Short and Simple Way Forward
1
389 I HAVE over the past few years been involved in trying to raise awareness and knowledge about research, evidence based practice, audit and other related topics. I have talked with a wide variety of clinically based physiotherapists (and other therapists) and have frequently been struck by the lack of basic understanding of the terminology commonly used in many journals. The quality of the articles contained in Physiotherapy has, in general, improved dramatically over the last few years. However I do wonder if many readers might find these articles inaccessible. Over the six months December 1999 to May 2000 it has published 28 'professional' articles; of these 17 lead authors were academic or research physiotherapists. The remaining 11 were written by clinically based physiotherapists, the majority of whom were studying for postgraduate degrees. A solution to this might be the introduction of short, simple articles which review much of the assumed knowledge needed to critically review these articles. In particular therapists need to have a certain amount of insight into the various research processes undertaken, in order to make objective decisions about the relevance of particular articles to their clinical practice. Another poorly understood area is that of data presentation and analysis. Authors need to remember that many physiotherapists find interpreting charts difficult. I freely acknowledge that these comments do not apply to all physiotherapists. Journals such as the British Medical Journal, however, are not beyond publishing series of short informative articles on many topics, some related to this area, while others review clinical conditions and areas. In conclusion I am not suggesting that Physiotherapy should turn back the clock and reduce its standards. I am however suggesting that its pages could be usefully filled with a small amount of accessible educational material. I am sure that as a profession we have many skilled people who could be commissioned to provide this material. I would welcome comments on this matter. Joanna Powell MPhil MCSP Leeds Short and Simple Way Forward Physiotherapy July 2000/vol 86/no 7 Letters Journal Must Expand I READ with interest the editorial on evidence-based physiotherapy (Bithell, 2000). At the end, the author asked for suggestions about how the Journal could facilitate the process of evidence-based practice. May I offer some ideas? First, Physiotherapy is in the unique position of being probably the most widely read source of information for physiotherapists in this country. It is thus a powerful medium for promoting practice based on the best evidence, especially research. In view of this, a most fundamental benefit could be achieved by increasing its size, even if it meant increasing CSP subscriptions. Because the number of papers it carries is no more than five or six, the total amount of new evidence in any area of clinical practice is restricted. Furthermore, there appears to be a long delay between the acceptance of some articles and their actual publication. Does this reflect an excess of supply (new papers) over demand (actual publication space available)? The delay in achieving publication could also disadvantage members of the profession who are competing for research funding; a published article carries more academic kudos than one awaiting a date to be published. Indirectly there could be an effect on the production of new research. Secondly, there is the role of the CSP in relation to the Journal. I believe there is a definite case for the CSP to sponsor articles to be published in Physiotherapy. In particular, this would be useful for literature reviews and meta analyses. While the Journal’s editorial independence needs to be maintained, the profession would gain from this. A final area in which the Journal could facilitate evidence-based practice is by encouraging short ‘opinion’ type articles that challenge current theoretical models. These would need to focus on theory rather than professional issues, and in themselves would not promote evidence- based practice. However, by questioning assumptions that exist within the profession, and challenging these, it would open the way for more debate and facilitate the move towards practice more closely based on evidence. Arguably one of the greatest weaknesses of the profession is the power of ‘expert opinion’ and its influence on practice. Significant areas of clinical practice are based on dogma and tradition, rather than careful, critical research. The Journal has a unique role to challenge the status quo rather than enforce it. The opportunity to write opinion-type articles should be open to all, and actively encouraged from non- academics. Sometimes Physiotherapy falls short of its potential role of promoting evidence-based practice by publishing articles that are irrelevant to the majority of readers. This is probably in part due to the fact that it is written mainly by academics. While it is vital to maintain scientific quality, as a professional publication it has to reflect ‘normal’ (ie most common) practice. By providing the opportunity for CSP members to write opinion-type articles (rather than papers based on research studies) it would broaden its opinion and scope, and ensure that full-time academics or researchers do not become isolated from the current ‘big’ clinical issues. Associated with this, perhaps the Journal could run regular essay competitions related to academic or theoretical issues. 389
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Transcript of Short and Simple Way Forward
389
I HAVE over the past few years beeninvolved in trying to raise awareness andknowledge about research, evidence basedpractice, audit and other related topics. I have talked with a wide variety ofclinically based physiotherapists (andother therapists) and have frequentlybeen struck by the lack of basicunderstanding of the terminologycommonly used in many journals.
The quality of the articles contained inPhysiotherapy has, in general, improveddramatically over the last few years.However I do wonder if many readersmight find these articles inaccessible.Over the six months December 1999 toMay 2000 it has published 28'professional' articles; of these 17 leadauthors were academic or researchphysiotherapists.
The remaining 11 were written byclinically based physiotherapists, themajority of whom were studying forpostgraduate degrees.
A solution to this might be theintroduction of short, simple articleswhich review much of the assumedknowledge needed to critically reviewthese articles. In particular therapistsneed to have a certain amount of insightinto the various research processesundertaken, in order to make objectivedecisions about the relevance of particulararticles to their clinical practice. Anotherpoorly understood area is that of datapresentation and analysis. Authors needto remember that many physiotherapistsfind interpreting charts difficult.
I freely acknowledge that thesecomments do not apply to all
physiotherapists. Journals such as theBritish Medical Journal, however, are notbeyond publishing series of shortinformative articles on many topics, somerelated to this area, while others reviewclinical conditions and areas.
In conclusion I am not suggesting thatPhysiotherapy should turn back the clockand reduce its standards. I am howeversuggesting that its pages could be usefullyfilled with a small amount of accessibleeducational material. I am sure that as aprofession we have many skilled peoplewho could be commissioned to providethis material. I would welcome commentson this matter.
Joanna Powell MPhil MCSPLeeds
Short and Simple Way Forward
Physiotherapy July 2000/vol 86/no 7
Letters
Journal Must Expand
I READ with interest the editorial onevidence-based physiotherapy (Bithell,2000). At the end, the author asked forsuggestions about how the Journal couldfacilitate the process of evidence-basedpractice. May I offer some ideas?
First, Physiotherapy is in the uniqueposition of being probably the most widelyread source of information forphysiotherapists in this country. It is thus apowerful medium for promoting practicebased on the best evidence, especiallyresearch. In view of this, a mostfundamental benefit could be achieved byincreasing its size, even if it meantincreasing CSP subscriptions. Because thenumber of papers it carries is no morethan five or six, the total amount of newevidence in any area of clinical practice isrestricted.
Furthermore, there appears to be a longdelay between the acceptance of somearticles and their actual publication. Does this reflect an excess of supply (newpapers) over demand (actual publicationspace available)? The delay in achievingpublication could also disadvantagemembers of the profession who arecompeting for research funding; a
published article carries more academickudos than one awaiting a date to bepublished. Indirectly there could be aneffect on the production of new research.
Secondly, there is the role of the CSP inrelation to the Journal. I believe there is adefinite case for the CSP to sponsorarticles to be published in Physiotherapy. In particular, this would be useful forliterature reviews and meta analyses.While the Journal’s editorialindependence needs to be maintained,the profession would gain from this.
A final area in which the Journal couldfacilitate evidence-based practice is byencouraging short ‘opinion’ type articlesthat challenge current theoretical models.These would need to focus on theoryrather than professional issues, and inthemselves would not promote evidence-based practice. However, by questioningassumptions that exist within theprofession, and challenging these, it would open the way for more debateand facilitate the move towards practicemore closely based on evidence.
Arguably one of the greatest weaknessesof the profession is the power of ‘expertopinion’ and its influence on practice.
Significant areas of clinical practice arebased on dogma and tradition, ratherthan careful, critical research.
The Journal has a unique role tochallenge the status quo rather thanenforce it. The opportunity to writeopinion-type articles should be open toall, and actively encouraged from non-academics. Sometimes Physiotherapy fallsshort of its potential role of promotingevidence-based practice by publishingarticles that are irrelevant to the majorityof readers. This is probably in part due tothe fact that it is written mainly byacademics. While it is vital to maintainscientific quality, as a professionalpublication it has to reflect ‘normal’ (ie most common) practice. By providingthe opportunity for CSP members to writeopinion-type articles (rather than papersbased on research studies) it wouldbroaden its opinion and scope, andensure that full-time academics orresearchers do not become isolated fromthe current ‘big’ clinical issues.
Associated with this, perhaps theJournal could run regular essaycompetitions related to academic ortheoretical issues.
389
