Show/hide main menu

Rehabilitation

Rehabilitation

The rehabilitation research programme is multidisciplinary involving clinicians, behavioural scientists, and heath service research methodologists.  The programme is focused on the evaluation of allied health professional interventions with an emphasis on physiotherapy. The goal is to examine and improve the benefit of interventions to patients and their families and consequently service users are actively involved at every stage of the work.  

The group has partnerships throughout the UK and international links with collaborators across the globe. Research capacity development is central to the group’s success and it welcomes applicants looking for support for doctoral and post-doctoral fellowships.

Aims

  • To understand the recovery of stroke, transient ischaemic attack, joint replacement, hip fracture, back pain and other disabling events.
  • To understand the rehabilitation implications of the progression of long term conditions, such as muscle and joint contractures, immobility, reduced participation in society and patient and family experiences.
  • To understand what successfully influences behavioural change and exercise adherence.
  • To develop an evidence base for public health interventions for continence, retaining mobility, obesity and back pain.
  • To develop and conduct randomised controlled trials of rehabilitation interventions.
  • To build the research workforce and leaders of the future.

 Current Research Programme

A multi-centre randomised controlled trial to compare the clinical and cost effectiveness of Lee Silverman Voice Treatment versus standard NHS speech and language therapy versus control in Parkinson's disease (PD COMM). Read more here.

Additional Trunk Training in Early Stroke Trial (ATTEST)

Previous research has shown that functional performance of trunk muscles directly affects overall outcome after stroke and strategies to improve this could promote better functional recovery. Most of these previous studies have delivered trunk training exercises to people with moderate trunk weakness after stroke, but the impact on individuals with severe trunk deficits have not been investigated. The ATTEST study is seeking to investigate the possible benefits of additional trunk training to this group of stroke patients with severe trunk weakness, specifically those who cannot sit for 30 seconds without support within the first three days after stroke.

The trunk training intervention involves delivering 16 hours of targeted trunk exercises in addition to usual care during early stroke rehabilitation. Our current work is testing the feasibility of recruiting 20 people within 7 days of stroke and delivering 16 hours of additional therapy. This trial is also assessing the acceptability of the intervention from the perspective of both patients and their families, as well as the health care professionals involved in its delivery.  Drs Isaac Sorinola, Claire White and Jane Petty are working on this feasibility trial with colleagues from Primary Care & Public Health Sciences (Dr Caroline Burgess), and Guy’s and St Thomas’ NHS Foundation Trust (Prof Anthony Rudd & Gareth Jones). ATTEST has been funded by the National Institute for Health Research (NIHR) - Research for Patient Benefit (RfPB) scheme. 

The PACT trial

Chronic low back pain is common and is a major cause of personal suffering, disability and time off work, costing the NHS over £1 billion a year. 1.26 million patients seek physiotherapy for chronic low back pain each year, yet standard physiotherapy is only moderately effective at improving patient outcomes. PACT is a new type of physiotherapy based on a form of cognitive behavioural therapy called Acceptance and Commitment Therapy (ACT).  This novel treatment is being compared to usual physiotherapy care to see which is most successful at improving people’s ability to manage their back pain in the long term. Dr Emma Godfrey and Dr Duncan Critchley are working with colleagues on the PACT trial funded by the NIHR Research for Patient Benefit Stream. The study aims to combine psychological approaches with physiotherapy to offer patients better support with their persistent back pain. The randomised controlled trial of 240 participants is being carried out by researchers at King’s College Departments of Psychology and Physiotherapy, working with physiotherapists and patients from Guy’s and St Thomas’ NHS Foundation Trust, King’s College Hospital NHS Foundation Trust and Ashford and St Peter’s Hospitals. The protocol for the randomised controlled trial was published in BMJ Open on 7 June 2016.

Public health continence intervention

Stress urinary incontinence (SUI) in women poses a considerable public health problem and is associated with distress, embarrassment, lower quality of life and avoidance of physical activity. SUI is also linked with substantial personal and health care costs, estimated in one study at £818 per year in the UK alone. Pelvic floor muscle training (PFMT) exercise is effective in both preventing and treating SUI, and is the first-line treatment recommended by the National Institute for Health and Care Excellence (NICE, 2013) guidelines for the management of urinary incontinence in women. However, few women seek help for SUI and of those that do, only around a third receive the recommended treatment. The literature also indicates that many women do not adhere to PFMT exercise programmes because of uncertainty over how to perform PFMT or its effectiveness. Cath Sackley, Sarah McLachlan, and Emma Godfrey are working with colleagues in Primary Care & Public Health Sciences (Janet Peacock and Jennifer Summers) and Health Sciences & Population Research (Mark Pennington), and at the University of Leicester (Kate Williams) and Glasgow Caledonian University (Doreen McClurg), to develop a public health PFMT intervention which will be delivered to women through hairdressing and beauty salons in the UK. This setting has been selected to reach women who are unlikely to seek help for SUI from health care professionals. The development work for the project has included extensive public involvement and this will continue throughout the research.

Screening and intervention for emotional impairment following TIA

Transient ischaemic attack (TIA) is defined as “a transient episode of neurological dysfunction caused by focal brain, spinal cord or retinal ischaemia, without acute infarction” (Easton et al., 2009). There are approximately 20,000 TIAs in England per year, and TIA has been associated with an increased risk of stroke. Although signs and symptoms are not expected to persist beyond 24 hours, the literature suggests that patients may experience functional and emotional impairments following TIA, including continued or increased depression 12 months after their event. This is particularly problematic as emotional impairments have been associated with increased risk of stroke. To address this problem, Cath Sackley and Sarah McLachlan are developing a screening tool to help identify those with maladaptive coping strategies and emotional deficits following TIA, and plan to design a psychological intervention to improve outcomes for these patients.

Motivating Structured Walking Activity in People with Intermittent Claudication (MOSAIC) Trial

The MOSAIC trial evaluates a new physiotherapy treatment for people with Intermittent Claudication. The trial is now open and will include 192 people aged 50 years and over with Intermittent Claudication from four NHS trusts in London and South-East England. Find out more here.

Survival and Recovery After Hip Fracture by Timing of Mobilisation

In 2016, UK health officials instructed that hospital staff must help patients get out of bed (mobilise) within 36 hours of surgery to fix their broken hip. We spoke with several patients and their caregivers who said they would like to know why they have to get out of bed so quickly. For those who did not get out of bed within 36 hours, they said would like to know whether waiting longer was harmful.

Our study asks whether waiting more than 36 hours to get out of bed is harmful for people who had surgery for a broken hip. We also want to know if waiting is harmful for some patients but not harmful for others. If this is the case then hospitals can identify patients who should get out of bed within 36 hours of surgery, and those who can wait longer.

This project is funded by the National Institute for Health Research (NIHR).

The project's privacy notice can be found here. 

Outcomes after Hip Fracture by Duration, Frequency and Type of Rehabilitation

We spoke to several patients after they had broken their hip. They said they would like to do more with the physiotherapists and more exercises. They felt this would help them to get better quicker. Currently, people who have had surgery to repair a broken hip receive different types and amounts of physiotherapy. We do not know which types and amounts are most beneficial for recovery.

Our study asks whether receiving more physiotherapy and more exercises is beneficial for recovery. We also ask whether a benefit is seen for some patients but not others, and if so who benefits most (e.g. patients admitted on the weekend, patients with dementia). We also ask why patients currently get different types and amount of physiotherapy after breaking their hip.

We will look at national audit records for patients who had surgery to fix a broken hip in May and June 2017. We will see how long people stay in hospital, how many die in hospital and up to one month after their broken hip, how many go back to hospital, and how many have recovered by four months after their broken hip. We will see whether patients who get more physiotherapy recover better than those who get less physiotherapy. We will interview physiotherapists to find out why patients get different types and amounts of physiotherapy after breaking their hip. We will involve patients and their carers to help us to interpret our findings.

We will then share what we learn with health care policymakers, people who have broken a hip and their families, and physiotherapists who work with them in scientific articles, reports, news articles, blogs, presentations, and via social media. The results will help to inform decisions to improve care for patients with a broken hip.

The project’s privacy notice can be found here

Latest research publications & grants

Department of Physiotherapy on the research portal

Contact

Professor Catherine Sackley - Chair in Rehabilitation & Head of Population Health Sciences
E-mail: catherine.sackley@kcl.ac.uk

Sitemap Site help Terms and conditions  Privacy policy  Accessibility  Modern slavery statement  Contact us

© 2019 King's College London | Strand | London WC2R 2LS | England | United Kingdom | Tel +44 (0)20 7836 5454