The NIHR is the nation's largest funder of health and care research and provides the people, facilities and technology that enable research to thrive. We work in partnership with the NHS, universities, local government, other research funders (including industry and charities), patients and the public to improve the health and wealth of the nation.
In 2017-18, the NIHR spent £11.1 million on research studies into musculoskeletal disorders. The NIHR Clinical Research Network (CRN) supported 406 musculoskeletal studies, 141 of which were new studies, and recruited 45,185 patients to studies last year (2018/19).
Impingement, where the bone and tendons of the shoulder rub together, is one of the main causes of shoulder pain and decreased function. Until recently, this was widely treated with surgery. The CSAW study investigated the effectiveness of surgical outcomes compared with a placebo surgery and no treatment interventions. The findings of CSAW did not show surgery to be more effective than either alternative treatment. As a result, the NHS has reduced rates of surgery to treat this. As well as avoiding unnecessary risk to patients, it is likely that rates of surgery will halve, saving NHS England £75 million per year.
Rheumatoid arthritis, an autoimmune disease that causes inflammation and damage in patients’ joints, currently affects around 600,000 people in the UK, with an estimated 20,000 new cases every year.
The second-line standard-of-care for rheumatoid arthritis is a combination of methotrexate and anti-TNF-alpha therapy; however, approximately 40% of patients do not have an adequate response to this treatment or become resistant within months. The protein Cadherin-11, found on stromal cells in the joint, has been identified as a novel target for new RA therapies.
Roche AG is investigating a monoclonal antibody called RG6125. The UK Musculoskeletal Translational Research Collaboration is supporting the second part of a Phase II randomised, multicenter clinical trial to recruitment to test the monoclonal antibody RG6125, following the successful completion of the first part of the study that was conducted in the US.
Complaints of back pain are the most common reason why middle-aged people visit their GP, and the second-most-common reason for sickness absence from work. To assist the management of lower back pain, the NIHR Collaboration for Leadership in Applied Health Research and Care West Midlands has developed a brief screening tool for use in clinical practice: STarT Back.
STarT Back is an example of stratified care for low back pain, whereby patients are initially screened for the type and likely duration of back pain and are then matched to pathways that ensure the right patient gets the right treatment. STarT Back has been shown to be both clinically and financially effective, by reducing over-treatment of low-risk groups.
In early 2014, the West Midlands Academic Health Science Network (WMAHSN) supported a funding application to extend the STarT Back approach to care management across the west midlands. To date, 109 physiotherapists have been trained in STarT Back
matched treatments, spanning 12 NHS providers within the west midlands.
Over 161,000 primary hip or knee replacements were undertaken in England, Wales and Northern Ireland in 2012. About 1 person in 100 develops a bacterial infection at their new, artificial (prosthetic) joint. Prosthetic joint infection is described as “devastating” and “associated with unbearable suffering.” If untreated, these infections can result in severe pain, persistent dislocation and death.
Researchers, surgeons and patients funded by NIHR Programme Grants for Applied Research have joined together to design and deliver the Infection: Orthopaedic Management (INFORM) research programme. They will be investigating why some patients develop infections after their hip or knee replacement surgery, and which type of surgical revision treatment is best.
You can find out more about musculoskeletal studies in your area through the Be Part of Research website.
The NIHR Clinical Research Network (CRN) provides researchers with the practical support they need to make clinical studies happen in the NHS. This support covers every stage of research, from set up to delivery.
We provide world-class health service infrastructure - research support staff such as clinical research nurses, and research support services such as pharmacy, pathology and radiology - to support organisations seeking to conduct clinical research in the NHS in England. Some of this research is funded by the NIHR, but most of it is funded by NHS non-commercial partners and industry.
We support the set up and delivery of clinical research in the NHS through our study support service and our Research Design Service helps researchers develop proposals to secure funding from our research programmes.
The Musculoskeletal Specialty is one of over 30 Specialties which bring together communities of clinical practice to provide national networks of research expertise. Our membership is made up of research-interested clinicians and practitioners at both national and local levels. Our job is to ensure that musculoskeletal studies receive the right support to ensure they are delivered successfully in the NHS.
The Musculoskeletal Specialty oversees clinical research that deals with the normal structure and function of joints, bone, muscle and cartilage and diseases resulting from problems with musculoskeletal structure and function
The Clinical Research Network is made up of 15 localities. Each one has at least one nominated local lead for musculoskeletal disorders research. These clinicians lead research groups to promote and support musculoskeletal disorders research within the NHS Trusts in their area.
At a national level the local leads come together to manage the national musculoskeletal disorders research portfolio overall. This involves regularly reviewing the progress of studies, identifying barriers to recruitment, and coming up with solutions and strategies to help overcome those barriers.
Read more about the NIHR Musculoskeletal Disorders specialty in our specialty profile.
The NIHR Clinical Research Network Musculoskeletal specialty group works closely with these organisations in integrating clinical research into NHS clinical service provision, and in driving priority setting that encourages research that will have the greatest impact on patients.
The British Society for Rheumatology is the professional organisation for rheumatoid and musculoskeletal medical and long term conditions. Our members are made up of the whole multi-disciplinary team: consultant rheumatologists, trainees, specialised nurses, physiotherapists, occupational therapists, psychologists and GPs with special interest in rheumatology.
Find out more about The British Society For Rheumatology
A charity working to take the pain away from people living with all forms of arthritis and helping them to remain active. They do this by funding high class research, educating health care professionals and providing information to people with arthritis and their carers
Find out more about Versus Arthritis
The Surgical Specialty Association for Trauma and Orthopaedics in the UK.
Find out more about the British Orthopaedic Association
Since its inception in 2006, the NIHR has significantly increased the scale of clinical research in the NHS, particularly through the NIHR Clinical Research Network. The enthusiastic engagement of NHS physicians and trainees is essential for sustaining and building on this success, particularly given the many competing demands on clinician time and resources.
Find out more about the Royal College of Physicians (RCP)
The NIHR provides the support and facilities the NHS needs for first-class research by funding a range of infrastructure.
NIHR Biomedical Research Centres (BRCs), partnerships between England’s leading NHS organisations and universities, conduct translational research to transform scientific breakthroughs into life-saving treatments. The following BRCs undertake research in musculoskeletal disorders:
NIHR Medtech and In vitro diagnostics Co-operatives (MICs) build expertise and capacity in the NHS to develop new medical technologies and provide evidence on commercially-supplied in vitro diagnostic tests. The following MICs undertake research in musculoskeletal disorders:
NIHR Applied Research Collaborations (ARCs) support applied health and care research that responds to, and meets, the needs of local populations and local health and care systems. The following ARCs undertake research in musculoskeletal disorders:
The UK Musculoskeletal Translational Research Collaboration (UK MSK TRC) between the NIHR and Versus Arthritis, brings together internationally recognised investigators in the UK's leading centres of excellence to carry out early phase research. Together with industry, charity and other partners, the UK MSK TRC focuses on early phase clinical research in patients to identify mechanisms of pathophysiology of disease, or to demonstrate proof of concept or evidence of the validity of new discoveries or treatments.
All of the NIHR facilities and centres are opening to working with the public, charities, industry and other partners. If you are interested in collaborating with the NIHR please contact the NIHR Office for Clinical Research infrastructure: email@example.com
Our experts in the NIHR Clinical Research Network (National Specialty Leads) can advise on delivering your musculoskeletal disorders study in the NHS.
Professor Siôn Glyn-Jones is the NIHR Clinical Research Network National Specialty Co-Lead for Musculoskeletal Disorders.
Professor Glyn-Jones read medicine at Cambridge and later conducted his clinical attachment in London. Thereafter, he went on to complete his surgical and orthopaedic training in Oxford, where he gained a DPhil. He now works as a Consultant Hip Surgeon in the Adult Hip and Knee Reconstruction Service at the Nuffield Orthopaedic Centre. He undertakes all aspects of adult hip surgery and has a specialist interests in the treatment of hip arthritis in the young patient and revision hip arthroplasty.
Professor Glyn-Jones was awarded a Professorship in the 2014 Recognition of Distinction awards. He sits on the Steering Committee of the Arthritis Research UK Centre of Excellence in Sport, Exercise and Osteoarthritis and is also a Chief Investigator on the Arthritis Research UK Centre of Excellence in the Pathogenesis of Osteoarthritis. He is the local CRN Musculoskeletal lead for the Thames Valley and South Midlands.
Dr Kirsten Mackay is the NIHR Clinical Research Network National Speciality Co-Lead for Musculoskeletal Disorders.
Dr Mackay read medicine at Bristol University and completed her rheumatology/general medicine training at a number of hospitals in the UK and abroad as well as working as a clinical lecturer for Oxford University. She now works as a consultant rheumatologist at Torbay Hospital in South Devon. Her areas of research interest are Spondyloarthritis, Psoriatic Arthritis, early inflammatory arthritis and biologic therapies. She has undertaken three years of research into the genetic susceptibility for Rheumatoid arthritis and also developed technology to help patients self-manage their conditions, recently winning a British Medical Association award for a rheumatology application she developed in 2018.
Dr Mackay has led the Torbay rheumatology trials unit since 2010 and been a Principal Investigator on over 40 trials in various diseases. She has been the Musculoskeletal Clinical Research Lead for CRN South West Peninsula since 2017.
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