Congratulations to Physiotherapist Emma whose innovative research into hand injuries has been shortlisted for a prestigious award
A UHDB Physiotherapist who set up a research trial to improve patient experience for those who have injured the tendons in their hand has been shortlisted for a prestigious award, for her ongoing work to support patients.
Emma Bamford, Extended Scope Practitioner in the Pulvertaft Hand Centre at Royal Derby Hospital, has been shortlisted in the category for Outstanding Achievement by an Individual in the Clinical Research Network (CRN) East Midlands Research Awards 2024 for co-leading the Flexor Injury Rehabilitation Splint Trial (FIRST), a rehabilitation trial that compares three different splint treatments for finger flexon tendon repairs by randomly assigning the different splints to patients.
Despite having no previous research experience Emma was inspired by patient feedback and a 'corridor conversation' with colleagues about the options available to patients and their outcomes to apply for a £1.2 million grant from the National Institute for Health and Care Research (NIHR) in the hopes of conducting a programme of research into rehabilitation post tendon ruptures and surgical repair in the hand.
The process very quickly 'snowballed' and in 2022, 18 months after submitting the application, Emma was awarded the funding and became the first non-medic at UHDB to lead/co-lead as Chief Investigator on an NIHR Health Technology Assessment (HTA) grant.
She said: "I had no formal research training other than the undergraduate research I had done so I assumed someone more senior would get it. It felt like an incredible responsibility, but also an incredible opportunity. It was the first time the hand unit had been given one of these grants so it's been the biggest learning curve of my life but it's been amazing."
In the UK, more than 7,000 people a year cut their tendons in their hands. Without surgery to repair them, their fingers would never bend, making everyday tasks more difficult. When recovering, patients are required to wear a splint for six weeks restricting their ability to carry out normal tasks such as washing, getting dressed, driving and going to work.
As part of the study, patients are randomly assigned one of three splints - the long forearm based splint, which covers the whole hand and forearm and prevents motion of the wrist; the Manchester short splint which covers the fingers but allows motion at the wrist; or the relative motion flexion splint, a custom made finger-based splint which prevents full extension of the injured fingers but allows the hand and fingers to be used for daily activities with a wrist support. All splints are worn continuously for five weeks and then a further week of evening and intermittent use. The aim of the trial is to show which one of the three splints in clinically effective while identifying the risks and the benefits of each splint to help guide treatment.
Emma said: "Clinically the longer splint is more protective so thought to prevent re-rupture of the repaired tendons, but it is very restrictive and quite an inconvenience. With the short and mini splints there might be a higher risk of potentially re-rupturing the tendon, but they are thought to be less cumbersome, allowing patients to return to work quicker and do light functional activities.
"The feedback we were getting from patients was that actually they were quite willing to take that risk if it meant they could stay in work, it was about looking to find a way that they could recover properly and still have a good quality of life, being able to manage everyday tasks like they normally would, while wearing the splint.”
Patient experience was one of the key drives for the research and Emma hopes it will allow colleagues to be able to offer patients ‘evidence-based choice’ sharing the advantages and drawbacks of each splint and providing them with the information to help them make the best decision for themselves. But it is not just the patients who are benefitting from the research. Emma’s passion and determination to lead the trial is paving the way for other Allied Health Professionals (AHPs) to explore research in the future.
Emma said: "When we first started the trial and started to set up sites we were told that therapists couldn’t be principle investigators at some of the sites and we've been able to challenge that, so most of our sites now have a hand therapist that’s leading. Traditionally it’s a surgeon or a more senior member of the team so that is really positive. All the therapists involved across all the different sites have really got behind it and been so enthusiastic in championing the project so I am hoping we can continue to shine a light on AHPs in research and open up more opportunities to follow in the footsteps of me and my team.”
In June last year, the NIHR reviewed Emma’s pilot data and gave her the green light to continue with the research with no amendments. There are now 26 sites across the UK involved in the project and Emma and her team are only 27 recruits away from completing the trial, which has inspired Emma to look ahead: "I know I have gone about my research career completely upside down and back to front, but I have definitely got the bug for research.
"Whilst working on FIRST I completed my pre-doctoral fellowship looking at research methodologies and learning more about analysis and my plan next year is to apply for a PhD fellowship. Even though we are nearing the end of recruitment now I still do a little dance every time someone is recruited to the trial because it really is an achievement.
"Research shows that any Trusts that are research active have better patient outcomes not just for the patients taking part in the study but others across the organisation so in running FIRST it will have pushed good care and evidence-based practice in other areas and driven up quality."
While Emma is up for the Outstanding Achievement by an Individual award, she said the trial would not have been a success without the input and passion of her team and external partners who have supported her research.
Emma said: "I am very excited to make the shortlist but there's no way I could have done it without my team and the support of so many others so I will be flying the flag for them. The trial has been our life for the last four years so it is really nice to have that hard work recognised and to showcase the importance of research. We are very proud."
Research gathered through the trial will, when the trial ends in 2025, contribute to updating hand therapy guidelines and clinical education nationally.
Emma will find out if she has won at the CRN East Midlands Research Awards Ceremony, which will take place on Wednesday 6 March 2024 at Kilworth House Hotel, Leicestershire.