Patient Reported Outcomes in Persistent Rheumatoid Arthritis (PROsPer-RA) Study

PROsPer-RA is a prospective observational study examining patient reported outcomes, such as mental health, fatigue, pain, and function in patients living with rheumatoid arthritis. The study will recruit patients across multiple NHS to determine access to psychoeducational support and examine mechanisms linking mental health, inflammation, and persistent symptoms. PROsPer-RA marks the third phase of a larger fellowship grant, awarded to Dr Sam Norton and jointly funded by MQ and Versus Arthritis, to examine the relationship between mental health and persistent symptoms in patients living with rheumatoid arthritis. The wider research programme aims to understand why levels of problematic symptoms have remained largely unchanged despite major advantages in the drugs available to treat RA in the last 20 years. Combining analysis from PROsPer-RA and other large rheumatoid arthritis cohorts, novel quantitative methods, including machine learning, are employed to develop prediction models for patients at risk of persistent symptoms irrespective of inflammatory treatment response where non-pharmacological interventions may be helpful. Find out more about the PROsPer-RA Project

Find out more about the PROsPer-RA Project

COMPASS: Navigating your long-term conditions

"COMPASS: Navigating your long-term condition" is an online programme that has been developed in the Health Psychology Section by Dr Katrin Hulme, Dr Joanna Hudson and Prof. Rona Moss-Morris. It is funded by King's Health Partners. The evidence and theory-based intervention aims to treat anxiety and depression in the context of long-term physical health conditions (LTCs). It uses a blended model of care, combining online cognitive-behavioural therapy (CBT) and self-management with therapist support. Throughout intervention development, the COMPASS project has taken an implementation-based approach to enable the translation of the programme into practice. Therapist training sessions and manuals have been created, and a COMPASS specific care pathway is also being developed. COMPASS has been launched in local NHS services, including Southwark Talking Therapies. This implementation feasibility work helped validate functionality and usability, gather preliminary data on outcomes, usage and adherence, and gain user feedback. This informed programme enhancements prior to a randomised controlled trial, working with five national LTC charities including Crohn's & Colitis UK and MS Society, to evaluate clinical and cost-effectiveness. LTC-tailored versions are now being developed and we are expanding the implementation of COMPASS across additional NHS services.

Find out more about the COMPASS online web-platform

Developing an Electronic-intervention to help people with breast cancer persist with and adhere to anti-hormone therapy (E-PATH)

Find out more about the e-PATH Study

GREAT - Gait Rehabilitation in Early Arthritis Trial

Dr Emma Godfrey is a co-applicant on this NIHR HTA funded 5 year research project, run through the Department of Population Health Sciences. It is a feasibility and multi-centre clinical trial of gait rehabilitation in patients with recently diagnosed rheumatoid arthritis: the Gait Rehabilitation in Early Arthritis Trial [GREAT] Foot impairments in early rheumatoid arthritis (RA) are common and lead to progressive deterioration of lower limb function. There may be a therapeutic ‘window of opportunity’ for preservation of gait and prevention of persistent walking disability during early disease. A gait rehabilitation programme underpinned by psychological techniques to improve adherence, may preserve gait and lower limb function. GREAT trial: UK multi-centre randomised controlled trial (RCT), patients with a RA diagnosed within the last 2 years and who are currently experiencing disease-related foot impairments (either foot pain or synovitis), are individually randomised to either the standard care arm or standard care plus gait intervention arm. Two compulsory plus two optional treatment sessions are delivered by trained physiotherapists or podiatrists over 12 weeks to guide participants undertaking a gait rehabilitation programme comprised of functional walking tasks. Intervention dose and progression is tailored to the individual. Treatment incudes a supported home-based gait rehabilitation programme with an embedded psychological component to promote positive sustainable behaviour change. This is designed to address barriers of adherence to exercise/physical activity-based interventions commonly experienced by people with RA, such as fear avoidance of activity and poor exercise self-efficacy. Primary outcome is Foot Function disability at 6 months, which had the strongest correlation with self-reported change in walking ability from the feasibility study. Fidelity of intervention delivery and uptake will be evaluated using a complementary mixed-methods design.

The IMPROVE cluster randomised controlled trial

Dr Emma Godfrey is a co-applicant on this NIHR HSDR funded research project run through the Department of Population Health Sciences. Improving life quality in chronic obstructive pulmonary disease (COPD) by increasing uptake and completion of pulmonary rehabilitation with lay health workers: the IMPROVE cluster randomised controlled trial. • Chronic obstructive pulmonary disease (COPD) is the most common lung disease caused by smoking. It affects more than a million people in the UK. COPD causes breathlessness, cough, and fatigue It is a major cause of emergency hospital admission in the NHS, with rates having changed little in 20 years. Pulmonary rehabilitation (PR) is the most effective treatment for the symptoms and disability of COPD, but for many patients referred to PR, rates of completion are only 40% due to poor uptake. • IMPROVE trial: UK multi-centre cluster randomised controlled trial (RCT), to test the impact of employing a lay health workers (LHW) intervention on completion rates of Pulmonary Rehabilitation (PR) centres throughout England. PR centres (clusters) will be randomised to intervention (LHW + usual care) or control arms (usual care). • Volunteer lay health workers will be recruited from among people with COPD, previously treated in the participating PR services. PR staff in services randomised to the intervention arm will be trained to work with volunteer lay LHWs. Training of PR teams and LHW will incorporate psychological theory and principles of behaviour change. • Principal outcome will be rate of completion of PR in intervention sites compared to control sites. • Process evaluation: Each element will be evaluated, including PR staff training, LHW training, intervention fidelity, and acceptability to patients, LHWs, and PR staff. Health economic evaluation will also be completed.

IBD BOOST

Fatigue, pain and urgency are a huge burden for many people living with inflammatory bowel disease (IBD) and can persist even when in remission. The IBD-BOOST research programme aims to develop and evaluate ways to improve the well-being of people who experience them, by relieving these most common and troublesome chronic symptoms and enhancing quality of life. Currently under investigation in a randomised controlled trial, BOOST is an online programme which consists of education as well as behavioural, cognitive and emotional techniques. It uses Cognitive Behavioural Therapy (CBT) strategies to support patients in identifying and addressing unhelpful activity, eating and sleeping behaviours, addressing unhelpful thoughts, managing stress, processing and accepting emotions, reducing symptom focusing and sustaining improvement. IBD-BOOST is funded by the National Institute of Health Research and hosted by London North West Healthcare NHS Trust. The research is conducted by King’s College London in partnership with Queen Mary University of London, NHS Trusts and Crohn’s & Colitis UK. Find out more about the IBD BOOST research programme by clicking on the link below and contact Professor Rona Moss-Morris and Dr Vari Wileman for further information.

IBD BOOST

Mothers in treatment for substance use: impacts on care proceedings

Many families engaging with child welfare system are affected by maternal substance use, yet there is little information about the relationship between substance use treatment and childcare outcomes. This project aims to investigate this by analysing patient records using SLaM Case Registry Interactive Search (CRIS) electronic health registry, Hospital Episode Statistics (HES) and family court dataset (Cafcass). The project is funded by Nuffield Foundation, for further information click on the link below.

Mothers in treatment for substance use: impacts on care proceedings