These are just some of the ways in which questions highlighted as important by James Lind Alliance Priority Setting Partnerships (PSPs) are being, or have been, addressed. This is research that we know has come about as a direct result of a PSP. We know that other research will be taking place that answers PSP questions, perhaps having been suggested already for other reasons. We’re keen to hear from you if you know of studies that we haven’t mentioned that directly result from a PSP. Please get in touch.
Interventions for acne scars
Addressing priority 3: A Cochrane Review was published in April 2016. The team reviewed 24 previous trials to pull together the evidence that already exists about interventions for acne scars, and to highlight where further research is needed.
Spironolactone for Adult Female Acne (SAFA): pragmatic multicentre double-blind randomised superiority trial to investigate the clinical and cost-effectiveness of spironolactone for moderate or severe persistent acne in women
Background Acne is very common and, although thought of as a teenage condition, it often continues into adulthood where impact on quality of life can be significant. The most commonly used treatment for acne is long courses of antibiotics but concerns about antibiotic resistance mean we need to find alternatives. Spironolactone reduces hormones called androgens that are implicated in acne as these increase grease production and cause changes in follicles in the skin making them prone to acne. This study will measure whether spironolactone helps adult women with persistent moderate-severe facial acne.
A Randomised Controlled Trial to investigate the clinical and cost-effectiveness of Paravertebral Blockade compared with Thoracic Epidural Blockade in reducing Chronic Post-Thoracotomy Pain (TOPIC 2)
A controlled study of the effectiveness of breathing training exercises taught by a physiotherapist by either instructional videos/DVDs/internet download or by face-to-face sessions in the management of asthma in adults
Addressing priority 7: NIHR research published. Many people with asthma are interested in non-drug treatments, particularly in breathing exercises. Teaching these breathing exercises face to face works well. This study showed that breathing retraining exercises improve quality of life in adults with asthma and at lower cost than usual care, with delivery by DVD having equivalent outcomes with lower cost than face-to-face training.
“It has been a great privilege to be involved in a research project like BREATHE, which had its roots firmly embedded in the wishes and priorities of patients with asthma and their families. We knew from the work of the James Lind Alliance, and our own clinical experience, that breathing techniques were of great interest to people with asthma.
We also knew that there were not enough NHS physiotherapists with the specialist skills needed to teach these techniques. BREATHE was developed out of these two key facts – and has resulted in a trial assessing the effect of physiotherapy breathing retraining learned through two different delivery methods – a) face to face with a physio, and b) digitally using a DVD plus booklet at home. We have found that both delivery methods were equally effective for our participants.
The interventions were developed iteratively with feedback from patients and clinicians, and this has helped to make sure they are not only effective, but also acceptable, and therefore more likely to be used in practice. We can honestly say that without the input of clinicians, patients and their families, we would not have been able to design, develop, test, and now implement, our new digital intervention.”
Anne Bruton, Co-investigator of the BREATHE study
Behavioural intervention to treat anxiety in adults with autism and moderate to severe learning disabilities
Commissioning brief advertised to researchers by the NIHR HTA programme.
Selective serotonin reuptake inhibitor for treating anxiety in adults with autism
Commissioning brief advertised. The UK’s NIHR and the Australian National Health and Medical Research Council (NHMRC) are collaborating on this research priority and will consider joint funding for any collaborative research proposals submitted.
Intensive behavioural interventions for young children with autism: A systematic review and cost-effectiveness analysis
Autism is a complex life-long condition that impacts on development in different areas including intellectual, communication, social, emotional, and adaptive skills for daily living. The proportion of children diagnosed with autism has increased considerably over the last two decades, and it now affects approximately 3 in 200 children born in the UK. This study aims to find out whether or not intensive early interventions based on applied behaviour analysis (ABA) can help young children with autism, and whether it represents good value for money.
Psychosocial intervention to address the mental health needs of parents/carers of children newly diagnosed with autism
Addressing priority 6: Commissioning brief advertised to researchers by the NIHR HTA Programme.
Managing Repetitive Behaviours: Clinical and cost effectiveness trial of a parent group intervention to manage restricted and repetitive behaviours in young children with ASD
Challenging restricted repetitive behaviours (RRB) such as repetitive movements, routines, restricted interests, and resistance to change can interfere with an autistic child's ability to engage in everyday living activities, reduce social opportunities and prevent learning new skills. Parents report they need strategies and advice on how to manage their child's challenging RRB. This study will assess the effectiveness of a Managing Repetitive Behaviours intervention.
Why are autistic people more vulnerable?
Treating anorexia in autistic women
Understanding suicide in autism
Anxiety and depression in autistic people who speak few or no words
Language and Communication Skills
A personalised anxiety treatment for autistic adults
Coping with uncertainty
Sensory reactivity and anxiety
Incredible Years for autism
A family toolkit for everyday life with autism
Pharmacological and non-pharmacological interventions for non-respiratory sleep disturbances in children with neurodevelopmental disorders: a systematic review
Bryony Beresford and her team are bringing together the evidence which already exists from lots of previous studies about sleep disturbance, to determine how well different treatments work. They will publish and promote their conclusions so that parents and health professionals are better informed about how to manage sleep disturbance. Their work will also identify where further research is needed.
Therapy interventions for children with neurodisability: a scoping study of current practice and perceived research needs
Addressing priority 1: Scoping study underway, funded by the NIHR HTA Programme and jointly commissioned with the NIHR HS&DR Programme.
This research looks at current approaches to therapy, how and why they vary and what influences decision-making. The team aims to find out what the evidence gaps are and to get the views of health professionals, parents and children on how future research might be designed to answer these gaps.
A pragmatic Randomised Controlled Trial of Sensory Integration Therapy versus usual care for sensory processing difficulties in Autism Spectrum Disorder in children: impact on behavioural difficulties, adaptive skills and socialisation (SenITA)
Autism Spectrum Disorder is a common lifelong condition affecting 1 in 100 people. A team based at Cardiff University is investigating whether Sensory Integration Therapy, provided by trained occupational therapists, improves a child’s behaviour, socialisation and daily functioning, compared with the usual care they’d receive.
Interventions to improve eating ability in children with neurodisability
Young children with developmental difficulties may also have eating, drinking and swallowing problems. Eating and drinking difficulties may lead to a restricted diet, poor growth, and impact on development, in addition to general physical health risks such as choking or chest infections. This research team wants to find out what treatments are currently recommended by health professionals. They will then decide which of these potentially useful treatments should be tested in a future study.
Identifying appropriate symbol communication aids for children who are non-speaking: enhancing clinical decision making
It’s a challenge to identify suitable communication aids and language representation systems for each child, and getting it right means that long-term successful use is much more likely. This team of researchers is exploring current provision of symbol communication aids. They aim to provide guidance to support clinicians, parents and others in their selection of the most appropriate aids.
Clinical and cost effectiveness of a parent mediated intervention to reduce challenging behaviour in pre-schoolers with moderate to severe learning disability: a randomised controlled trial
Cost-effectiveness of earlier provision of powered wheelchair interventions for children with mobility limitations
Addressing priority 4: Commissioning brief advertised to researchers by the NIHR HTA Programme
Improving continence in children and young people with neurodisability
Addressing priority 7: Commissioning brief advertised to researchers by the NIHR HTA Programme
Addressing a broad range of the priorities: Commissioning brief advertised to researchers by the NIHR HTA Programme.
Optimising acute care for people with dementia - a mixed-methods study
This research was informed by a number of service uncertainties throughout the whole list of questions identified by this PSP: NIHR research in progress.
Numbers of people with dementia who are admitted to general hospitals are increasing. This research team aims to help us understand what works best in hospitals when providing quality care for people with dementia.
Evaluation of specialist nursing support for carers of people with dementia
This research was informed by a number of service uncertainties throughout the whole list of questions identified by this PSP : NIHR research in progress.
We need to know more about how to provide specialist nursing support to carers of people with dementia, effectively and efficiently. Gillian Parker and her team are looking at the costs and benefits, what kinds of help leads to the best outcomes for carers and what the outcomes are that carers want?
Investigating the best ways to put dementia care research into practice
Research has given us a growing list of things that can be done to improve dementia care, but there is a gap between what we know and what actually happens. This project looks at how we can best communicate the practices that have been shown to improve care.
Physical exercise for depression in adolescents
Addressing priority 18: Commissioning brief advertised to researchers by the NIHR HTA Programme.
Selective serotonin reuptake inhibitor to prevent depression following traumatic brain injury
Addressing priority 1: Commissioning brief advertised to researchers by the NIHR HTA Programme.
Pragmatic, primary care, multi-centre, randomised superiority trial of four emollients in children with eczema, with nested economic evaluation and qualitative study
Addressing one of the top 4 priorities: NIHR research in progress. 1 in 5 children in the UK have eczema There are many different emollients (moisturising treatments applied directly to the skin) to relieve skin dryness and hardly any research comparing them. This research team wants to do a fair test of the four most commonly used types of emollients.
Surgery for early osteoarthritis
Addressing any of the priorities in the Surgical Top 10: Evidence synthesis commissioning brief advertised to researchers by the NIHR HTA Programme
Surgical interventions for Meniere’s Disease
Intensive day patient versus inpatient treatment for anorexia nervosa in adult specialised eating disorder services
Addressing priority 5: Commissioning brief advertised to researchers by the NIHR HTA Programme
Addressing priority 8, 16 and 29: Commissioning brief advertised to researchers by the NIHR HTA Programme
Management of isolated or incidental subsegmental pulmonary embolism
Addressing priority 23: Commissioning brief advertised to researchers by the NIHR HTA programme
Getting it right: the continuing support and service needs of ICU survivors
Addressing priority 2: In 2015 the Intensive Care Foundation gave a £50,000 ‘JLA Award’ to Dr Brenda O’Neill and Dr Bronagh Blackwood of Queen’s University Belfast, who led a UK-wide collaborative project proposal aiming to improve the assessment of ICU survivor’s support needs across the continuum of care.
What is the best treatment for controlling diarrhoea and/or incontinence symptoms in people with IBD, including novel pharmacological and non-pharmacological options? Is high-dose Loperamide safe and effective in the treatment of diarrhoea in IBD?
Addressing priority 6: Commissioning brief advertised to researchers by the NIHR HTA Programme.
Optimal treatment strategies for fistulising perianal Crohn's disease
Addressing priority 5: Commissioning brief advertised to researchers by the NIHR HTA Programme.
Addressing any of the relevant priorities in the Top 10: forCrohns and Core announced a joint call for research projects on Crohn’s Disease, which should reflect at least one of the Top 10 from the PSP in IBD
Mesothelioma and Radical Surgery 2: a multicentre randomised trial comparing (extended) pleurectomy decortication versus no (extended) pleurectomy decortication for patients with malignant pleural mesothelioma (MARS 2)Addressing priority 10: NIHR research in progress
In the UK, over 2,000 patients are diagnosed yearly with pleural mesothelioma, a cancer of the lining of the chest wall and lung mainly due to previous (40 to 60 years ago) exposure to asbestos. This trial compares surgery (extended pleurectomy decortication) versus no surgery with respect to overall survival in patients with pleural mesothelioma.
Horizon scanning reviewAddressing priorities 5 and 6:
In March 2017, the NIHR published the results of its horizon scanning review, which looked for new and emerging technologies for hearing loss. The review identified 55 new technologies. Patients, clinicians and researchers highlighted the technologies of interest to them which, if successful, would have the potential to change the cochlear implant landscape for patients, improve patient experience and use of hearing aids, and would affect service delivery and provision.
Exercise therapy for fatigue in Multiple Sclerosis
Addressing priority 3: A Cochrane Review published in September 2015 brought together the best available evidence looking at whether exercise therapy is an effective and safe way of reducing fatigue in MS.
Read more from Evidently Cochrane.
MS-STAT2: A phase 3 randomised, double blind, clinical trial investigating the efficacy of repurposed simvastatin compared to placebo in secondary progressive multiple sclerosis, in slowing the progression of disability
In 2014, the MS-STAT1 clinical trial of 140 people with secondary progressive multiple sclerosis followed for 2 years showed promising results in those taking simvastatin (dose-80mg/day) compared to placebo (a dummy drug). This MS-STAT2 trial is based on the original MS-STAT1 trial, but is a larger clinical trial. Patients will be followed for 3 years to investigate whether there is confirmed slowing of disability progression or not.
Determining the Effectiveness of Early Intensive versus Escalation Approaches for the Treatment of Relapsing-Remitting Multiple Sclerosis (DELIVER-MS).
Nikos Evangelou from the University of Nottingham is leading the UK arm of this trial, to investigate whether early treatment with disease modifying therapies (DMTs) could benefit people with MS.
CARer-ADministration of as-needed sub-cutaneous medication for breakthrough symptoms in home-based dying patients: a UK study (CARiAD)
Addressing priority 1 and 4: NIHR research in progress Most people want to be cared for and die at home. As people get weaker in the last weeks or days of life, they usually can’t swallow. In the UK, when this happens, it is standard practice for medicines to be given by a drip under the skin to relieve symptoms. If, despite a drip being in place, distressing symptoms still occur, a family member is advised to call a healthcare professional to give the patient an injection under the skin. This can take time. In Australia, family members are trained to give such an injection. This feasibility study aims to find out more about how acceptable and effective this would be in the UK and how feasible a large-scale trial would be.
A prospective observation of secretion problems in motor neurone disease (ProSec)Addressing PSP priorities 6 and 8 from the Top 10:
Research grant awarded to Dr Christopher McDermott, University of Sheffield, in March 2017, by Marie Curie and the Motor Neurone Disease Association.
The palliative care needs of people with motor neurone disease (MND) and their informal care giversAddressing PSP priority 6 from the Top 10 and number 33 from the long list of questions identified:
Research grant awarded to Dr Kate Flemming, University of York, in March 2017, by Marie Curie and the Motor Neurone Disease Association.
Enabling tailored and coordinated support for family carers of people with MND through adaptation of a Carer Support Needs Assessment Tool (CSNAT) InterventionAddressing PSP priorities 4, 8, and 10 from the Top 10 and numbers 36, 37, 42 and 45 from the long list of questions identified:
Research grant awarded to Professor Gunn Grande, University of Manchester and Dr Gail Ewing, University of Cambridge, in March 2017, by Marie Curie and the Motor Neurone Disease Association.
Supporting people with palliative and end-of-life care needs “out of hours”: a mixed-methods study of needs, demands and experiences to inform person-centred service developmentsAddressing PSP priority 1 from the Top 10:
Research grant awarded to Professor Scott Murray, University of Edinburgh, in March 2017, by Marie Curie and the Chief Scientist Office Scotland.
ENeRgy: Exercise and Nutritional Rehabilitation in patients with advanced cancer: a single centre, randomised (1:1), open label, feasibility study of a rehabilitation programme (exercise and nutrition) versus wait list control, in patients with advanced cancerAddressing PSP numbers 18, 21, and 73 from the long list of questions identified:
Research grant awarded to Professor Marie Fallon and Dr Barry Laird, University of Edinburgh, in March 2017, by Marie Curie and the Chief Scientist Office Scotland.
ACCESSCare II - bereavement outcomes for LGB (lesbian, gay, and bisexual) and heterosexual bereaved partners: a population-based cross sectional mixed methods studyAddressing numbers 47, 48, 49 and 50 from the long list of questions identified
Research grant awarded to Dr Richard Harding and Dr Katherine Bristowe, King’s College London, in March 2017, by Marie Curie.
The effectiveness in alleviating pain, anxiety and enhancing wellbeing, and the expectations and experiences of palliative care patients of aromatherapy, massage and reflexology: A multi-level synthesisAddressing number 80 from the long list of questions identified:
Research grant awarded to Dr Bridget Candy, University College London, in March 2017, by Marie Curie.
Accessing and delivering person-centred care in advanced non-cancer conditions: developing and testing a Support Needs Approach for Patients (SNAP) with advanced COPDAddressing PSP priorities 2 and 6 from the Top 10 and number 64 from the long list of questions identified:
Research grant awarded to Dr Morag Farquhar, University of East Anglia, in March 2017, by Marie Curie.
A multi-perspective qualitative study to understand the experience and impact of the Child and Young Person’s Advance Care Plan (CYPACP)Addressing PSP priorities 3 and 4 from the Top 10:
Research grant awarded to Dr Karen Shaw, University of Birmingham, in March 2017, by Marie Curie.
Taking positive steps to prevent falls
Addressing priority 1: Katherine Baker hopes her Parkinson's UK-funded study will shed new light on the complex relationship between physical activity and falls in Parkinson’s. And that the new knowledge this study produces will empower people with the condition to manage their condition more effectively and reduce their risk of falling.
Mindfulness to tackle anxiety and depression
Exploring anxiety in Parkinson’s
Addressing priority 2: Researchers are investigating whether anxiety in Parkinson’s is similar to anxiety in people without the condition and then test whether this anxiety can be reduced with a simply computer training task in this Parkinson’s UK-funded study.
A combined therapy for dyskinesia
Addressing priority 3: In another Parkinson’s UK-funded study, a team led by Riccardo Brambilla has been looking at what makes nerve cells become overactive when taking Levodopa, resulting in uncontrollable movements..
Towards treatments for Parkinson’s dementia
Addressing priority 5: In this Parkinson’s UK-funded study Roger Barker and his team are working to further understand the changes that happen in the brain if people with Parkinson’s go on to develop dementia so that new treatments may be developed in future.
Developing a simple test for Parkinson’s dementia
Addressing priority 5: Michele Hu wants to develop a simple blood test which could help diagnose and predict the risk of a person with Parkinson’s developing dementia. This Parkinson’s UK-funded study aims to find biomarkers that predict the risk.
Understanding how genes are involved in dementia with Lewy bodies
Addressing priority 5: Researchers are looking at the gene activity in different parts of the brain in people affected by dementia with Lewy bodies and with Parkinson’s. They will then compare gene activity levels to those found in healthy people to understand the differences in this Parkinson’s UK-funded study
Learning new movements with rewards
The New Monument Discovery Award
Addressing priority 7: This largest ever research grant given by Parkinson’s UK brings together a world-class team of researchers to betters understand Parkinson’s.
Understanding the causes of pain in Parkinson’s
Solution for swallowing problems in Parkinson’s
Get it on time: What’s the evidence
Addressing priority 25: This Parkinson’s UK-funded research aims to find out if people with Parkinson’s will recover more quickly and spend less time in hospital if they are given their medication on time.
Read more about what Parkinson’s UK is doing to address the priority areas for research from its PSP in this 2016 Unmet needs report.
Surgical treatment of pressure ulcers
Addressing priority 11: Commissioning brief advertised to researchers by the NIHR HTA Programme.
Patient and lay carer education for preventing pressure ulceration in at-risk populations
Dressings and topic agents for treating pressure ulcers
Addressing priority 8: A Cochrane Review published in June 2017 brought together the best available evidence to help health professionals and people with pressure ulcers make decisions about the use of dressings or topical agents as treatments.
STEPWISE: Structured lifestyle Education for People WIth Schizophrenia
Obesity and problems with weight are two to three times more common in people with schizophrenia. This project creates a lifestyle education programme (based on an existing one for Diabetes around diet and physical activity) and evaluates how it can support weight loss in around 5,000 adults, within 10 mental health trusts across the UK.
EMPOWER: Early Signs Monitoring to Prevent Relapse and PrOmote Wellbeing, Engagement and Recovery
Addressing priority 2: Joint research through NIHR and the Australian National Health and Medical Research Council in progress
Relapse in schizophrenia is a major cause of distress and disability among patients and their families. Teams based in the UK and Australia are working together to build an intervention that refines existing smartphone technology for the monitoring of early warning signs. They will assess the acceptability of this to service users, carers and health professionals and look at the feasibility of a larger scale trial of its acceptability and safety.
Training to recognise the early signs of recurrence in schizophrenia
A Cochrane Review was published in February 2013. It looked at all previous evaluations of how effective early warning signs interventions are and what kind of future research we need in this area.
Management of sexual dysfunction due to antipsychotic drug therapy
Addressing priority 4: Commissioning brief advertised to researchers by the NIHR HTA Programme.
Strategies for managing sexual dysfunction induced by antidepressant medication
Addressing priority 4: A Cochrane Review was published in May 2013. It looked at the results of previous studies around this relatively common side effect of antidepressant medication to find out what management strategies are effective and what the adverse effects and acceptability of them are.
Management of sexual dysfunction due to antipsychotic drug therapy
Clozapine for children and young people with treatment resistant schizophrenia
Addressing priority 1: Commissioning brief advertised to researchers by the NIHR HTA Programme.
Prevention of recurrent Symptomatic Urinary Tract Infections in Patients with Chronic Neurogenic Bladder Dysfunction: PReSUTINeB study
Addressing priority 4: NIHR research in progress. There is no clear agreement among experts on how to detect urinary tract infection in people who have loss of bladder control. Also many scientific studies disagree on the correct definition of a urinary tract infection. Stoke Mandeville National Spinal Injuries Centre is seeking to answer these questions by working with patients and reviewing the current evidence. The results will help doctors better understand how to treat these infections.
Effectiveness and cost-effectiveness of Reverse Shoulder Arthroplasty versus Hemiarthroplasty versus Non-surgical care for acute 3 and 4 part fractures of the proximal humerus in older adults - The PROFHER-2 Randomised Clinical Trial
Breaking (fracturing) the upper part of the arm at the shoulder (proximal humerus) most commonly occurs in people over 65 years old after a simple fall. Fractures are considered more serious & complex when the bone is broken into more than 2 parts or are widely separated This study will assess which is the most effective treatment for these more severe fractures.
A Randomised, single masked, non-inferiority trial of Femtosecond Laser Assisted vs Manual Phacoemulsification Cataract Surgery for Adults with Visually Significant Cataract: The FACT trial
Mark Wilkins, consultant ophthalmologist at Moorfields Eye Hospital, is leading a team comparing two forms of cataract surgery. The trial will include more than 800 people, from Moorfields Eye Unit at St Ann’s Hospital in North London, and Wolverhampton Infirmary. They’re looking at the benefits of making some of the steps of surgery more robotic.
KERALINK: Efficacy and safety of cross-linking in children with Keratoconus
Read more information about this study. Keratoconus is a long term eye disorder that impairs the ability of the eye to focus and reduces vision. Frank Larkin, a consultant at Moorfields Eye Hospital, and his co-investigators will test a treatment known as ‘collagen cross-linking to find out if it’s safe and whether it works in children and young people.
Summary of work funded by Fight for Sight, the NIHR and the Macular Society
The Sight Loss and Vision PSP report of funded research in the priority areas.
Horizon scanning review
In June 2014, the NIHR published the results of its 'horizon scanning review', which looked for any new and emerging technologies for inherited retinal disease. The review found 40 new and emerging technologies.
Horizon scanning review
In September 2016, the NIHR published the results of its horizon scanning review, which looked for any new and emerging technologies for the treatment of corneal disorders. The review identified 130 new and emerging technologies and procedures.
The effect of light therapy on birdshot uveitis
Participants in this study will be given a course of experimental light therapy in one eye only, in addition to their existing treatment, to see if this can reduce inflammation in the eye caused by auto-immune activity.
The world’s first birdshot uveitis database
This biobank of samples from patients with birdshot will ultimately enable a great variety of statistically-valid studies to be performed on large numbers of patient samples.
Can we develop a fast, reliable and cheap way to monitor Birdshot’s progress?
Omar Mahroo and colleagues tested a portable device that measures electroretinogram activity to find out whether it can reliably monitor Birdshot’s progress.
Can supercell analysis diagnose Birdshot uveitis
In this project, a research team from Birmingham explores a machine learning method known as ‘supercell analysis’ to see if it can help speed up diagnosis and ultimately lead to a reliable diagnostic test.
Are there any early signs or symptoms that can predict Birdshot’s course?
In this project, Mark Westcott and team at Moorfields Eye Hospital are looking for which clinical signs that appear early in the condition are good predictors of poor prognosis later on.
A patient-friendly way to measure flare-ups of birdshot uveitis
This team based at Queen Elizabeth Hospital Birmingham is testing a light-based imaging device to see how good it is at detecting ‘flare-ups’.
How many new cases of birdshot are there each year?
This project is a 2-year national survey of the demographics, signs and symptoms of each new case of birdshot in the UK.
Studying birdshot using stem cells from patients
It would help our understanding of birdshot to study cells and tissue from patients, but donor tissue is in short supply. This team aims to develop a suitable layer of tissue from certain stem cells that come from patients.
Are the genetics of birdshot related to iron overload in the eye?
This research team is studying genes to find out whether iron overload is related to birdshot and can therefore be helped by standard therapy for iron overload.
Does ultrasound assessment of fetal growth in the third trimester reduce stillbirth?
Care and support for bereaved parents
Addressing priority 7: Commissioning brief advertised to researchers by the NIHR HTA Programme.
Why do people with tinnitus use apps?
Addressing priority 1: Research in progress, supported by The British Tinnitus Association Head of Research.
Currently available tinnitus apps suggest a range of ways in which they might be effective for managing and treating tinnitus, including masking, neuromodulation, relaxation etc. Many allow customisation and personalisation of sounds used. Despite increasing popularity of apps it is unclear what proportion of people use apps for tinnitus management and which apps are the most popular. Also deeper and independent assessment of tinnitus apps that would assess quality of apps (including accuracy of content and usability) and mechanisms of action is lacking. In this ‘horizon scanning’ study, Magdalena Sereda at the NIHR Nottingham Hearing Biomedical Research Unit will identify apps that people use for tinnitus management, evaluate their content, and assess their potential strengths and limitations through an online survey.
Manualisation and feasibility study of audiologist-delivered counselling for tinnitus
In the UK, emphasis is placed on audiologists meeting tinnitus patient needs but few receive the necessary training to provide patient counselling and few audiology departments have counselling-trained audiologists. In this feasibility study, NIHR Nottingham Hearing Biomedical Research Unit staff led by Derek Hoare will develop a manual for audiologists which defines standard care and counselling. Feasibility study objectives include evaluating acceptability of the counselling intervention, compliance, and whether there is sufficient interest and need for a randomised controlled trial.
Cognitive Behaviour Therapy for tinnitus-related insomnia
Sleep disturbance is one of the most common complaints from people with tinnitus affecting between 50-70% of people attending tinnitus clinics. Cognitive Behavioural Therapy (CBT) is a psychological talking therapy which has been shown to help manage insomnia. CBTi is now part of the NICE guidelines for the management of long term insomnia (NICE 2014). This study, led by Dr Laurence McKenna and Dr Liz Marks, University College London, will investigate the effectiveness of CBTi as a treatment of tinnitus-related insomnia. Sleep Hygiene (an approach commonly used in the tinnitus clinics) will be used as a control.
Evaluating the Tinnitus E-Programme, an internet-based self-help programme for tinnitus
Until a cure for tinnitus is found, people need support to manage their tinnitus and reduce its impact on their everyday lives. Self-help programmes provide one way of achieving this. A systematic review was published in May 2016 which identified the self-help techniques used in self-help interventions for adults with chronic tinnitus and assessed their effectiveness. From 5 previous studies 15 behaviour change techniques and eight self-management components were identified but confident conclusions could not be drawn regarding efficacy. The PhD project has also evaluated the Tinnitus E-Programme (www.tinnituseprogramme.org), an internet-based self-help programme for people with tinnitus.
Amplification with hearing aids for patients with tinnitus and co-existing hearing loss
Addressing priority 5: A Cochrane Review was published in January 2014. The team reviewed one previous trial to pull together the evidence that already exists about hearing aid interventions for tinnitus and co-existing hearing loss, and to highlight where further research is needed.
The British Tinnitus Association is funding a Head of Research fellowship that addresses priorities 1, 4, 5 and 9. Research is in progress. Dr Magdalena Sereda hopes her funded research will shed new light on the clinical efficacy and cost-effectiveness of NHS contracted sound therapy options for tinnitus including hearing aids and combination hearing aids.
Combined amplification and sound generation devices for tinnitus: towards creating clinical guidance and recommended procedure
Addressing priority 5: Research in progress. Supported by the British Society of Audiology Tinnitus and Hyperacusis Special Interest Group Part-funded by a BSA Applied Research Grant.
Combination hearing aids are devices which amplify sounds in the same way as hearing aids, but also can create sounds such as white noise. They are used to manage tinnitus and are a fairly new addition to use in the UK. Many audiology clinics can offer combination aids. However, there is no standard guide to help audiologists decide on who to offer the devices to or how to fit them to best meet the needs of each patient with hearing loss and tinnitus. Ongoing research led by Dr Magdalena Sereda is conducting a series of surveys to 1) identify where there is and is not clinical consensus on who should be recommended combination hearing aids (candidacy) and how those devices should be fitted; 2) explore expectations and experiences of people with tinnitus who have used combination hearing aids.
Tinnitus in children practice guidance
Addressing priority 6: In March 2015, the Paediatric Audiology Interest Group (PAIG) of the British Society of Audiology published practice guidance – a project that was undertaken by a working party of national specialists in paediatric tinnitus. The guidance offers child-friendly, practical advice for those wanting to develop their skills in the management of children with tinnitus. It is intended for a multidisciplinary audience including audiologists, medical professionals, school nurses, teachers of the deaf, and psychologists. This project was supported by the British Tinnitus Association.
People's experiences with different degrees of hearing loss and tinnitusAddressing priority 7: People who are deaf or have profound hearing loss are often marginalised by both their tinnitus and hearing loss. The British Tinnitus Association commissioned The Ear Foundation to investigate people's experiences with different degrees of hearing loss and tinnitus (supported by the James Tudor Foundation). The report was launched in September 2015 and presents the views of 1432 participants on the treatment they have received, what helped, what didn't and their hopes for the future.
The QUest In Eliminating Tinnitus (QUIET-1): testing a novel drug for tinnitusAutifony Therapeutics Ltd sponsored a Phase IIa tinnitus clinical trial in the UK, funded by Innovate UK. Professor Jaydip Ray, Consultant Ear, Nose and Throat (ENT) surgeon at Sheffield Teaching Hospitals NHS Foundation Trust and Sheffield Children’s Hospital NHS Foundation Trust was the national Coordinating Investigator and Professor Deborah Hall, University of Nottingham and NIHR Nottingham Hearing Biomedical Research Unit (BRU), was the academic partner. See BRU project page. The main aim was to try to demonstrate an improvement in the severity of tinnitus symptoms and impact after 28 days of treatment with the study medicine compared to placebo. Findings from the planned interim analysis of completed participants led to the closure of recruitment due to lack of efficacy. On a statistical basis, it would not be possible to reach the magnitude of change needed to show improvement over the placebo. Nevertheless, the team gained many valuable insights about trial design and patient recruitment.
Multicentre randomised trial of the effectiveness and cost-effectiveness of basic versus biofeedback-mediated intensive pelvic floor muscle training for female stress or mixed urinary incontinence (OPAL – Optimal PFMT for Adherence Long-term)
Addressing priority 1 and 3: NIHR Research in progress Accidental leakage of urine is a distressing problem that affects about one in three women and the NHS spends considerable amounts of money treating it. Biofeedback equipment allows women to see their pelvic floor muscles working as they exercise. This study compares exercise with this equipment with standard exercises in around 600 women.
UVB light combined with topical corticosteroid for treatment of vitiligo
Addressing priority 4: NIHR Research in progress. Read more information about this study. Vitiligo can have a devastating effect on the quality of life of those who have it, particularly where it is easily seen by others, for example on the face or hands. Over 440 people with vitiligo are involved in this study which looks at combinations of light therapy delivered at home, with steroid ointment.
Identifying High-Risk Women for Endometrial Cancer Prevention Strategies: Proposal of an Endometrial Cancer Risk Prediction Model
Addressing priority 1: This review published in December 2016 discusses a prediction model for identifying women at high risk of endometrial cancer who may therefore benefit from prevention strategies.
Interventions for weight reduction in obesity to improve survival in women with endometrial cancer
Addressing priority 10: Cochrane Review review protocol published in January 2017. This review will look at the impact of weight loss interventions, in addition to the standard management of womb cancer, on overall survival and frequency of adverse events.