dr Paul Redding is a consultant neurologist there. Professor Danjoux is a Visiting Professor in the Health and Social Care Institute and has established a successful collaboration with Professor Alan Batterham, who is also on the project team alongside Dr Louisa Ells.
Teesside University has provided three years of funding for a PhD student, Sophie Suri to research the links between physical activity, obesity and obstructive sleep apnoea.
Obstructive sleep apnoea is the name of the syndrome where the upper airways partially or completely collapse during sleep, leading to the person waking up, sometimes more than 30 times per hour.
People with sleep apnoea are at an increased risk of developing a high blood pressure and having a stroke or heart attack. They also find it very difficult to stay alert during the daytime because of the sleep disruption. Obesity is an important predictor of obstructive sleep apnoea.
Diagnosis of obstructive sleep apnoea is difficult and can involve costly overnight monitoring in a sleep medicine laboratory. Part of the project focusses on other ways of diagnosing obstructive sleep apnoea and exploring whether physical inactivity and/or being unfit makes the symptoms worse.
Ultimately, the project team want to see if a supervised exercise programme can make symptoms of obstructive sleep apnoea better.
Team: Professor Greg Atkinson, Professor Alan Batterham, Dr. Louisa Ells, Sophie Suri, Teesside University; Professor Gerard Danjoux, James Cook University Hospital.
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