"RfPB Application Form, Ver 1.2"
Programme Monitoring Form v1.2 PROGRAMME GRANTS FOR APPLIED RESEARCH PROGRESS REPORT It is a contractual requirement that all recipients of NIHR Programme Grants for Applied Research funding submit Progress Reports documenting activity and progress in the previous reporting period. Progress Reports are required at the following intervals: (18 and 36 months for 4 and 5 year programmes and 18 months for 3 year programmes) Programme Grant holders are also required to complete and submit, on an annual basis, a Financial Reporting Form, summarising expenditure in the previous financial year. IMPORTANT Note the maximum field sizes shown include both printing and non-printing characters, such as spaces and carriage returns. Reference Number: RP-PG-0707-10012 1. Programme Details Programme Title: Development of an integrated service model incorporating innovative technology for the rehabilitation of the upper limb following stroke Lead Applicant: Prof Ian Swain Contracting NHS Salisbury NHS Foundation Trust Organisation: Programme 38 Duration: (months) Start Date: 01/01/2009 (dd/mm/yyyy) End Date: 29/02/2012 (dd/mm/yyyy) Progress Report 1 No.: Page 1 of 13 Programme Monitoring Form v1.2 2. Changes to Research Team Please describe any changes to the research team (e.g. changes to co-applicants or collaborators) or changes to the contact details of the Lead Applicant, since the last Progress Report (Maximum 3,000 characters). Applicants, research and technical staff There have not been any changes to the applicants on the original application or to the research or technical staff employed. Directly appointed staff The Programme Manager and the Research Fellows (RF) were appointed at the beginning of the funding period although there was some delay in Dr Farmer’s start date which is explained below. Joanna Regan was appointed as Project Administrator. Jo has a Law degree and comes from a project management background. She has been invaluable not only to this project but in her work developing the ATRAS web page, the format of which is being used more widely by NIHR. Gabrielle Mc Hugh was appointed as the RF on WP1, the survey of current practice in upper limb rehabilitation following stroke (ULRFS). Gabrielle comes from a psychology background and recently completed her PhD on ‘The influence of culture climate and leadership as determinants of health in the workplace’ Dr Sybil Farmer was appointed as WP2 project coordinator commencing work on 27th April 2009. Dr Farmer spent many years working as a research physiotherapist at ORLAU, Oswestry. The salary underspend has been used to employ a temporary RA to support the WP2 systematic review processes so to bring the WP2 back on schedule after the delayed start. The RF post on WP3 has been organised as a job share between Dr Anne-Marie Hughes and Dr Sara Demain. Both are chartered physiotherapists with PhDs from Southampton University; Dr Hughes on ‘Iterative Learning Control in Stroke Rehabilitation’ and Dr Demain on ‘Decision making leading to discontinuing physiotherapy after stroke’. Their complementary research skills, Dr Hughes quantitative and Dr Demain qualitative, making them ideal for the work of WP3, the acceptance of ATs in ULRFS. Steering Committee There have been a number of changes to the Steering Committee as people changed posts or their other commitments increased. Anne Barby, Different Strokes, has been replaced by Debbie Wilson and Stephen Little. Isabel Lee, Stroke Association, has been replaced by Stephanie Armstrong and Marion Walker by Dr Pauline van Vliet. Dr Van Vliet is a physiotherapist and Associate Professor at Nottingham University specialising in Stroke Rehabilitation. Appointment of external consultant Following the first meeting of the Steering Committee in July 2009 there was a strong recommendation from the committee to seek funding to employ Prof Maarten Ijzerman from University of Twente to provide expert guidance in the way we manage the decision making process leading to the choice of ATs to be included in the clinical trial WP4. Prof Ijzerman’s specialities are; Clinical epidemiology, outcomes research and patient reported outcomes, medical device development and testing, multiple criteria decision making and discrete choice methods. His contribution to the programme is discussed in more detail in Section 4. Page 2 of 13 Programme Monitoring Form v1.2 3. Progress (specifically since last report) Taking each theme (work package) individually, in the order described in the original application, please provide details of: The key milestones achieved during this period (an annex for figures and diagrams may be included) together with a commentary on whether these are as described in the original proposal. Any problems or adverse events encountered to date and describe the measures taken to resolve them. Any matters that require the attention of, or action from, the NIHR CCF. Comment also on your experience of patient and public involvement in your programme (Maximum 20,000 characters). Page 3 of 13 Programme Monitoring Form v1.2 3.1 WP1 The objective of WP1 is to delineate current treatment methods, outcome measures and associated costs for ULRFS in England during the first twelve months. To achieve this objective, the activities of WP1 were portioned into five consecutive phases Phase 1 – Advisory Group: An 8 member Advisory Panel was set-up to oversee the direction of a workshop and survey development. The inaugural meeting was held 21 May 2009 during which the structure and content of the workshop was established. A recommendation of the Panel was to include the patient perspective in WP1. The Panel was also used to provide evaluative and corrective feedback for the pre-pilot iterations of the clinicians’ national survey Phase 2 – Workshop 9July 2009, Bournemouth University: Thirty multidisciplinary specialists in stroke care from across the south west attended the half-day workshop. The workshop provided feedback on what is happening locally, providing a snapshot of outcome measures used, treatment provided and an indication of what services are available for ULRFS. The information obtained from the attendees informed the structure and content of the clinicians’ national survey. The attendees also participated in the pilot testing of the early iterations of the clinicians’ survey Phase 3 – Pilot: Several iterations of the survey were reviewed by the Advisory Panel, attendees from the workshop, members of the ATRAS Steering Committee, and the Health Economist attached to the project prior to the primary pilot test. The survey was also previewed at our workshop held at the Glasgow Stroke Forum in December 2009. Concurrently we began to build a national distribution list of clinicians. Initial contact was with the Directors from the 28 Stroke Improvement Networks to whom we explained ATRAS and the scope of WP1, and asked them to provide contact details for stroke care specialists in their areas. Of the 28 networks contacted, 17 responded giving a contact list of 219 stroke clinicians. One clinician was randomly selected from each of the 17 networks to participate in the pilot testing of the survey. In April, 2010 the survey was emailed to these 17 clinicians. Ten clinicians returned completed surveys the feedback of which was used to make amendments to the final survey entitled ‘National Survey of Current Treatment Methods in Rehabilitation of the Upper Limb after Stroke’(Appendix1) Phase 4 – National Survey of Stroke Clinicians: Ethics approval was received from Bournemouth University in December 2009. The survey is designed in two parts, A and B. Part A captures demographic information about the various teams and the referral sources frequently used. We are suggesting that this section is best completed by the team lead. Part B captures the most frequently used treatment interventions for ULRFS which we suggest is best completed as a multidisciplinary team effort Distribution of the survey, (Appendix 1), began in June 2010. To ensure national coverage of acute, combined and community services, we are using the contacts provided from the Stroke Improvement Networks and the South West Stroke Co-ordinators network for the initial release of the survey. We will use the contacts provided in Part A of returned surveys to further cascade the survey across the country and across the various services. To date, we have released 120 surveys. Our expectation is to release 300 by December, 2010 Phase 5 – The Patient Perspective: The initial ATRAS grant application did not include this phase of WP1. This phase was incorporated into the goals of WP1 following the recommendations of the Advisory Panel, Workshop attendees, and Steering Committee. The purpose of Phase 5 is to capture the patient perspective of service provision for ULRFS. To achieve this we will collaborate closely with 28 randomly selected acute stroke care units and carer/spouse of the stroke survivor across England. Each stroke unit will identify six individuals from their unit who are most likely to need ongoing upper limb rehabilitation following discharge. We will follow these 168 individuals for the 12 months post- stroke. Half will report what rehabilitation they have received via regular two monthly telephone interviews – the prospective group. The remainder – the retrospective group - will report at the end of the six and twelve months with our expectation that they will remember the pertinent and most beneficial treatment they received. All this will inform the clinical trials. This information is required to help us identify patients’ perceptions and needs and to determine if this differs from the clinicians’ views. Of the 28 acute stroke units contacted to date, 12 have indicated their willingness to collaborate. Selection of patients will begin October 2010. When all the information received is collated and analyzed, we will have a broad view of the first twelve months ULRFS. This information will inform the treatment provided to the control group in our clinical trial Page 4 of 13 Programme Monitoring Form v1.2 Problems or adverse events None Any matters that require the attention of NIHR None Experience of PPI The patient and public involvement has been increased on the advice of the WP1 Advisory Group and the Steering Committee and as a result a separate patient focused survey (Phase 5) is being undertaken. Ethics permission and registration of this part of the programme through the SRN is being sought 3.2 WP2 Induction of Research Fellow/Project Coordinator The RF undertook training in the use of an on-line reference data base (RefWorks) and was provided with an Athens accounts at Keele University, North Staffs PCT and access to Southampton University Library facilities. This permitted access to the relevant bibliographical databases Development of Search Terms and Strategy The search terms and strategy were developed after discussions with Keele University systematic reviewers and visits to the STEP team in Glasgow and the Cochrane stroke group / Edinburgh Stroke research group; together with the use of scoping searches in Medline and CINAHL. These were approved by the Steering Committee. Definition of AT For this project an AT is defined as an electrical or mechanical device used in a functional task orientated training process or for a therapeutic process which will have a systematic or rehabilitative effect on the person Search Terms and searches undertaken The search terms used and the combinations of terms used to complete the searches is shown in Appendix 2 of the Annex (RP-PG-0707-10012_IR1_AN1) Search execution The project coordinator searched; Medline, Cinahl, PsycInfo, CASIllumina, AMED, EMBASE, Web of Science, PeDro, Cochrane Library, Compendex Initial Screening A definition of assistive technology was agreed by the ATRAS team and was used to plan the initial screening spreadsheet to identify relevant papers The reviewer determined if the paper was English language Peer reviewed Selection on title or Abstract Consistent with AT definition Human study Stroke (Ischaemic/Haemorraghic) 18years or older Exclusive to UL And recorded Technology Used or Reviewed Upper limb Joint/muscle/limb segment studied Study design Results of the search and classification of Papers 2424 papers were found; of these 1361 were excluded by the RF on the basis of the initial screening process. The remaining 763 references were checked by a second reviewer and with the agreement of the first reviewer a further 299 papers were rejected. Page 5 of 13 Programme Monitoring Form v1.2 464 papers were accepted for further consideration; 384 papers were experimental papers and the remaining 80 papers were reviews. All references are retained in a Ref Works database and are organised in folders according to assistive technology, database origin and acceptance or rejection status. (Full access can be provided for audit purposes) Website and on-line data entry The NIHR provided support for the use of the website and online forms were developed byJo Regan, Dr Pandyan(WP2 Lead) and RF to permit all reviewers to enter their data on-line. There are two unique features associated with part of the work, described in 3.4 1. We developed an automated process for importing, filtering and collating the reference in a systematic and structured way (WP2 Lead,RF and Dr Postans) 2. We developed a method of collaborative working across national research sites via a web interface (WP2 Lead, RF and Dr Wood) Assessing quality of research The quality of the experimental papers was assessed using the van Tulder criteria. (Appendix 3). A formal training session on the review process was conducted on 2 September 2009. Each paper was allocated to 2 reviewers who independently scored each paper; and subsequently resolved any disagreements through discussion. Review papers were assessed using a questionnaire developed from the PRISMA guidelines (Appendix 4)—this was developed by the WP2 Lead, RF and Dr Wood Audit The first phase of filtering and reviewing the experimental research was audited by Dr Paul Taylor (a member of the management team) and the process of reviewing the 'review' papers was audited by the WP2 lead. A final audit of the remainder of the review process will be carried out in the next year Data Extraction A workshop was held to explore the issues in extracting data to calculate effect size and odds ratios from RCTs. The team agreed on the format to be used on-line. After the meeting an online form was developed and tested prior to allocation of papers for data extraction Problems We have had no significant issues in the operational management of WP2. However, there are some concerns with respect to the data being collected. These are (a) a paucity of high quality experimental research and review papers; (b) The diversity of treatment protocols; (c) The lack of scientific rationale for matching the treatment regimes to the conditions being treated Patient and Public Involvement This work on WP2 was not designed to involve patient and public involvement. However, the team are considering ways in which information generated can be disseminated to user groups (clinicians and patients) to inform shared decision making 3.3 WP3 Ethical issues Ethical and Research Governance approvals for WP3 activities (focus groups and questionnaire) has been granted (Appendix 6) Interactive exhibition The exhibition was held on the 7-9 October 2009 at the University of Southampton. Seven companies from the UK, Europe and the US presented 15 different technologies including robots, FES systems and orthotic devices (Appendix 7) Of the 202 people attending, 51% were people with stroke or carers, and 49% were healthcare professionals (including doctors, physiotherapists PT, occupational therapists OT, medical engineers and academics). The first day was specifically targeted at healthcare professionals HCP, and the subsequent days for patients, carers and HCPs. Participants were encouraged to test each of the technologies and provide written comments. Over 400 comments were made. Attendees were asked to leave their contact details if they were interested in taking part in the Focus Groups and were asked to keep a copy of their ‘comments’ as a ‘memory jogger’ to refer to if they attended a Focus Group Focus Groups and Interviews Four Focus Groups were completed by 30 March 2010. Focus Groups 1 & 2 included patients who had Page 6 of 13 Programme Monitoring Form v1.2 post-stroke hemiparesis affecting the upper limb (and carers) of different genders, ages, levels of ability and time (<5 years) since stroke 1. People naïve to AT: 4 people with stroke and 3 carers 2. People experienced in using AT: 4 people with stroke and 2 carers 3. Carers alone (with and without experience of AT): 5 - this group was identified as being important to enable carers to express their views in confidence 4. HCPs with a range of experience of AT, of different disciplines and levels of seniority: 7 (OT, PT, Specialist Registrar in Rehabilitation) In addition five telephone interviews were held as it proved to be impractical to bring budget holders and commissioners together for a focus group • 4 budget holders (PT, OT and 2 Medical Consultants) • 1 commissioner The following additional activities not included in the application have been undertaken to extend our understanding and increase publicity for the programme • An Association of Chartered Physiotherapists in Neurology (ACPIN) meeting on issues around Commissioning ATs • A one day meeting with SW Commissioners (their views were identified during the focus groups and interactive exhibition as being of particular importance) • A Workshop with physiotherapists at the National ACPIN conference • A review of Policy Documents • Meeting with a Local Different Strokes Group Analysis of Focus group and interview data Data has been transcribed verbatim and analysed using thematic analysis. The transcripts from each focus group and interview has be analysed separately to produce separate themes relating to each individual or group. Themes have been compared and contrasted to highlight differences and similarities. The multiple themes identified fell into two categories: a) devices b) services Questionnaire Three versions of the questionnaires: Patients and carers; HCPs; Budget holders and Commissioners, have been designed based on the findings of Stage 1 and will be piloted according to the protocol in the application in September 2010. The questionnaires are in a format that will enable them to be completed either on paper or electronically; the latter will enable data to be downloaded for analysis without manual entry. The four main headings which emerged from the focus group and interview analysis and from other data sources were: barriers, benefits, carer involvement and opportunities. The questionnaires will be advertised and targeted through the Stroke Association and Different Strokes as well as through Stroke Units and GPs Problems or adverse events None Any matters that require the attention of NIHR None Experience of PPI WP3 is almost entirely focussed on patient and public involvement and this is covered in the report above. Beyond these activities we have not engaged with the general public except through a general Press release encompassing the research within the Rehabilitation and Health Technologies Research Group at the University of Southampton and the public pages of the web-site 3.4 Website To facilitate communication within the project, web support was provided by David Henstock of the NIHR CCF working with Joanna Regan to ascertain the requirements of the research team. In September 2009 the ATRAS study site www.atrasproject.org was launched hosted by the NIHR portal and is used extensively by the research team as a contact database, a document store and to complete the systematic reviews This is one of the first study sites to be adopted by an NIHR funded research team. It has subsequently become the template for all future study sites. Joanna is the administrator and has provided Page 7 of 13 Programme Monitoring Form v1.2 consultation to the NIHR in order to facilitate new similar sites, includes providing information to assist creating Global NIHR Document Libraries. In addition the academic IP produced by the development of the study site, has received considerable interest from other research teams wishing to apply the online systematic review process. Discussion with John Wilkinson, DoH, could lead to extending this process to the wider research community 3.5 Summary and decision making leading to WP4 Good progress has been made to date on all work packages and all are approximately on schedule. The structure for the decision making process has been determined in conjunction with Prof Ijzerman is being implemented at present but the results will not be know until later this year. A brief description of this process is given below. Analytical Hierarchical Process (AHP) to support decision making The AHP is a technique that was first introduced by Saaty, a mathematician, for weighing multiple attributes in complex decisions. Since then, many publications have appeared in the fields of operational research, marketing and mathematical sciences. AHP has been used quite frequently in different applications, e.g. environmental economics and waste management. In the early 90s, AHP was introduced into healthcare by Jim Dolan. Prof Ijzerman started using AHP in 2000 for a variety of decision problems, including medical product development (engineering decisions), health care planning, and valuing multiple clinical outcomes The concept of AHP is that all relevant implicit (e.g. clinical experiences) and explicit (evidence from the systematic reviews) knowledge is necessary to obtain the best possible decision. Therefore a decision structure is determined in which all relevant attributes are defined, e.g. clinical benefit, that are relevant to select the treatment. Attributes are structured and can even define a second layer (hierarchy) of attributes. E.g. clinical benefit can be analyzed in terms of “improved function” and “improved activity”. The final step is to define the alternatives to be considered. In this case, the alternatives are seven different treatments that may possibly be selected for the clinical trial Following Prof Ijzerman’s presentation to the Exec Committee at their six monthly meeting in March he worked closely with Prof Swain to develop the key attributes and decision structure to go into the model. This was based on a study by Van Til (2008) Arch Phys Med and Rehabil. The Steering Committee was used to approve and where necessary modify these attributes and assign weights to them. This was done using Expert Choice software. The resulting eight attributes were; Clinical benefit in terms of function, comfort, long term risks, short term risks, daily effort for the patient both in terms of time taken and complexity, impact on health services both in terms of time and complexity The next stage is to undertake pairwise comparisons of each combination of the seven ATs (Peripheral FES, Central/cortical stimulation, CIMT, Robotics, Active Orthotics, Biofeedback, VR including Wii) in terms of each of these attributes in order to get the performance weights. e.g. how would you rate Peripheral FES and CIMT in terms of comfort, again using Expert Choice. Time did not permit the Steering Committee to assign performance weights to all pairwise comparisons of ATs at the meeting and therefore at present this is being completed electronically using the ATRAS website Where possible these performance weights in the decision tree will be replaced with the objective data obtained from WP2, however in the absence of objective data expert opinion will be included. In addition to the attribute weights being determined by the Steering Committee, we will also be obtaining attribute weights from the questionnaires sent to patients and carers as part of WP3. Previous work has shown differences in the relative importance patients and professionals assign to these weights The outcomes of this decision making process will then be considered in conjunction with the Health Economic analysis and the information from WP1, in terms of the prevalence of given impairments, in order to determine the choice of ATs to go into the clinical trial. It is planned to include the two ATs for which there is the greatest scientific evidence, which are cost effective and acceptable to patients, staff and commissioners and which if utilised in clinical practice will have the greatest possible benefit to the greatest number of people. This is a complex decision making process and it is for this reason that the AHP method is being used to determine the optimal solution 4. Milestones for the next reporting period Page 8 of 13 Programme Monitoring Form v1.2 Please list milestones for the next reporting period (18 months) including any revisions of your original plans as a consequence of the research so far. (Maximum 5000 characters). The CI will continue to monitor all current WPs by requiring three monthly project reports 4.1 WP1 The inclusion of Phase 5 as the patient perspective of treatment provided during the first twelve months of recovery evolved from recommendations of the WP1 Advisory Panel, Steering Committee and feedback from the Workshop attendees. To attain the patient perspective we will be following patients through regular telephone interviews beginning at two months post-stroke. Six patients will be recruited from each of 28 acute stroke units to represent the areas covered nationally by the Stroke Improvement Networks. Currently 12 acute units are willing to engage in Phase 5. We continue to seek collaboration with the remaining 16 units. We anticipate all patients will be recruited by January 2011. Telephone interviews will continue until January 2012 This phase will serve as second source data to validate the clinicians’ perspective on treatment provided. Gathering information from the patients during their first year of recovery will also illicit the predominant problem for which stroke patients require treatment after discharge. This information will assist the decision making process for the clinical trials 4.2 WP2 1. Complete data extraction 2. Continue audit of the research process 3. Update the searches to ensure that the reviews are up to date 4. Analyse results from data extraction providing input to the decision making matrix to assist with WP4 5. Present our findings to the extramural teams that were consulted in the early stage of the research process (in particular STEP team at Glasgow and the Stroke research group in Edinburgh) 6. Contact the Cochrane Stroke Team to register new titles ( if appropriate) and support revision of existing titles 7. Revise tools to simplify methods used quantify bias in experimental research 8. Develop method to quantify quality of review papers 9. Submit an abstract of the review work in one national/international conference 10. Explore methods to automate the whole review process ( subject to availability of additional funding) 4.3 WP3 Piloting of the Questionnaires will be completed by early October Data collection via the Questionnaires will be completed by January 2011. The results of the qualitative stage of the study will be presented at the UK Stroke Forum Workshop on 2December 2010 This Forum will also provide an opportunity to raise awareness of the questionnaire. Analysis of questionnaire data completed by April 2011 4.4 Web site The online systematic review process will continue to be developed as part of the WP2 objectives. This will allow future research teams to have access to an end-to-end online systematic review process. WP1 will utilise the website to provide stroke units and their patients’ access to the stroke survey. WP3 will also use the website to advertise and post their questionnaire to stroke patients and their carers. We will continue to provide support and assistance to the NIHR in developing their Global study site templates. As well as providing consultancy study site advice to new NIHR funded research teams, who are looking for start-up advice on how to utilise the site for their individual research 4.5 Summary and decision making leading to WP4 The additional information for the AHP model will be obtained from the Steering Committee by the 25September 2010 and will be considered at the Executive Team meeting on the 28th Questions for the patient questionnaire in WP3 will be developed over the next few months in conjunction with Prof Ijzerman and included in these questionnaires. The information will be obtained by January 2011 The information from WP1-3 and that obtained from the AHP process will be used to determine the Page 9 of 13 Programme Monitoring Form v1.2 ATs to be included in the clinical trial. An outline trial design, including the ATs chosen will be determined and submitted to NIHR by the end of March 2011 If the trial design is accepted recruitment will begin for the 4 physiotherapists. The trial will be undertaken in Salisbury, Southampton, Bournemouth, Stoke and Birmingham. Ethical permission will be sought. It is planned that the clinical trial would commence in the autumn of 2011 and will run for 2 years. It is probable that this timescale might run late if there are any delays in approval of the additional funds being obtained. Therefore the majority of the next 18 months work will be in planning and starting the clinical trial In addition to the clinical trial a number of papers on WP1-3 will be written over the next 18 months. These will include papers on the trial design process using the AHP methodology in addition to papers on the results obtained from the three work packages. Permission will be sought and manuscripts submitted to NIHR before any papers are submitted to journals. It is probable that there will be a number of presentations given at national and international meetings over the next 18 months as results are produced 5. Publications and other outputs (specifically since last Progress Report) Page 10 of 13 Programme Monitoring Form v1.2 Please list any reports of the research funded via the Programme Grant award which have been published or submitted for publication since the last Progress Report. Please also list any other outputs such as conference presentations, media interviews etc. during this period. (Maximum 5,000 characters). Please note that all publications must acknowledge the funding from the NIHR Programme Grants for Applied Research funding scheme and must also contain a disclaimer indicating that the views and opinions expressed within it do not necessarily reflect those of DH/NIHR. Please also note that all publications and other outputs (whether in oral, written or other form) should be submitted to the NIHR CCF at the same time as submission for publication, or at least 28 days before the date intended for publication/presentation, whichever is earlier. Grant-holders are also reminded of NIHR's support for the principle of Open Access to research as set out in its statement supporting UKPubMed Central: http://www.nihr.ac.uk/files/pdfs/OpenAccessPolicyStatement.pdf. To date there have not been any papers submitted to conferences or to journals specifically on the work of ATRAS apart from the poster and the two workshops organised at the UK Stroke Forum. However a number of presentations have been made during which the ATRAS project has been described in order to increase awareness and hence participation amongst staff involved in Stroke rehabilitation. WP1 1. Workshop at UK Stroke Forum Glasgow 1-3 December 2009. Concentrating on the work of WP1 WP2 Although not a direct result of ATRAS work WP2 were invited reviewers to NHS Evidence Updates 2. Pandyan AD Farmer SE 2009 NHS Annual Evidence Update on Stroke Rehabilitation - Upper Limb http://www.library.nhs.uk/stroke/viewResource.aspx?resid=331186 WP3 3. 3Hughes, A. M., Burridge, J., Demain, S., Ellis-Hill, C., Jenkinson, D., Pandyan, A., Swain, I. and Yardley, L. (2009) An exploration of stakeholders’ perceptions of the barriers to clinical use of Assistive Technologies in services for upper-limb stroke rehabilitation. In: World Congress for Neurorehabilitation, 21-25 March 2010, Vienna, Austria. 4. Workshop with physiotherapists at National ACPIN conference General 5. Poster at UK Stroke Forum Glasgow 1-3 Dec 2009 (Appendix 5) Assistive Technologies for the Rehabilitation of the Arm following Stroke - The ATRAS Project - NIHR Programme Grant for Applied Research RP-PR-0707-10012 1,2ID Swain, 3JH Burridge, 3S Demain, 4SE Farmer, 3AM Hughes, 5DF Jenkinson, 2G McHugh, 6AD Pandyan, 5EJ Wood 6. Swain ID., The future – Stroke and Rehabilitation Engineering. Presentation at BASP teaching meeting Queen’s Square, London, Feb 2010 7. Swain ID., Stroke, Assistive Technology and Rehabilitation Engineering, Presentation at SW Stroke Research Network, Exeter 22 April 2010. Page 11 of 13 Programme Monitoring Form v1.2 Forthcoming presentations Swain ID., Stroke, Assistive Technology and Rehabilitation Engineering, Presentation at Coventry and Warwickshire Stroke Research Network, 21 September 2010. Swain ID., Assistive Technologies for the Rehabilitation of the Arm following Stroke - The ATRAS Project - NIHR Programme Grant for Applied Research RP-PR-0707-10012, RAatE meeting, Warwick 29 November 2010 ATRAS Workshop UK Stroke Forum Glasgow 2010. This time concentrating on the work of WP3 Page 12 of 13 Programme Monitoring Form v1.2 6. Comments Please let us have any other comments, including on ways in which the system for reporting progress might be improved (Maximum 3,000 characters). The working relationships with the Programme Manager, Amanda Woods and the team at NIHR and David Henstock on the web design have been extremely good. Any questions we have had have been answered promptly. The change to the personnel in the appointment of Prof Ijzerman as a consultant to the project was handled very efficiently and will ensure a rigorous process leading to the design of the clinical trial in WP4 We did have a number of problems around the contract and IP agreements at the start of the programme. At the time the Model Agreement was only just being developed and we used an interim contract as a temporary measure. Once all the Model Agreements were signed we had no further problems. However this is an area of which the Lead Applicants need to be made aware and any assistance and standard approaches from NIHR would be much appreciated. The Lead Applicant needs to made aware of this system well before the start of the funding period so that the necessary infrastructure can be put in place in advance. In our case the final contract was not signed until nearly 9 months after the start of the grant There are still severe limitations in the production of reports using the current system, much as there were using the same system to complete the original grant application. It is impossible to format the report to improve its readability and it is impossible to include tables or photographs. There is no spell checking facility and any cut and paste operation has to be done in Word and then copied back in. Word and this form do not even count control characters in the same way. Until the question was asked it was not even clear if it was possible to have appendices in the Interim report. To dispense with the current online form would have a number of advantages and the use of even simple editing tools such a word/character count, allowing spaces, changing font sizes/bold/underline etc would enable much improved documents to be produced, in turn making it easier for reviewers The work we have been doing on the ATRAS website could further enable this process. The reviewers of this report are free to look at the website www.atrasproject.org and if this is required then we can provide access so that they can look at the member’s area. This will give a far greater insight into the work we are undertaking and if this report was embedded in the website, only obtainable by people with the relevant level of access, it would make review of the entire programme much easier and far more complete. We would be happy to work with NIHR to further develop our website to enable these additional functions and to roll out such a system for other research programmes In conclusion the organisation and running of this programme grant has been an enjoyable and very informative one. We have an extremely good team who have worked hard to keep all WPs on target. We look forward to the next phase and developing the protocol for the clinical trial Page 13 of 13