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Marion Walker

Professor in Stroke Rehabilitation, Faculty of Medicine & Health Sciences

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Biography

Marion Walker is Professor in Stroke Rehabilitation and Associate Pro Vice-Chancellor for Equality, Diversity and Inclusion at the University of Nottingham. She is an occupational therapist by professional background and a Fellow of the College of Occupational Therapists.

Marion is a National Institute for Health Research (NIHR) Senior Investigator and as such has been recognised as one of the nation's most outstanding leaders of clinical and applied health research.

Marion has managed and steered many randomised controlled trials of stroke rehabilitation. Her trial involvement includes service evaluations of occupational therapy for stroke patients not admitted to hospital, multi disciplinary stroke teams, intermediate care, day centre care for young stroke patients, occupational therapy and physiotherapy provision in nursing homes and occupational therapy for patients with Parkinson's disease. Her trial experience also involves evaluations of specific components of stroke therapy including leisure, dressing, mobility and behavioural approaches in patients with aphasia and depression.

Marion has a strong research portfolio covering a wide area of local, national and international research projects. Marion is a strong advocate of patient partnership and co-chaired the Nottingham Stroke Research Partnership Group for 10 years.

Marion is a Trustee of the Stroke Association and a Fellow of the European Stroke Organisation. Marion was awarded the MBE in the Queens New Year Honours list 2012 for her service to stroke rehabilitation research and stroke survivors.

Marion is an international advisor for stroke and stroke rehabilitation research in Sweden, Norway and Australia and holds honorary professorial positions at the University of Queensland and the University of Gothenburg. She has served as Chair (UK Stroke Forum, Stroke Association Strategic Research Board), President (UK Society for Rehabilitation Research) of learned societies and Associate Director for Rehabilitation and Portfolio Development of the UK Stroke Research Network (2005-2015).

Professor Marion Walker's current portfolio of research studies totals in excess of £7 million and she has published well over 100 peer reviewed publications.

Marion is also passionate about equality for women in STEM subjects and currently Chairs and leads the Women in Nottingham (WiN) agenda at the University of Nottingham, formerly WinSET (Women in Science Engineering and Technology).

Expertise Summary

Keywords:

Stroke rehabilitation, randomised controlled trials, evaluation of occupational therapy interventions, implementation research

Teaching Summary

Professor Marion Walker leads the MSc Stroke Rehabilitation Research Module and supervises research by PhD, MPhil, and MSc students. Professor Walker is committed to excellence in teaching and always… read more

Research Summary

Professor Marion Walker leads a multi-professional team of over 25 people with a dynamic research portfolio that has gained both national and international recognition. This active research community… read more

Selected Publications

Working in Partnership: patient and carer involvement and influencing stroke service development

Patient partnership is high on the stroke rehabilitation group's priorities and the Nottingham Stroke Research Partnership Group has received local and national awards for its innovative work. This group of stroke survivors proactively work to ensure the needs and wishes of stroke survivors are embedded at the heart of research and service development. Mr Ossie Newell, MBE has worked tirelessly following his stroke to collaborate with Professor Marion Walker in developing this initiative and both have influenced stroke service management in Nottinghamshire.

At the end of 2015 Ossie Newell handed over the Lay Chair role to Ms Christine Knott, with Mr Fred Higton taking up the Deputy Lay Chair position and Professor Marion Walker relinquished her Academic Chair role to Dr Rebecca Fisher and Dr Niki Sprigg who are joint chairs.

Professor Marion Walker leads the MSc Stroke Rehabilitation Research Module and supervises research by PhD, MPhil, and MSc students. Professor Walker is committed to excellence in teaching and always ensure the student experience is at the centre of all her teaching duties.

She lectures on the MSc Rehabilitation Psychology Course and is course convener for the Stroke Rehabilitation module. This module is always in great demand and includes home and international students. Year on year the course student evaluation metrics demonstrate that the teaching is of very high quality.

Professor Walker teaches each year on the European Stroke Masters Programme. Danube University, Krems, Austria.

Professor Walker helped to set up a new Rehabilitation Doctoral Training Centre (the first in the School of Medicine) which in its first year enrolled a cohort of six new students with deferred enrolment for a further six in 2015.

Professor Walker supervises 6 PhDs. She has examined 15 PhDs in the UK and 3 International PhDs. She has also examined 12 MPhils.

Current Research

Professor Marion Walker leads a multi-professional team of over 25 people with a dynamic research portfolio that has gained both national and international recognition. This active research community has worked hard to raise the profile and standing of all allied health professions (Occupational therapists, physiotherapists, speech and language therapists and psychologists) in stroke rehabilitation research.

Professor Marion Walker's research expertise lies predominantly in the field of randomised controlled trials of stroke rehabilitation. This is her chosen research methodology as she believes it is the most influential in guiding clinical practice. Her PhD was the largest occupational therapy randomised controlled trial of its time, which was later published as a leading article in The Lancet (impact factor 25.800). She has subsequently conducted multiple stroke rehabilitation evaluations which have greatly influenced NHS clinical care, both in the UK and abroad. Professor Marion Walker's research expertise has also extended into the field of implementation research where she has written seminal papers influencing this new and innovative area of research. She has successfully led a £4 million programme of work in stroke rehabilitation implementation research incorporating four studies, bringing them all to successful completion. Her research leadership and expertise has also been recognised by NIHR who have awarded her NIHR Senior Investigator status acknowledging her as one of the top 200 clinical academics (all fields) in England.

Professor Marion Walker is regarded as a world leader in her research field with her expertise regularly sought from international colleagues. She is an international advisor for stroke and stroke rehabilitation research in Sweden, Norway and Australia. In 2014 she initiated a Memorandum of Understanding between the University of Kebangsaan Malaysia and the University of Nottingham; signed in Feb 2015 by Professor Christine Ennew the Provost of University Nottingham Malaysia Campus at a ceremony in Kuala Lumpur. This MoU has led to joint PhD studentships and a key study investigating the unmet needs of stroke survivors in mainland Malaysia.

Stroke Rehabilitation Interventions: Randomised Control Trials

Of prime importance is that stroke rehabilitation research is embedded in the real life problems experienced by stroke survivors. The Nottingham Stroke Rehabilitation group have particular expertise in the conduct of randomised controlled trials. Professor Walker currently leads work investigating the ability to dress after a stroke, a problem still experienced by 52% of stroke survivors one year after their stroke. Other trials that she is actively involved in are the provision of occupational therapy in care homes (OTCH study), outdoor mobility (Getting out the House Study), the use of dopamine and stroke rehabilitation (DARS study) and stroke survivors with low mood and dysphasia (CALM). At an international level she has been a key member of a research team who have investigated the impact of family led rehabilitation in India. This study (ATTEND) involved over 1200 patients with recruitment from 13 centres (north to south India). This study not only provided essential information on efficacy of such rehabilitation input but has also led to the formation of a research network across India for stroke which has recently received further funding to consolidate and further expand research capacity.

Read more about Stroke Rehabilitation Research at the University of Nottingham

Research into practice

The translation of research findings into clinical practice is not always straightforward and has been highlighted by the government as a key concern and area for further investment. To address this, in 2009, Professor Walker's team embarked upon a programme of work (funded by National Institute for Health Research, part of CLAHRC NDL) investigating the barriers and facilitators of putting stroke rehabilitation evidence into practice. This work is both innovative and new and promises to make clear improvements to the effectiveness of care provided to stroke patients.

Read more about the stroke rehabilitation theme at CLAHRC

Research to Implement EVidence Based In-Hospital Stroke Rehabilitation (REVIHR) study (CLAHRC)

East Midlands CLAHRC - Caring for Older People and Stroke Survivors Theme (COPPS)

The aims of this study are to develop a change intervention designed to facilitate the delivery of evidence based stroke rehabilitation in hospitals across the East Midlands.

Project Lead: Professor Marion Walker

Co-Investigators: Dr Rebecca Fisher, Dr Niki Chouliara, Dr Brian Crosbie

A theory-driven research approach will be used. Behavioural mapping will be conducted in hospital sites to examine how the delivery of rehabilitative care relates to national stroke audit scores and evidence based guidelines. Qualitative research will be conducted, using a case study approach at each site, to identify challenges faced. Realistic evaluation will provide a framework to explore interactions between the context and service organisation that influence the rehabilitation that patients receive. Findings will be used to develop a change intervention, in collaboration with stakeholders, that will be piloted in several sites.

Biopsychosocial Intervention for Stroke Carers (BISC study) funded by NIHR Research for Patinet Benefit

The aim of the BISC study is to evaluate whether a group intervention offering support and education based on biopsychosocial principles improves adjustment and mood outcomes in carers of stroke survivors.

Project Lead: Professor Marion Walker Co-Investigators: Dr Rebecca Fisher, Dr Penny Benford, Dr Eirini Kontou, Dr Shirley Thomas, Dr Joanna Fletcher-Smith

Visit the BISC webpage

Electrical Stimulation to prevent Complications in the Arm Post-Stroke (ESCAPS) - A feasibility study

The ESCAPS study will evaluate the feasibility of running a definitive trial to ascertain the efficacy of using early, intensive ES therapy to prevent post stroke complications in the affected arm. The qualitative aspect of the feasibility study will explore possible barriers and facilitators to protocol adherence.

Project Lead: Dr Joanna Fletcher-Smith

Visit the ESCAPS webpage

Behavioural Activation therapy for Depression after Stroke (BEADS)

This is a pilot randomised controlled trial to assess the feasibility of a study to investigate the clinical and cost-effectiveness of behavioural activation (BA) therapy for people with post-stroke depression. Project Lead: Dr Shirley Thomas and the Trial is being coordinated from the Sheffield Clinical Trials Research Unit.

Visit the BEADS webpage

FAmily-Led RehabiliTaTion aftEr Stroke in INDia - The ATTEND Trial

The primary aim of the study is to determine whether stroke recovery at home given by a trained family member is an effective, affordable strategy for those with disabling stroke in India when compared to usual care.

Secondary aims are to determine if Early Supported Discharge with a trained family-led caregiver-delivered, home-based rehabilitation program reduces hospital length of stay; reduces death or dependency (as measured by scores of three to six on the modified Rankin Scale) of people with stroke three months after randomisation; improves patient and caregiver mood at six months; and reduces caregiver burden.

Chief Investigator: Richard Lindley

Local Project Lead: Professor Marion Walker

Read more about this trial.

Past Research

Recently completed research projects, or research in the writing-up stage, led by Professor Marion Walker:

Successful implementation of Early Supported Discharge Services

This research programme investigated the implementation of Stroke Early Supported Discharge. The aim was to investigate whether the health benefits identified in clinical trials were still evident when Early Supported Discharge services were implemented into local areas. [Project leads: Dr Rebecca Fisher, Prof Marion Walker)

NIHR CLAHRC Nottinghamshire, Derbyshire and Lincolnshire (2009−2013)

Stroke Early Supported Discharge is a multidisciplinary team intervention that clinical trials have shown reduces length of hospital stay and reduces risk of death and dependency. In 2009, many stroke services in the UK were in the process of implementing Early Supported Discharge Services as a result of the National Stroke Strategy 2007. This research aimed to gain clarity around how an Early Supported Discharge service might be organised in practice, test methods to facilitate its implementation and test methods to measure the effectiveness of Early Supported Discharge services.

Consensus on the definition of Early Supported Discharge Services

An agreed definition of Early Supported Discharge following stroke was established amongst all Early Supported Discharge trialists. Consensus was then gained amongst researchers and clinicians on the implementation of community stroke rehabilitation services.

A Consensus on Stroke Early Supported Discharge. Stroke. 2011; 42:1392-1397.

The implementation of evidence based rehabilitation services for stroke survivors living in the community. The results of a Delphi consensus process. Clinical Rehabilitation 2013. 27(8): 741-749

Mapping Early Supported Discharge Services

Semi-structured interviews were completed with stakeholders, commissioners, service providers and allied healthcare professionals to understand the factors influencing the development, organisation and implementation of Early Supported Discharge services in the Nottinghamshire and Northamptonshire regions. Face-to-face interviews were also conducted with patients and their carers.

Implementing evidence-based Stroke Early Supported Discharge services: a qualitative study of challenges, facilitators and impact. Clinical Rehabilitation. 2014. 28(4):370-377

A qualitative study exploring patients' and carers' experiences of Early Supported Discharge Services after stroke. Clinical Rehabilitation. 2013. 27(8): 750-757

Implementation activities

The research team designed and delivered interactive workshops focused on 'Eligibility for Early Supported Discharge' and 'Effective Data handling' to facilitate evidence based practice.

Implementation of Early Supported Discharge: expectation not icing on the cake.

Evaluation of ESD services: the utility of routine data

Measuring the effectiveness of Early Supported Discharge Services

Two Early Supported Discharge services operating in practice were evaluated; both services had adopted an evidence model (based on consensus documents). Stroke survivors who accessed the evidence based Early Supported Discharge services had significantly shorter length of hospital stay and accelerated improvement in activities of daily living compared to stroke survivors who didn't access Early Supported Discharge.

Is Stroke Early Supported Discharge still effective in practice? A prospective comparative study. Clinical Rehabilitation. 2015 Mar 31. pii: 0269215515578697

Improving community stroke services across the East Midlands (2013−2015)

This NIHR CLAHRC research informed a two year programme of service improvement activities designed to facilitate the provision of evidence based community stroke care across the East Midlands. Commissioned by the East midlands Academic Health Science Network, this programme involves commissioner support, alignment of performance metrics, delivery of a multidisciplinary team effectiveness programme and improved information provision for stroke survivors. For more information: http://emahsn.org.uk/programmes-and-projects/stroke-rehabilitation/

Dressing Rehabilitation Evaluation Stroke Study (DRESS)

A trial to compare a neuropsychological approach to dressing, with the conventional approach commonly used by occupational therapists in the UK. (Project lead: Professor Marion Walker)

Getting out of the house after stroke

A randomised controlled trial to test if an occupational therapy treatment package could be used to overcome the problems faced by people with stroke who cannot get out of the house. (Project Lead: Prof Pip Logan)

Communication and Low Mood

A multicentre randomised controlled trial to evaluate whether a psychological treatment, called behaviour therapy, is effective at treating low mood in people with aphasia due to a stroke. (Project lead: Dr Shirley Thomas)

Wii STAR

Evaluating the feasibility of using a modified Wii system in the home to assist in the rehabilitation of stroke patients with residual upper limb problems. (Project lead: Prof Penny Standen)

Return to work after stroke

Determining what people with stroke, their employers and other stakeholders want from vocational rehabilitation services, so that appropriate services can be designed. (Lead: Dr Kate Radford)

Predicting fitness to drive

Illustrating the simple tests which can be used to predict fitness to drive in people with dementia, multiple sclerosis, Parkinson's disease and stroke (Lead: Dr Kate Radford)

Home Visits After Stroke

Evaluating the feasibility of conducting a large multi centre randomised controlled trial of home visits conducted prior to discharge from hospital. (Lead: Prof Avril Drummond)

STEMS-3

Granulocyte-Colony-Stimulating Factor Mobilizes Bone Marrow Stem Cells in Patients With Subacute Ischemic Stroke: The Stem Cell Trial of Recovery EnhanceMent After Stroke (STEMS)

Loss of motor function is common after stroke and leads to significant chronic disability. Stem cells are capable of self-renewal and of differentiating into multiple cell types, including neurones, glia, and vascular cells. The trial is assessing the safety of granulocyte-colony-stimulating factor (G-CSF) after stroke and its effect on circulating CD34+ stem cells. (Lead: Dr Niki Sprigg)

Chief Investigator: Dr Niki Sprigg

"Looped" naso-gastric feeding after stroke

Can looped nasogastric tube feeding improve feeding in people who can't swallow after a stroke? (Lead: Dr Niki Sprigg)

Future Research

Professor Marion Walker, Lead for Stroke Rehabilitation Research Group:

We develop and evaluate new stroke rehabilitative interventions informed by the needs and real-life problems experienced by stroke survivors, for example dressing after stroke. Our Stroke Implementation research investigates how research findings can be used to inform clinical practice and improve the organisation of care provided to stroke survivors. We have developed a unique group of stroke survivors and carers - The Nottingham Stroke Research Partnership Group - who work with us to guide and inform the research we do.

As featured in a REF 2014 4* impact case study, our Early Supported Discharge research has informed provision of stroke services both nationally and internationally.

School of Medicine

University of Nottingham
Medical School
Nottingham, NG7 2UH

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