This body of work covers a broad range of unanswered questions on the important clinical problem of peripheral nerve injury (PNI). PNI is a significant health problem that can leave patients with reduced sensation or function of their injured limb and may cause chronic pain that is difficult to treat. Treatments for these injuries have not changed for decades in part due to a lack of data on key aspects of clinical care. Perhaps the most obvious lack of data lies in knowing the scale of the problem, addressed in chapter 2 which uses national data from the National Health Service in England to determine the incidence and epidemiological characteristics of PNI. Chapter 3 describes a single centre Phase 1 clinical trial focussed on the safety of a novel academic designed and manufactured device for nerve gap injury and used in 17 digital nerve injuries with no safety concerns raised. The perceived adequacy of the outcome measures used in this study led to Chapter 4, a systematic review of all outcome measures used in PNI to explore the most frequently used outcome measures and develop the framework for a core outcome set in PNI. In identifying a lack of high quality reproducible and objective outcome measures, novel methods were sought. Firstly, in Chapter 5 which investigates sensory end organ changes, including epidermal thickness and sweat duct density after PNI as a novel biomarker of sensory nerve regeneration. Then in Chapter 6, which explores repair site ultrasound morphometric changes, grey-scale and volumetric measurements and how these relate to current clinical outcomes during nerve regeneration. Overall, this thesis seeks to define the recent epidemiology of PNI in England in order to demonstrate the scale of the clinical problem. It also seeks to address the need for a clear and uniform approach to outcome measurement of peripheral nerve regeneration whilst developing much needed objective and detailed measurement of the early stages of peripheral nerve regeneration where clinical interventions may be required.
Developing Novel Outcome Measures for Peripheral Nerve Regeneration
Murphy, R. (Author). 31 Dec 2022
Student thesis: Phd