… from Tasha
So one thing that I’ve found fascinating during my time as a researcher is the disconnect that sometimes occurs between therapists working clinically and researchers studying clinical treatments. Some of the recent posts on the recent WCPT conference have captured this idea of disconnect through discussions of therapists saying, “I know this treatment works” and researchers saying “I’ve tested this treatment and I know it doesn’t work (e.g. it isn’t any better than placebo or usual care)” with both speaking of the same treatment.
The interesting thing is that the disconnect goes both ways. I’ve spoken to therapists who start a research career and who start to work academically and they say that their previous clinical colleagues immediately assume that they no longer know how to treat a patient, or that they are far removed from the clinical world. And you speak to researchers who disregard anything a clinical physiotherapist has to say, because they don’t ‘understand’ research.
Now obviously these are extremes, but I feel these varying levels of disconnect can sometimes be very dangerous. Now I can’t talk for physios working clinically as I currently don’t and I won’t likely again. However, I can speak from my view as a researcher. First, we know so little about so many musculoskeletal pain conditions. Often we don’t even properly know what causes the pain. Now if this is the case, any hypothesis we have on how a treatment works is, at best, an educated guess. So as researchers, if we continue to test treatments based on these ‘guesstimates’ of mechanisms of action, we can be missing a massive part of the picture. I strongly feel that we have to go back to the patient and see how and what they are presenting to us to try to develop alternate hypotheses and develop new treatments. To me this is where an alliance with clinical physiotherapists is vital to researchers (who don’t work clinically). Clinical physios are the ones who will treat a million people with a condition and notice the strange things that sometimes occur that can present us, as researchers, with ideas for new hypotheses. This is the fascinating part of research and what I’d argue, imperative to move the field forward.
I’d appreciate others’ opinions on this and of course, any experiences that you may have had.
9 Comments
Tasha,
Great post on an interesting topic. When I talk to experience clinicians, they say that research is 10-15 years behind clinical practice. When I talk to researchers, they say clinicians take 10-15 years to implement research. A disconnect indeed!
As a full time clinician, here’s were I think the clinicians contribute to the disconnect. Most do not do a good job of measuring actual improvement of the patient with validated tools like those used in research. I think this causes a huge disconnect between what clinicians read in the research and “see” in the clinic. Obviously, we’re going to believe (rightly or wrongly) what we see in the clinic.
I also think its difficult for clinicians to see how a line of inquiry evolves and how it applies clinically. We tend to read research 1 study at a time, and only consider them in isolation. Its easy to discount the results of just one study as not relevant to you. I love going to conferences and seeing a well established researcher present how one study lead to the next, then the next and how the cumulative result applies clinically. It really bring home the clinical relevance. Currently, the only way to get this experience is to go to conferences, which only a very small percentage of clinicians actually do.
So, we’ve clearly identified there’s a disconnect. Both sides have things to work on. I’ve heard several times that clinicians and researches need to close the gap. How do we connect or form an alliance and once we connect, what do we do? I’m a clinician interested in helping out, it sounds like there’s several researchers here…now what?
Cody
Cody, thanks so much for your reply. Your comments are spot-on and it’s really awesome to hear from you, speaking from a clinical therapist point of view.
My view of how we can bridge this gap involves having clinicians and researchers actively engaging in research together. Having clinicians like yourself who are interested in asking questions, finding out answers, and helping out with the process is exactly what we need!! As researchers, it can actually be incredibly hard (and incredibly time-consuming) to find clinicians who are willing to assist in data collection. And this is not to bag the clinicians – they are absolutely engaging out of good will as they are not paid. In fact, I can completely understand why, in some circumstances, being involved with a research study just can’t work. I love having open-minded, inquisitive clinicians as part of the research network, where over a beer or a glass of red, a great discussion occurs!
Soo…having said that, where do you work and what are your interests? We would love to bring you into the research discussion!
Tasha,
I agree that part of bridging the gap involves having clinicians more involved in the research process. To that end, from your perspective, what should the level of that involvement be in an ideal world? Cab sav conversation consultant? Managing data collection? Helping out writing it up? Managing an entire study that is a part of a PhD’s research agenda? Managing an entire clinical study that is their own idea with consultation from a PhD? Without consultation? Obviously it depends, but I’d like to get your thoughts and the thoughts of others here as to where we fit in the process.
I’m definitely interested in the research discussion. I work in an outpatient ortho clinic in the US, just outside of Boston, Massachusetts. We see a primarily non-surgical population, the majority being low back and neck pain. I’m interested generally how we do a better job with this population, and more specifically what features of a patients presentation suggest they will benefit from different interventions and how we implement those interventions as effectively and efficiently as possible. I’m also interested in how we measure patient recovery or outcome to determine the quality of care delivered. You can email me at concordpt@gmail.com anytime.
Cody,
You raise a good point – I certainly didn’t mean to infer in my last comment that the role of clinicians should be limited to cab sav consultant! Hahaha! Although I always do enjoy increasing my numbers of those type of consultations! I think all the things you suggest (with the exception of the last one) all are feasible and important collaborations.
The only reason I’m a bit sceptical about the last one (clinician driving a research project without consultation of a researcher) is that very interesting ideas, that could have major impact, may not be tested in the best way that would allow one to best answer the question if a researcher is not consulted. I don’t mean at all to make it sound like researchers have all the answers (I know I certainly don’t) or that clinicians can’t have valid research ideas. Clinicians certainly can and do. But just like I recognize that you have a vastly superior understanding of treating ‘actual patients’, I think that it is important to recognize that as researchers we have received anywhere from 3-6 years of intensive research methodology training and have run many studies and have worked with ethics committees, etc.. So to not use the resource of researchers seems to me to be making more hard work that is not needed for an already busy clinician. Granted, this requires finding a researcher that is interested in your area/ideas, but I’d argue that most researchers would welcome ideas coming from the other source! I guess I just reckon that combining the strengths of both teams would be more conducive to good ideas and good research.
I think in the end what determines your role is how much you are interested in the project and how much time and effort you are willing (and can afford) to put in. I’ve mainly done the planning of the studies with other researchers and then worked with clinicians, at the clinics where we are recruiting patients, to tweak the study so that it works in that setting. But having said that, I’ve had fascinating conversations with clinicians that are now developing into research projects in which the clinicians are putting their ideas on paper and then I’m tweaking those ideas into a research project. I would love to have more clinicians come to me with their ideas based on what they’ve seen and then work with them to develop an incredible project! I’ll definitely drop you a line in the near future and we share some ideas.
Tasha,
I certainly agree that the level of interest likely determines the role. I’m sure there are many clinicians who would love to have their role limited to cab sav consultants. Not a bad gig if you can get it!
I agree with your thoughts that having someone who’s spent a lot of time and effort gaining expertise at designing and running studies is clearly very valuable. But I added the last statement because I’ve spoken with plenty of clinicians who feel that if the things they are interested in aren’t being researched. Frequently they don’t have contacts in the research community, so they figure they may as well give it a shot and do it themselves. There was a recent podcast from the PT Journal exploring why only 25% of abstracts presented at the Combined Sections Meeting in the US, from 200-2004 were ultimately published. I wonder if you looked back at those abstracts, would you find many of the abstracts were submitted by clinicians trying to put together an idea without the help of a professional researcher and didn’t have the experience to bring it all the way to publication?
I guess all that brings me back to the question of how do we make these connections happen on a larger scale. Clinicians and researchers tend to work in separate settings, doing related but very different jobs and directly interact very infrequently. I linked here through Body in Mind, which I think is doing some very good things to try to bring research to get clinicians involved in a more meaningful way, but at this point, its the exception. How can this happen on a larger scale. We’ve managed to connect, but its taken me lurking on a research blog, that I linked to from another blog, and then taking the time to post a comment before the connection happened! To make this happen on a larger scale, there can’t be that many barriers to sharing ideas. Obviously this is a huge and difficult question, and not one we’re likely to answer soon, but worth thinking about.
Hi ICECReamers,
Firstly thank you, Tash, for the post. As a newby researcher (I’ll be a year into my PhD on Tuesday at about 9am!) with an-albeit-short history of working clinically, this concept of a ‘disconnect’ between those in research and those treating patients does frustrate me. I agree entirely with you both in that there needs to be some clear way in which the two parties might meet and ultimately lead to better outcomes for patients.
On a personal note, I’m not sure what I find more irritating of the two extremes at either end of the spectrum: the clinician who knows what works anecdotally and is out of touch with new findings; or the researcher who has never been faced with a patient in pain, and completely discounts any findings in the literature that don’t reach statistical significance.
I’ve made a little pact with myself I guess– that I won’t be a ‘black-and-white’ thinker and instead I’ll constantly remind myself of our common goal. We’re all in this game because we want better outcomes for, in our case, people living in pain. If we get too black-and-white with our thinking, a divide is forged between people who may in fact have the same ultimate goal. This goes for anything I reckon, not just physiotherapy…politics comes to mind!
Flavia
Tasha, thank you for that post! Well said.
Your “First, we know so little about so many musculoskeletal pain conditions. Often we don’t even properly know what causes the pain.” led me to the following comment:
I must mention is that too many clinicians do NOT read research from other fields of exploration and thus miss out on some very important and vital knowledge that should impact their practice.
I am talking about research like Lorimer Mosely’s, Michael Shacklock’s, Ramachandran’s and others’, as well as the elegant theoretical and scientific model from Melzack, the “Neuromatrix”. Yes, this stuff is mainly about brain and neurophysiology, but when explored, has a significant impact on any treatment of people in pain.
Nowadays, there are internet communities that help disseminate the wide range of research and studies “out there”. As a sole PT in my own clinic, I have found a wealth of help in getting and staying up-to-date.
A plug for SomaSimple.com seems appropriate – vast library and threads with discussions can provide a huge resource to any clinician. And there are researchers actively involved.
No excuses.
A big “second that” to Flavia!
Flavia,
Excellent reminder and great pact. I was actually noticing how much I was writing “us vs them” or “clinician vs researcher” type statements in my posts above. It really is an artificial dichotomy. A little more interaction will likely go a long way in terms of blurring those lines and helping remind each other that we’re trying to reach the same goal, even if its from somewhat different perspectives.
Thanks for your and Tasha’s efforts in giving clinicians tools and knowledge to better treat our patients. I’m glad I’ve been able to make connections with some like minded people. This discussion has been fun, but tomorrow I get to step back from the PT world for a few weeks and head off to play in the mountains of Colorado. I look forward to possibly trading ideas in the future!
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