nt research framework

Bench to Bedside Research Framework

Priority 3 ISCRR Neurotrauma Research

Strategy 2011-2015

May 2013

Contents Glossary .......................................................................................................................................... ii

1 Background .......................................................................................................................... 1

1.1 Strategic intent ....................................................................................................................... 1

1.2 Funding arrangements and timeframe .................................................................................. 1

1.3 Development of the framework ............................................................................................ 2

2 Research themes ................................................................................................................. 3

2.1 Theme 1: Neuroprotection and early intervention ................................................................ 3

2.2 Theme 2: Interventions or combination of interventions with direct therapeutic effects on end organs ............................................................................................................. 4

2.3 Theme 3: Improved accuracy of diagnosis and prognosis through valid assessment tools or biomarkers ............................................................................................ 4

2.4 Theme 4: Post-acute management ........................................................................................ 5

2.5 Theme 5: Better characterisation of neurotraumatic conditions and clinical care ............... 5

3 Scope of research ................................................................................................................ 7

3.1 Scope of research ................................................................................................................... 7

3.2 Evaluation of research proposal ............................................................................................ 8

3.3 Research teams ...................................................................................................................... 8

3.4 Geographic locations of research activities ........................................................................... 8

4 Criteria for selection ............................................................................................................ 9

4.1 Decision-making principles .................................................................................................... 9

4.2 Governance .......................................................................................................................... 11

4.3 Milestone-driven research ................................................................................................... 12

4.4 Decision-making process ...................................................................................................... 12

Appendix A : Context ................................................................................................................... 14

About ISCRR and the Neurotrauma Research Strategy 20112015 ................................................ 14

Appendix B : References .............................................................................................................. 16

Figures Figure 3.1 : Biomedical research translation continuum ............................................................... 7

Figure 4.1 : Application review process ....................................................................................... 11

Figure A.1 : ISCRR organisational and strategic alignment .......................................................... 14

Glossary CER Comparative effectiveness research

DALYs Disability adjusted life years

InTBIR The International Initiative for Traumatic Brain Injury Research

ISCRR Institute for Safety, Compensation and Recovery Research

TBI Traumatic brain injury

SCI Spinal cord injury

NHMRC National Health and Medical Research Council

NTRI National Trauma Research Institute

TAC Transport Accident Commission

Background

Bench to Bedside Research Framework ISCRR Neurotrauma Research Strategy 2011-2015 May 2013 1

1 Background 1.1 Strategic intent

The purpose of this research framework is to assist the neurotrauma research community in Victoria in determining an agreed strategic plan for research under the Bench to Bedside theme of the Institute for Safety, Compensation and Recovery Research (ISCRR) Neurotrauma Research Strategy1.

ISCRRs Neurotrauma Research Strategy has an alignment with the goals of the Transport Accident Commission (TAC) as outlined in TAC 2015: to improve client outcomes; to improve client experience; and to maintain scheme viability. However, ISCRR recognises that it may not be feasible for bench-to-beside research to generate a financial return on investment within a five-year timeframe, compared to research in other priority areas. For this reason, ISCRR expects the funded research in the bench-to-bedside theme to lead to:

making a difference in treatment for persons with neurotrauma within five years, and/or

making a difference in diagnosis for persons with neurotrauma within five years.

Importantly, ISCRR recognises the value of bridging the knowledge between biomedical and technological innovations in the laboratory, and their application in clinical settings. It understands that laboratory innovations would have a fundamental impact on the recovery of neurotrauma clients only if proved beneficial in a clinical setting in a timely manner. On the other hand, knowledge from the clinics also stimulates knowledge generation and discovery from the laboratory (ie bedside to bench). A seamless bidirectional interface between the bench and the bedside is therefore fundamental to any strategy aiming to improve patient outcomes. Such strategy necessitates a strong collaborative interdisciplinary culture that fosters a wide range of expertise.

This research framework acts as a guidance document detailing areas of research interest. It provides the required information to the neurotrauma research community interested in engaging with ISCRR for collaborative research under the research themes specified herein (see section 2). It is worth noting from the outset that proposals submitted for consideration may span more than one research theme.

1.2 Funding arrangements and timeframe

There is a total of $2.5 million available for programs of research under this priority. The fund may be used to leverage financial resources obtained from other funding sources from Victoria, other Australian jurisdictions and internationally. Funds may be allocated to build on research that is currently underway. However, applicants should note that all proposals must be de novo and not duplicate major research efforts elsewhere (eg InTBIR research program). In considering the possibility of leveraging funds, applicants should refer to ISCRRs timelines for delivery of research outcomes.

Projects funded under this priority area are expected to deliver research outcomes within a five-year period from the date of commencement. Funded projects would need to commence prior to 24 December 2013.

1 A description of the context can be found in Appendix A.

Background


1.3 Development of the framework

ISCRR appointed Deloitte Access Economics to develop a recommended research framework for Priority 3 of ISCRRs Neurotrauma Research Strategy 20112015: Bench to Bedside. The aim is the development of the research framework by ISCRR to determine an agreed strategic plan for translational research under this priority area. It also aims to promote interdisciplinary collaboration for research on neurotrauma in Australia and globally, particularly between neuroscientists and clinical researchers.

In developing this recommended framework, Deloitte Access Economics undertook a targeted review of the literature to identify extant literature on the definition, scope and challenges of translational research, especially those pertaining to the area of neurotrauma. Furthermore, a number of reports published or commissioned by ISCRR or TAC were reviewed. These included:

ISCRR, 2011. Neurotrauma Research Strategy 20112015. Melbourne: ISCRR, TAC.

Gruen R, Bragge P, Sedgman C, Pitt V, Chau M, 2011. An Environmental scan of traumatic brain injury and spinal cord injury research. Melbourne: NTRI.

Victorian Neurotrauma Initiative, 2011. Legacy Report. Melbourne: TAC.

To identify promising areas of neurotrauma research, Deloitte Access Economics undertook consultations with ISCRRs Bench to Bedside working group and semi-structured interviews with five experts from Australia and overseas. These individuals have extensive expertise and research interests in both clinical and basic science of TBI and SCI.

Research themes


2 Research themes This section outlines five overarching research themes that were considered as the most promising areas of translational research that would make a difference in diagnosis, prognosis, treatment and/or patient outcomes within five years. It is worth noting from the outset that these themes are not mutually exclusive; some funded projects may span more than one theme.

2.1 Theme 1: Neuroprotection and early intervention

Rationale

Neuroprotection aims to slow or halt the loss of neurons following a neurotraumatic event by interfering with the underlying neurodegenerative processes. These processes include oxidative stress, mitochondrial dysfunction, excitotoxicity, inflammatory changes, iron accumulation and protein aggregation. Researchers have explored a range of interventions with the intent of disrupting these neurodegenerative processes (see Rosenfeld et al 2012, Kwon et al 2011, Loane and Faden 2010). These include the following:

Pharmacological interventions: erythropoietin, the statins, cyclosporine-A, tranexamic acid, minocycline, riluzole, glyburide, nimodipine, progesterone, magnesium, diketopiperazines, substance P antagonists, SUR1-regulated NCCa-ATP Channel inhibitors, cell cycle inhibitor, caspase inhibitors, intravenous corticosteroids.

Non-pharmacological interventions: therapeutic hypothermia or normothermia, fluid resuscitation, decompressive craniectomy, normobaric and hyperbaric hyperoxia, anaemia correction, intubation versus non-invasive ventilation.

The timing of applying these interventions can influence the degree of neuroprotection. Past research has a focus largely on neuroprotective interventions applied at the hospital setting; pre-hospital intervention has received limited attention. Early intervention at the pre-hospital setting (eg medical attendance at the scene of injury) may have the potential to confer benefits in preventing secondary neuronal damage and, in turn, would improve patient outcomes.

Example of research activities

It is anticipated that research programs proposed under this theme would be interventional studies based in the laboratory and clinical settings (eg randomised controlled trials). Observational studies that examine the relationship between neuroprotective interventions and certain health outcomes may also be considered under this theme (eg retrospective cohort study of patients who received and did not receive advanced life support at the pre-hospital setting).

Research themes


2.2 Theme 2: Interventions or combination of interventions with direct therapeutic effects on end organs

Rationale

TBI and SCI can significantly impair the proper functioning of organs, including the muscles, bowel, bladder and lungs, to name a few. Such impairments commonly result in conditions such as spasticity, immobility, and faecal and urinary incontinence/retention. These dysfunctions can cause complications such as pressure ulcers, bacterial infections (eg urinary tract infection, pneumonia, infected wounds) and other medical complications (eg bowel obstruction, bladder distension, osteomyelitis, sepsis and gangrene).

These impairments have significant impact on the patients quality of life. The management of these complications also incurs substantial financial burdens to patients, their carers and compensation systems. For these reasons, any interventions with therapeutic effects on end organs are likely to bring about improvement in patients health outcomes and quality of life and maintain TACs scheme viability.

Past research has largely focused on establishing the efficacy of single therapeutics. Research under this theme may consider exploring the effect of a combination of therapeutics and interventions because of the complexity and heterogeneity of SCI and TBI, and the potential synergistic or additive effects of different therapeutics.


Proof-of-principle studies of therapeutics that directly improve or maintain the functioning of end organs may be considered under this theme. Other interventions for the prevention or management of complications may also be considered (eg pressure-relieving interventions, nutritional interventions, rehabilitative interventions).

2.3 Theme 3: Improved accuracy of diagnosis and prognosis through valid assessment tools or biomarkers

Rationale

Access to reliable information at different time points following a traumatic event is fundamental to sound decision making about treatment or care approaches in order to minimise neural damage and restore function. For instance, valid neurological assessment at the scene of injury is important to support clinical decisions on early interventions. However, while there are technologies available to make such assessment in the hospital setting for conscious patients, no technology is currently available to clinicians or paramedics to make a reliable early assessment at the scene of injury, especially when many patients are unconscious. Innovations that allow such assessments (eg portable devices for rapid testing of key biomarkers or validated clinical assessment tools with high sensitivity and specificity) would greatly improve diagnosis and equip clinicians with better information about early course of clinical actions. Likewise, at other post-traumatic time points, the identification and validation of mechanistic or target biomarkers (including structural and functional neuroimaging biomarkers) would greatly improve diagnostic and prognostic accuracy, and inform clinical care over time.

Research themes



Over the years, a range of biomarkers have been identified and tested for validity, including S-100B, glial fibrillary acidic protein, neuron-specific enolase, spectrin breakdown products, and apolipoprotein. Recent research has also identified novel biomarkers, such as microRNAs, or multi-array analysis of cerebrospinal fluids. Neuro-proteomic search for biomarkers and their validation may be explored under this theme, provided such biomarkers have value in informing diagnosis, prognosis and treatment. Another potential area of research under this theme is the development of biomarkers (including neuroimaging biomarkers) to better characterise injury by type and severity.

2.4 Theme 4: Post-acute management

Rationale

Research in neurotrauma has a particular focus on the acute phase and there is little continuity in research to understand how care provided during the subacute and post-acute phases influences functional recovery. Given the chronic nature of most TBI and SCI, it is important to undertake research in the post-acute phase, especially in relation to post-acute neuro-rehabilitation, which has now become the mainstay of clinical management.


In line with the bench to beside theme, rehabilitation research may consider leveraging the advancement in laboratory science in measuring biomarkers to determine the degree of functional improvement, rather than solely focusing on clinical assessment tools. Other research may consider investigating the relationship between rehabilitation and neuroplasticity, for example whether improvement in a particular function through therapeutic rehabilitation would be at the expense of other functions.

Another relevant area of research is the use of intelligent techniques or technology developed in the laboratory to improve functional recovery or day-to-day functioning of individuals living with the consequences of TBI and SCI (eg robotic-assisted gait training, speech recognition software or technology, bionic bladder control, mobility technology).

2.5 Theme 5: Better characterisation of neurotraumatic conditions and clinical care

Rationale

TBI and SCI are complex heterogeneous conditions. Injuries of similar clinical presentation and assessment (eg on the Glasgow Coma Scale) may have vastly different patho-anatomical and patho-physiological characteristics.

Past discoveries have been largely unsuccessful in yielding meaningful benefits in clinical settings, in part because of a lack of understanding and differentiation for different subtypes of TBI and SCI. Laboratory experiments and clinical trials in the past have often tested promising interventions on animal models or patients who have been crudely categorised as mild, moderate or severe, when in fact the underlying patho-physiological and patho-anatomical characteristics might have been vastly different. Indeed, the heterogeneity of TBI and SCI has been considered one of the most significant barriers to finding effective therapeutic interventions. Furthermore, differences in individuals medical

Research themes


history and time window of clinical care, as well as discrepancies in the level and quality of clinical care, also confound prognostication and medical decision about treatment approaches.

For these reasons, one research priority is to delineate the heterogeneity of TBI and SCI. The purpose is to find interventions, or combinations of interventions, that are the most effective for neurotrauma patients with specific patho-anatomical or patho-physiological characteristics, under a particular clinical circumstance. This type of research is in line with the overall trend in medicine to develop personalised medicine the ability to customise a treatment based on individual patient and disease characteristics to optimise patient outcomes.


Better characterisation of neurotraumatic conditions and clinical care can be achieved through a range of research activities, including those described under previous themes. Recently, researchers and government research bodies have increasingly recognised Comparative Effectiveness Research (CER) as a promising type of research to disentangle heterogeneity. CER is largely observational in nature (ie non-interventional) and can address the issues of heterogeneity through carefully considered study design and statistical methods. Using a variety of data sources and methods, CER assesses comparative effectiveness among different interventions in achieving an array of clinically meaningful outcomes for diverse patient populations and subgroups.

Based on the analysis of observational data, researchers make inferences about the causative relationships between diagnosis, prognosis, interventions and clinical outcomes. The interventions could be pharmaco-therapy, procedures (eg rehabilitation or surgery), medical and assistive devices and technologies, diagnostic testing, behavioural change and delivery system strategies. The range of data may include those from the bench, such as genomic, proteomic and neuroimaging data, as well as data from the bedside, such as clinical parameters and outcomes data. Recent technological advancement such as diffusion tensor imaging would inform CER with more patho-anatomical data. Given the broad scope, CER necessitates an interdisciplinary approach with close involvement of researchers with the right expertise in laboratory science, clinical science, epidemiology, statistics, bioinformatics and so on.

Scope of research


3 Scope of research 3.1 Scope of research

Research projects within the scope of this priority area could include animal/laboratory-based proof-of-principle studies AND/OR clinical studies designed to lead to new diagnostic or treatment approaches in SCI and TBI that can be reasonably expected to lead to tests of safety and efficacy in humans within five years. If animal or laboratory studies are proposed, it is expected that they will lead to safety and efficacy studies in humans within the five-year timeframe.

For the purposes of this document, ISCRR uses the below definitions for the three phases of the translational model (Figure 3.1).

T1: Evaluation of biochemical findings in animals proposal of potential application.

T2: Evaluation of safety and efficacy (ie clinical trials).

T3: Translation to practice through implementation and adoption.

Figure 3.1: Biomedical research translation continuum

Zone of translation

Basic science discovery

Proposed human

application

Laboratory to clinical

(T1)

Proven clinical

application

Safety andEfficacy research

(T2)

Clinical practice

Public health

impacts

Implementationand adoption

(T3)

Practice based research

Feedbacks bedside to bench

Source: adapted from Drolet and Lorenzi (2011).

Research under this priority area is required to comprise translational research activities in T1 and T2 of the research translation continuum. Given the strategic focus on improving patient outcomes and maintaining scheme viability, a focus on T2 is preferable. Research programs are not required to have a T1 component if the existing body of laboratory evidence has soundly demonstrated its translational potential. However, it is acknowledged that clinical research may involve laboratory components to measure safety and efficacy outcomes. Furthermore, clinical research may also bridge knowledge translation from the bedside back to the bench.

For a research program that includes activities at T1, it is a requirement that T2 components are also included by the fifth year (ie entering the clinical trial phase) if the research is to deliver into a difference in treatment or diagnosis for persons with neurotrauma within the specified timeframe. For projects that include T1 laboratory components, it is expected that such work is essential in confirming the potential of promising innovations in readiness for translation. In this case, it is required that the proposed research already has a body of robust pre-clinical evidence to support its potential.

Research that bridges clinical evidence and clinical practice (ie T3 of the zone of translation), while important, is out of scope for the purpose of this research priority.

Scope of research


3.2 Evaluation of research proposal

An independent expert review panel will assess the merits of proposals. The expert panel may consider the following factors:

Do animal and injury models adequately represent the human condition under study?

Is there any evidence about the time window of efficacy for a therapy in an animal model being consistent with the time window of efficacy in the human condition?

Have the experimental studies examined clinical meaningful efficacy in animal models?

Have the experiments been replicated with independently reproduced evidence?

Other considerations include:

use of randomisation and blinding in experimental design

extant knowledge of the basic mechanisms by which a therapy works

systematic reviews of animal studies

commercial potential of the therapy

potential applications outside of neurotrauma, and

laboratory environments effects on interpretation of study results.

3.3 Research teams

We recommend that research proposals should harness interdisciplinary expertise from the laboratory and clinical settings, with a view to promoting a culture of collaborative research. ISCRR and the expert panel will consider favourably research programs that have a strong collaborative involvement from clinician(s); it is expected that clinicians would have the capacity to champion and implement the research evidence in their day-to-day clinical practice to bring about changes in patient outcomes.

3.4 Geographic locations of research activities

In our view, ISCRR need NOT limit the proposed research activity to Victoria. It may include collaborative research between Victorian researchers and researchers from other Australian jurisdictions or countries. However, in line with the TACs organisational objective, the anticipated benefits of the research would need to be realisable in Victoria. For this reason, it is desirable that at least one of the chief investigators should be from the Victorian research community such that research outcomes are applicable to the Victorian clinical context.

Criteria for selection


4 Criteria for selection 4.1 Decision-making principles

Similar to all other research, there are some general principles that researchers should observe in undertaking research activities as part of this framework.

Maintaining high ethical standards

All research undertaken within this priority area must comply with the highest standards and guidelines for research ethics and research integrity as endorsed by the NHMRC and ARC. These include the Australian Code for the Responsible Conduct of Research2 and NHMRC codes3.

Fostering research partnerships

With a view to bringing together a collaborative relationship between laboratory and clinical researchers, research activities should strive to foster research partnerships between scientists and clinicians, as well as other stakeholders: individuals living with neurotrauma and their carers, research and patient support organisations, universities, and clinical service providers both in Australia and internationally. An effective partnership would allow for the appropriate translation of findings as outlined below.

Ensuring effective adoption and communication of research findings

Knowledge translation is fundamental to the advancement of medical research and clinical practice. Adopting a participatory, inclusive and transparent process in undertaking the research, as well as utilising existing research expertise across disciplines is essential for knowledge translation. One example is having substantial interdisciplinary inputs from biostatisticians, clinicians and basic and translational scientists in the design process of the clinical trial. Research findings should be communicated in a manner that is most likely to enhance the adoption of the evidence in clinical practice or inform further research. Knowledge translation should be embedded in the research program and translation activities planned during the development of the project plan with input from all partners. This should include identifying key performance indicators related to the project (see section 4.3 for further guidance), end users and audiences, formats and channels of communication and the appropriate timing for knowledge translation activities. Translation activities should be included in project milestones. The target audience should include neurotrauma communities (including people living with neurotrauma and their carers) in Victoria, Australia and internationally, clinicians and policy makers.

In addition, ISCRR emphasises the following principles:

Collaborative development of the research with the TAC and ISCRR

ISCRR develops research collaboratively with researchers and the TAC. Via ISCRRs collaborative research model, extensive and ongoing consultation and engagement is applied to every stage of a research endeavour: from setting the research agenda, through facilitating and conducting research to translating the research findings into

2 www.nhmrc.gov.au/guidelines/publications/r39

3 www.nhmrc.gov.au/guidelines/publications/e72
http://www.nhmrc.gov.au/guidelines/publications/r39



best practice. This kind of collaborative research is more likely to lead to relevant and adoptable findings by the end users.

Considering linkages to other aspects of the Neurotrauma Research Strategy

ISCRRs Neurotrauma Research Strategy outlines three other priority areas, including Models of Lifetime Care, Improving Rehabilitation and Disability Management and Capacity Building. Linkages identified with these areas will allow for cross-priority developments, maximising expertise and knowledge translation. For further details on the priority areas please refer to the ISCRR Neurotrauma Research Strategy 2011-2015, which can be located on the ISCRR website (www.iscrr.com)

Maximising opportunities to leverage funding from other sources or agencies

To maximise the funding available under this priority theme, researchers are encouraged to consider leveraging opportunities.
http://www.iscrr.com.au/reports-pubs/research-reports/neurotrauma-research-strategy.pdf



4.2 Governance

4.2.1 Review committee

We understand that ISCRR will establish a panel of Australian and international experts with appropriate credentials for the evaluation of the Expression of Interest submitted for consideration and project plan proposals.

4.2.2 Overall review process

Figure 4.1 provides a preliminary description of the recommended review process. This review process is subject to further refinement by ISCRR.

Figure 4.1: Application review process

EOI assessed for compliance and eligibility.

Eligible EOIs subject to expert review.

Scored by expert review panel that consists of International and Australian

experts. Short list approved by ISCRR and TAC

Rejected

Project Plan proposals invited from short listed

applicants

Review and ranking of project plan proposals by Expert review panel and selection by TAC/ISCRR according to: Scientific merit including

translational readiness Impact on treatment and/

or diagnosis for persons

with neurotrauma within

3-5 years

Alignment with the

Research Framework

Feasibility Clinical Partnerships Track Record

Brief commentaries

sent to applicants

Project Plan approved by TAC and ISCRR and

commencement of research

ISCRR invites researchers to consider putting forward an expression of interest (EOI) based on

the Bench to Bedside Research Framework.

Conclusion of research project

Funding commitment from ISCRR contingent uponthe applicant reaching the agreed milestones

RejectedFull critiques sent

to applicants

Project plan proposals selected for funding.

Comments/ requests from reviewers included into the

project plan.



4.3 Milestone-driven research

The investigators should predefine research milestones on a project-by-project basis, for consideration by an independent panel of individuals who have expertise in the specific area of research. Researchers should consider the below points in bold from the US National Institutes of Health:

A milestone should describe precise study outcomes, not simply completion, eg 28-day toxicology studies in two species with no observed adverse events at drug levels at least five-fold above the therapeutic dose, and NOT completion of 28-day toxicology studies in two species.

A milestone should provide quantifiable measures of success, eg 'Medicinal chemistry optimisation will produce a compound analogue with EC505-fold above EC50', and NOT 'Medicinal chemistry optimisation will produce compound analogues with improved potency and reduced toxicity.

A milestone should briefly (34 sentences) state the rationale for the type of cells or assays used, parameters tested, and quantitative values for the go/no go outcomes.

A milestone(s) should be defined at least for each year of funding. However, it would be ideal if a series of intermediate milestones at approximately six-month intervals were identified to head off any potential problems early enough, and for TAC and ISCRR to work with the investigator in identifying solutions or alternative approaches. As part of the funding requirement, ISCRR conducts a review at six-monthly intervals (in January and June of each calendar year) following submission of a progress report from the research team.

Meeting milestones. Failure to meet milestones could result in discontinuation of a project. If a milestone is not met, the expert panel will evaluate whether a redirection of the project is a possible alternative to project discontinuation, as long as the new direction remains within the scope of the original approved project, including the original overall goals of that project.

4.4 Decision-making process

To ensure a strategic approach to research, it is essential for the review committee to adopt a structured decision-making process to assess and identify research proposal(s) that would be most likely to deliver the greatest impact on the outcomes and experience of TACs clients as well as financial return on research investment.

This research framework specifies the following criteria:

Contextual considerations

How does the proposed project relate to the bench-to-bedside priority and the research themes?

Which group of TAC clients would receive the benefits from this research, if the outcomes are proved to be successful?

What is the potential applicability of the intervention and technology in the Victorian context (ie clinical adoption)?

Is there a clear pathway to application of the research?



Methodological and expertise considerations

What is the translational readiness of the proposed research?

What is the feasibility and suitability of the proposed methodology to answer the research question(s)?

What is the track record of the research team?

Financial considerations

What is the cost effectiveness of undertaking the proposed research? Consider the:

feasibility of the proposed budget (including availability of other research funds), and

likely returns on investment, both financially and non-financially (please refer to Collie et al 2012).

Other considerations

What are the synergies between the proposed research and other priority areas of ISCRRs Neurotrauma Research Strategy?

What are the risks associated with the research?

What is the proposed timeframe?

ISCRR Neurotrauma Research Strategy 2011-2015 Bench to Bedside Research Framework May 2013

Appendix A: Context The Institute for Safety, Compensation and Recovery Research (ISCRR) appointed Deloitte Access Economics to develop a recommended strategic research framework for Priority 3 of ISCRRs Neurotrauma Research Strategy 20112015: Bench to Bedside. The development of the research framework is to determine an agreed strategic plan for translational research under this priority area. It also aims to promote interdisciplinary collaboration for research on neurotrauma in Australia and globally, particularly between neuroscientists and clinical researchers.

About ISCRR and the Neurotrauma Research Strategy 20112015

The Transport Accident Commission (TAC), WorkSafe Victoria and Monash University established ISCRR in mid-2009. The purpose of this joint initiative is to provide a sound research and evidence base to improve compensation scheme policy, practice and performance in injury prevention, rehabilitation and compensation practice. TACs raison d'tre is to fund treatment and support services to individuals injured in transport accidents, including those living with the consequences of TBI or SCI. On this basis, it is logical for ISCRR to direct its research effort in the area of neurotrauma (Figure A.1).

Figure A.1: ISCRR organisational and strategic alignment

Monash University

Transport Accident

Commission

WorkSafe Victoria

ISCRR

Research programs

Occupational health and safety

Return to work and recovery

Health and disability services delivery

Compensation systems

Research translation

Neurotrauma

TAC 2015

improve client outcomesimprove client experiencemaintain scheme viability

Neurotrauma Research Strategy 2011-2015

Priority 1: Models of lifetime carePriority 2: Improving rehabilitation and disability managementPriority 3: Bench to bedsidePriority 4: Capacity buidling


In line with the TACs organisational focus, ISCRR has a Neurotrauma Research Strategy 20112015 to guide neurotrauma research within Victoria for the five-year timeframe from 2011. The intent of this strategy is to assist the TAC in achieving its strategic objectives, as outlined in the strategic document TAC 2015. These are to:

improve client outcomes, including supporting the recovery and independence of clients who have sustained TBI or SCI

improve client experience, and

maintain scheme viability.

The development of the strategy involved extensive consultations with a range of stakeholders, including members of the neurotrauma community in Australia and internationally. Based on an assessment of need, probability of impact, reward and capacity, the strategy specifies four areas of research priority (ISCRR 2011):

Priority 1: Models of lifetime care

Priority 2: Improving rehabilitation and disability management

Priority 3: Bench to bedside, and

Priority 4: Capacity building.

The TAC and ISCRR recognise the importance of fostering a collaborative culture in neurotrauma research. The TAC commissioned the National Trauma Research Institute (NTRI) to undertake a cross-discipline environmental scan of neurotrauma research. The environmental scan, with 166 participants, was conducted in February 2011 and identified 31 problem areas across TBI and SCI (Gruen et al 2011). It also concluded that a balanced neurotrauma research portfolio to meet the TACs goals would include investment in acute management, in rehabilitation and in community services and disability management. It should also spread investment across projects involving review of existing knowledge, discovery of new knowledge and translation of findings into practice and policy.

In mid-2011, ISCRR commissioned NTRI to undertake a series of workshops to develop concepts for research in the priority areas with researchers and TAC policy makers who are interested in conducting the research. These workshops led to identification of the sub-themes listed under the major priority areas in the strategy.


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nt research framework

Documents

scope of research

research themes

research teams

milestonedriven research

combination of interventions

direct therapeutic effects

valid assessment tools

improved accuracy of