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Take your partners please

Encouraging more research and greater therapist participation is at the heart of a new UK-wide stroke initiative. Mary Salmon reports

Marion Walker feels a good analogy is to view the recently formed UK stroke research network as a dance floor. She says, ‘It doesn’t do the dancing, but it helps arrange it’.

Her analogy works well: this is what the network does. It creates a national infrastructure enabling multicentre, multidisciplinary clinical studies looking at stroke to be developed and implemented.

This was needed, says Dr Walker, an occupational therapist, and associate professor and reader in stroke rehabilitation at the University of Nottingham. Marion points out that before the network’s inception, the majority of studies were done in a single centre. One effect was that researchers found it a lot harder to meet appropriate potential partners. Wallflowers were common, as was dancing in the dark.

With the SRN celebrating its first birthday last month, this is all changing. Now linking up should be a lot easier. It’s hoped the network will foster stronger collaborations, and multicentre studies will further enhance the quality of clinical trials undertaken (as results are more easily generalised, that is applied to a wider number of people). The end result: better healthcare.

As the third most common cause of death after heart disease and cancer, stroke is a major health problem. According to the Stroke Association, every year in the UK, around 130,000 people experience a stroke for the first time. While the majority of those affected are older people, one third are under 65.

‘It is a major cause of severe disability in the UK,’ says physiotherapist Sheila Lennon, senior lecturer at the University of Ulster. At least 50 per cent of people experiencing stroke are left with a physical or psychological disability, and a quarter of acute hospital beds are occupied by a stroke patient at any one time. Yet despite this, research has been poorly funded in comparison with other conditions, and less than one per cent of stroke patients enter clinical trials.

The SRN is funded by the Department of Health and is made up of eight coordinating local research networks (LRNs), with a national coordinating centre at the University of Newcastle. Each LRN will get between £300,000 to £400,000 a year.

Northern Ireland is also setting up an LRN (developed in part by Sheila Lennon ), while that for Wales is in the early stages of planning and Scotland’s is up and running.

'In addition, there are six clinical study groups, responsible for developing and overseeing a portfolio of studies in their specific area. The groups cover acute care, prevention, primary care, rehabilitation, service development and training, and translational research (research which bridges the gap between basic science and its clinical application).

Many people are set to benefit from the existence of a national body coordinating research into stroke: patients, their carers, health professionals and researchers.

For physiotherapists, opportunities beckon in terms of getting involved with and continuing to influence and lead research. To date, one physiotherapist, Anne Forster, heads up an LRN. Anne is the clinical lead for the Yorkshire LRN, which includes 20 stroke units and has a catchment area of 2.7 million people.

Therapists are also playing a key role in the network’s clinical study groups. Marion Walker is chair of the rehab clinical studies group, while Anne Forster co-chairs the network’s service delivery and training group. In addition, two physiotherapy professors, Ann Ashburn and Val Pomeroy, are part of the rehab and translational research groups, respectively.

Part of the SRN’s remit is to widen participation in research, as well as improving the care of people with stroke and their carers, and increasing the number of patients recruited into clinical studies. Dr Lennon explains more: ‘Trials will be multidisciplinary and not necessarily doctor-led: universities, drug companies and the health services will all make a coordinated effort... It’s a really exciting opportunity for physios to get involved.’

Marion Walker concurs, adding: ‘District and general hospitals will be involved in doing research under the SRN, whereas it used to be only the big teaching hospitals. It’s a whole new way of working.’

One way physiotherapists and others can get involved is to collaborate with their LRN rehabilitiation lead on specific projects that they feel need to be investigated. This is a fantastic way for allied health professionals to exert their influence on research and healthcare right from the ideas stage, Sheila says. ‘It’s good for physios as they can develop research skills... it’s a way for people to put their toe in the water.’ LRNs can also act as a sounding board for ideas.

Sheila suggests that if the hospital that a physiotherapist works with is getting involved in research, the physio could take part. ‘Research can take place in several different areas; for example, seeing what kind of training can help stroke patients once they are home from hospital, or physios can volunteer to be research assistants.’

Both Sheila and Marion Walker stress that therapists don’t need to have previous research experience. Part of each LRN’s role is to educate staff on research. As part of this, physios can get training on general research and also stroke specific training through the network. ‘They may be able to negotiate protected research time within their clinical role and they can gain support from the LRNs to apply for grants,’ adds Sheila.

Of primary importance is getting physios and other therapists aware of research opportunities. It’s intended that as the research network becomes more well-known, research posts will be advertised, perhaps internally within the hospital or in external sources such as Frontline.

The network is putting together a portfolio of research (more information on this is available at the ‘study adoption’ section of the SRN website). The aim, notes Dr Walker, is to have a balanced portfolio of trials. ‘We are concentrating on four areas: acute care, rehabilitation, prevention and primary care. We have recruited eight to 10 experts for each of the four areas.’

The SRN does not provide funding for research into stroke. Funding has to be applied for from the usual sources, such as the Stroke Association, the Medical Research Council and the DoH. However, LRNs can give advice on applying for grants, and will help to recruit patients and in delivering the study on time.

Looking to the future and the major hurdles ahead, Marion says: ‘The main challenge is getting funding for the research.’ What’s needed now is for physiotherapists to take the chance that the stroke research network offers them. It’s time to get involved; there’s no excuse not to. Take your partners please. 

FURTHER INFO

www.uksrn.ac.uk

The UK clinical research collaboration (UKCRC), set up in April 2004 is a partnership between government, the charity sector, the private sector and the public. The aim is to establish the UK as a world leader in clinical research by harnessing the power of the NHS. Visit www.ukcrc.org

Part of the CRC’s remit is the formation of clinical research networks in six priority areas: stroke; dementias and neurodegenerative diseases; medicines for children; cancer; diabetes and mental health. There is also a primary care research network. Visit www.ukcrn.org.uk. The first UK Stroke Forum conference is to be held in Harrogate on 7 to 8 December, 2006 www.ukstrokeforum.org

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