Physical therapy research: academic inadequacies.

Academicians tend to be the primary producers of research in professions. Presumably these persons have the training, facilities, and other resources necessary to conduct research. In our profession, many academicians have made substantial contributions to our theoretical and clinical literature, but in general the physical therapy academic community has not adequately fulfilled its role in the area of research, particularly in the area of clinical research.

This journal and other journals geared toward physical therapy have published too many studies that dealt with clinical issues through the testing of healthy or nondisabled subjects. All too often these subjects are physical therapy students. We still receive many articles that have little or no clinical relevance because of the types of subjects being tested, the conditions under which the testing occurred, or the scope of the study.

Academicians not only should conduct clinical research, but should be the source of much of our basic knowledge. Although the increased research production by physical therapists is encouraging, I find it disheartening that we have not done more. The structure and funding characteristic of many physical therapy academic programs actually discourages, rather than promotes, research.

A doctorally trained faculty member joining a college biology department will often not only receive start-up funds, but will be provided with laboratory space. In addition, teaching responsibilities will ensure that research will be nurtured. This is not usually the case in physical therapy, yet we wonder why so many of our academicians fail to develop in their roles, to publish, or to attain tenure. Perhaps more importantly, the state of our academic institutions explains why many of our questions go unanswered and why many of our treatments remain unevaluated. Often the students are doing more research than the faculties.

There are numerous reasons why so little research is conducted by physical therapy academicians and why so much of the research that is conducted does not address issues that concern clinicians. In most medical schools, clinical and academic departments are essentially one and the same. The chairperson of the educational unit oversees the clinical component. In physical therapy there are few such setups, and as a result many academicians lose touch with clinical practice or believe they will not be able to find patients for their research. Certainly the task of finding patients is difficult, but I doubt that it is impossible. Relevance requires the extra effort. Patient availability remains an obstacle we must overcome

I am discouraged that we do not require stronger links with clinical programs for all our academic institutions. To be accredited, medical schools must have ready access to teaching hospitals. Physical therapy program accreditation requires only the looser relationship of the affiliation. Clearly the latter is less beneficial than the former, yet more physical therapy programs with even more distant relationships with clinical facilities are currently being accredited.

We must also consider the preparation of our academicians. There can be little doubt that the degree that best prepares a person for independent research is the doctorate. Our ongoing shortage of doctorally trained faculty members could partially explain why more research is not being conducted. Increasing the number of doctorally trained persons, however, may create a false sense of security. Many of our doctorally trained faculty have received their terminal degrees in areas that do not relate to their teaching, clinical specialities, or research areas. This makes it difficult for faculty members to remain up-to-date in teaching and research and makes it almost impossible for them to conduct programmatic research that adds to and refines a body of knowledge.

We need behavioral researchers, and I applaud those who obtain such degrees as a prerequisite to teaching and conducting research in the behavioral sciences. Degrees in education also have merit and value when that is a person's chosen area of specialization. Degrees should relate to what academicians teach, to their areas of research, and to their clinical specializations. My argument is for relevance and consistency. How can we expect to gain respect within academic institutions when physical therapy faculty members teach in areas distant from their advanced training? How often are physics classes taught by professors with doctorates in English?

Unless the environment within our schools changes, there is little hope that physical therapy academicians can attain their rightful place as contributors to our body of knowledge and full-fledged members of the academic community. Many of the situations I have described exist because most physical therapy education programs started out within schools of education or allied health. Role models for funding, for basic and clinical research, and for true academic functioning have not existed in many of these schools. This is to be expected, because, like many other nonphysician health care professions, ours has evolved from technician to professional status in a remarkably short time span.

Elimination of the inadequacies in our education programs should be a concern for all physical therapists. Our academic adminsitrators must ask themselves whether they are tolerating structures and funding mechanisms that are archaic and regressive. We must all ask how our accreditation process can be effective in bringing about changes in existing programs and why new programs are currently being accredited when their size and structure essentially preclude meaningful scientific activities by their faculties. Each of us should look at our alma maters and ask questions about the status of those programs. As responsible professionals, we should also look critically at the schools in our regions. Enthusiasm for the creation of new programs should be tempered by our acceptance that resources for teaching, practice, and research are all needed. Students should even be asking what the faculty is doing to increase the profession's body of knowledge.

Because clinicians make up the majority of physical therapists, they can serve as a constituency that places demands on the academic community, the leadership of the American Physical Therapy Association, funding agencies, university and college boards of trustees, and legislative bodies. Clinicians have been handicapped by the lack of scientific literature relevant to practice for too long. As a result, clinicians have a right to be frustrated, but they also have an obligation to help change our academic institutions. When clinicians focus solely on the shortage of therapists and not on the critical issue of adequate resources, they may be sending a message that encourages the development of programs with inherent deficiencies.

Academic institutions have a responsibility to society not just to produce more therapists, but to produce new knowledge so that therapists can practice more effectively and efficiently. All physical therapists have a responsibility to make certain that our education programs have the resources and the commitment to move beyond the level of "training" schools to that of comprehensive academic departments capable of excellence and productivity in education, service, and research.

Jules M Rothstein, PhD, PT Editor