Title: NIHR Global Health Research Group on Acquired Brain and Spine Injury (ABSI)
Funder: Department of Health and Social Care

Abstract: Background: Injuries to the brain and spine have profound consequences and are an important contributor to death and disability worldwide. The term ‘acquired’ brain and spine injury encompasses traumatic injuries (e.g. due to road traffic accidents, falls) and non-traumatic injuries (e.g. stroke, brain infections, CSF disorders/hydrocephalus etc). Many of these acquired injuries are treated with surgery. The burden of disease of ABSI is greatest in LMICs with severe economic consequences. A recently published value of lost economic welfare model estimated that 127 LMICs experienced $3 trillion US dollars in economic welfare losses in 2015 due to ABSI that can be treated surgically. Thus, research into ABSI is urgently required. _x000D_ _x000D_ Aim: We aim to expand the previously funded NIHR Global Health Research Group on Neurotrauma to focus on five conditions (traumatic brain injury, traumatic spine injury, stroke, brain infections, CSF disorders/hydrocephalus) causing a substantial burden of disease in LMICs. We will retain the successful theme-based format (Mapping care; Understanding Care; Generating and implementing innovation; Capacity building). We aim to pay particular attention to the role of nurses, allied health professionals and rehabilitation services in the care of patients with these conditions._x000D_ _x000D_ Method: 16 projects under 4 themes will be undertaken. The projects have a diverse methodology from qualitative research, registries, observational cohort studies to interventional randomised trials. The projects span over 24 countries and involve a diverse skill set and a multi-disciplinary team (clinicians, nurses, allied health professionals, public health researchers, and patients). In addition, we will continue supporting the Global TBI registry. _x000D_ _x000D_ Impact: This proposal tackles 5 key conditions by defining the scale of the problem and by evaluating / developing innovative ways of addressing unmet needs. There is also a large component dedicated to education and training. Through ongoing engagement with stakeholders (e.g. ministries of health, hospital management etc) we aim to significantly influence health policy. Furthermore, the networks created will establish a sustainable platform for global health researchers to flourish for years to come. Finally, many of our projects directly address the UN sustainable development goals by promoting wellbeing for all.

Lay abstract: Background: Acquired injury to the brain and spine is an important global problem and is a significant contributor to death and disability. The term 'acquired' means it consists of injuries caused by trauma (e.g. road traffic accidents, falls) but also non-trauma related injuries (e.g. stroke, brain infection). Many of these acquired conditions are treated with surgery. Importantly the term 'acquired' does not include neurodegenerative conditions such as dementia that cause problems more gradually. The disease burden of acquired brain and spine injury (ABSI) is being addressed in high income countries (HICs) by prompt diagnosis, improvements in emergency and in-hospital care, and focused rehabilitation pathways. However, the vast majority of ABSI occur in low- and middle-income countries (LMICs) where robust treatment and rehabilitation pathways are either deficient or do not exist. Furthermore, it is not useful to simply translate the treatments used in HICs to LMICs since the local needs and resources available are often very different. Thus, a dedicated research framework that addresses the unique needs of patients with ABSI in LMICs is warranted._x000D_ _x000D_ Aim: (1) Expand the previously funded NIHR Global Health Research Group on Neurotrauma (focus on traumatic brain injury) to focus on the four overarching themes (Mapping care; Understanding Care; Generating and implementing innovation; Capacity building) consisting of five conditions (traumatic brain injury, traumatic spine injury, stroke, brain infections, cerebrospinal fluid disorders/hydrocephalus) causing a substantial burden of disease in LMICs_x000D_ (2) Create training and educational opportunities for LMIC researchers and establish a global health fellowship exchange programme_x000D_ (3) Ensure nurses, allied health professionals, and patients are an integral part of the working group and lead in developing the projects – an area in particular need of development in LMICs. _x000D_ _x000D_ Method: We will undertake 16 unique projects under the 4 themes described above. The projects are varied in how they are designed and what they are aimed to do. There are projects on: (1) understanding how many patients are affected by a disease, (2) evaluating what we can do about it, (3) proposing treatments, (4) studying two different treatments to see which one is superior and more cost-effective. The projects will be undertaken in 24 countries and will involve a range of health specialists with different skillsets. In addition, we will continue our registry work on brain injury and commence a spinal injury registry to map the burden of these conditions globally. We will also establish a global health fellowship exchange programme so students in LMICs and HICs an collaborate and learn from each other. _x000D_ _x000D_ Impact: We believe our projects will positively impact the lives of patients in LMICs suffering from acquired brain and spine injuries. Furthermore, it will create partnerships between LMIC and HIC researchers and create a platform for mutual development and future work. Finally, we believe many of our projects directly address the United Nations sustainable development goals by 2030 of ensuring healthy lives and promoting wellbeing for all.

Research activity codes: 2.3 PSYCHOLOGICAL, SOCIAL AND ECONOMIC FACTORS;3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING;7.1 INDIVIDUAL CARE NEEDS;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: ORAL AND GASTROINTESTINAL