The Need to Improve the Clinical Relevance of O&P Research
February 2015 Issue
As a reviewer for journals and research proposals, I have read many O&P studies, and most fall short of being clinically relevant. To me, clinical relevance means that clinicians will find the information or results of interest in their clinical practice and may adapt or apply the ideas presented. There are several reasons for the lack of clinical relevance.
A lack of clinical experience among researchers. There is no substitute for patient care experience when defining problems. Each patient presents with a different set of conditions, and researchers who lack patient care experience may not have a keen understanding of the treatment parameters most pertinent to practitioner decision making.
The lack of a good theoretical mechanism for linking research findings to clinical decision making. A practitioner has to be able to reason from the scientific generalizations presented in published research to apply it to the needs of a specific patient. Abductive logic can make this conceptual linkage by pointing out the difference between scientific questions and clinical practice. Making greater use of measurements taken in the clinic, including the unique characteristics of patients, will help to establish and define the clinical relevance between practitioner decision making and research.
The need for agencies to implement funding mandates. Federal agencies are granted monies by Congress, which places the agencies under pressure to make awards. Agencies are then empowered, many times without input from clinicians, to grant research dollars irrespective of whether the research will ever be useful in a clinical setting.
The problems associated with the dissemination of clinically relevant research. Most of the research journals available to practitioners contain papers that deal with pure research. These journals accept research papers based on their adherence to scientific principles and peer review, and frequently both are concerned with the universality of the findings. Patient-centered clinical care is focused on the needs of the individual patient. In O&P, the rehabilitation needs of the individual are not necessarily the same as the goals of pure research. Thus, it may be difficult for the clinician to find relevance in the published research. Having their work published in journals is important for researchers because it offers an enduring format and is prestigious; researchers rely on their published articles to lay the foundation for their study funding requests. Thus, if researchers are to focus on research of clinical importance, a more inclusive definition of the work accepted for publication should be established to improve the dissemination of research that has clinical relevance.
Practitioners, especially those who have a background in science, including me, wish to see an improvement in the clinical relevance of funded research. The presented ideas are not difficult to implement-they only require the motivation to change the status quo.
Edward S. Neumann, PhD, PE, CP, FAAOP, is emeritus professor of civil and environmental engineering, and adjunct professor of kinesiology at the University of Nevada, Las Vegas.