Physiotherapy's research network is off to a highly promising start. Colleen Shannon examines the reasons for its early success
Ask anyone who works alongside them – physiotherapists have their own way of doing things. They have a different perspective to medics and nurses, and they are good at solving clinical problems in a practical way that suits individual circumstances.
Crest of a wave: West of Scotland
Physiotherapists in the West of Scotland launched their hub on the crest of a local research wave, thanks to good timing and strong relationships. Just as the hub was forming at Glasgow Caledonian University, a major multi-disciplinary research consortium, HealthQWest, was also taking shape in the area. HealthQWest is building a local infrastructure for research in nursing, midwifery and allied health professions. It has £4.9 million funding, and partnerships with NHS Scotland and several universities. The hub had an opportunity to become a research community within HealthQWest and held its first event at the consortium's launch day. HealthQWest continues to provide back-up in areas like administration and the hub website. 'HealthQWest have been great in supporting us and we are just delighted to be part of it,' says Lorna Paul, lecturer in physiotherapy and senior research fellow at Glasgow Caledonian University. She is one of the hub's founders and a member of its strategic planning group. Since September 2005 the hub has grown to 83 members. Most are physiotherapists, but there are also occupational therapists, dieticians and orthotists. Members come from primary and acute care, the private sector, and academia. The primary immediate goal is to build research capacity, Dr Paul says. There has already been a series of workshops on developing research questions, time management, and implementing research in clinical practice. The hub has also held disease-specific events, including a research day on multiple sclerosis.
The broader health community: North East rehabilitation research hub
One of the youngest hubs is forging links with the local health community in the broadest sense, involving industry and service users, as well as academics and clinicians. The North East rehabilitation research hub was only launched in the autumn of 2006 but is already working with the regional development association, One Northeast, and talking to local businesses about working together. 'It's an exciting development that might include, for example, a knowledge transfer relationship with industry partners,' says Liz Holey, deputy dean of the school of health and social care at the University of Teesside in Middlesbrough and the hub's facilitator. The hub also strives to be truly multi-disciplinary and this is reflected in its name, Ms Holey adds. One of the hub's senior advisers is a specialist in podiatric rehabilitation. Already, the hub has applied for classification as a centre of excellence through BioNEt, a regional network in the North East promoting health research across industry, academia and the NHS. If this is awarded, the hub will gain administrative support and funding for its events. While the hub is still in its early stages, Ms Holey and her colleagues already have some strategic goals in mind. They would like to do a scoping exercise to identify all of the rehabilitation research underway across the region. Dissemination is also a priority, and there are probably opportunities to link and co-promote conferences and other events in the region, Ms Holey says. Finding the time has been the hardest part for everyone involved, she adds. But the rewards have been worth it: 'It's helping us think more creatively and given us new energy.'
Big is beautiful: Sheffield hub
The Sheffield Hub has 60 members who are active researchers. There is multi-disciplinary involvement and the steering group includes professors of speech and language therapy and nursing, with input from medical advisers in orthopaedic surgery and geriatrics. Hub members are undertaking a wide range of work, from small pilot studies to £500,000 projects. The launch in September 2005 was funded by a health care company, Allergan, which continues to provide commercial sponsorship.The main goals are to: develop research capacity and capability; develop the knowledge base; and disseminate methods and findings. The hub works with the Trent R&D support unit, which is part of a national DH-funded network. It provides finance for events and publications, and offers hub members free research training courses. Sue Mawson is one of the hub's founders and a reader in rehabilitation at the Centre for Health and Social Care Research, Sheffield Hallam University. She holds a joint NHS/academic post and is also head of research for the directorate of professional services at Sheffield teaching hospitals trust. One advantage of this post is that, by keeping in touch with patient care, she can make sure academic research activities answer clinically relevant questions. 'I have a much better understanding of the drivers within the NHS and some of the problems that physiotherapists have in doing research,' Dr Mawson says. With a multi-disciplinary team of researchers from universities across the UK, she and Dr Jane Burridge, senior lecturer in the school of health professions and rehabilitation sciences at the University of Southampton, have won a grant of £579,000 from the Engineering and Physical Science Research Council. They will investigate ways of using interactive technology to increase mobility, confidence and independence for people such as the frail elderly, those with multiple sclerosis, and those recovering from stroke. So it's only to be expected that physiotherapists have come up with a radical – and highly successful – model to develop their own research network. And they haven't wasted any time in doing it. In just 18 months since its launch, the National Physiotherapy Research Network has grown to involve hundreds of physiotherapists and health professionals from other disciplines, too. This growth has exceeded even the most optimistic expectations, says Ann Moore, director of the Clinical Research Centre for Health Professionals at the University of Brighton, and chair of the NPRN's core executive. 'We called for possible collaborators from around the physiotherapy profession, experienced researchers who might want to get involved with this project and perhaps set up local hubs. We thought we might, if we were lucky, get six people to do this,' she explains. There are now 20 NPRN hubs covering most of the UK and parts of the Republic of Ireland. 'We're really pleased with the progress that we've made and the enthusiasm that it has met with,' says Professor Moore. 'The fact that we have people coming consistently means they are voting with their feet, and I think generally people are very keen on meeting together with like-minded individuals.' GOING ORGANIC It hasn't all been easy, though. One of the initial difficulties was persuading people to set aside traditional ideas about how research networks should be organised and directed, says Di Newham, another member of the NPRN core executive. She is professor of physiotherapy and director of the division of applied biomedical research at King's College, London. She and the other small group of NPRN founders were determined to avoid a control-and-command model with plans dictated from the centre. Instead, the hubs have been allowed to grow organically, according to their own local needs and influences. 'The last thing we wanted was a one-size fits all policy,' says Professor Newham. The NPRN's success has been noticed in wider circles, too, she adds. The Council of Deans, which is the national voice of higher education and research in nursing and the allied health professions, thinks the network could be a promising model for other disciplines to follow. From the outset, working with other professions has been an important goal for the network. At a local level, some of the hubs have been very successful in this. Nationally, the hub can draw on the advice of Elizabeth White, head of research and development for the College of Occupational Therapists and a member of the NPRN core executive. She also convenes the Research Forum for Associated Health Professionals. 'It's been a very good experience working with the NPRN,' Dr White says. 'It does demonstrate how well allied health professionals can work together for a common purpose.' This kind of multi-professional working is crucial to gain funding for research projects in today's climate, she adds. 'So opening it up to other allied health professionals does open up opportunities.' Ultimately, Dr White believes, research cooperation between allied health professionals will optimise the benefits for patients because each discipline brings its own unique perspective. 'The whole is greater than the sum of the parts. You get a more rounded research outcome.' So it's off to a great start, but the network does have more work ahead. One obvious challenge is that currently the network only has funding for five years from the CSP. 'We're busy trying to think of ways in which we can attract funding for support for local hubs,' says Ann Moore. The NPRN has a national research officer, Philippa Lyon, but beyond that each of the hubs operates mostly on the goodwill of its members. 'Obviously if we could get some administrative support for each of the hubs that would be ideal,' Prof Moore adds. Some of the hubs are already tackling this need themselves, and have won or are seeking support from a variety of sources, including regional development funds, the Department of Health's network of regional research and development support units, and industry. Another big challenge is the overall research environment in England's NHS, where major new policies, organisations and funding mechanisms are being rolled out. Research in the NHS will be overseen by a new national body, the National Institute for Health Research. New career structures for some health professionals are proposed to encourage more individuals, such as nurses, to pursue research. The NPRN hopes these structures will be developed further to encompass allied health professionals. And some of the funding that has traditionally been streamed through the big university teaching hospitals is being redirected to a more local level. NEXT STEPS In the meantime, the NPRN is carrying on with its efforts to support physiotherapy researchers in their day-to-day work. While the NPRN's local diversity is a strength, it is also a challenge to capture and share all of the knowledge and contacts that are being generated. NPRN research officer, Dr Lyon, is putting together an information resource so that physiotherapists can contact colleagues with expertise in specific areas. This is already on the NPRN website, and will support the CSP's researchers' database. The network has almost completed a tool to track and analyse activity across all of the hubs. With this data, the NPRN will be able to provide a national picture and a systematic evaluation of its work. FL
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