Invited Commentary

A Missed Opportunity to Articulate a Bold Vision of Research for the Profession

First, I am troubled by the fact that there is no clear statement about the purpose of having a Research Agenda for the profession. In the abstract, the authors state that the Research Agenda emphasizes the comprehensive nature of rehabilitation research that potentially can enhance practice—however, this is really not a purpose. In the article, the authors do state that one purpose of the revised Research Agenda was to make it broad enough so that all areas along the continuum developed by Eisenberg were included. There was no rationale provided for why the Eisenberg conceptual model was chosen in the first place, and, as such, this argument seems a bit forced, if not circular. A second purpose was to make sure the agenda is disseminated. The third purpose was to be able to share it with a broad range of funders, not just those interested in clinical research. I do not see these necessarily as purposes for developing a research agenda, but more as guidelines for the scope of an agenda, in part related to its intended use. Indeed, in the next paragraph, the authors refer to these aims as “characteristics” of the Research Agenda and not “purposes.” The authors convey confusion about the purpose for the agenda: Is it meant to define areas of rehabilitation research for the profession, as suggested by the title, or is it to provide guidance to the budding physical therapy researcher, as suggested in the article? While perseverating on the need to provide guidance to junior investigators “trying to establish a program of research,” in my view, the authors missed an opportunity to articulate a powerful vision of the possibilities for research to shore up the practice of physical therapy in general.

I challenge the authors to be bolder in their vision and less timid, as implied by the cautious tone that permeates the article. After all, sound clinical practice rests on a foundation that includes research and education. A powerful and bold vision of the possibilities for research for the profession would be welcome and not limited to only those in the United States. The statement about providing guidance for physical therapist researchers in the United States seems counterproductive to others outside of the United States who continue to look to us for leadership in physical therapy research.

Too Much on Process, Not Enough on Research Infrastructure and Training

Research does not occur in a vacuum—at least, high-quality research warrants the proper infrastructure and appreciation for its importance—yet there is no mention of the infrastructure, let alone the quality of the research that could be promoted with this new Research Agenda.³ There is significant emphasis on the consensus process used to generate the items for the new Research Agenda. In fact, 1 of the 2 figures in the article was chosen to illustrate the steps in the process. I may be reading into this, but it appears to this outsider that the focus on process represents a somewhat defensive stance taken, in large part, as a preemptive measure against those who might argue for a more open and inclusive process. Although the process used to generate the items in the Research Agenda is important, I would have liked more acknowledgment at the least—or a discussion at the most—of the important aspects of the context for research, including an adequate research infrastructure and educational training programs for clinician scientists.

I was surprised that, for example, there was no mention of sharing the Research Agenda with academic education programs in physical therapy for purposes of aligning faculty recruitment efforts with program research strengths or for mentoring junior investigators within these programs in planning their research programs (see Boninger et al⁴ for examples in physical medicine and rehabilitation departments). It would be naïve at best and possibly even detrimental at worst to suggest that simply providing a list of 80 items (generated using an inclusive consensus approach) comprising a research agenda was all that was necessary to launch a program of research. However, because there is no mention of the context for the research outlined in this Research Agenda, the implication is just that—a sort of rogue “have list, will travel” approach is implied. In all likelihood, the individuals who will benefit the most from this Research Agenda are those who come out of strong graduate programs and who have between 2 and 4 years of postdoctoral training before seeking a faculty position in an academic institution. Beyond training, more and more, high-quality research requires a modest level of funding, whether laboratory-based, computer simulations, or survey/qualitative in nature. Furthermore, in times such as these when funding is tight and only high-quality proposals are exceeding funding thresholds, the requirement to articulate an important research question and provide concise specific aims is fast becoming an important and necessary skill for success.* Having a list of 80 items as potential research directions is simply not enough and to suggest that it is, is simply not realistic.

In all likelihood, the Research Agenda will most often be used in a post hoc manner after the research question and approach have been selected in order to assess whether the chosen direction falls within the Research Agenda of the profession. In fact, in putting together the research goals for the Physical Therapy Clinical Research Network (PTClinResNet), the first clinical research network in physical therapy funded by the Foundation for Physical Therapy,⁵ we proceeded in a post hoc manner—we wrote the proposal, and only then did we consult the Clinical Research Agenda to see if our plan fell along the lines of the agenda. As suggested by Goldstein et al, we identified what we defined as a set of important research questions, chose an appropriate design and methods, and only then did we consult the Clinical Research Agenda.² We chose clinician scientists to lead each randomized controlled trial hosted by PTClinResNet based on their experience and track record—we knew that our chances for success were much better going with experienced and skillful researchers than with new investigators. The important take-home message and the one that is missing from the revised version of the Research Agenda is the necessary context to the agenda (ie, infrastructure, training) for putting together a successful research program. Simply having a laundry list of research items will never make for a successful researcher. If I wanted to be a successful ballet dancer, I would need much more than a tutu and a pair of ballet shoes.

Is the Research Agenda Forward Thinking Enough?

My final concern is more a question about whether the process used to generate items was better suited to characterize what is going on in research rather than what should or could be going on in research in the future—thereby limiting the forward vision of the Research Agenda. This reminds me of a somewhat similar problem we identified more than 20 years ago in the introduction to a special series on movement science.⁶ There, in connection with a 4-year citation index review of PTJ,⁷ we remarked that doing an analysis of items in this manner and concluding that these items are the “most relevant” for the profession is limiting and restricts the vision necessary to move a discipline forward in an organic and real way. An example of the kind of forward thinking that I would have thought would be important for setting out a revised Research Agenda for the profession is the excellent report on the Physical Therapy and Society Summit (PASS) meeting.⁸ Yet, there was not even a passing nod to this extraordinary gathering, likely reflecting more on a disconnect within the Association's administration than on anything else.

On a positive note, I was particularly encouraged to see “genetics” included in several items under the Basic Research category. This aligns nicely with recent interdisciplinary perspectives on improving patient care.⁹ “The intersection of behavior and genetics provides exciting research possibilities,” said Richard Suzman, PhD, director of National Institute on Aging's Division of Behavioral and Social Research. “If we can determine the extent to which we can tailor behavioral treatments to the unique genetic characteristics of an individual, then we will be on our way to the era of personalized medicine for a variety of conditions.”¹⁰ Indeed, there are tremendously exciting and challenging times ahead for rehabilitation research—it will be particularly important for our profession to embrace these challenges and opportunities and firmly embed them into our very being. What better way to do so than through an expanded and revised Research Agenda that has an eye on the future?