NJR Research Committee (RC)
Chairman’s report 2020/21 - Professor J Mark Wilkinson
The Research Committee is responsible for delivering the research agenda of the NJR. The committee’s aim is to enhance the understanding of the science of arthroplasty, improve clinical practice and benefit public health.
Research provides the route to improved treatments and keeping patients at the centre of what we do is a guiding principle for all of our research activity. During 2020/21 the committee has had oversight of several major projects. Below are details of a small selection of these projects amongst a varied programme of work currently underway. These projects represent key achievements for the NJR in meeting our aim to maximise the value of the registry dataset to patients and the wider healthcare community. My thanks go to all members of the committee for their efforts in the past year and for their hard work which makes it possible to facilitate data access and to support these high quality research outputs.
We are pleased to welcome Derek Pegg, NJR Regional Clinical Coordinators Committee and Data Quality Committee Chair onto the committee as a co-opted member. We also welcome Dave Townshend onto the committee as a specialist in foot and ankle research. I’d like to also express my thanks to Jitendra Mangwani for his contributions to the committee over recent years.
NJR ePREMs Pilot
Collection of patient-reported metrics remains a major strategic priority for us and the NJR PROMs Working Group was established to collaboratively draft an operational plan for how the NJR develops its patient reported outcome measures (PROMs).
This multidisciplinary group – consisting of clinicians, academics, information management and communication specialists as well as patient representatives – has undertaken a review of ongoing PROMs activity in the area of arthroplasty surgery across the UK, engaging with multiple key stakeholders who are involved with orthopaedic PROMs – including NHS Digital, NHS England/Improvement, the Care Quality Commission and the Medicines and Healthcare products Regulatory Agency (MHRA).
Having developed and agreed tools for the pilot collection of electronic Patient Reported Experience Measures (ePREMs) from all patients at six weeks following their surgery, we had delayed starting this pilot due to reduced surgical volumes as a result of COVID-19. This pilot will take place during 2021/22 and will be delivered using patient contact details (email address and mobile number) either provided by the patient, or from patient data already held by hospitals. At the end of the pilot, data will be analysed to determine if patient reported metrics are likely to be feasible at scale. Aggregate PREMs results will also be shared with hospitals to enable these to usefully feed into any relevant local improvement discussions.
Patient Decision Support Tool
In 2019 we launched the NJR Patient Decision Support Tool. This is a web-enabled personalised patient decision-making tool for those considering hip or knee replacement. This simple tool, the development of which was supported by the charity Versus Arthritis, will help patients who are considering having a joint replacement to make evidence-based choices about their treatment and share decision-making with their clinicians, when considering the benefits and risks of their undergoing joint replacement. To date, there have been over 35,000 visits to the website from over 100 countries, with very positive feedback received.
Having launched this tool (available at: https://www.njrcentre.org.uk/patients/patient-decision-support-tool/), we are continuing to collaborate with academic partners to further develop the underpinning prediction algorithm methodology. This will result in more agile algorithms that will allow the most up-to-date registry data to be used to calculate the projected risks and benefits of joint replacement surgery, thus increasing the versatility of the prediction tool.
NJR Health Economics
We continue to fund health economics work conducted at the University of Bristol and this year this programme has focused on examining the budget impact on the NHS of implant types used in primary total hip replacements.
NJR Data Access Portal
The NJR Data Access Portal represents a secure data access platform that houses registry data in a secure environment that researchers can access under strict data protection protocol, reducing the administrative burden of legal permissions that would be required if data were to be released to them directly. This portal has been used by several groups to access registry data and the portal will now be the standard mechanism by which data is made available to researchers. We have entered into a sub-licensing agreement with NHS Digital that allows applications for linked NJR, HES, PROMs and mortality data to be managed under a single application. Details of how to apply for secure access to NJR data for research purposes can be found at: https://www.njrcentre.org.uk/research/research-requests/.
NJR Annual Research Programme
Building on many high quality publications over the years, we continue to develop our annual research programme. Current projects include: inequalities in provision and outcomes; development of an arthroplasty morbidity index; examining factors associated with revision and its outcomes and an examination of the data quality of the national PROMs programme. As projects complete, new topics are brought on-stream. All projects are delivered in a collaboration between the NJR Research Committee and the University of Bristol.
Use of NJR data this year
The Research Committee encourages external use of the registry dataset to address questions of clinical relevance and this year the dataset has provided opportunities for several external researchers to develop innovative projects.
Our dataset has been used as the key resource in 21 research papers published during this same time-period, of which five were conducted or led by external, independent researchers.
Please see the NJR Research Project Portfolio here which catalogues all sanctioned research projects, progress reports and NJR updates in relation to research, using the NJR dataset, together with links to all publications related to NJR data.
Research Fellowship Scheme
Due to the COVID-19 pandemic the committee was unable to appoint to the NJR Research Fellowship in 2020. The NJR’s Joint Clinical Research Fellowship scheme is run in partnership with the Royal College of Surgeons of England, helping the NJR to support high quality research in orthopaedics. Prospective fellows are encouraged to apply to the rolling programme. The NJR encourages applications from a diverse pool of applicants. Look out for ongoing opportunities on the NJR website.
Submitting a research application
The Research Committee takes formal responsibility for the approval for the release of NJR data for research through an impartial and objective process and has oversight of the use and reporting of this data by research groups. Its priority is to ensure that any research question justifies access to the data and offers potential benefits to patients. Research proposals should align to our priority framework and be feasible, ethical, relevant, and methodologically-sound.
We have a commitment to uphold the standard and consistency of work that is carried out using registry data, in line with both national and international legislation. Therefore, all requests must also be approved by the Healthcare Quality Improvement Partnership (HQIP) Data Access Review Group for final authorisation of data release.
If you would like to submit a research application, the first step in this process is to check whether the same topic is currently being examined by another research team by visiting the NJR Research Project Portfolio, then submit an expression of interest for consideration. Invited full applications are reviewed by the committee quarterly. Full details of the NJR’s research application pathway, together with detailed guidance notes for applicants, can be found here.
A full list of publications related to NJR data is included in Appendix 4.