Title: NIHR Global Health Research Group on Physical Trauma from Injury & POsT Conflict; iPrOTeCT
Funder: Department of Health and Social Care

Abstract: Physical trauma resulting in serious, life changing injuries is endemic in Low- and Middle-Income Countries (LMICs). We will build on our prior work by understanding of the broader global burden of physical trauma from conflict, non-conflict events such as terror attacks and the growing burden of road traffic accidents due to rapid increases in urbanisation and motor vehicle use. iPrOTeCT focuses on saving limbs after these injuries (surgery and technology), and where limbs cannot be saved, ensuring the best possible functional outcomes (prosthetics). This healthcare provision saves lives, increases functional outcomes, provides independence and enhances quality of life. We will work across three continents and will collaborate with some of the largest humanitarian organisations to make change happen._x000D_ Addressing the issue of the lack of robust data, Aim A will establish, for the first time, a global picture of the clinical burden of conflict and accidental injuries and the resulting long-term societal issues. We will collect, collate and analyse data on injuries to develop policy and understand patterns and relationships in the types of injuries, injury mechanism, treatments, prosthetic use required, distance from medical care, and details of age, gender and status of the injured. Stakeholder meetings will be held, case studies for different countries and contexts will be published, and training materials will be produced. Community Engagement Groups (CEGs) will provide a platform for the voices of patients to help the research team understand societal issues for the injured and their voices will feed into treatment and the design of prosthetic and rehabilitation technologies (Aim B). CEGs will directly feed into iPrOTeCT’s dissemination activities. _x000D_ Aim B will use our appropriate technology development pathway to identify, develop (using frugal principles) and clinically translate appropriate healthcare technologies in the areas of: surgical orthopaedic reconstruction and regenerative medicine technologies for surgeons in LMICs which will lead to faster recovery and reduce the number of procedures and interventions for physical trauma patients; and prosthetic and rehabilitation technologies for children and adults whose limbs could not be saved. We will create a Regulatory Hub to facilitate clinical and regulatory approvals. _x000D_ Aim C will co-create, evaluate and improve capacity building opportunities in research, education, global clinical collaboration and research management. This will focus on embedding trainees in interdisciplinary research, with first-hand experience of how medicine and engineering can work together to impact human health. A Virtual Clinical Network will be established to ensure LMIC teams’ voices are heard clearly in all aspects of iPrOTeCT and will feed into the identification of new technologies for development. A specific focus has also been put on research management and the development of a cohort of administrators across the grant who will train and learn from each other. _x000D_ iPrOTeCT builds on a foundation of strong international, interdisciplinary collaborations to embed research sustainability. By the end of the four years we will have held stakeholder meetings to engage policy makers and health practitioners, worked with community groups to ensure their voices feed into the research, and trained the next generation of interdisciplinary leaders.

Lay abstract: Conflict resulting in serious, life changing injuries is widespread and Accidental injuries through road traffic accidents (RTAs) are increasing in prevalence in Low- and Middle-Income Countries (LMICs). iPrOTeCT focuses on saving limbs after these injuries (surgery and technology), and where limbs cannot be saved, ensuring the best possible functional outcomes for amputees (prosthetics). This provision of the best healthcare and rehabilitation to physical trauma patients saves lives, increases functional outcomes, provides independence and enhances quality of life. We will work across three continents and will collaborate with some of the largest humanitarian organisations to make change happen. We will:_x000D_ A) Establish a GLOBAL PICTURE of the clinical and societal burden of ACCIDENTAL AND CONFLICT INJURIES. We will explore the patterns of injuries from conflict situations (blast, gunshots), and other trauma (RTAs and non-conflict blast injuries). This knowledge will inform the understanding of the impacts on healthcare services and will influence policy and practice changes. We will also collect data to understand the impact of disabling extremity injuries on access to educational, societal and cultural participation._x000D_ B) Identify, develop and translate APPROPRIATE HEALTHCARE TECHNOLOGIES. We will use our clinical engineering expertise based on frugal principles to 1) identify technology need, 2) design, develop and test solutions that can be implemented and manufactured locally within the partner countries, and 3) develop a clinical translational plan for sustainability that is relevant and unique to the partner countries. We will initially focus on technologies that stabilise large fractures, prevent infection, and provide enhanced prosthetic function to those with amputations. Other technologies will be identified through research into clinical need and technology gaps._x000D_ C) Create, evaluate and improve CAPACITY BUILDING opportunities in partnership. This will help to improve opportunities and provide long-term benefits for those in research and research management. A cohort of researchers will be recruited onto the grant from all four partner organisations, with a range of engineering and clinical backgrounds. The cohort will receive peer-to-peer mentoring, tailored training, and research visits to partner institutions. A network of research administrators will also be formed who will provide oversight of grant management across the research partners, and who will learn from each other. All of these activities, as well as the ongoing development of links between academics across the different partner organisations, will contribute to capacity building and learning across the partnership._x000D_ Within Aims A and B we will work closely with community groups formed of patients, their families, rehabilitation service practitioners and clinicians. The groups will be facilitated by the Legacy of War Foundation. Their insights will help the iPrOTeCT team to better understand concerns about treatments, devices and socioeconomic needs and the main outcome will be to help reduce stigma, raise awareness and support changes in policy. The community groups will also help with dissemination of research from the iPrOTeCT team throughout the project, to reach a wider audience. We will also disseminate our work at conferences and meetings with policy makers and health professionals around the world.

Research activity codes: 2.4 SURVEILLANCE AND DISTRIBUTION;5.3 MEDICAL DEVICES
Health categories: INJURIES AND ACCIDENTS