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Break into print

If you’ve been inspired to carry out clinical research, be sure you do all you can to smooth the route to publication. Janet Wright explains

Physiotherapists endlessly fine-tune their practice in the light of new research published in specialist journals. Those wishing to publish their own findings are often disappointed, as the average paper is more than likely to be rejected. This happens for the best of reasons: competitive standards reduce the risk of wrong information getting into the public sphere. ‘The work needs to be rigorous and scientifically sound,’ says Dr Michele Harms, editor of the CSP’s peer-reviewed journal Physiotherapy, which rejects about 75 per cent of the papers it receives. ‘By the time I get a paper, authors have invested a lot of time and effort. But if the research isn’t sound, it’s too late to do anything about it.’ Many papers fall at this first and highest hurdle. Their conclusions are worthless because the research hasn’t been properly carried out. ‘It happens when people think they’ve developed the skills at undergraduate level and go about things in a naïve way, because their knowledge is fairly limited at that stage,’ says Professor Ann Moore, joint editor of Manual Therapy, which has a 52 per cent rejection rate. She’s looking for findings that move the knowledge base along. ‘I really like studies that are adequately powered,’ says Michele Harms. ‘It’s very exciting when you get samples of a couple of hundred people and you know you’ve got some serious research going on.’ One problem, she says, is that researchers don’t continue long enough. ‘The whole set-up of a trial is so expensive, you want to say “Run it a bit longer, you’ve got everything in place”. But they stop at 20 subjects and think that’s enough.’ So the most important step is to ensure, from the start, that your research will be publishable.

One at a time

Next, choose what journal to approach only one at a time, as the reaction of editors tricked into publishing duplicate work would probably abort your research career. The choice depends on your goals and your intended readership. Research published in peer-reviewed journals is considered the most reliable, as it has had to pass expert scrutiny. From a career viewpoint, that makes it more useful on a CV. To share your findings with other physios in general, you’d submit it to a journal such as Physiotherapy or Manual Therapy. To reach colleagues in a particular field, such as sports injuries, a specialist publication such as Physical Therapy in Sport is more targeted. In some cases you’ll trade a smaller readership against a better chance of publication. If your work is relevant to a wider audience, including doctors, you could try medical journals such as the BMJ, though the competition is fierce by this stage. If you hope to build up the research side of your career, you’ll be offering your work to the journals with the highest impact factors within your reach. Impact factors rank journals by how often the studies in them are cited by other researchers. The BMJ’s, for example, is 13.66. The most cutting-edge scientific research is published in Nature, which has an impact factor of 34.480 and rejects well over 90% of submissions. On the other hand, says Michele Harms, ‘very few physios read Nature’. When you’ve chosen a journal, find its website and read its guide to authors. This will provide essential information on how to submit your manuscript: length, style, headings, references and so on. Its ‘aims and scope’ section will clarify whether or not your work is suitable. If you’re not sure, try a query to the office.  Most editors receive submissions that break every one of their guidelines. Some are even set out in another journal’s format, revealing that they have been rejected elsewhere and sent on without revision. Clumsy or jargon-laden writing loads the odds against others. Michele Harms recommends having your work read before submission, starting with someone who has no specialist knowledge, such as a family member, to make sure it’s written clearly enough for anyone to understand. Then get it read by a colleague at about your own level, and then, if possible, by someone more experienced. ‘Somebody who writes in a succinct way and has followed the guidelines  their papers are the ones we really welcome because they use the reviewers’ time better, concentrating on the science instead of the writing,’ says Ann Moore. Some five per cent of submissions to Manual Therapy are weeded out immediately, she says, because they are either weak, outside the journal’s scope, or impossible to read. Most papers for physiotherapy journals will make it to first review, where experts in the field read them closely and send back comments. This is the stage when most papers are weeded out. ‘Peer review can seem quite harsh, but it’s supposed to be a critique,’ says Michele Harms. ‘If you’re a novice researcher, look at the positives and work with it and think of it as a constructive process.’


For many authors, the next stage is rewriting. Those working in teams, such as Dickon Crawshaw, have an advantage. ‘When I got comments back from peer review, I had five experienced people saying “this is how you should respond”,’ he recalls. MSc or BSc students should get back-up from their tutors. But lone researchers have to work through this alone if they haven’t linked up with mentors. Rewritten work is sent back for second review. After this, the paper should need little if any further rewriting. A small percentage are rejected if, after two attempts, they haven’t been able to deal with the reviewers’ issues properly. If your paper wasn’t inaccurate but didn’t make it into a peer-reviewed journal, there are other options. They may not carry the same kudos, but will still get your message across. ‘We sometimes suggest authors send their papers to clinical interest and occupational groups because a lot of them have their own journals or newsletters,’ says Michele Harms. ‘It might have been a case history we weren’t interested in publishing, but if it’s sound it could go to a Clinical Interest and Occupational Group. That’s often a good place to start, and they don’t have the same number of submissions.’ Alternatively, submitting a paper for peer review at an event, such as the CSP Congress, can really pay dividends. If successful, your paper is allocated display space to be viewed by all attendees. And if it’s deemed to have particular merit, you’re given the opportunity to platform present your research in a 15 minute talk. This year, no less than 12 authors were due to present their papers at Congress. Don’t let the sometimes daunting process dishearten you. As Michele Harms says, ‘It’s a learning process and we’ve all had to go through it.’ fl

Top tips:

  • get the backing of your line manager and employers before anything else
  • put work in at the beginning, assembling the team you need or at least ensuring you have a mentor and guidance
  • expect to make a commitment of several years to a research project
  • allow more time than you think you’ll need to secure funding, satisfy ethics committees and recruit subjects
  • don’t start a project if you’re likely to be moving on within a year or two
  • ensure the study is rigorously designed


  • choose an appropriate journal
  • read and follow its guidelines
  • get your work read through for clarity and correct English
  • take criticism on the chin and learn from it


  • use unnecessary jargon
  • submit the same work to more than one journal at once


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