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
What is the impact of large-scale implementation of stroke Early Supported Discharge? (WISE) study
NIHR Health Services & Delivery Research
The three-year study will investigate the implementation and effectiveness of stroke Early Supported Discharge services across England. It involves a collaboration with the Royal College of Physicians' Sentinel Stroke National Audit Programme and a world class team of co-applicants from Nottingham, Leicester and Glasgow. The aim is to facilitate provision of evidence based care for stroke survivors leaving hospital.
Project Lead: Dr Rebecca Fisher
Co-Investigators: Professor Marion Walker, Professor Sarah Lewis, Professor Justin Waring, Dr Claudia Geue, Professor Peter Langhorne, Professor Tom Robinson, Alex Hoffman, Prof Tony Rudd
Visit the WISE webpage.
Return to work after stroke (RETAKE)
The RETAKE study is a four-year study that aims to determine whether early stroke specific vocational rehabilitation (ESSVR) in addition to usual NHS rehabilitation (UC) is more effective and cost effective at returning stroke survivors to work and keeping them there at 12 months post-randomisation than UC alone.
Biopsychosocial Intervention for Stroke Carers (BISC study)
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
Recently completed projects, or in the writing-up stage
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.
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 & Dr Rebecca Fisher
Co-Investigators: Dr Rebecca Fisher, Dr Niki Chouliara, Dr Brian Crosbie, Prof Tom Robinson, Prof Niki Sprigg, Prof Peter Langhorne, Prof Marion Walker.
This study aimed to uncover the mechanisms that enable or inhibit the implementation of evidence based rehabilitation within "real life" clinical settings with the view to informing improvement strategies. A realist evaluation approach guided the collection of mixed methods data from four stroke units in the East Midlands region. Despite the observed variability of practice across the four units, common mechanisms driving evidence based care were identified. The explanatory power of these mechanisms has been used to engage teams in evidence based service development.
Find out how to get involved with CLAHRC in the East Midlands
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
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)
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 (Feasibility study)
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)
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)
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.