Research

My research programme crosses the boundaries between primary and secondary care; physical and mental health; health and social care. I have research expertise in the co-production and evaluation of complex interventions, pragmatic randomised controlled trials, feasibility studies, mixed-methods process evaluations and systematic reviews.

Fracture in the Elderly Multidisciplinary Rehabilitation

We have developed a rehabilitation programme in the community, for those aged over 60 years, following surgical treatment of hip fracture. This involved a realist review, a survey and focus groups. The methods for a future randomised controlled trial (RCT) were tested in a randomised feasibility study. This research project linked researchers from all of the schools of the College of Health and Behavioural Sciences. A phase III definitive multi-centre RCT of the intervention funded by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme is in progress (HTA Reference Number 16/167/09). HTA final report for FEMuR phases I and II. This RCT has recruited 216 participants. Follow-up will be completed in 2023. Further information can be found on the website FEMuR III

Function First - be active, stay independent

We co-designed a physical activity intervention for long-term conditions managed in primary care. As people age and accumulate long-term conditions, physical function declines. In order to reduce declining physical function, people with long-term conditions need to become more physically active. Primary care is well placed to reduce this decline, but management of long-term conditions does not prioritise physical activity promotion. The aim of this research project was to develop a programme theory explaining how interventions improve physical activity and function, in people with long-term conditions, then to use this programme theory to co-design a prototype intervention. We used realist synthesis to combine evidence from the literature with the views of stakeholders. Five context CMO statements were developed to explain how physical activity could be promoted to enhance physical functioning (and also psychosocial functioning) in people with long-term conditions, who are managed in primary care:

1. Primary care settings are characterised by competing demands, and improving physical activity and physical function are not prioritised in a busy practice (C). If the practice team culture is aligned to promote and support the elements of physical literacy (M), then physical activity promotion will become routine and embedded in usual care (O).
2. Physical activity promotion in primary care is inconsistent and uncoordinated (C). If specific resources are allocated to physical activity promotion (in combination with an aligned practice culture) (M), then this will improve opportunities to change behaviour (O).
3. People with long-term conditions have varying levels of physical function and physical activity, different attitudes to physical activity and differing access to local resources that enable physical activity (C). If physical activity promotion is adapted to individual needs, priorities and preferences, and considers local resource availability (M), then this will facilitate a sustained improvement in physical activity (O).
4. Many primary care practice staff have a lack of knowledge and confidence to promote physical activity (C). If staff develop an improved sense of capability through education and training (M), then they will increase their engagement in physical activity promotion (O).
5. If a programme is credible to patients and professionals (C), trust and confidence in the programme will develop (M) and more patients and professionals engage with the programme (O).

This programme theory informed three co-design workshops and one knowledge mobilisation workshop to develop a prototype intervention. This prototype consisted of:
• Resources designed to encourage a culture of physical literacy amongst staff and within the practice.
• Suggestions for changing the layout of the practice and other promotional materials to create an environment that encourages physical activity.
• Materials to help develop the role of a credible professional who will facilitate behaviour change during consultations with people with long-term conditions.
• Identification of community resources, which can address barriers to the uptake of physical activity, such as community transport schemes.
• Plans to develop, or adapt, an electronic directory of local physical activity opportunities, clubs and groups.

A culture of physical activity promotion is needed in primary care, with appropriate resources, training and a credible intervention. [HSDR Final report for Function First] (https://www.journalslibrary.nihr.ac.uk/hsdr/hsdr09160/#/abstract).
The Liverpool Primary Care Network is recruiting Clinical Exercise Physiologists to provide physical activity advice and guidance for people with long-term conditions, who will be using components of this approach in their work.

Cardiac rehabilitation for people with chronic stable angina: a randomised controlled trial. Acronym: Angina Controlled Trial Investigating the Value of the 'Activate your heart' Therapeutic E-intervention (ACTIVATE)

Cardiac rehabilitation is routinely offered to patients following myocardial infarction or revascularisation procedures, but not for chronic, stable angina. Cardiac rehabilitation consists of lifestyle change, exercise training, education and mental health interventions. The National Institute for Health and Care Excellence will not support cardiac rehabilitation for chronic stable angina until stronger evidence of effectiveness and cost-effectiveness is available.
A randomised controlled trial funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment (HTA) programme is in progress (https://www.dev.fundingawards.nihr.ac.uk/award/NIHR131015). The aims of the ACTIVATE trial are to improve the health of people with long-term angina, that is not getting worse and does not require an operation, but which still limits daily activities. We aim to assess whether a rehabilitation programme is more effective than usual care in improving the health of people with angina, whether the programme is good value for money, and whether it is delivered as intended.