Latest research findings

New research findings from the NIHR Dissemination Center

The NIHR Dissemination Centre puts good research evidence at the heart of decision making in the NHS, public health and social care. The centre critically appraises the latest health research to identify the most reliable, relevant and significant findings. It then disseminates these findings as:

NIHR Signals - The latest important research, summarised
NIHR Highlights - Conditions, treatments and issues explored using NIHR evidence
Themed Reviews - Bringing together NIHR research on a particular theme

To keep up to date with the latest important research, sign up to their mailing list or follow @NIHR_DC on twitter. Visit the Discover Portal for a complete, searchable selection of NIHR Signals, or see the latest on clinical trials below.

Two nerve drugs are not suitable for treating long-term low back pain
The drugs gabapentin and pregabalin (gabapentinoids) were found not to help lower back pain that had lasted more than three months. Gabapentin gave no benefit compared with placebo, while pregabalin was less effective than other painkillers. Both were associated with several side effects, such as dizziness. Long-term low back pain without clear cause is very common. It causes considerable loss of productivity and places a high demand on the healthcare service. It is difficult to treat, and people often get limited relief from simple painkillers, causing practitioners to consider alternative options. This review gathered eight trials looking at gabapentinoids for adults with long-term lower back pain. The evidence was very low quality, but overall, supports NICE guidance not to use these drugs to treat long-term lower back pain. Larger, high-quality studies may provide further insight, particularly regarding their value when there is associated sciatica as gabapentinoids may help some types of nerve pain.
05 December 2017

Low FODMAP diet may improve irritable bowel symptoms more than other diets
Adults with irritable bowel syndrome (IBS) who followed a low FODMAP diet had fewer symptoms than those who followed standard dietary advice. They scored their symptoms about 50 points better on a 500 point scale. The low FODMAP diet is an emerging approach for IBS. It is based on the theory that certain carbohydrates can expand or ferment in the gut and cause symptoms for some people. This review included five randomised trials in adults who rated their symptoms before and after introducing the low FODMAP diet, or a standard diet, for between one and three months. There are weaknesses in the reporting of this review and uncertainties about the reliability of the underlying trials and the duration of any benefit. However, given the chronic nature of IBS and negative impact on quality of life, FODMAP may be worth considering despite the comparatively low qualityevidence.
05 December 2017

Blood test could shorten antibiotic treatment in newborns with suspected sepsis
Measuring procalcitonin levels in newborns with suspected sepsis in the first days of life reduced antibiotic duration by 10 hours compared with standard care. There was no increase in the risk of re-infection or death. Systemic infection can be rapidly life-threatening in newborn babies, so those with risk factors are often treated pre-emptively with intravenous antibiotics. If sepsis is not confirmed by blood culture the decision whether to discontinue antibiotics needs to be made, but results of the blood culture takes time. Procalcitonin is released into the blood in response to inflammation, and low levels may give an earlier indication that there is no serious infection. This trial in 1710 term or late-preterm babies compared procalcitonin-guided treatment with standard care, which includes monitoring of an alternative inflammatory marker C-reactive protein. Reduced antibiotic use and hospital stay are highly relevant outcomes for parents and in the overall aim of reducing unnecessary antibiotic use. Importantly use of the new marker was not inferior to standard care regarding the risk of complications either. NICE guidance, issued before this study, in 2015 did not recommend using procalcitonin to monitor sepsis due to lack of evidence. This study could inform future updates.
28 November 2017

Specialist-led improvised music therapy did not improve children’s symptoms of autism
After five months, improvised music therapy added to enhanced usual care was no better than enhanced usual care alone for young children with an autism spectrum disorder (ASD). Clinically meaningful improvements in social and communication skills were not achieved in either group over this time. This result from a large well designed NIHR-funded international trial contrasts with an earlier systematic review of small trials that suggested beneficial effects for this specialised therapy. Qualified music therapists provided social interactions with the children through music and singing once to three times per week. Centres in nine countries participated, including the UK. Usual care comprised a wide range of local services including communication therapies. The enhanced care was three counselling and support sessions provided to all parents in the study. Though music itself may be useful for some children with an ASD, this specialist delivered therapy did not show any detectable benefit.
28 November 2017

Exercise improves symptoms and function for people with ankylosing spondylitis
People with ankylosing spondylitis showed improvement in their symptoms and their ability to perform day-to-day tasks when they did more exercise. Symptom and function scores improved by almost one point on a 10-point scale after 3 to 12 weeks of exercise. Ankylosing spondylitis is a type of arthritis which mainly affects the spine, causing pain, stiffness and progressive fusion of the spine. There have been recent advances in pharmacological treatment, and it was uncertain whether exercise along with modern drug treatment has useful benefits. This review pooled the results of eight trials comparing different types of exercise with education or no exercise. People’s symptoms and ability to perform daily activities improved regardless of whether they were receiving new drug treatments. The functional improvements shown in this research and the potential to prolong independence and working life for the most severely affected might also be another important reason to maintain activity.
21 November 2017

Blood pressure self-monitoring works best when people are well-supported
People with high blood pressure are more likely to have their blood pressure controlled after 12 months if they self-monitor and receive counselling by telephone compared with usual monitoring in the clinic. When people were asked to self-monitor their blood pressure with no additional support, it was no better than getting their blood pressure measured in a clinic. This NIHR-funded review of 25 trials found that self-monitoring with counselling by telephone reduced systolic blood pressure by about 6mmHg. Self-monitoring became less effective as the amount of healthcare support and education decreased. It is not clear what the optimum frequency of checks is, but involving people in monitoring their condition is in line with NICE guidelines. The review did not look at the costs involved in providing the additional support. The accuracy and maintenance of home blood pressure machines also need to be taken into account, but the results look promising.
21 November 2017

Comprehensive assessment when older people are in hospital improves their chances of getting home and living independently
Older people who received comprehensive geriatric assessment when in hospital were slightly more likely to be living in their own homes one year later. Sixty percent were discharged to independent living compared with 56% receiving standard ward care. People who had received this proper assessment were also 20% less likely to be in a nursing home after three months or more. Older people often have multiple complex conditions combined with frailty and are more likely to lose independence after illness. Comprehensive geriatric assessment is a careful review by a multidisciplinary specialist team of people’s medical, functional, mental and social capabilities. It aims to improve recovery and enable people to maintain function and independence. This updated Cochrane review covered 29 trials comparing this assessment with routine care for people over 65, excluding those with stroke and orthopaedic conditions. It may save NHS resources, but the quality of evidence was too low to assess this reliably. This assessment is not carried out in all hospitals, and the mode of delivery varies. Research has yet to answer how best to deliver this assessment to those most in need.
21 November 2017

Uncertain benefit of adding amisulpiride to clozapine for treatment-resistant schizophrenia
For adults with schizophrenia who continue to have symptoms despite treatment with the antipsychotic drug clozapine, adding amisulpride (another antipsychotic) was not shown to improve their chance of responding. It is not yet clear whether a larger trial would show an effect, as too few people were recruited to the NIHR-funded trial to be sure. Participants were more likely to experience side effects and the trial does provide some important information for future studies in this difficult treatment area. The current NICE guidance recommends adding a second antipsychotic to clozapine for patients in these circumstances but does not specify any particular drug. Amisulpride is often used in practice, but to date, there had not been much evidence on which to base this decision. Only 68 people with this severe form of schizophrenia were recruited instead of the expected 230, so the ability to detect any clinically significant differences between the groups is reduced.
14 November 2017

Breathing exercises improve asthma and can be learned by DVD
Breathing exercises taught by a physiotherapist in person or on DVD both improved the quality of life of adults with poorly controlled asthma to a small but similar extent. The DVD was the cheapest option, and it could lead to inexpensive internet delivery in the future. This NIHR-funded trial recruited 655 UK adults with poorly controlled asthma. It showed about 63% of those receiving the breathing exercises had clinically important improvements in their asthma-related quality of life over a year, compared to 56% who improved receiving usual care. Exercises did not improve formally measured lung function, suggesting the underlying biology of the asthma was unchanged. The findings imply that breathing exercise programmes – currently recommended in the 2016 British guideline on the management of asthma when delivered by a physiotherapist – may be equally effective, and cheaper when delivered via DVD (or another video).
07 November 2017

A commonly used treatment does not improve chronic low back pain
This trial found that destroying nerves that take pain signals to the brain using heat (radiofrequency denervation) did not improve pain, function or a sense of “recovery”. The treatment was used alongside exercise and was a variation of the technique commonly used in the UK. In this large study, it was compared to exercise alone. Low back pain is usually short-lived, but some people develop long-term back pain which can negatively impact their lives. NICE recommends exercise, pain relief and self-management to cope with pain. If these treatments are not effective and pain is severe, then more intensive options, such as radiofrequency denervation can be considered. These findings suggest that this technique of radiofrequency denervation does not provide a significant advantage in addition to exercise. This trial used different denervation techniques that are used in the UK, and the participants were still improving with exercise therapy. Radiofrequency denervation is only used in the UK when exercise is no longer effective. Therefore, the findings may not be directly applicable to practice in this country, but certainly, raise doubt regarding its use.
07 November 2017

More findings are available on the NIHR Dissemination Centre website.