Lower limb rehabilitation

We are focussed on the causes and consequences of chronic health problems such as diabetes and vascular disease on lower limb function and the impact loss of function has on health and wellbeing experiences. We use quantitative and qualitative methods as the research question requires and work comfortably with a very broad range of disciplines, health professionals and external health care and commercial partners.  

Current research projects

LOad Monitoring and Intervention System (LOMIS) to prevent diabetic foot ulceration 

Diabetic foot ulcers are one of the major causes of the >120 lower extremity amputations that occur each week in the UK.  High pressures under the foot are one of the main risk factors for foot ulcers and allied health professionals have long sought ways to reduce pressures and therefore ulceration risk.  
This project uses wearable insole system embedded with unique pressure and shear sensors (developed at the University of Southampton) that provide real time assessment and alerts for high foot pressures and elevated risk of foot ulcers during daily activities. This is the first time that shear forces have been measured alongside normal pressure, providing new insights into the mechanical conditions that lead to tissue death and ulceration.  In partnership with the University of Salford, foot pressure/shear force, alert and user data will be collected over 3 months in those at moderate to risk of foot ulceration. This will be used to underpin future risk modelling research and clinical evaluation.  
www.lomis.co.uk 
This is funded by the NIHR “invention for Innovation” scheme, which supports translational research and aims to de-risk early-to-late-stage development of medical devices and digital health technologies for NHS use.

REAL PRETECTION - Preventing diabetic foot ulcers using real-time foot pressure monitoring and alert technologies 

A recent study showed diabetic foot ulcer incidence can be reduced by some 71-86% by using a simple foot pressure monitoring/alert technology that provide alerts when high foot pressure occurs. In this project Manchester metropolitan University and Keele will develop a new adherence enhancing health behaviour intervention to enhance the monitoring systems and compare the effectiveness of three different foot pressure monitoring/alert technologies in 60 people with diabetes and at-risk of foot ulceration. Data will underpin a national clinical trial of the accepted technologies in 2025. 
This is funded by Diabetes UK, the UK’s largest diabetes charity, with support from “Great Foundations” – a UK based foot health research charity.

MARS - Manchester Amputation Reduction Strategy

One overarching question: how do we reduce lower limb amputations secondary to chronic disease?

Amputation is the culmination of a number of steps and each phase in the journey towards amputation requires intervention. MARS is based on the 3FOUR50 principle: three lifestyle behaviours (smoking, poor diet, lack of exercise) contribute to four medical conditions (type 2 diabetes, cardiovascular disease, respiratory disease, cancer) which cause over 50% of deaths. A whole systems approach is required to achieve population-based transformation and reap a wide range of health and social care benefits, reduced amputations being one of these. It is for this reason MARS has three facets; a public health framework, a community health service review and a hospital-based plan. MARS is sponsored by the Strategic Clinical Network and developed following the close collaboration of systems wide stakeholders.   

The academic work in MARS work is based on evolution and application of implementation science principles and specifically the Knowledge to Action framework and COM-B. Through this we seek to support sustainable and scalable change in services to improve outcomes. 

This work is in partnership with the University of Salford, and we are currently working with leisure providers to enable their integration into healthcare systems and support improve services to promote being more physically active. We are also working directly with community teams to improve foot care screening and care so that risk factors for ulceration are identified earlier and managed accordingly.