Why bother with research?' 'What has research ever done for us?' 'We're very busy people'. 'I don't have the time.' 'I just want to treat patients.' 'It's not very interesting.' 'It's not really relevant.' These are some of the common refrains triggered by the thorny topic of research in physiotherapy. While it can be difficult to find the time and energy to engage with research, the perhaps unpalatable truth is that, no matter what your background, there is a reason for making a working relationship with research, and a way to do this.
Research - based on robust and relevant evidence - is necessary to help raise the professional status of physiotherapy. By creating a specific knowledge base, research helps to define what physiotherapy is, and how it is separate from other professions. Put plainly, research is needed to justify the existence of physiotherapy - to patients, the public, other professionals and those who hold healthcare's purse strings. Without it, physiotherapy as a respected, recognised and rewarded profession will not survive.
As the CSP's director of learning and development, Jill Higgins, says: 'The only way we will ever move forward is to have strong robust evidence on which to base the selling of the profession. We have to prove we're good or nobody is going to listen to us.' She adds: 'It will mean a lot of us changing out roles. We don't all need to become active researchers. However, we must all become active users of research.' As Jill puts it: 'If you're not doing research, you need to be using research. It's not an add-on or optional extra. Research is actually about quality of care: making the right decisions at the right time.'
Dr Higgins is part of the core executive of the National Physiotherapy Research Network (NPRN). Her comments on research, physiotherapists and the profession came at the launch of one of the NPRN's hubs (see 'Local research for local people'). The NPRN was set up by the CSP in June last year with a threefold mission. To develop the physiotherapy scientific knowledge base; to provide access to the knowledge base to the physiotherapy profession and like-minded researchers; and to support the implementation of the knowledge base within physiotherapy practice.
At its helm are four physiotherapy professors: Ann Moore (director of the clinical research center for health professions at the University of Brighton); Di Newham (director of the division of applied biomedical research at King's College, London); Julius Sim (professor of healthcare research at Keele University) and Maria Stokes (director of research at the University of Southampton). Helping them are numerous researchers, clinicians and managers arranged in 17 regional hubs around the four countries (see 'When you need an expert').
Professor Ann Moore is passionate and clear about the need for physiotherapists to engage with research. She says: 'We have to develop a positive research culture in the workplace. We need to get people used to looking at data. You have to know how to appraise an article, have a grounding in statistics.' However before 1992, when physiotherapy became a degree profession, there was no formal research training. This is why many physiotherapists will pick up a research paper only to throw it down in horror. Yet, all physiotherapists, even those qualifying pre-1992, are now statutorily obliged to engage with evidence-based practice. Ann is practical about how to tackle this situation. First of all, she stresses the importance of working together, as a profession, to help each other - a goal which is at the heart of the NPRN.
She comments: 'One of the big things that people think is that they have to do it all on their own. We have to offer learning opportunities, some physiotherapists could bring others on, acting as mentors.' She sees engaging with research as part of in-service training. As she notes, running an audit and standard data collection are all part of continuing professional development activities.
Ann suggests approaching research by starting small and local. Each service, she says, needs to look at what the issues are for them, and ask the question: could we do it better? 'Look at the literature as a group, start to appraise it. It needs to be relevant.'
Another issue, she says, is time - principally, how much time to set aside. 'This is where managers are important to the process,' she stresses, noting that the NPRN aims to work with managers, supporting them in how they change working practice to accommodate research needs. She adds: 'I appreciate there often isn't any time.' On a personal level, Prof Moore asks physiotherapists to start challenging presumed authority. 'Physiotherapists must ask: "why?" and "who says?" when they go to courses they pay a lot of money for.' She has a message for individuals not to run courses unless they are evidence-based. Looking to the Society, Ann applauds the CSP's support of the NPRN and other research activities. However, she says she would like to see the development of more guidelines, such as the recently published ones on whiplash.
She also feels that the profession's annual conference, Congress, needs to develop. 'We need to be offering a conference that has international appeal,' she comments. She notes that only a small percentage of the profession attends the conference - 'not a sign of academic health' - yet, this is a situation that can only be remedied by physiotherapists themselves. Individually, within workplaces, and professionally, the path to relating to research is laid out. With the creation of the NPRN, the foundations to do this are now firmly in place. There really are no excuses for saying no to research.
When you need an expert
The regional hubs of the National Physiotherapy Research Network are led by experienced researchers who are primarily based in higher education institutes. They are likely to include local clinicians, local physiotherapy and therapy managers, and physiotherapists in academia. Each hub is expected to reflect the needs of its location, and the local expertise available, and develop its own particular strengths and characteristics. It's anticipated the hubs will offer peer support for novice researchers: helping the development of robust research questions; advising on methods; offering peer review support and increasing awareness of and facilitating the use of evidence-based practice.
It's hoped that hubs will also impact on physiotherapy clinicians in the workplace. First, by diffusing negative myths about research and encouraging more therapists to become interested in research by contributing to the development of research questions. Hub members can also help with patient recruitment for research purposes, data collection and carrying out research themselves. Through its hubs, the network aims to help all physiotherapists use evidence more effectively in the workplace - even those who do not wish to do research themselves. They can provide a venue for discussion of new research evidence and contribute a forum for the discussions regarding, for example, the implementation of clinical guidelines.
'We hope the hubs will help physiotherapists understand what evidence is good evidence and perhaps whether the evidence is applicable to their own individual practice,' says Professor Ann Moore. So if you do need help, you know where to look.
Local research for local people
Going back to her roots, Catherine Blackledge found out what's happening up north
'We're not about blue sky research' - this was the clear message from the Lancashire and Cumbria physiotherapy research hub.The northern hub, which was launched at the end of November last year, is aiming to be far more down to earth and practical in its outlook. Speaking at the hub's launch, James Selfe, reader in physiotherapy at the University of Central Lancashire said: 'We want to help support and sponsor research in a local area. one of the key things is to focus on clinically relevant research - this is one of the reasons we applied for hub status.'
The hub has already arranged bespoke research training for a local trust. Following a research needs analysis, training was tailored specially for that locality, with its particular population and characteristics.
'The dark side of research' - research for researchers, which loses sight of the patient and doesn't help move clinical practice forward - was something the hub would not support, Dr Selfe stressed. He painted a picture of studies that claim statistically significant results, but don't say what this means for the patient, or what difference it makes to the service or therapist. 'Numbers, numbers, everywhere, but where is the person?
Members of the hub are also concerned about the lack of consultant physiotherapists in the region. Supporting the development of consultants, who will in turn support local research, is 'an important aspect of what the hub is about'.
Although the northwest is one of only three regions in the UK with more than two consultants, there is still a great need to increase numbers. Dr Selfe said around a quarter of a physiotherapy consultant's time should be devoted to supporting research activity. 'So having so few consultants in the region is a major problem.' Pat Sutton, manager of Preston primary care trust and chair of the northwest physiotherapy research and development forum, said she was aware that at grassroots level there was a lot of enthusiasm for research. But, she added: 'There are stumbling blocks around time and money.' Tackling the finance issue, she said the hub was 'talking to trust research and development leads to direct money less to doctors and more to allied health professionals'.
She added: 'One of the activities we are involved in is identifying people trying to get funding for research.' Funding can be hard, or impossible to find, unless you have the requisite history. 'One in 10 grant applications may get funded. You may need to piggyback with other people who have a track record when applying for funding. This is something we can assist with.'
Another stumbling block to engaging with research is, quite simply, getting started, and the Lancashire and Cumbria hub hopes to help there too. 'The idea behind the hub,' said James, 'is that it doesn't matter what stage of the process you're at, or even whether you've started the journey, we can help. 'Usually the earlier you get help the better the outcome. the key thing is to look for help from other people.' Networking in this way is essential to a flourishing research environment, he said. 'Unless you engage with the hub, we won't achieve anything.'