Latest research findings

New research findings from the NIHR Dissemination Center

The NIHR Dissemination Centre puts good research evidence at the heart of decision making in the NHS, public health and social care. The centre critically appraises the latest health research to identify the most reliable, relevant and significant findings. It then disseminates these findings as:

NIHR Signals - The latest important research, summarised
NIHR Highlights - Conditions, treatments and issues explored using NIHR evidence
Themed Reviews - Bringing together NIHR research on a particular theme

To keep up to date with the latest important research, sign up to their mailing list or follow @NIHR_DC on twitter. Visit the Discover Portal for a complete, searchable selection of NIHR Signals, or see the latest on clinical trials below.

Repetitive task training can help recovery after stroke
Following a stroke, people who received repetitive task training showed greater improvements in performing functional tasks, such as picking up a cup, standing up and walking. These improvements were sustained for up to six months. Disability following stroke is common, affecting around half of all stroke survivors. This NIHR-funded review of over thirty trials found that repetitive task training provided small gains in arm and leg function, balance and walking distance (about 35 metres). We do not yet know the optimum number of sessions, or the ideal duration or intensity. However, it is a versatile and relatively easy intervention which can be delivered by physiotherapists/occupational therapists in groups, individually, in hospital, in the community or at home. Depending on the nature of the exercise, there is also potential for people to continue to practice on their own or with carer support. This review shows that it can help people to improve functionality and mobility and should be considered as part of routine rehabilitation, in line with national guidance.
25 April 2017

Fortified donor breast milk led to similar development for very-low-birthweight babies compared with formula milk
Providing very-low-birthweight babies with fortified human donor breast milk made no difference to their developmental neurological outcomes at 18 months compared with giving formula. This randomised controlled trial looked at 363 babies with birth weights of less than 1500g in neonatal intensive care units in Canada. When the mother’s own milk supply was limited, the babies were given either nutrient-enriched donor breast milk or formula developed for premature babies. There was no difference in their understanding, language, or ability to manipulate objects at 18 months. This finding might help to reduce anxiety about providing formula in areas where donor breast milk is difficult to obtain. However, the research was focussed on developmental outcomes rather than potential effects of donor breast milk on other risks of prematurity, such as immunity or gastrointestinal complications. This trial will continue to collect data to re-assess developmental outcomes when the children reach five years of age.
18 April 2017

New casting technique is an option for older people with ankle fracture
A new casting technique called “close contact casting” is an alternative to surgery for older people with ankle fracture. Ankle function at six months was similar in people who had casting and those who had surgery but there are some disadvantages to both that patients and surgeons could consider. This UK-based NIHR trial recruited 620 people aged over 60 years with an unstable ankle fracture that would usually be fixed with surgery. People who had a cast were less likely to have infections or wound problems than those who had surgery. However, one in five people in the casting group had to undergo surgery later because their fracture was not healing in the right position. Close contact casting was around £650 cheaper than surgery, and was very likely to be cost effective at current NHS thresholds. Participants are being followed up for another year and a half to assess longer term outcomes such as arthritis and this will further help in balancing the benefits and harms of these options.
18 April 2017

Antibiotics by injection into the eye can prevent severe infection following cataract surgery
Injecting the antibiotics vancomycin or moxifloxacin into the eyeball after eye surgery can reduce the risk of developing severe infection inside the eye (endophthalmitis) compared to other routes. Cefuroxime is currently the antibiotic of choice for this in the UK, but researchers wanted to see if drugs with lower rates of resistance might also be effective. A review of 34 studies, mostly observational studies with nine randomised controlled trials (RCTs), explored the effects of different types of antibiotic regimens on the risk of endophthalmitis in people who had received eye surgery. There were no randomised trials of vancomycin or moxifloxacin injections but there were nine observational studies that linked to fewer infections with use of the injection. Another, more recent, review also includes an RCT of cefuroxime injections into the eye. This shows that this drug is also effective when compared to surface antibiotics or injections just under the surface. Therefore, the main question remains the choice of antibiotic. There is always a trade-off between using antibiotics to prevent infection and keeping them effective for treating other infections. Vancomycin is the drug of choice for MRSA infections, with few other options, but resistance is increasing. Widespread use to prevent eye infection following surgery has been discouraged for this reason. There are similar concerns for the use of moxifloxacin. So although the resistance to cefuroxime might also be rising, careful consideration of all the “pros and cons” including drug resistance will be required before prescribing guidance and antibiotic stewardship guidance can be offered. Without firm guidelines, there is likely to be continued variation in practice.
11 April 2017

Counselling services help expectant mothers quit smoking
Counselling services, including cognitive behavioural therapy and motivational interviewing, help women to stop smoking during pregnancy by increasing quit rates. Feedback and financial incentives may also be effective, though evidence is weaker for both. Education alone and peer support were not found to be effective. Some of the counselling interventions are already at least partly supplied through NHS Stop Smoking Services – two of the UK trials recruited through the Service. When pooled together, these non-pharmacological interventions, called psychosocial interventions, increased the chances of quitting by over 40% and reduced the chance of giving birth to a low birthweight baby by 17%, and chance of admission to a neonatal ward by 22%. Smoking during pregnancy is associated with poor health outcomes for mother and child. This high quality Cochrane review included 102 relevant trials in which the researchers had high confidence. It suggests that psychosocial interventions can help pregnant women quit, but that health education alone is not sufficient. Interventions may need to be targeted for deprived and underserved populations, although it remains unclear how they should be implemented into routine pregnancy care.
11 April 2017

Patients receiving pedometers by post increased their physical activity for at least 12 months
Use of pedometers, received by post, resulted in a sustained increase in walking of around 650 steps a day, equivalent to about one km or 30 minutes of moderate to vigorous physical activity per week. The study was set in London general practices and achieved similar results whether or not people had additional support from a practice nurse. The number of people agreeing to participate was low. Of the 11,015 people invited, 1,023 took part, a take-up of just 10%. Some contacted were already meeting physical activity guidelines. Participants were mostly women and on average undertook about 80 to 100 minutes of moderate or vigorous physical activity a week. The additional steps noted in this trial were less than in other studies that had more contact with advisors. These noted an increase of about 2,000 to 2,500 steps daily. This NIHR-funded large-scale study of people not meeting current guideline levels of moderate physical activity showed that a simple intervention can have small but lasting effects. It might be a low-cost way to motivate people to hit physical activity targets. The message delivered to participants in this trial was to aim for an additional 3,000 steps in 30 minutes on at least five days a week. This could become a measurable goal for existing public health physical activity advice and confirms the benefit of self-monitoring for some people.
28 March 2017

Skin-to-skin contact improves breastfeeding of healthy babies
Early skin-to-skin contact improves breastfeeding of healthy full-term babies. Skin-to-skin contact is the direct contact between a naked baby and the mother’s bare chest. It can occur before or after the baby is cleaned following birth. This review found that about a quarter more women who have this contact with their babies are still breastfeeding at one to four months after birth compared with those who don’t. The evidence that skin-to-skin contact may also help to stabilise the baby’s heart and breathing rates and blood sugar levels after birth was based on fewer trials and less strong. These findings support UK good practice to promote immediate skin-to-skin contact after birth to improve breastfeeding rates. It remains one of the important steps recommended by NICE and UNICEF aimed at improving the low rates of breastfeeding in the UK. Other measures include providing a favourable environment, support and education.
28 March 2017

A group weight loss programme shows promise compared with usual approach
A new, intensive NHS group weight management programme was more effective than the more common individual sessions with a practice nurse. In an NIHR-funded trial based in deprived districts in East London, people who took part in the primary care group-based programme lost nearly 2kg more than those who had individual sessions with a nurse. Most of the participants were women, and over a third was from black and minority ethnic groups. Despite the greater intensity and duration of the group programme compared to the individual sessions with a nurse, the cost per participant was similar, £195 versus £176, respectively. On a national scale, cost effective long-term weight management interventions are needed urgently to help deal with the problems of increasing obesity. This group approach shows promise, but needs further evaluation in men, different ethnic groups and different areas.
21 March 2017

Research highlights the challenges of preventing diabetes with group education sessions
In people at high risk of type 2 diabetes, the educational programme ‘Let’s prevent’ had minimal impact on blood sugar control, and cholesterol. Overall it did not prevent people developing diabetes, though the risk was reduced for the 29% of people who attended all three sessions. The NIHR-funded trial compared three educational sessions plus telephone support with usual care. The main difficulty was recruitment and attendance. Only 19% of people at high risk of type 2 diabetes were willing to have a blood sugar test. Even when this showed high sugar levels, 23% of people allocated to the ‘Let’s prevent’ arm did not attend the first session. Other programmes – with more sessions over a longer period of time – have had a greater impact. The NHS is implementing a Diabetes Prevention Programme, involving 13 personalised education and exercise sessions over nine months. This trial highlights that focusing on maximising attendance will be vital to the success of this initiative.
14 March 2017

GP letter to improve medication adherence did not reduce unplanned care for children with asthma
A one-off GP letter reminding parents of children with asthma to use their medications over the August summer holiday did not prevent a characteristic annual peak in unplanned care on returning to school in September, but did lead to more prescriptions. Unplanned care represents visits to the GP or accident and emergency that is not part of the child’s asthma care plan. They do not include scheduled medical review or visits for repeat prescriptions. The letter prompted about a third more parents to collect inhaler prescriptions in August than parents receiving no letter. But this failed to reduce the high proportion of children receiving unplanned care in September (45% of children in the letter group compared to 44% in the control group). Most of the unplanned care was not for asthma, which may be why the letter had little impact. It remains unclear why children with asthma are more likely to access unplanned care. This NIHR-funded trial was large, well-designed and, despite problems with labelling planned and unplanned care, is likely to be reliable.
14 March 2017

More findings are available on the NIHR Dissemination Centre website.