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Research Reports |
Sargent College
Boston University
Boston, MA 02215
 | Introduction |
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The findings reported in this article inform us that a majority of articles being published by these journals are original research studies (56%). From my perspective, that finding is very good news given the paucity of research evidence in physical therapy. However, although 86 of the articles reviewed were categorized as "containing information relevant to patient care," just 27 focused on interventions, only 1 addressed clinical prognosis or prediction, and none addressed questions regarding etiology, prevention, diagnosis, quality improvement, or health economics. This finding is less reassuring given the profession's urgent need for clinically relevant research evidence to inform evidence-based practice in physical therapy. Evidence-based practice is not possible in the absence of evidence on topics such as treatment efficacy, diagnosis, prognosis, prevention, and prediction.
If one accepts the implication that the infrequent publication of clinically relevant research in physical therapy is an indicator that insufficient clinically relevant research is being done in physical therapy, one needs to ask, Why is this so? In the United States, the American Physical Therapy Association recently formulated and published Clinical Research Agenda for Physical Therapy,1 a clear demonstration of the growing importance and emphasis being placed on clinically relevant research to the profession. This document calls on scientists in the field to conduct precisely the type of clinically relevant research evidence cited by these authors as infrequently appearing in these 4 journals.
What can be done to stimulate more research in physical therapy that has direct clinical relevance? In the United States, and possibly elsewhere around the world, I believe clinicians and scientists in physical therapy have functioned too separately, with the university operating in isolation from the clinical setting. Unlike medicine, in physical therapy there has been a divergence of clinical specialization and scientific inquiry, a divergence that I believe has hindered the conduct of clinically relevant research that will meet the contemporary demands of society for clinical interventions rooted in sound theory and scientific evidence, versus tradition and anecdote.
I believe clinically relevant research will proliferate when our university faculties and clinical specialists come together to collaborate closely on the design and conduct of research. Clinicians must seek out researchers, and researchers must find clinicians with whom to collaborate. Better yet, clinical specialists must develop skills to conduct clinical research and be rewarded for it. The time constraints faced in today's insurance-regulated practice environment cannot be allowed to deter the profession from initiating and participating in clinical research. We researchers and clinicians must develop innovative ways to collaborate in the development, evaluation, and dissemination of future clinical innovations in physical therapy.
The second issue I would like to comment on is what the article says about the role of professional journals in physical therapy. The authors used Haynes' 4 forms of communication within professional journals2 to raise some interesting questions about the role of professional journals. Haynes categorizes professional communication as: (1) preliminary studies (scientist-to-scientist), (2) studies ready for direct clinical application (scientistto-practitioner), (3) review articles (practitioner-to-practitioner), and (4) case series (practitioner-to-scientist). What does this article tell us about the state of scientific literature in physical therapy? How do we evaluate the current emphasis in professional journals? And most importantly, what mix of articles should a journal aim for in the future?
The evidence presented in the article suggests that contemporary physical therapy journals contain articles that represent all 4 forms of communication as outlined by Haynes.2 Most attention is directed toward scientist-to-scientist communication. Is this an explicit policy on the part of these journals, and, if so, is it one that should be encouraged or discouraged? Can the needs of all these audiences be well met by one journal? What is the primary audience for each journal? Is it the scientific community? Is it the clinical community? Or both? Has the priority been made clear to readers and those who submit articles to the journals?
Can a professional journal meet the needs of both communities? Haynes challenges us by suggesting that journals that include all 4 types of articles represent a "hazard to clinicians and their patients"2(p725) because most clinicians do not have the necessary skills to critically appraise research articles and understand how they might apply to their practice. Is Haynes correct in this assertion, or does he beg the question of why don't clinicians have the skills needed to critically appraise articles in the literature? Should the profession and academic institutions, in particular, strive to better prepare clinicians with the critical appraisal skills necessary to appraise articles and conduct evidence-based practice, or should journals abandon the goal of communicating directly to practitioners and serving as a vehicle for clinicians to communicate with scientists? Leave communication to clinicians to other vehicles such as evidence-based journals, whose goal is to distill clinical research for its readers?
The findings in this study raise interesting issues for the profession, editors, and editorial boards representing these physical therapy journals. The authors are to be congratulated for bringing these issues to our attention, and I look forward to further dialogue on these issues in the coming years.
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This article has been cited by other articles:
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  J. Schreiber, P. Stern, G. Marchetti, and I. Provident Strategies to Promote Evidence-Based Practice in Pediatric Physical Therapy: A Formative Evaluation Pilot Project Physical Therapy, September 1, 2009; 89(9): 918 - 933. [Abstract] [Full Text] [PDF]
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S. M Collins Complex System Approaches: Could They Enhance the Relevance of Clinical Research? Physical Therapy, December 1, 2005; 85(12): 1393 - 1394. [Full Text]
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T. Oliveri and J. M Rothstein Autonomy or Isolationism? Physical Therapy, August 1, 2003; 83(8): 745 - 745. [Full Text]
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