Theme Leads: Professor Hemant Pandit and Professor Carl Thompson
Background
West Yorkshire’s surgical and rehabilitation service users are a diverse mix of ethnicities, social and cultural backgrounds (https://forumcentral.org.uk/wp-content/uploads/2020/06/Leeds-CCG-Health-Inequalities-Framework-for-Action.pdf). The poor and old are less likely to access and benefit from rehabilitation services and new technology.
Only 2% to 4% of inpatients over 65 years old receive rehabilitation or reablement post-discharge. Those receiving social care (in care homes or in their own homes) are even more disadvantaged: rehabilitation/reablement support varies widely and access to rehabilitative technology and equipment largely relies on private funding (http://arma.uk.net/wp-content/uploads/2021/12/ARMA-msk-health-equalities- roundtable-report.pdf).
Up to 13,000 patients a day fail to leave NHS hospitals because suitable care and access to short term bedded support is lacking. Effective technologies that augment social care’s workforce skills, add value to the sectors, and increase capacity, have a valuable role to play in reducing these numbers, equitably.
Areas of Focus
Optimising pre and re-habilitation using remote (sensor) technologies with a diverse patient population. Working with existing and new industry partners, we will evaluate “upstream” technologies, e.g. implantable / wearable sensors; and “downstream”, market-ready, technologies – e.g., “Virtual Knee School” pre and reablement app.
Extending learning beyond orthopaedics by developing, refining and evaluating new rehabilitative technologies aligned to our technology themes and contributing to the science and theory of technology-related adoption, diffusion and (cost) effectiveness.
Developing and providing a portal and platform for commercial and academic technology developers to access and work with social care (domiciliary care providers, care homes and community services). We will provide technology-enabled solutions and routes to improve outcomes and reduce inequalities in access to technology- enabled services. We aim to target the full range of populations we serve, including those in care homes and domiciliary care recipients. Delivering efficient rehabilitation, extending service reach and releasing potential in social care – in part using technology – is a key policy goal (https://www.england.nhs.uk/coronavirus/documents/discharge-centres-care-units-in-care- homes-short-term-rehabilitation-and-reablement-care/).
Our research includes evaluating technologies in social care: wearables and environmental smart sensors, analysis of social networks, falls risk and gait analysis.
Understanding care sector preferences for informing technology development and adoption choices (SENSITISE)
The number of people who need care is rising. At the same time, it is hard to recruit enough people to work in care. Technology could help with these problems. For example, by freeing up resources and improving care quality. These benefits have not yet been widely achieved in practice. One problem is that there is limited information about what people want from social care technologies. This makes it hard to design effective products and make good choices about what technologies to provide. To address this, the SENSITISE project aims to find out and share information about what people want from social care technologies. During the project we will carry out interviews, group discussions, and surveys. These will be with people who use services, workers, and funders. Support for this project comes from the School for Social Care Research.
START: Social care Tech: Asking the Right questions Tool (START)
Technology companies do not always know how best to approach social care providers. This can make it challenging for companies and care providers to work together. We are developing an online tool called ‘START’ to help with this. START will include a series of prompts and questions. These will help companies work out what information to give to care providers. START will also aim to help companies and care providers work well together.
Accelerometry and Rehabilitation after Knee replacement study (ARK)
Knee replacement is a common operation. It is usually carried out to relieve pain from bad knee arthritis. To recover from a knee replacement, patients need to carry out exercises. This is known as ‘rehabilitation’. Patients do not always receive enough support to exercise. This is due to problems like not having enough staff. Wearable sensors could help address this by allowing staff to monitor patients remotely. The staff could then give feedback and adapt patients’ exercises. The ARK study aims to assess if wearable sensors are helpful for patients before and after knee replacement. It is also assessing how the sensors affect care costs. We have recruited all 250 participants to the study. We are currently carrying out the follow up.
National survey of information and rehabilitation support for patients undergoing knee replacement
Information and rehabilitation support for patients having a knee replacement varies. But there is no up-to-date evidence in this area. This makes it hard to identify how to improve care. To help address this, we are carrying out a survey of NHS hospitals in England and Wales. The survey will explore what information and support is provided to patients before and after knee replacement. We plan to find out how the information and support is delivered. We will find out what information topics are covered.
Feasibility study of a digital tool for patients with knee pain
An app called ‘getUBetter’ provides support for patients with knee pain. It includes things like information and an exercise plan. We have recently added extra modules to the app. The modules are based on a ‘Virtual Knee School’ we developed for patients having a knee replacement. This means the getUBetter app could support patients with knee arthritis at all stages of care pathway. This could help to improve patients’ symptoms and quality of life. We aim to find out if it is possible and acceptable to give the getUBetter app to patients receiving specialist care for knee arthritis. To do this, we will carry out a small ‘feasibility’ study. This will help us decide if and how to carry out a larger study of the app.
Improving patient outcomes following knee replacement surgery
Digital technology has advanced significantly over the past decade, with the increasing use of mobile devices and wearable and implantable sensors in medicine. These technologies enable better monitoring and improve patient care before and after a medical procedure.
At LTHT, we have worked closely with public and patient groups and industry partners to co-develop, evaluate, and optimise wearable and implantable sensors for patients undergoing knee replacement. Knee replacements are common but can have life-changing consequences: up to 20% of patients are dissatisfied and may have knee stiffness and pain that can last for many months. Patients with a knee replacement leaving hospital are usually given written instructions for knee exercises and assessed by phone or at a later hospital visit. This provides only a snapshot of a patient’s recovery and does not reduce unwarranted variations in recovery outcomes.
We are conducting a clinical study to assess the use and costs of wearable sensors in patients following knee replacement. These single-use devices, made by B Braun Medical Ltd., connect to a patient’s mobile phone and relay information to the hospital team to monitor progress remotely. The sensors suggest exercises that can be tailored to patient’s individual progress. Early results show improved patient engagement and satisfaction with better continuity in care. With the Yorkshire & Humber AHSN we are determining the costs associated with adoption across the NHS.
Our next steps include introducing sensors in the knee replacement itself. This will provide valuable information about potential infection and the stability of the knee replacement. Our collaboration with industry (Medacta International), led to development and testing of a prototype implantable sensor and funding for regulatory approvals and first-in-human studies at LTHT. We have secured funding of £2.4 million (worth another £2 million in kind support for regulatory approvals, supply of implants, implant testing, know-how and access to market). The UoL and its academic partners will receive licensing fees and royalty of £2 million+ from the industry partner.
Our “SMART” implant could revolutionise recovery for patients after knee replacement. By integrating relevant and important information from primary and secondary care, patients will have more control over their recovery and clinicians will be able to intervene faster should a problem occur.
Coming soon…..
Coming soon…..
Patient and Public Involvement/Engagement (PPIE) is key to our theme. This will help make sure our projects:
- Focus on what matters to patients and the public.
- Meet different patients’ needs.
We are currently setting up a PPIE group for our knee replacement projects. We also plan to work with the NICHE-Leeds PPIE group on our social care projects.
Coming soon…..
