Leap!

Twilight is supposed to be a quiet time, a time when you gaze at the setting sun, that giant globe ducking behind crimson clouds and dipping below the horizon. Amazing, how fast the sun seems to descend that last little bit, as though anxious to call it a day and prepare for the coming dawn. Twilight seems to herald the end of something, but the miracle unfolding before our eyes really is about transition, not endings. Twilight brings darkness, but it also promises the end of darkness and the return of light. The sun will rise, and there will be a new day. And it will be a day unlike any other.

During the past year or so, I approached death's door more than a half dozen times, and it appeared as though I was in what some would call the twilight of my existence, at the edge of some kind of eternal darkness. I was, I now know, only on the precipice of a new challenge, taking on a life unlike the one I had lived before.

The everlasting twilight will, of course, overtake me someday. Until then, I choose to celebrate, living fully and relishing the love of family and friends. This circle of friends includes the thousands of physical therapy colleagues whose thoughts, prayers, and messages led to the many miracles that allowed me to spend several weeks regaining function in a rehabilitation facility and to overcome 2 liver transplants, 4 additional surgeries, the development of leukemia, and the effects of multiple rounds of chemotherapy and systemic infections. I am one lucky SOB, but then again, how could I lose when I had the support of so many?

The events of the past year have effected massive changes not only in my body but in my way of thinking, especially in my way of thinking about the future. I write this Note at my daughter Kathy's computer because my wife, Marilyn, and I have moved in with her, my son-in-law Wally, and my 2 sparkling grandchildren, Andrew and Rachel. We are only a 3 hours' drive from our youngest daughter, Jessica. We have relocated to be close to family, which also includes our APTA family, 2 hours north of here. Soon, we will move into our own home, only minutes away from where I sit.

As most of you know, I have decided not to return as Editor in Chief for the final 3 years of my agreement with APTA. I am retiring from this position so that I can do other things in this new day that I have been given. I want to serve our profession in new ways, and I have lots of ideas, trucks full of hope, and endless expectations. I am honored that, as I proceed into this new role, I can carry a part of this Journal with me forever. I have been awarded the title of Editor in Chief Emeritus of Physical Therapy. It is impossible to explain how much this means to me.

I love our profession and its Journal. One out of every 3.8 days that I have been on this planet, I have spent as Physical Therapy's Editor. The role would seem to be part of my flesh and sinew--but it is not. I love the Journal the way a parent loves a child. At some point, there must be a parting. I am prepared to see this Journal welcome a new Editor in Chief and to move toward that Editor's vision for the future. As I have often noted in these very pages, the Journal is not mine, and it is not the Editorial Board's. The Journal belongs to all those who contribute to it, to all those who read it, and to every patient who is made better by a physical therapist who learned from the reports published in these pages. The Journal is yours!

I am particularly thankful to the Editorial Board members of the past 15 years for all of the work they did (they made me look good!). I also want to send special thanks for the extra work they did in carrying on last year in my absence. Under the extraordinary leadership of Dr Alan Jette, who has acted as Editor in Chief in 2005, and our Managing Editor Jan Reynolds, the Editorial Board kept this Journal going and, more importantly, kept it growing. They didn't sit idly by, waiting for me; they pushed forward with the strategic plan that we initiated in 2000, committed to making the Journal increasingly relevant and useful. They too know whose Journal this is and whom the Journal serves.

A new Editor in Chief will bring new visions; I do not fear for the Journal. Submissions are dramatically increasing in number and quality, and we are viewed as the premier journal not just in physical therapy but in all of rehabilitation. More and more, we are able to serve practice and the development of the science that underlies physical therapy.

I hope the search for a new Editor will be vibrant and will be seen as a critical element in the growth of our profession. When I became Editor, things were a little different. There were a minority of physical therapist education programs at the master's degree level, and none at the professional doctoral degree level. I was one of a handful of therapists who actually had a PhD in physical therapy. Physical therapy research was a rare "finding" among faculty members. Few physical therapists had attained National Institutes of Health grants.

Too many of the articles that were submitted to the Journal in those days were reports of student research projects, and, as a result, their scope was often limited and the relevance to practice often nonexistent. In general, we did not see a great many papers that were part of programmatic research efforts designed to explore and refine our knowledge and practice.

At the same time, the Journal had only just started to develop a manuscript review process that could genuinely be called "peer review." Before that time, manuscripts submitted to Physical Therapy were more likely to be reviewed by people whose credentials and expertise were not appropriate or adequate for the topic. In addition, it was hard to know who made the final decisions about papers, and an editor with little scientific expertise might be overseeing the process. Many of the peer reviewers in those days had never published papers, and, as such, could hardly be seen as peers in the review process. Times have changed. Now, we see many papers that are part of funded research and many papers that are designed to advance and, more important, refine our knowledge; and these papers are reviewed by experts from all over the world.

One of the criticisms that had always been leveled at the Journal was that the articles were not useful to clinicians, so I focused on publishing articles with clinical relevance and worked with authors to make sure implications for practice were clearly addressed. We took great pains to make certain that articles were reader friendly. We also changed a policy that basically discouraged case reports and instead sought these papers as credible scientific papers that--though they cannot show causality---can illuminate the nature of practice and help define what is occurring when we see our patients. We added an Update section to help practitioners stay current, and we initiated several types of articles designed to illustrate how we can obtain and use evidence in practice.

But most of all, since 1989, our researchers have grown in number, in competence, and in ties to practice, especially on issues of effectiveness and efficacy. I like to think that the Journal has played a role in the development of the profession; in the growth of those who worked so hard as Editorial Board members, reviewers, and authors; and, of course, in the growth of those who read the Journal.

During my tenure as Editor, there have been many surprises. The most dramatic surprise was the realization that the Editor had to serve as an ambassador for the profession. I have been thrilled to play this role with other organizations, including governmental entities, in the United States and in more than 20 countries throughout the world. Because I was lucky enough to be Editor, I have met physical therapists from distant and near places and developed friendships that know no borders. I was fortunate to become a citizen of the world and, I hope, have been a good representative of the Journal, our Association, and our profession.

The peer-review process itself never ceases to surprise. For example, authors find clever ways that neither editors nor editorial board members could ever imagine for addressing problems. Their creativity and dedication to their work is a marvel. Editors, editorial board members, reviewers, and authors each tend to believe that only they have the magic prose that can be understood by everyone else. The delightful surprise here is the real magic that occurs when all of these parties enter into an iterative process in which everyone is committed to improving a manuscript. The exchange of ideas as we learn from one another is truly extraordinary. It takes a lot of courage to submit and bear with the peer-review process, and I admire all who engage in it. In the end, everything seems to work out through this mysterious, flawed, but still best-possible process that we call peer review.

I wish everyone could experience the happy side of vigorous peer review. There is nothing like the joy of watching the evolution of a paper that makes an impact on the profession and especially on practice, wins an award, or is found to be particularly reader friendly. I also wish that we would see rejection not as an end but as a point on a continuum. For one thing, papers often can be successfully revised; and even if they are not, authors can learn from the process and do better next time. There is no doubt in my mind that whoever you are, and no matter what you do in life, candid feedback hurts. The Editorial Board and I always tried to make sure that review comments were phrased in the least objectionable way possible. We may not have always succeeded. But it is from candid feedback that we learn and grow.

Feedback can indeed hurt. I should know! I never had a manuscript rejected by Physical Therapy until I became Editor. In at least one case, I thought the reviewers were crazy, but in time other people's research showed me that the peer-review process had kept me from making a fool of myself in print. The reviewers and editors were right, and I was wrong! One of the benefits of peer review is that it protects authors from themselves.

There are many memories and insights that I could share after 15 years and almost 3,000 manuscripts, but after about 200 Editor's Notes, enough is enough--or, as Eugene "Mike" Michels once told me at a meeting, "Jules, you are beating a dead horse." Realizing Mike was right, I said in my defense what I say now: "But at least I do it well, don't I?" You have been a tolerant and appreciative audience, and I am grateful. As I take leave of the Editor in Chief role and look forward to new challenges, I remind you to visit the library or the Internet if you need my nagging, my pleas for the use of evidence in practice, my desire to see more case reports, or my argument for making clinical thinking--including the rationale for the choice of interventions, tests, and measurements--more explicit in the literature.

In my publication career, there are 3 achievements in which I have special pride. Editing the first two books on measurement in physical therapy--Measurement in Physical Therapy (Churchill Livingstone) and APTA's Primer on Measurement: An Introductory Guide to Measurement Issues--is the first; being Editor of this Journal is the second; and coauthoring The Rehabilitation Specialist's Handbook is the third. On reflection, I have come to realize that there is one common element that allowed me to meet these challenges (often simultaneously and while I also was serving as Head of the Department of Physical Therapy at the University of Illinois and Chief of Physical Therapy Services at University of Illinois Hospital). I wish I could say that this element was some laudable character trait or admirable skill, but no--the secret of my success is stupidity.

Had I been bright enough to understand the true magnitude of these challenges, I am sure I would have deferred and run the other way! In every case, I was blessed to find myself in over my head but with a will to survive that led me to solutions. I never lost my will, and I was always fortunate to find supportive colleagues. As I took on each role, the smart money seemed to be on my failure. Our book editor came close to a nervous breakdown waiting for our pages, and some people even cried in public when I was named Editor! But as I have seen, especially in the year gone by, odds apply to the group, not to the individual, and when special people have faith in you and support you with their love, you can face almost any obstacle--and perhaps beat any odds.

Therefore, my advice as a "sage" Editor Emeritus is as follows:

Allow yourself to be stupid occasionally. Leap before you spend too much time looking.

When fear rather than excitement grips your soul, the fear will limit your opportunities and make voyages to the far horizon impossible. In this past year, with precious few choices available to me, I have come to an even deeper understanding of the need to banish fear and to look beyond the impossible, past the sorrowful. I learned how to envision new days that would be unlike any others that had come before. With your help, with the assistance of colleagues throughout the world, and with the support of a loving family, I have come to this wonderful day. I thank all of you for the opportunities, for the joy of serving, and for the life-giving compassion you have shown me.

In July, the Board of Directors of the American Physical Therapy Association designated Jules M Rothstein, PT, PhD, FAPTA, as Physical Therapy's first Editor in Chief Emeritus. President Ben Massey, Jr, PT, MA, and Chief Executive Officer Frank Mallon, Esq, presented him with a citation and award at his daughter's home in Chester, Va, in August. The Board of Directors cited his 15 years of exemplary service to the profession as Editor and Editor in Chief and his many other scholarly achievements. Future editors in chief and staff may seek Dr Rothstein's advice on matters of policy or content and may invite him to write on selected topics.

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Jules M Rothstein, PT, PhD, FAPTA

Editor in Chief Emeritus

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