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Letters and Responses |
Richter and colleagues'1 report of publication productivity in academic physical therapy programs is timely for a number of reasons. First, the previous review of scholarly productivity in physical therapy was performed 2 decades ago,2 prior to the introduction of "Vision 2020" by APTA and the transition of the majority of academic programs within the United States to the Doctor of Physical Therapy degree. Second, there is increasing expectation for those within the academic realm to demonstrate productivity in order to achieve promotion and tenure and meet standards set by the Commission on Accreditation in Physical Therapy Education (CAPTE). Third, there are increasing threats to the profession from complementary and alternative health care professions, all of whom have also recognized the importance of publication productivity.3–6 Based on these facts, determining the overall publication productivity within physical therapy is a necessity, and Richter and colleagues should be applauded for their work.
Unfortunately, there are numerous serious caveats to the report by Richter et al. These ultimately result in the data providing an inaccurate representation of the profession's true publication productivity. The investigators rightly searched for peer-reviewed journal articles within publicly available bibliographic databases. However, the search execution using field tags with the terms "physical" and "therapy" in the affiliation field is overly simplistic. Because both PubMed and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) report only the first affiliation of the first author for each paper, Richter et al's search strategy retrieved articles only where the first author listed his or her first affiliation as being "physical" and "therapy." It did not retrieve publications in which a physical therapist: (1) was working as part of a multidisciplinary research team but was not the first author; (2) was senior or last author and the first author was not affiliated with an academic physical therapy program; (3) teaches within an academic physical therapy program which does not contain the terms "physical" and "therapy" in its department's name (for instance, when physical therapy is a division within a broader department); or (4) had an external affiliation that was listed within a publication prior to their academic physical therapy program affiliation. Richter et al1 acknowledge the possible limitation of their search strategy; however, a full appreciation of how the strategy grossly underestimates the actual productivity within academic physical therapy programs was not provided for readers.
To illustrate the limitations in Richter and colleagues' search strategy, consider the following examples. I performed a search of PubMed using my own name and the terms "physical" and "therapy" as affiliation field tags. Using Richter and colleagues' search strategy, I am accredited with 12 publications during my time affiliated with an academic physical therapy program within the United States (August 2004–January 2008). However, when the affiliation field tags are removed, I am accredited with the more accurate number of 24 publications during this time period in which my academic physical therapy program affiliation was clearly listed in the publication. To demonstrate that this is not a finding related to an individual, I looked in PTJ for the 2007 calendar year. PTJ published 37 original research reports during this time that were co-authored by at least 1 investigator affiliated with an academic physical therapy program in either the United States or Puerto Rico. Using the search strategy used by Richter et al, 30% (11 out of 37) of these publications were not located using either PubMed or CINAHL.
In addition to grossly underestimating the contribution of the profession to health care in terms of total number of publications, the search strategy implemented by Richter et al also discredited important research contributions by the profession. As an example, recent research from the Extremity Constraint-Induced Therapy Evaluation (EXCITE) trial showed that constraining the nonparetic upper limb following stroke improves functional outcome of the paretic upper limb and reduces self-perceived hand function difficulty for up to 12 months.7 Physical therapists were the principal investigators in this trial and lead authors on the resulting publications; however, this influential body of work would not have been credited to the profession using the search strategy of Richter et al, because the first author's affiliation did not include the terms "physical" and "therapy."
A further limitation is the fact that the search period was for publications between 1998 and 2002. The rationale for performing a search with a concluding time point of 2002 (5 years ago) was that there is "a time lag between initiating a project and seeing the work published." While this is true, it does not explain why more recent publications were not included. A body of work that has been published has already experienced the time lag between project initiation and publication. Thus, it is not clear why Richter and colleagues did not conclude their search with a date closer to the initial submission of their manuscript (September 2006). This would have provided more up-to-date, rather than historical, information.
In summary, I applaud Richter et al for their foresight in recognizing the need to establish journal publication productivity in academic physical therapy programs. Although their intent was genuine, their methods were not, and I am concerned that the data obtained does not provide an accurate representation of the actual contribution of the profession.
SJ Warden, PT, PhD, is Assistant Professor and Director of Research, Department of Physical Therapy, Indiana University, Indianapolis, Ind
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  S. R Harris On "Journal publication productivity..." Richter et al. Phys Ther. 2008;88:376-386. Physical Therapy, June 1, 2008; 88(6): 791 - 791. [Full Text] [PDF]
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