Non-medical clinical academic careers
Pip Logan
Professor in Rehabilitation Research
May 2013
to encourage an environment where academic therapists can flourish
UCLP CENTRE FOR NEUROREHABILITATION
Plan for tonight
—  Little bit about myself
—  Developing a career
—  Research projects
—  Clinical
—  Collaborations
—  Courage
Occupational Therapist
MPhil 1994
PhD 2004
Senior Clinical Academic Award2011
Chair in 2012
What is a clinical academic
—  Engages concurrently in clinical practice & research
—  Clinical and research leadership in pursuit of innovation,
scholarship and excellent evidence based healthcare
—  Develops and leads clinically relevant /driven research
—  Builds capacity and capability in others
—  Challenges practice, contribute to delivery of excellence in
health and healthcare outcomes
http://nuhrise.org/wp-content/uploads/Launch-event_final.pdf
Developing the Role of the Clinical Academic
Researcher in the Nursing, Midwifery and Allied
Health Professions
More research training will be offered to nurses, midwives
and allied health professionals thanks to a new strategy that
will be launched by Health Secretary Andrew Lansley later
today. 2012
Clinical Academic Training Programme for Nurses,
Midwives and Allied Health Professionals
http://www.nihrtcc.nhs.uk/cat/
Money and time
—  Nottinghamshire Non-medical Clinical Academic Career
Programme 2012/2013
—  HIEC Internships
—  NIHR MARMs courses
—  NIHR Clinical academic PhD Scholarships
—  NIHR Clinical academic post doctoral fellowships
—  NIHR Senior fellowships
Informal route
—  Take a job on a research project
—  Get seconded
—  Get on a research steering/ management committee
—  Apply for grants
—  Ask the R&D directors for support
—  Link to successful groups
How to get going
MRC Framework: Development
and Evaluation of Complex
Interventions
Phase IV
Phase III
Phase II
Phase I
Pre-clinical
Theory
Modelling
Exploratory trial
Continuum of increasing evidence
Definitive RCT
Long term
implementation
Research ideas
—  Clinical practice
—  Other research projects
—  Reading papers
—  Attending conferences
—  Talking to people
—  Funding opportunities
—  Patient groups
—  Professional groups
—  Commercial groups
£500 College of Occupational
Therapists grant
To investigate the role of the social service
occupational therapist
£25,000 Stroke Association grant
To evaluate the role of occupational
therapy in social services
£1,450,000 NIHR grant
This project was funded by the National Institute for Health Research Health Technology Assessment
Programme (project number: 08/14/51). The views and opinions expressed herein are those of the authors and do not necessarily
reflect those of the Department of Health.
Primary Care
Research Network
Stroke Research
Network
Comprehensive
Local Research
Network
Service Support
costs
Multi- Centre randomised controlled trial of outdoor
mobility rehabilitation
Professor Pip Logan – Chief Investigator
Dr Matt Leighton – Trial Manager
Mr Ossie Newell – Service user
Mrs Shirley Smith – NHS Commissioner
Dr Annie McCluskey – Stroke Research Expert, Australia
Ms Kathleen O’Neil – Stroke Clinical Expert, Newcastle
Professor Marion Walker – Professor of Stroke Rehabilitation
Professor John Gladman – Professor of Geriatric Medicine
Professor Tony Avery – Clinical Academic GP
Dr Sarah Armstrong –Medical Statistician
Ms Lisa Woodhouse – Medical Statistician
Dr Garry Barton – Health Economist
Dr Tracey Sach - Health Economist
Professor Hywel Williams – Director of Clinical Trials Unit
Excess treatment
costs
Research Assistants
Therapists
Participants and
carers
Background
•  Stroke can make people isolated, imprisoned and
housebound
•  Limitations in outdoor mobility reduces visits to the doctors,
dentist, opticians
•  People go outside to shop, meet friends and ‘just for the sake
of it’
•  42% of people who have had a stroke do not get out as much
as they would have like
Interventions
Routine Clinical Care
—  Leaflets and verbal advice
Specialist schemes
—  Travel training
—  Group training
—  Travel buddies
Outdoor mobility intervention
•  Personalised information
• Verbal advice
•  Equipment
•  Practice
Research question:
Does outdoor mobility rehabilitation
improve outdoor mobility participation
and quality of life ?
Methods
•  Multi-centre parallel group RCT
•  Participants received baseline visit.
•  Participants then randomised to either control or
intervention groups.
•  Participants completed travel diaries each day over a year
and questionnaires at 6 and 12 months.
Outcome measures
Primary Outcome
•  Social Function Domain of SF-36v2 at 6 months
Secondary Outcomes
•  Social Function Domain (SF-36v2) at 12 months.
•  Functional Ability (NEADL) at 6 and 12 months
•  Mobility (RMI) at 6 and 12 months
•  Satisfaction with outdoor mobility (SWOM) at 6 and 12 months.
•  Mood (GHQ - 12) at 6 and 12 months.
•  The number of journeys made in 6 and 12 months.
15 Sites
Aberdeen
Lanarkshire
Gateshead
Lincolnshire
Wolverhampton
Nottinghamshire County
Cwm Taf
Nottingham City
Norwich
Bristol
Cardiff
Southend
East Kent
North Somerset
Tower Hamlets
Recruitment
700 650 600 550 500 450 400 350 300 Target Actual 250 200 150 100 50 0 Oct-­‐09 Dec-­‐09 Feb-­‐10 Apr-­‐10 Jun-­‐10 Aug-­‐10 Oct-­‐10 Dec-­‐10 Feb-­‐11 Apr-­‐11 Jun-­‐11 Aug-­‐11 Results
—  11126 letters sent
—  1448 replies
—  Median age 73 years (IQR 63,81)
—  56% female
—  3.5 years post stroke
—  568 participants – 287 intervention
—  503 six month - 264 intervention
—  404 twelve month - 232 intervention
—  Median of 7 intervention sessions (IQR 3, 11), mean 6.80
(SD 4.01)
—  26 Therapists
Summary of type of intervention and the number of sessions the
intervention type was delivered
* Percentage out of 264 participants
Interven'on Type
N(%)* Par'cipants
Goal Se@ng
243 (92.1)
Mobility
222 (84.1)
InformaKon
205 (77.7)
Confidence
202 (76.5)
Other Rehab
139 (52.7)
Referral
104 (39.4)
AdapKve Equipment
63 (23.9)
Results at 6 months
Slightly higher SF score in the intervention group but not significant
—  No significant differences between groups on NEADL, RMI, GHQ
—  Significant increase in journeys
—  Change in satisfaction in outdoor mobility in both groups
—
Unadjusted
Adjusted
Outcome
Intervention
Mean [SD]
Control
Mean [SD]
Social
Function
Domain
47.0 [30.5]
(n=261)
43.9 [29.8]
(n=239)
4.630
Travel
1·0 [1·0]
1·1 [1·2]
Rate ratio
journeys
(n=263)
(n=241)
1·42
Numbers
Yes = 72
Numbers
Yes = 52
Odds ratio
(n=261)
(n=233)
1·37
SWOM
Diff. in means 95% Credible Interval
ICC
Therapist
Centre
0.0051
0.0099
(1·14, 1·67) - - (0·89, 2·22) 0·0289 0·0123 (-0.549,9.848)
Economic evaluation
—  Cost benefit analysis from a NHS and personal social perspective
—  Control cost £34.78 pp
—  Intervention cost £509.84 pp
—  No significant difference between groups on the EQ5D
—  The intervention was neutrally effective and more costly so not
cost effective.
Qualitative study
—  26 participants in qualitative study
I would just like to let you know that I am now driving with an adapted car I would
like to thank "Getting out the house study " I didn't realise how
much I stayed in until I took part in the study.
Summary
—  The intervention
—  Did not improve health related quality of life
—  Did increase the number of journeys
—  Did increase satisfaction with outdoor mobility
—  Control participants also improved
—  People long after stroke can make improvements
Future projects
Falls after stroke
Motivational
interviewing for
long term
neurological
conditions
Care homes
Six month assessment
Neuropsychological
rehabilitation for dressing
Integrated
services for
long term
neurological
conditions
Facial palsy
Organised curiosity and reflective
practitioners - the keys to a research
rich environment
Thank you
Pip.logan@nottingham.ac.uk