Initiatives in rehabilitation research.

Federal funding of rehabilitation research depends on how much that research is valued, both within the physical therapy profession and among the external groups and individuals who have a stake in the research outcomes. To help advance rehabilitation research, the American Physical Therapy Association (APTA) forges partnerships, coalitions, and collaborations for advocacy, awareness, and legislative action; promotes the appointment of physical therapists to federal panels; and fosters infrastructure and research capacity building. To further cement the physical therapy profession's relationship with policymakers, APTA also is identifying health policy questions.

Many of APTA's efforts to increase federal support for rehabilitation research have centered around various institutes or centers comprising the National Institutes of Health (NIH). But there is another federal agency--the National Institute for Disability and Rehabilitation Research (NIDRR)--that advocates for the advancement of rehabilitation research. Unfortunately, and perhaps due to its location in the Department of Education, NIDRR is continually faced with the problem of a small budget that must support a large number of activities and priorities. To meet the challenges of a broad agenda and limited fiscal support, NIDRR recently convened a panel of experts to provide advice on NIDRR's plans to expand its research capacity to carry out complex studies. Marc Goldstein, EdD, APTA's director of research, was included on this panel. This was an excellent opportunity for physical therapy as APTA was the only health care professional association represented at the meeting. Other members were academics and scientists from other federal agencies or departments.

NIDRR's research focus is congruent with APTA's priorities as both organizations attempt to foster research on health and function. However, NIDRR's purpose is much broader.

NIDRR is interested in improving and expanding opportunities for people with disabilities within their communities, and one of the ways to improve and expand these opportunities is through support of research. NIDRR's dilemma is how to meet its varied priorities while also serving a wide range of individuals with a limited budget--only $110 million in the most recent fiscal year (FY 2006). The panel's charge was to develop strategies that NIDRR might adopt to more effectively accomplish its goals within the limited funding it receives.

NIDRR distributed 13 questions to the panelists and asked for responses that would be discussed during the course of the meeting. Of prime importance for APTA's rehabilitation research initiatives were those questions that dealt with methods to increase both the number of researchers and the number of institutional (primarily university) environments to support these researchers. These questions are very much in line with the types of discussions that APTA has been having with its own research community. The following are examples of how the panel discussions match up with APTA initiatives:

* Funding investigator-initiated research versus research centers. Although the importance of both funding strategies was noted, the dialogue about funding centers was especially salient. It was suggested that NIDRR might want to think beyond centers and instead focus on research networks. The model used by the Foundation for Physical Therapy was shared with other panelists and NIDRR staff in attendance. The logic of enhancing strategies to facilitate patient accrual and increase potential mentors resonated with NIDRR staff.

* Increasing the number of individuals interested in a career focused on research. This discussion was certainly relevant to APTA's research directions. The recent anecdotal reports stating that there are shortages of physical therapists in a number of clinical settings only exacerbate this issue. Furthermore, there is the potential that the transition to the entry-level Doctor of Physical Therapy degree may reduce the number of physical therapists who seek a research-based degree, such as a Doctor of Philosophy (PhD) or Doctor of Science (DSc) degree. The PhD is viewed as the traditional degree defining a career in academia and research. However, with clinical opportunities available, as well as the potential for a clinical rather than a research doctoral degree, discussions centering on increasing the available pool of researchers are paramount. It was gratifying to see that NIDRR staff recognize these issues and are enthusiastic about increasing the pool of physical therapist researchers.

* Increasing the number of institutions that should be funded to conduct what NIDRR referred to as "high-quality research. "The panelists generally agreed that funding should primarily be received by those institutions that could design studies that would represent the best science. Because the panel did not want to exclude people who are at institutions that do not have the capability to design such studies, the panel recommended developing a system whereby individuals could study with mentors at well-funded institutions and then return to their original academic programs, a model somewhat similar to an NIH-sponsored institutional career development award.

Participation in this meeting can potentially be quite advantageous in advancing our rehabilitation research initiatives. First, much of the discussion that had already been conducted between APTA members and staff was shared with NIDRR. Many of the ideas or programs that have already been put into place, such as the Foundation's Clinical Research Network, were enthusiastically received by NIDRR staff present at the meeting.

Second, there was consensus that federal funding for research is currently characterized by a somewhat fallow period. NIH will likely face a budget decline of 7% across all institutes in its FY 2007 budget. Other agencies will likely experience similar problems. The idea of creating coalitions of public and private funding agencies was perceived as a sound and pragmatic strategy by those individuals attending the meeting. Thus, more creative ways to fund research may be available.

Third, because panelists represented other funding agencies and administrators of academic programs in which physical therapist education programs are housed, APTA was able to take advantage of an opportunity to share our ideas with individual stakeholders outside the profession.

More follow-up on this meeting will be needed. None of the recommendations submitted by panelists was prescriptive, and NIDRR staff is under no obligation to accept any of the recommendations. However, the thought-provoking discussion that took place in a collegial atmosphere provided an additional opportunity for APTA to increase its visibility.

Justin Moore, PT

Director

Congressional Affairs

Marc Goldstein, EdD

Director

Research Services

[DOI: 10.2522/ptj.2006.86.10.1448]