Our Impact

We have been incredibly successful in implementing research across various sectors, and we're delighted to be able to share our success stories below, however, we understand that there is still a long way to go and we shall continue to work together with patients and the public, to escalate the impact of our research within health care practice. 

The Impact Accelerator Unit expanded its remit to support Keele University's Faculty of Health across a range of research implementation case studies. We are supporting all authors within the Faculty to maximise the impact of their research. 

view our REF 2014 Impact Case Studies

in 2018, the JIGSAW-E project, led by the Impact Accelerator Unit, was selected by the funder EIT Health to be showcased on their website as a best example of success. 

What is JIGSAW-E?

JIGSAW-E is an EIT Health Innovation by Ideas project improving management of chronic joint pain from osteoarthritis (OA) by implementing a new model of supported self-management in general practices across five European countries.

Joint pain in adults 45 years and over is one of the largest causes of years lived with disability worldwide. In the EU, delivery of quality OA care is highly variable.


JIGSAW-E addresses unmet needs in OA management by supporting self-management and encouraging adherence to the National Institute of Health and Care Excellence (NICE) OA quality standards.

The innovation package includes:

  • A model consultation for OA in Primary Care
  • An OA e-template embedded into clinical systems
  • Bespoke training package for clinical and non-clinical staff
  • An OA guidebook for citizens, translated for each country
Results to date

• In 2017, the JIGSAW-E approach was implemented across 33 practices (exceeding the target of 5 sites per country), with over 350 healthcare professionals trained and 600 patients directly benefitting internationally.

• 20 clinical champions successfully translated and culturally adapted the training package for clinical and nonclinical staff. Its excellent usability means training has been expanded to professionals outside the Beacon sites. The in-development online training courses will further increase outreach and accessibility.

• A strong Citizens Engagement programme was implemented internationally using high-quality standards of good practice for citizen engagement to develop the material. • Using internationally validated quality indicators of osteoarthritis care, patient data has been optimised to reduce clinical variation across communities.

• The clinical champion network for each country has promoted the innovation packages on a national level and links into national groups with responsibility for recommendations and models of care.

• The Osteoarthritis Research Society International Conference 2018 invited the Chief Investigator to speak on the implementation of OA research and clinical guidelines.

• EIT Health and industry partners are supporting the project scaling across additional EU countries in 2018. 

  • Developing the programme for use in community pharmacy settings
Benefits of EIT Health support

“Without EIT Health, there would not be an integrated and systematic implementation of international guidelines for the primary care and management of osteoarthritis. It has opened up a whole new way of understanding how we might close the evidence to practice gap in osteoarthritis care. Learning from different Beacon sites gives us implementation stories and a sense of community in tackling the largest cause of years lived with disability in the western world.” Professor Krysia Dziedzic Chief Investigator JIGSAW-E, February 2018.


University of Southern Denmark

Diakonhjemmet Hospital, Norway

University of Algarve, Portugal

Edinburgh Napier University, Scotland

West Midlands Academic Health Science Network, England

Keele University, England

Erasmus University Medical Centre, Netherlands

Saint-Antoine Hospital Paris, France 


Useful Resources

 [LC1]Logos and links to partners webpages

 [p2]I can’t add all these logos in, the new system doesn’t allow adding in ad hoc images to prevent poor resolution. I’ll provide the links for now.


STarT Back was named as one of the UK’s 100 'Best Breakthroughs,' thanks to its significant impact on people’s everyday lives.

The 'STarT Back' approach from Keele University is honoured in the UK’s Best Breakthroughs list for its pioneering work to transform care for people with low back pain.

Low back pain is the number one cause of disability worldwide. In the UK, 70% of people will experience a significant episode of back pain during their lives, and the condition costs society over £10bn each year.

Whilst effective therapies exist, finding the right personalised treatment used to be difficult. The new approach developed at Keele University changes that as it matches patients with the right treatment, at the right time.

Over the past 15 years, Keele researchers have pioneered new treatments and developed the easy-to-use STarT Back approach, which identifies those most at risk of future pain and then matches patients with the most appropriate treatment. STarT Back has been proven to:

  • Significantly decrease disability from back pain
  • Reduce time off work due to back pain - by 50% in trials
  • Save money - trials found a saving of £400 per person, which equates to overall savings of more than £700 million in the UK.

Professor David Amigoni, Pro Vice-Chancellor for Research and Enterprise at Keele University said:

"It is fantastic to see the University featured in the UK's Best Breakthroughs list. We're extremely proud of the work of our academics and of the difference that they are making to people's lives both here in the UK and overseas." 

Today's list of breakthrough demonstrates how UK universities are at the forefront of some of the world's most important discoveries, innovations and social initiatives. The list was compiled by Universities UK, the umbrella group for UK Universities, as part of the MadeAtUni campaign to bring to life the differences that universities make to people, lives and communities across the UK. 

Professor Dame Janet Beer, President of Universities UK, said: 

"Universities really do transform lives. The technology we use every day, the medicines that save lives, the teachers who inspire - all come from UK universities and the important work being done by academics. 

"The UK's Best Breakthroughs list is a testament to the difference that universities make to people's lives and we want everyone to join us in celebrating the work they do."

You can find out more about the UK's Best Breakthroughs and the MadeAtUni campaign at MadeAtUni.org.uk.

STarT Back saved £226.23 for every £1 spent

Public Health England showed that the STarT Back approach would give an estimated net saving of £21.07 per patient when implementing the intervention and a small estimated gain in quality of life of 0.0029 per patient. There is also evidence of productivity gains via days of work saved.

The Public Health England Report showed that the return on investment (ROI) from a healthcare financial perspective of £10.58 for every £1 spent on the intervention. When QALY gains are included, this increases to an estimated return of £90.92 for every £1 spent and when days of work saved are also included, this increases to an estimated £226.23 for every £1 spent. 



The National Institute for Health Research (NIHR) Dissemination Centre’s 2018 Themed Review, called ‘Moving Forward: Physiotherapy for Musculoskeletal Health and Wellbeing’, features many studies which were led by the Research Institute for Primary Care and Health Sciences, working in partnership with local and regional NHS Trusts and GP Practices. 

The review demonstrates the return on investment in physiotherapy research for musculoskeletal conditions such as back pain, osteoarthritis, and rheumatoid arthritis and summarises 55 high-quality research studies from over the past decade, with the aim to give a clear direction to patients, physiotherapists, researchers, commissioners and planners of physiotherapy and musculoskeletal services. Musculoskeletal conditions (pain in the joints, ligaments, muscles, nerves, tendons) are the leading cause of pain and disability in the UK, affecting more than 10 million people. These conditions can have a huge impact on a person’s quality of life, as well as affecting their family, friends, carers and the wider society.

This included the STarT Back approach, developed and tested by Keele researchers over the last decade in a randomised trial and a quality improvement (or implementation) study, which is now being implemented by the IAU.

The STarT Back tool identifies an individual patient’s risk of persistent disabling back pain and helps healthcare professionals to better match patients to the available treatments.

STarT Back intended to improve patient’s outcomes and make good use of healthcare resources. It was successful in reducing unnecessary investigations and saved money by reducing repeat GP consultations, referral rates to secondary care, medications, and investigations such as MRI scans.

Public Health England went on to recommend the service as one of seven preferred interventions for treating patients with a musculoskeletal condition. Both Public Health England and the National Institute for Health Care Excellence (NICE) guidelines recommend STarT Back, and the tool is now freely available to the NHS.

NIHR Professor of Musculoskeletal Health in Primary Care, Nadine Foster, and ARUK Professor of Musculoskeletal Therapies, Krysia Dziedzic, were part of the expert group steering the Themed Review.

Professor Foster commented: “It’s absolutely fantastic to see so much of our research showcased in this important review, which celebrates how the quality and impact of musculoskeletal research is delivering improvements in the quality of patient care.”

“This NIHR Themed Review is really relevant to physiotherapists, patients, service managers and commissioners of musculoskeletal services, and will help disseminate key research further, and make a real difference in the way that practitioners treat patients with musculoskeletal conditions.”

Professor Dziedzic added: “I really hope that this review will act as the benchmark for wider engagement in research, evaluation and implementation within the field of musculoskeletal health. I’m looking forward to working with all key stakeholders, including patients, carers, and the public, to see how this evidence can transform physiotherapy services for those with musculoskeletal pain.

Useful Resources


STarT Back

Hill JC, Vohora K, Dunn KM, Main CJ, Hay EM. Comparing the STarT Back screening tool's subgroup allocation of individual patients with that of independent clinical experts. Clin J Pain. 2010 Nov-Dec;26(9):783-7. doi: 10.1097/AJP.0b013e3181f18aac. PubMed PMID: 2084 2014. 2 star

Hill JC, Whitehurst DG, Lewis M, Bryan S, Dunn KM, Foster NE, Konstantinou K, Main CJ, Mason E, Somerville S, Sowden G, Vohora K, Hay EM. Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial. Lancet. 2011 Oct 29;378(9802):1560-71. doi: 10.1016/S0140-6736(11)60937-9. Epub 2011 Sep 28.PubMed PMID: 21963002; PubMed Central PMCID: PMC3208163. 4 star

Main CJ, Sowden G, Hill JC, Watson PJ, Hay EM. Integrating physical and psychological approaches to treatment in low back pain: the development and content of the STarT Back trial's 'high-risk' intervention (StarT Back; ISRCTN 37113406). Physiotherapy. 2012 Jun;98(2):110-6. doi: 10.1016/j.physio.2011.03.003. Epub 2011 Jun 12. PubMed PMID: 22507360.

Whitehurst DG, Bryan S, Lewis M, Hill J, Hay EM. Exploring the cost-utility of stratified primary care management for low back pain compared with current best practice within risk-defined subgroups. Ann Rheum Dis. 2012 Nov;71(11):1796-802. doi: 10.1136/annrheumdis-2011-200731. Epub 2012 Apr 4. PubMed PMID: 22492783; 3.5 star

Foster NE, Mullis R, Hill JC, Lewis M, Whitehurst DG, Doyle C, Konstantinou K, Main C, Somerville S, Sowden G, Wathall S, Young J, Hay EM on behalf of the IMPaCT Back Study team (2014). Effect of stratified care for low back pain in family practice (IMPaCT Back): a prospective population-based sequential comparison. Annals of Family Medicine, 12(2): doi: 10.1370/afm.1625 [5.355] 4 star

Hill JC, Afolabi EK, Lewis M, et al Does a modified STarT Back Tool predict outcome with a broader group of musculoskeletal patients than back pain? A secondary analysis of cohort data BMJ Open 2016;6:e012445. doi: 10.1136/bmjopen-2016-012445


MOSAICS / JIGSAW references


Wathall S, Stevenson K, Duffy H, Edwards J, Cooper V, Porcheret M, Dziedzic K. The Implementation of STarT BACK and an OA e-template: Utilising Existing GP Electronic Clinical Systems to Manage Patients with Low Back Pain or Osteoarthritis during a Routine Consultation. Second West Midlands Health Informatics Network Conference (WIN 2017). January 2016             

Dziedzic K, Bierma Zeinstra S, Vliet Vlieland T, Roos EM, Skou ST, Hagen KB, Osteras
N, Pais S, Cordeiro C, Duffy H, Hughes R. Joint Implementation of Guidelines for oSteoArthritis in Western Europe: JIGSAW-E  Physiotherapy. 2016; 102S: eS138. [The 4th European Congress of the ER WCPT]

Schiphol D, Vliet Vlieland TP, van Ingen R, Peter WF, Meesters JJ, de Wit MP, van de Boogaard JN, Krol J, Buitelaar H, Evans N, Bierma-¬Zeinstra SM, Dziedzic KS. Joint Implementation of Guidelines for oSteoArthritis in Western Europe: JIGSAW-¬E in progress in the Netherlands. Osteoarthritis and Cartilage. 2017; 25: S414. [OARSI 2017]

Quicke J, Rimmer Y, Beasley J, White N, Stevenson K, Duffy H, Evans N, Dziedzic K. Implementing Osteoarthritis Clinical Guidelines Amongst UK Physiotherapists. World Congress of Physiotherapy, Cape Town South Africa 2017                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   

Additional Publications

Allen KD, Choong PF, Davis AM, Dowsey MM, Dziedzic KS, Emery C, Hunter DJ, Losina E, Page AE, Roos EM, Skou ST, Thorstensson CA, van der Esch M, Whittaker JL. Osteoarthritis: Models for appropriate care across the disease continuum. Best Pract Res Clin Rheumatol. 2016 Jun;30(3):503-535.

Blackburn S, Higginbottom A, Taylor R, Bird J, Østerås N, Hagen KB, Edwards JJ, Jordan KP, Jinks C, Dziedzic K. Patient-reported quality indicators for osteoarthritis: a patient and public generated self-report measure for primary care. Res Involv Engagem. 2016 Mar 17;2:5

Dziedzic KS, French S, Davis AM, Geelhoed E, Porcheret M. Implementation of musculoskeletal Models of Care in primary care settings: Theory, practice, evaluation and outcomes for musculoskeletal health in high-income economies. Best Pract Res Clin Rheumatol. 2016 Jun;30(3):375-397.

Dziedzic KS, Healey EL, Porcheret M, Afolabi EK, Lewis M, Morden A, Jinks C, McHugh GA, Ryan S, Finney A, Main C, Edwards JJ, Paskins Z, Pushpa-Rajah A, Hay EM. Implementing core NICE guidelines for osteoarthritis in primary care with a model consultation (MOSAICS): a cluster randomised controlled trial. Osteoarthritis Cartilage. 2018 Jan;26(1):43-53.

Egerton T, Diamond LE, Buchbinder R, Bennell KL, Slade SC. A systematic review and evidence synthesis of qualitative studies to identify primary care clinicians’ barriers and enablers to the management of osteoarthritis. Osteoarthritis Cartilage. 2017;25(5):625-38.

Finney A, Dziedzic KS, Lewis M, Healey E. Multisite peripheral joint pain: a cross-sectional study of prevalence and impact on general health, quality of life, pain intensity and consultation behaviour. BMC Musculoskelet Disord. 2017 Dec 16;18(1):535.

Finney A, Healey E, Jordan JL, Ryan S, Dziedzic KS. Multidisciplinary approaches to managing osteoarthritis in multiple joint sites: a systematic review. BMC Musculoskelet Disord. 2016 Jul 8;17:266.

Healey EL, Main CJ, Ryan S, McHugh GA, Porcheret M, Finney AG, Morden A, Dziedzic KS. A nurse-led clinic for patients consulting with osteoarthritis in general practice: development and impact of training in a cluster randomised controlled trial. BMC Fam Pract. 2016 Dec 21;17(1):173.

Healey Elm Afolabi EK, Lewis M, Edwards JJ, Jordan KP, Finney A, Jinks C, Hay EM, Dziedzic. Uptake of the NCIE osteoarthritis guidelines in primary care: a survey of older adults with joint pain. BMC Musculoskeletal Disorders. 2018;19:295.

Jackson H, Barnett LA, Jordan KP, Dziedzic KS, Cottrell E, Finney AG, Paskins  Z, Edwards JJ. Patterns of routine primary care for osteoarthritis in the UK: a cross-sectional electronic health records study. BMJ Open. 2017 Dec 29;7(12):e019694.

Jordan KP, Edwards JJ, Porcheret M, Healey EL, Jinks C, Bedson J, Clarkson K, Hay EM, Dziedzic KS. Effect of a model consultation informed by guidelines on recorded quality of care of osteoarthritis (MOSAICS): a cluster randomised controlled trial in primary care. Osteoarthritis Cartilage. 2017 Oct;25(10):1588-1597.

Oppong R, Jowett S, Lewis M, Clarkson K, Paskins Z, Croft P, Edwards JJ, Healey E, Jordan KP, Morden A, Ong BN, Porcheret M, Finney A, Hay E, Dziedzic K.  Cost-effectiveness of a model consultation to support self-management in patients with osteoarthritis. Rheumatology (Oxford). 2018 Mar 14.

Porcheret M, Main C, Croft P, Dziedzic K. Enhancing delivery of osteoarthritis care in the general practice consultation: evaluation of a behaviour change intervention. BMC Fam Pract. 2018 Feb 6;19(1):26

Evidence Based Practice – General Practice Nursing Group shortlisted as Innovators of the Year at the GP Awards 2011

Evidence Based Practice – General Practice Nursing Group British Society of Rheumatology Best Practice Winner

The IAU has been recognised by being shortlisted for the following awards:

  • West Midlands Academic Health Science Network (WMAHSN) Meridian Celebration of Innovation awards 2017 – Team of the Year (This award recognises teams which have made game-changing discoveries, research or interventions which drive healthcare innovation forward within the West Midlands)
  • West Midlands Academic Health Science Network (WMAHSN) Meridian Celebration of Innovation awards 2018 – Supporting Self Care and Prevention of Illness Award for JIGSAW-E
  • Health Service Journal Awards 2015 & 2016
  • NICE Shared Learning 2015
Launch of the international JIGSAW-E project September 2016

The IAU’s European EIT Health-funded project JIGSAW-E was launched at Keele in September 2016. Colleagues from the UK, Netherlands, Portugal Denmark and Norway came together to discuss how osteoarthritis is managed in Primary Care in each country and how the JIGSAW-E approach could be rolled out internationally to enable patients to self-manage their arthritis.

Keele Research User Group Annual Event 2017 

The 2017 event was entitled ‘Accelerating the impact of research using patient and public involvement’ and was centred around the work that the Impact Accelerator Unit delivers with its patient and public partners, otherwise known as the LINK group (Lay Involvement in Knowledge Mobilisation).

Over 80 stakeholders, patients and researchers joined the event, which was held in Keele Hall’s grand ballroom. The keynote speech was delivered by Professor of Public Involvement and Engagement at Warwick University Sophie Staniszewska, who highlighted that studies often fall victim to research waste, where findings are either not implemented or take up to 17 years to be so. Promising concepts of co-production and knowledge mobilisation can go a long way in bridging the research to implementation gap by ensuring that clinicians, economists, academics and patients are all involved in all elements of the research design, which can be done through knowledge brokers or knowledge mobilisers. Other presentations were given by Impact Accelerator Unit Projects Manager Nicki Evans, along with JIGSAW-E patient member John Murphy, who spoke about the successful role of champions in the project; Senior NIHR Knowledge Mobilisation Fellow / Consultant Physiotherapist Kay Stevenson and Impact Accelerator Unit Projects Support Laura Campbell spoke about the progress of the unit’s STarT Back project; and the room also heard all about the role of the LINK group.

EULAR 2018, Amsterdam

A PARTNERSHIP IN IMPLEMENTATION: ADAPTING AN OSTEOARTHRITIS GUIDEBOOK ACROSS EUROPEAN CULTURES - WITH PATIENTS, FOR PATIENTS L. Campbell* 1, .. JIGSAW-E Patient Champions1, 2, 3, 4, 5, 6, 7, 8, S. Blackburn1 , J. Meesters2 , M. De Wit8 , D. Schiphof2 , T. Vliet Vlieland2 , S. Bierma-Zeinstra3 , N. Østerås4 , S. Pais7 , E. Roos6 , N. Evans1 , K. Dziedzic1 1Research Institute for Primary Care & Health Sciences, Keele University, Keele, United Kingdom, 2Leiden University Medical Center (LUMC), Leiden, 3Erasmus MC-University Medical Centre, Rotterdam, Netherlands, 4Diakonhjemmet Hospital, Oslo, Norway, 5University of Algarve, Algarve, Portugal, 6University of Southern Denmark, Odense, Denmark, 7 Centre for Biomedical Research, University of Algarve, Algarve, Portugal, 8VU University Medical Center, Amsterdam, Netherlands

Impact Accelerator Unit REF Workshop 2019

Impact in Real Life – Lessons from the IAU, March 2019

External visits

The Impact Accelerator Unit has hosted visits from colleagues across the globe, including New Zealand, Australia and Europe.