EPSRC-NIHR HTC Partnership Award 'Plus': IMPRESS

IMPRESSPlus has been designed to maximise and extend the impact of the current IMPRESS network by applying engineering sciences to deliver novel solutions to the many challenges that exist in the management and treatment of incontinence. There is a critical lack of scientific research in this area compared to areas such as vascular, cardiac and orthopaedic healthcare - each of which have shown huge gains through the application of focussed basic and translational science.

Faecal Incontinence (FI) is defined as the inability to fully control the passage of faeces through the anus. This may arise due to a weakened anal sphincter muscle (typically following child birth), problems with nerve supply (e.g. stroke, multiple sclerosis), or in association with other gastrointestinal conditions (e.g. irritable bowel syndrome). It is a common and distressing condition that causes shame, embarrassment, depression, social isolation, secrecy, poor self-esteem, and sexual avoidance. As a result, more than 54% of patients with FI have not discussed their symptoms with a physician , and only one-quarter of patients with FI are referred by their GP for specialist treatment . Its exact prevalence is difficult to determine but best estimates suggest that in the adult population it is around 10%, and that 0.5% - 1% below 65 years and 3% - 8% over 65 years' experience regular faecal incontinence. Urinary Incontinence (UI) is defined as involuntary leakage of urine, UI presents a major burden on NHS resources. It is a common and distressing condition, which impacts of quality of life. The main forms of UI are stress incontinence (SUI), which is leakage with physical exertion, and urge incontinence (UUI), which is leakage with a strong desire to void. Mixed urinary incontinence is a combination of SUI and UUI. The prevalence of UI increases with age and is higher in institutionalised adults, who tend to be older and suffer associated co-morbidity. It is more often a problem for females, with prevalence rates of UI ranging from 4.5% to 53% in women, as compared to 1.5% and 24% in men. Although previously considered in isolation, it is increasingly recognised that many forms of FI and UI share a common underlying pathophysiology and frequently co-exist with pelvic organ prolapse.
Incontinence places a massive burden on the NHS and impacts significantly on quality of life for thousands of patients in the UK. Whilst many areas of medical engineering share a growth in the engagement of engineers and scientists to push forward the exploitation of emerging technologies it is arguably the case that the nature of this disease prevents engineering and science research leaders seeing the potential for some rich research challenges.
To date the IMPRESS network has been successful in fulfilling its objectives of increasing the number of leading UK technologists (from academia and industry) that are engaged with research into the clinical changes associated with incontinence. This is demonstrated through a range of exciting new collaborative projects that have arisen from IMPRESS workshops and events and have been supported by competitive pump-priming funding from the network.

IMPRESSPlus will secure the legacy of the existing IMPRESS network. This will be achieved by:
1) strategically supporting emerging research with feasibility project funding
2) running international IMPRESSPlus conference workshops to build the network
3) using a researcher secondment scheme to aid knowledge-transfer with industry and leading international research centres
4) disseminating the networks findings to researchers, patients, healthcare providers and policy makers
5) identifying long-term funding for the network and its research

In summary, through the IMPRESS network we aim to resolve the current impasse that stifles innovation and translation of new engineering technologies for the management, treatment and prevention of incontinence.

Impact from IMPRESS is centred about the innovative framework we have built which provides a new way to enhance communication between researchers in the engineering and physical sciences, persons affected by incontinence and their healthcare providers, and industry. In doing so, we aim to resolve the current impasse that stifles innovation and translation of new engineering technologies for the management, treatment and prevention of incontinence.

IMPRESSPlus will secure and extend this impact by
1. Expanding the IMPRESS Network to an international stage
2. Accelerating novel research in the area of incontinence technologies toward further funding
3. Using knowledge-exchange activities to inspire and engage new researchers
4. Providing enhanced dissemination to our end-users and policy makers

Knowledge:
Our IMPRESSPlus Feasibility Projects and IMPRESSPlus Fellowship initiatives will develop new scientific advances in a range of cross-cutting areas. Our Knowledge-Exchange program will complement these activities by both bringing new expertise into the network and providing another path for wider international dissemination at key scientific research centres. We will also continue to route our translational activities within IMPRESS through our collaborating HTCs, building on existing success in this area.

Society:
Our IMPRESSPlus sessions at specialised incontinence technology meetings will provide a mechanism for focused engagement with Patient Focus Groups to provide direct discourse between the research community and persons in society affected by incontinence.
Policy - The IMPRESS Network is addressing a significant unmet medical need and aims to provide an impetus to invest and create new disruptive engineering technologies for this rarely mentioned but highly prevalent condition. We are working, and will continue to build our relationship with, the International Longevity Centre-UK (ILC) and the All Party Parliamentary Group for Continence Care to disseminate, promote and implement its findings into future healthcare and social policies.
Health - The Network will extend our existing channels of communication between basic scientific and clinical expertise to identify further research challenges translate innovative technologies for management and prevention of incontinence into clinical practise. Our research projects are intended to catalyse further funding applications and ultimately first-in-man safety studies. Subsequently they will be suitable for translational 'Follow-on' funds from the MRC, BBSRC and EPSRC, Invention for Innovation product development schemes, and appropriate Technology Strategy Board calls.
Quality of life- Direct feedback/input from persons affected by incontinence is a major component of our Network's objectives. These allow IMPRESS to identify more clearly patient needs at the early stages of product engineering for incontinence.

People:
Skills- Through the activities of the IMPRESS network scientists will be educated about the causes and medical needs that currently exist for persons affected by incontinence. Our 'Incontinence Technology Advocates' are serving as a conduit between clinicians/surgeons/patients and the wider scientific community. Through IMPRESSPlus we will expand this cohort to an international stage.
Economy:
Wealth creation-Incontinence is a relatively unexploited clinical condition that offers significant opportunities for academic-industrial collaboration and subsequent value for commercial exploitation. We will translate research through liaison with our HTC partners and strategic groups including the TSB Catapult Centres and Industrial Partnerships Group/Translational Research Office at UCL. Successful academic-industrial partnerships formed via the Network will help deliver products for future early phase clinical studies and commercialisation and in doing so help foster UK economic competitiveness.