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Where is the research????
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Where is the research???? - December 12, 2001 3:35:00 AM
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mcap
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Group:
Somewhat related to the previous thread.......
As we are all concerned about our futures and where we stand as "professionals," we often hear and find ourselves saying we need more research. And although we all know it isn't the only answer we do know that it is important.
So.....here is my question......where is it? The research I see coming out of some of the universities is poor. They are asking questions that matter very little in the big picture. Furthermore, the sample sizes never seem to get large enough to have any power. What gives and will this change???????
mcap
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Re: Where is the research???? - December 12, 2001 4:28:00 AM
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Mark Hirsch
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Hi mcap,
I'll try to make a few points. Excellent question you pose...where is the research. Well, there is ALOT of it out there and much of it is clinical and some of it is basic science or aniumal studies which have application value in clinical neurosciences, my field, for example. My experience is that there is alot of PT relevant literature out there, but few bother to read it and so it just sits on the stacks and molds away. Another problem is that alot of good quality research is being done in other fields and these are very relevant to PT but noone reads it from our field because we dont have time and we are not broadly enough trained to understand literature in another field, say, education or physics.
More and more journals are asking for power analyses these days, but you are right, that wasnt always like that....
I think several points are crucial:
1. We dont necessarily need more research. We need people who can sift through what has been done and extract clinically relevant information. That means clinical neuroscientists, social workers, nurses, PT's OT's, physicians etc working hand in hand and each drawing on their respective field for information retrieval and exchange within the group. After all, we just had the decade of the brain and supposedly have learned more about how the brain works in the last 10 years than in the last 10 centuries...so alot of info out there but noone to bring pieces together.
2. Start exploring other journals for relevant info to PT...such as the Journal of Applied Physiology...if you have the time.
3. Attend a professional conference outside your area of expertise where you can make a contribution to their body of knowledge with your specialized background. I do one of those a year...but then I work in a very interdisciplinary field.
just my 2 cents.
[QUOTE]Originally posted by mcap:
Group:
Somewhat related to the previous thread.......
As we are all concerned about our futures and where we stand as "professionals," we often hear and find ourselves saying we need more research. And although we all know it isn't the only answer we do know that it is important.
So.....here is my question......where is it? The research I see coming out of some of the universities is poor. They are asking questions that matter very little in the big picture. Furthermore, the sample sizes never seem to get large enough to have any power. What gives and will this change???????
mcap[/QUOTE]
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Re: Where is the research???? - December 12, 2001 7:57:00 PM
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henryryry
Posts: 100
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From: Brisbane, Australia.
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mcap and mark,
you guys are quite right in saying that the research that are coming out do not necessarily correlate to what we are doing clinically. While this does not apply to all, I think the problem lies in the fact the academics tend to be stuck in Universities, while clinicians are too busy to read. Personally, after my graduation from undergraduate physiotherapy, there were no instructions or set protocols on how to keep up with the latest literature, and no incentive for most people, especially in Australia where the continual education program is very chaotic.
Henry***
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Re: Where is the research???? - December 12, 2001 11:39:00 PM
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Mark Hirsch
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Very true henry. The incentive is knowledge. I wish there were a payoff in terms of dollars and cents but unfortunately there isnt, as far as I can tell. If I think about what I invested into my education in the last 16 years and how much I earn now, its sad....but I'm not in clinical neuroscience for the money. Heck, you probably make more than I do as a PT!
I cant keep up with the literature either henry...as a matter of fact it has been calculated that to keep up with the literature in, for example, internal medicine, a person would have to read 16 research articles per day 365 days per year (Sacket et al. I forgot the year but I can get it for you if ure interested). Now I have interest and expertise in a variety of specialisations and I do research in three areas...its impossible to keep up with the literature.
And a final point is that perhaps it's not THAT important to keep up with the literature after all...what is even more important, im my opinion, is that we are innovative and creative when we work with our patients. Experts are quick to say that something will work or not based on theri experience....many good PhD ideas never made it to the drawing board because of this attitude. I always say that very often graduate students have the best ideas because they have not been spoiled by years and years of academic experiences. Reading literature is often a waste of time and it can make one think that nothing works.
[This message has been edited by Mark Hirsch (edited December 13, 2001).]
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Re: Where is the research???? - December 13, 2001 7:09:00 AM
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mcap
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Hirsch and Henryry:
I agree with both of you guys. Hirsch....you point about multidisciplinary involvement is an important one. We need to be looking at what others are doing. As someone with an interest in the spine, I read Spine. There are PTs who publish there occaisionally. I also read the journal of applied biomechanics although I am not so happy with it. I have read JOSPT from time to time but I don't find it that useful. Am J Sports Med is a better choice.
Yes, perhaps PTs don't need to be involved with research and keep up with every latest thing, but they should make the effort to be aware. I just don't think many PTs are motivated. I don't know what it is......part of the problem is that there is very little motivation. No one gets more money, or even more recognition. So individually, it won't get you much. As a profession however, it would help.
Furthermore, as I have contended on several occaisions......there are many PTs who do not have a very big vested interest in the field. They may have the spouse making more money, they may already have money, etc. So the motivation isn't there.
Just my two cents although I am sure to blasted by one SJBird [IMG]http://www.rehabedge.com/forums/frown.gif[/IMG]
mcap
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Re: Where is the research???? - December 14, 2001 4:08:00 AM
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Andrew M. Ball MS MBA PT
Posts: 271
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From: Chapel Hill
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Wow,
Ya'll are getting heavy duty into my area of doctoral research. I don't want to give too much away because I don't want to get scooped, so I'll just clarify a few points:
There are still many more females than males in the profession. Roughly 75% to 25%.
It does matter actually, because the age distribution of members is bimodal. APTA members tend to be members for about 3 years following graduation, then drop out. A pecentage of former members return after about 45 years of age.
They cite "cost" as a reason for dropping out, but it's more likely a "cost-related" factor of financial resource priority being prioritized toward children as opposed to APTA membership. Strictly speaking, that's not cost . . . it's a change in life priorities mitigated by cost. If it were truly cost, then states with lower membership dues (adjusted for cost of living of course), would have higher memberships. A demand curve (For all you Quant Jocks out there - basically an ROC curve) can be created with 51 points because dues are different values in each state and D.C. --- and we know membership percentages for each geographic area. Were cost roughly 90% of the issue, as Susan McGinty suggests, the R squared (aka coefficient of determination) would be around .90. It's not. It's not even close. It's less than .10. This means than the decision not to join the APTA can be attributed, no more than 10%, to cost.
National membership percentage is only about 35%, and has maintained at roughly this level sinch the mid 1970's. Members are far more likely to be involed with research efforts, if only by collecting data.
Finally, there is a perception that RCT's are the only kind of reserach that's acceptable. Those who graduated years and years ago stick to this. It's wrong. We know very little about rural physical therapy, and interview/hypothesis generating qualitative research is what's critically needed now. If quant jockeying isn't your thing, no sweat . . . but that's a poor excuse for not collecting data and calling on someone like myself or someone at a University to help out with the write up (in return for second authorship of course).
"I also think that a lot of therapists are just "doing a job." I haven't met many that go the extra mile. The majority just seem to be going through the motions." Sort of true. My data is beginning to show that older, more "experienced" PT's describe physical therapy as a "job," where newer graduates, esp. DPT's describe it as a profession, or "way of life." That change in philosophy can't help but have positive effects.
More themes as they emerge.
Drew
[This message has been edited by Andrew M. Ball MS MBA PT (edited December 14, 2001).]
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Re: Where is the research???? - December 14, 2001 5:24:00 AM
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mcap
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Drew:
Interesting points. I truly hope you are correct about new grads viewing everything as a profession. I see too many people viewing PT as just a job......and not one they plan on staying in.
I have a question for you about about expenses. The states with the lower state dues probably have lower costs of living, but also....lower salaries. Is there any way to compare the value of cost as a percentage of monthly or annual income. This would be a better indicator of whether the membership is too expensive.
Second.....there is, in my opinion, another reason why people don't join the APTA. Cost may be a politically correct answer but many people are angry. They feel that the APTA encouraged the development of new programs (this is true although the glut of programs may not be responsible for current woes - it doesn't help though). And they feel that the APTA has been weak in advocacy - this I would disagree with.
Another factor is ignorance of the clinical realities for the rank and file. The APTA came out with a salary survey whose main point was basically....if you join the APTA you are more likely to be fully employed. (Of course, if you are fully employed and have the money and are motivated, you are more likely to join. They should not have implied causation). Not long after the advance came out with a salary survey stating that the average salary hadn't increased in 7 years!!!!! This despite the largest peacetime expansion of our economy in history!!!! Therapists were facing adverse working conditions and salary reductions. Many talented people I went to school with left the field. I know people that left programs before they were finished and opted for med school or other choices.
No one is saying that they APTA can influence salary strongly or that they control the individual clinical situations. I am a member and I beleive in membership. But things were, in my opinion, close to crisis for a while and a little candor would have been appreciated.
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Re: Where is the research???? - December 14, 2001 6:05:00 AM
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Andrew M. Ball MS MBA PT
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From: Chapel Hill
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Mcap,
Again, I don't want to give too much away other than to say that all of the points that you rasied are currently under analysis. Philosophical differences with the national professional association is a great point, as is clinical ignorance of the rank-and-file.
I agree that APTA membership is critical, and a responsiblity that 65% of rank and file PT's punk-out of. There are more issues than the "what can I get from the APTA issues" that one typically hears from nonmembers. The pejorative effects of low national association membership percentages are quite numerous for an emerging healthcare profession such as physical therapy. The APTA is currently engaged in legislative efforts to acquire "direct-access" to patients in all 50 states (currently, 20 states require physician referral), as well as legislative efforts to protect of scope of practice against chiropractors who are attempting to restrict the abilities of physical therapists to use grade V mobilizations (manipulations) in the treatment of their patients. The APTA is currently engaged in elevating the entry-level education of physical therapists by putting forth a vision that by 2020 all physical therapists will be Doctors of Physical Therapy (DPT) , and continuously upgrading the accreditation standards of physical therapist education programs. The APTA is currently engaged in improving the scientific base of physical therapy by both funding and coordinating clinical research, and drafting clinical research agendas. Finally, the APTA is engaged facilitating contemporary clinical competence through establishment of section listservs (pediatrics, administration, health policy, etc.), and promotion of quality continuing education through a newly-developed endorsement process. Through summation of all of these efforts, the APTA seeks to develop the role of the physical therapist from that of a subordinate healthcare technician, to that of a primary care practitioner (such as an O.D., D.D.S. or D.P.M.) Low APTA membership percentages diminish the efficiency and effectiveness with which these goals can be achieved.
An interesting aside that I've pushed upon Ben Massey, Jr. (he's not quite in agreement by the way), is to introduce ammendment to the PT direct access legislation that ONLY APTA members be afforded direct access under the law. My argument is that they are the only ones bound by a CODE OF ETHICS, and though non-members may practice ethically . . . there is no punishment for not doing so. I bet if that went though, APTA membership percentage would double in a hurry.
Anyway, you may be interested to know that for the purposes of pre-study preparation, thematic analysis, using open-ended comment responses to two Chiroweb.com "Chiro Polls," were entered into a NUD*IST N4 database and coded (by my). The first question was, "How important is it for you to be a member of a national chiropractic association?" Of 644 total respondents, 20.3% stated that membership was "unnecessary," and 36.2% stated that membership was, "not important."
The second question was, "How low would the yearly membership dues have to be for you to join a national chiropractic association?" Of 1378 total respondents, 74.5% stated that they, "wouldn't join if it was free." All 26 comments attributed to a chiropractor voting in support of one of the three above sentiments were coded.
Sentiments of the respondents could be classified into one of six categories: (1) Unhappiness with Fragmentation, (2) Philosophical Differences, (3) Lack of Leadership, (4) Charges of Corruption or Poor Ethics, (5) Self-Centeredness, and (6) Cost. Roughly 50% of respondents cited philosophical differences with national chiropractic associations. Specifically, just over 20% found such associations too restrictive and limiting of chiropractic scope of practice to the status quo. Another 20% held an diametrically opposing viewpoint, citing differences in clinical philosophy (e.g. these respondents did not support subluxation theory pushed by national associations). Some went so far as to attack their colleagues with statements such as, "Take a look at the nonsense many of them preach to their patients. Some of them make no sense at all. DC who practice faith healing should not be given a larger scope of practice then they currently have," and, " . . . too many DC's have no regard for basic scientific principles or even rational clinical judgment." A little more than 10% complained that national chiropractic associations cater to older, non-scientific, "good ol' boy" clinicians, or that chiropractors were not, by definition, true scientific professionals. Fifteen percent of respondents cite a lack of leadership in protecting chiropractic turf, respectability within the healthcare environment and general public at large, and maintenance of high salaries (with respect to the 1980's) of chiropractors. Finally, several respondents gave self-centered, "what has the association done for me lately?" answers, and almost 8% charged both national associations and fellow chiropractors with corruption and a lack of ethics.
I think that we have similar issues going on in terms of philosophical mismatch between APTA and rank-and-file.
Drew
[This message has been edited by Andrew M. Ball MS MBA PT (edited December 14, 2001).]
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Re: Where is the research???? - January 9, 2002 2:13:00 PM
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jma
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From: NY
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Hello everyone,
I just skimmed through the January issue of the PT Journal and found something of interest that pertains to research. It is called evidence in practice. This shows how evidence is gathered and used to guide clinical decision making. This is an extremely beneficial update to the Journal and should help out in the research process. There also seems to be a database coming out called "Hooked on Evidence" to give clinicials quick and easy online access to knowledge from current research. A good step in the right direction. [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG]
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Re: Where is the research???? - January 9, 2002 6:44:00 PM
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mcap
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JMA:
Sounds good. I do like some of the trends I am seeing.
mcap
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Re: Where is the research???? - January 10, 2002 4:05:00 AM
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Mark Hirsch
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From: USA
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How does one access the hooked on evidence database?
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Re: Where is the research???? - January 10, 2002 6:44:00 AM
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mcap
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Mark:
As far as I know the hooked on evidence was tested in California and is currently being launched nationally. They are actually looking for grassroots participation.
For additional information call 1-800-999-2782 or visit the APTA website [URL=http://www.apta.org.]www.apta.org.[/URL]
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Re: Where is the research???? - January 13, 2002 4:45:00 PM
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PTupdate.com
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From: Pittsburgh, PA USA
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I may have a more unique perspective, as I have managed large regions and employed more than 50 different PT's over 7 years. First, I find that most PT's are not really motivated, either to work, treat successfully, or learn more. We have had various orthopaedic study groups here in Pgh, with educated persons from various organizations speak about a topic, and then we all have a round table discussion and teach each other new things. Attendance is usually poor, and the therapists that do make the effort to be present, are almost always the ones that really give a **** about getting people better, learning, and even doing research.
When I first entertained the idea of putting everything in my head on a web page, along with adding new educational material daily, so many PT's were "great idea, can't wait until it is up". Once launched, I had to laugh at how some reacted when informed...you would think that the $35 yearly fee was the equivalent of their first-born child! I have since stopped communicating with all these clowns, and they have learned to stop calling me for help with their patients.
I have always considered this a frustrating problem, and often became irate when performing chart reviews, where it seemed the only reason the patient improved was because of mother nature! Luckily, I am seeing more competent practitioners arrive, but I know there are so many apathetic PT's still out there treating people every day.
Has our own association done enough to promote a thirst for continued excellence? They are finally considering posting links to sites such as this and NOIgroup.com, as I have been requesting. The average PT, even when a member of the APTA, does not know about this whole other world, found in webpages by other PT's, or by the journals mcap mentioned earlier. Why isn't this information readily known by PT's? Is someone afraid PT's are going to discover that outside the APTA, there is all this wonderful stuff, and leave the association?
Why is the research in our own journals often so clinically irrelevent? I see PT's publish pertinent information all the time in Spine, JBJS, MSSE, among others. Why did they go to these journals instead of our own?
I know Mr. Ball and I have indirectly discussed the "time" factor regarding research in the past. It is a valid reason for many of us to not perform research. I personally have 20 different studies I want to perform, yet would probably end up divorced if I spend any more time from home! Perhaps the physican community has an advantage, with more free time to perform these tasks, more corporate dollars for the support, and more staff to perform some of the data collection.
I would be interested to see how various PT corporations would respond when one of their clinicians wanted one day off per week, spending money, and the OK to perform a research project.
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Re: Where is the research???? - January 14, 2002 11:46:00 PM
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Mark Hirsch
Posts: 101
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From: USA
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Hi Ptupdate,
Interesting comments you make. Physicians don't have more time to do research...research happens after hours and at the big universities it's done by graduate stundents and post-docs. The divorce rate is pretty high here I think.
I can somewhat understand how some of your studdents might have felt when they did not sign up for your internet site. Why pay $35 if I can get information at Rehabedge and Noi when its free of charge? Personally, I think $35 is a steal!
I'm not sure why the APTA wouldnt post a link to this site and to NOI...great places to share information as far as I'm concerned...but it doesnt suprise me. I had some bad experiences with the APTA a number of years ago when I attended their conference as a presenter of two posters and a platform presentation in 1992 0r '93. I was a doctoral student at the time and was told I could pay the conference registration fee for an APTA student member if I joined their association, which I did. Three weeks after the conference was over I get a call from the business office saying that since my University doesnt host a PT program and I am not enrolled as a PT student I cannot join the association and "would I like my money back". I'm sure APTA guidelinbes have changed but it left a bitter taste in my mouth and I Have not attended an APTA conference since.
I've worked at University Hospitals in the USA and Germany where the PT's ARE interested in research eventhough there's nothing (financially) in it for them. Also, at conferences I find that some PT's are very interested in research and love to debate the issues with them. PT's Ive talked to at conferences have an open ear....a little while back I was mentoring a staff of roughly 50 PT's, OT's and sport rehab staff in a brand new neurological rehabilitation hospital and found a lot of resistance to evidence-based neurological rehabilitation methods...I think partly that has to do with accessibility...obtaining clinically relevant information via computer or library stack is time consuming and its easier to ask an experienced PT for help, suggestions...part of the problem is human nature...some people are interested in research for whatever reason and some are not; partly its due to education...not being exposed enough to the value and method of science in PT school and not using science in clinical practice -- but that doesnt mean people can't turn around and change. For example, in Germany one of the biggest names in Evidence Based Medicine and Neurological Rehabilitation is a PT who was once one of the strongest proponents of Bobath, PNF and NDT. Roughly 5 years ago, at around 45 years of age, she switched 360 degrees and now not only treats patients according to a more EBM approach but also does research comparing NDT to EB methods. Her motivation to do so? I don't know...but in Germany PT's dont make squat compared to the US counterparts...there is no financial incentive whatsoever for a PT to do research here.
Mark
[This message has been edited by Mark Hirsch (edited January 15, 2002).]
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Re: Where is the research???? - January 15, 2002 5:00:00 AM
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PTupdate.com
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From: Pittsburgh, PA USA
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Hi Mark,
Thanks for the comments. Like you, I was left with some bad impressions regarding the APTA, and did not belong for years until just last year, when I rejoined. I have had even more bad experiences, but will wait and see how they respond to the website thing.
Actually, when I mentioned the 50+ I supervised, I wasn't talking about students, but actual paid PT's! That is the frustrating part! Actually, students have been quite receptive to the site, and are often still so eager to learn.
Perhaps I will add to my long list of "reseach projects I want to do" one more: a survey to 1000 PT's asking them why they choose not to perform any research or write articles, what could be done to change that, what they do to continue learning, etc.
Regards,
John Duffy
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Re: Where is the research???? - January 15, 2002 6:06:00 AM
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mcap
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PTupdate:
I agree with your comments. However, I think the issue at hand isn't necessarily whether PTs should be performing research. This is expensive and time consuming and yes, in many instances, boring [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG] My own plan is to get my PhD, make a few people call me Dr. and then commit suicide [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG]
But the other issue you raise is very important. Why don't they even want to read some of the research? For this, there is no excuse. You would expect your physician to keep up, so why not your PT. I am not sure. Accessibility is certainly a factor.
I formed a study group here in NYC and have been to several others. The PTs are certainly motivated to learn. However, in some cases, they were simply a forum for a clinician to disseminate the latest Guru technique. I have also found that these groups can come to be dominated by the "grizzled veterans" who have many years of experience but not much use for EBM. They have been doing things the same way for years and are not open to much criticism from younger upstarts. My group was a lot more research oriented and we always criticized any technique we were using. I haven't had it in a while however because of school.
As for your website, it seems like a great idea and 35 is not a lot to pay. However, you must realize that it is a philosophical issue. People do not like to pay anthing for anything on the web.....period. There is a lot of stuff out there for free and most people refuse to hand over money. I have had a web site with a lot of good information (at least I think) up for years now. However, I don't expect that anyone would pay for access.
mcap
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Re: Where is the research???? - January 15, 2002 6:14:00 AM
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Mark Hirsch
Posts: 101
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From: USA
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Whats your website www mcap?
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Re: Where is the research???? - January 17, 2002 3:00:00 PM
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jma
Posts: 2415
Joined: August 24, 2000
From: NY
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Hello,
The web address where you can access Hooked on Evidence is at:
https://www.apta.org/hookedonevidence/search.cfm
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