If you asked PT students to name their least favorite class in school, I imagine the following classes would be the most common responses: ethics; practicum or seminar course; and then research. That’s a shame. It’s not hard to understand why students and clinicians avoid research. It’s not easy to read and isn't a lot of fun. You wouldn’t take a stack of research articles to the beach. It requires concentration and effort. Sometimes you have to read an article several times before it makes sense. There are a lot of numbers, a lot of statistics, and a lot of terminologies that even experienced clinicians don’t understand. For this reason, many physical therapists decide that research is for researchers and academia only, and is irrelevant to practicing clinicians . . . it's not!
There are 4 reasons why every practicing clinician should and must-read research consistently:
- Personal and professional growth through research
In the end, I’ll give you some tips that will help keep you informed in as little time as possible. If your goal is to know what PTs are researching and what the latest evidence says, then keep reading for the why and the how.
Reason number one: Personal and professional growth through research
Research (Pubmed) is how we progress as individual clinicians and as a profession. Unfortunately, there are many physical therapists who haven’t read any research since they graduated from PT school. You know who I’m talking about: the clinic director in a nursing facility who has worked there for 30 years. It’s hard to believe that they can deliver high-quality care to their patients when they’re still doing knee-to-chest exercises and diathermy to treat back pain. Imagine going to a cardiologist who hadn’t read a single article about the heart in 20 years and still thinks eating cholesterol raises your cholesterol! No, thank you.
Reason number two: Competency
Janet Bezner, the former deputy executive director of the APTA, says we need to stop talking about continuing education and start talking about continuing competence. There is little evidence that weekend courses produce better results. If you want to be a competent physical therapist, you need to be constantly learning new ideas and new techniques. More importantly, though you need to focus on removing bad ideas and bad techniques. You can’t rely on a couple of expensive weekend courses to make you a better PT. You must become a better PT every day.
Reason number three: Ignorance
Warren Buffett, the great investor, and president of Berkshire Hathaway, once said you should discard at least one of your most cherished ideas every year. Start with one idea, but if you want to be a great physical therapist, you should discard at least three or four every year. There are a lot of fads in this profession and you need to be able to identify them as soon as you can so you don’t waste time and money. If you’re treating the patients the same way you treated them five years ago, you’re doing something wrong. Rehab science is constantly evolving, and it’s evolving fast. Charlie Munger, Buffett’s vice-president at Berkshire Hathaway says, “spend each day becoming a little bit wiser than you were when you woke up. Discharge your duties faithfully and well. Step by step, you get ahead, but not necessarily in fast spurts. You build discipline by preparing for fast spurts. Slug it out one inch at a time, day by day. If you live long enough, most people get what they deserve.” Reading research will make you less ignorant, but you must be consistent.
Reason number four: Fulfillment
Staying current on research will make your career as a PT more fulfilling and more rewarding. You will get bored and you won’t care about your patients. You will be going through the motions. If you constantly modify the way you practice and treat patients, you are less likely to burn out, you will be more motivated, and most importantly, you will be a happier human being. “It actually makes for a more enjoyable career,” says Chaconas. “You get out of the monotony of doing the same old thing and integrate a more contemporary approach to patient care.”
How to do physical therapy research without getting bored out of your mind
Research is not dull, it’s exciting. Reading a systematic review might not be as fun as reading Fifty Shades of Grey, but it’s necessary. With the right attitude, you will no longer need the motivation to do it but will find it intriguing. If you say you don’t like research, you’re saying you’re satisfied with the status quo and are not interested in changes or new advances. Instead, you should wake up every day and ask yourself these questions:
We live in a time of rapid change, and you should have a desire to know what’s next.
Ultimately, the only way to be 100% current on all the latest research is to read every article related to PT, every single day. No one has time for this. It’s impossible to read everything, and there are many great articles that you will not be able to read. That’s why I recommend just an article a day. As Erik Meira, the founder and host of PT Inquest, noted last year,
"Let’s look at what was published on the ACL last year (2013). Oh. Only 1252 articles ON ONE FREAKING LIGAMENT OF ONE FREAKING JOINT!!!”(i)
Don’t let the fear of missing out deter you from enjoying research. An article a day is a great start, and if you read articles from the leading journals of our industry, you will have a good idea about what the latest research says about our field.
Step one: Make a plan
Choose a particular time each month and set aside two hours of your time. It doesn’t matter what time it is, but it needs to be consistent. If you don’t set a consistent time, you will never read the research. It’s too easy to say, “I’ll do it when I have time.” For me, I choose the first weekend of every month. Put away the phone and eliminate time wasters. Research requires all of your attention. Choose five journals that are most pertinent to PT. Here are the five I recommend:
- Physical Therapy (official journal of APTA and free with your membership)
- Clinical Rehabilitation
- Journal of Sports and Orthopedic Physical Therapy (free if you’re a member of the orthopedic section of APTA)
- American Journal of Sports Medicine
- British Journal of Sports Medicine
You can choose whichever journals you want, but I think the five above should be a great start. Here are some others you might want to consider:
- Journal of Manual and Manipulative Therapy (included with membership to American Association of Manual Physical Therapists)
- International Journal of Physical Therapy
- Movement Disorders
- Journal of Medicine and Sports Science
- Arthroscopy (primarily for surgeons but includes a few articles that pertain to PT and post-op rehab)
- Sports Health (included in your membership to the sports section of the APTA)
- Archives of Physical Medicine and Rehab
- Journal of Strength and Conditioning Research
- Journal of Physical Therapy Science
Physical Therapy in Sport Experiment
There are a variety of journals, but once you find the journals that give you the best return on investment, double down. In other words, focus most of your attention on those journals. I’ve experimented with over 20 journals, and I’ve found that the five above give me the best return on investment. The other journals have more of a medical background but you can still find some gems there. Again, it’s your choice. The next step is to read the abstracts of most of the articles. Read the abstracts that are the most pertinent and most relevant. You don’t need to read all of them.
As you find the abstracts that interest you, write the reference info, so you can easily find it later. Reading the abstracts of the five major journals should only take one to two hours. Another option is to a perform focused review of the research. Let’s say you’re seeing a lot of patients with lumbar spinal stenosis. You can search the databases for recent articles that only pertain to this diagnosis. The next step is to download seven articles, so you have an article a day to read; that way, you’re not downloading an article a day. Do it all at once and you don’t have to remember later in the week.
Step two: Find your articles
The question now is, where do you find the articles? This is tricky, even in the information age, because most journals charge fees for their articles. You have several options:
1) Become a member of APTA, or a section of the APTA.
Of course, you should be already, but another benefit of the APTA is that you have access to some online databases, including:
- PEDRO: free for anyone
- PTNow: free with APTA membership
- This includes access to Cochrane Databases
- CINAHL (Cumulative Index to Nursing and Allied Health Literature)
This is how Eric Chaconas, assistant director of physical therapy at the University of Saint Augustine, FL, and also a fellow of the association of orthopedic manual physical therapists (FAAOMPT), stays on top of research: “I get JOSPT, Sports health, JMMT, and Physical Therapy. They all come to my house due to memberships I pay for APTA Orthopedics Section, Sports section and AAOMPT,” says Chaconas. “These are the main journals that affect my specialty area the most, so I try to read through them monthly. [Get] at least one journal coming to your house monthly and read it briefly. It’s amazing how it doesn’t really take that much time.”
2) Another option is to ask your school if they can give you access to the databases.
I can find almost any article I want through my school’s databases (University of Saint Augustine). It doesn’t hurt to ask. If the databases don’t have the article and I really want to read it, I can send an email to the librarian at my school and he will send it to me.
3) Ask the author himself!
To be honest, I’ve never done this before, since I can find almost any article through my school or through the APTA, but I don’t see why it wouldn’t work. If you spent a lot of time and money to do a research trial, wouldn’t you want to disseminate your research to as many people as possible? Nobody does research to get rich. Meira supports this, saying, “When all else fails, [send the authors] an email and ask them nicely for a copy of their article, expressing your strong interest in learning more. They are usually excited to share.”
Even if you aren’t an APTA member, reading the abstracts will catapult you ahead of most physical therapists. At least you will know what is going on, what researchers are doing, and who the researchers are.
Step three: Read the articles
Let’s assume that you have access to at least one or two databases and that you can download the articles. The next step is to actually read the article. This isn’t as tedious or boring as it sounds. Read the abstract and conclusion first. This is a great way to read books, by the way. You know what’s coming and if you ever get lost during the article, you can remember what the summary and conclusion said. At least now you have a compass. You don’t need to understand what’s going on at every moment. As long as you know the beginning and end, you at least have some idea of what happened.
Spend most of your time reading the results and the discussion. Results have a lot of numbers and symbols, but this is where the meat of the article is. You don’t need to know every statistical term (kappa, regression to the mean, chi-square test, etc.), but you should be able to read a chart critically. The discussion section is the authors’ interpretation of the article. Meira says to not “get too bogged down in statistics. Before you even consider study design and statistical analysis, consider whether or not they are asking a scientific question, or whether or not the initial premises are sound. These are very simple questions that many studies fail to stand up to. Some studies will just be over your head. Don’t sweat it. That article isn’t for you. There are plenty others for you to read.”
When you finish the article, make sure you add it to the bibliography as a reference. If you read an article a day for several years, you’re going to have your own personal bibliography. If you’re trying to recall an article, you will be able to find it.
Here are four simple "don'ts" that will help you become a research champion.
1) Don’t say “I’ll read it tomorrow.”
It was the Chinese philosopher Lau Tsu who said, “do hard things when they’re easy.” Today reading research is easy.
Tomorrow it will be harder because the pile of articles you want to read is higher. If you wait too long, eventually you will never do it. That’s why I encourage you to set aside a specific time each day, or each week, to read the research. I prefer to do it in the morning before work and before I have any interruptions in my day, but it’s your choice.
2) Do not be overwhelmed.
Personally, this is my biggest barrier to research. What the hell do I read? The proliferation of information is staggering. More information has been produced since 2003 than before 2003. There are potentially hundreds of articles, dozens of textbooks, dozens of con-ed courses, and now at least a dozen quality PT podcasts. It’s easy to be overwhelmed. The solution is not to try to consume everything. You could read 24 hours a day every day and you still would not be able to consume even 1% of the available research. There’s a term among businessmen and investors called “fear of missing out” or FOMO. Here’s a sad fact: you will not be able to read or learn everything you want to. You will have to make tough choices. You will have to be judicious. That’s okay. As long as you are reading or learning something, you are becoming a better clinician. Remember the key is to make as few mistakes as possible.
3) Do not rely on social media.
You should be on social media although not 24 hours a day like some people. I know PTs love social media to communicate, but do not use it to find research. I was at CSM and someone during a lecture suggested that someone make a Facebook page so that it would be easier to find research. Here’s why I don’t recommend social media: someone else is finding the research, and the research you read is biased because the articles you read were suggested by people that you agree with. Remember, one of the reasons you should do research is to challenge the ideas you already have, not to confirm them. Eric Meira of PT Inquest strongly urges PT’s to avoid social media as a way to find research:
“Social media is the WORST place to get your research. What you will get is the cherry-picked greatest hits from people you already agree with. Huge mistake. Remember, in order to find the truth you need to challenge your beliefs, not confirm your biases. You need a more complete exposure.”
4) Do not base your practice on one study, regardless of the authors, the expense, the letters behind the names of the authors, the conclusion, the title, etc.
“Most people over-react to one study,” says Eric Chaconas, assistant director of physical therapy at the University of Saint Augustine, FL, and also a fellow of the association of orthopedic manual physical therapists (FAAOMPT). “People usually use their own bias to agree or disagree with the published literature. Rarely do you see people come in with an open mind and be unbiased when they interpret evidence?”
One study is one study, and every study has limitations. No study can exactly replicate the real world or your specific clinic. The summation of literature is what should persuade you to change the way you practice. There is evidence for EVERYTHING (ghosts, demons, afterlife, near-death experience, aliens, etc.) but you need to discern what is true and what is not. It takes 15-17 years for research to be implemented consistently. That’s too long, but don’t change your approach every day either. The best way to do that is to consume research: “Most PTs don’t dedicate much time to getting better at research critique,” Chaconas says. “Signing up to be a reviewer for a journal is a great way to do this, research consumption and critique is a skill that one has to constantly hone just like anything else.”
I hope you have enjoyed this series. I’ve tried to present a systematic way to do research as efficiently as possible.
Here are the key points:
- Research is important. It’s your duty and obligation, not a choice. You should be constantly evolving. Don’t ever be content. Don’t rely on others (i.e., social media) to do research for you.
- Be consistent. Set aside a certain time to do research. Otherwise, you won’t do it. Remember, aim for an article a day.
- Read-only a few journals. They should be articles you have full access to. If you go to school, you should have full access. If you’re an alumnus, ask your school for full access. You deserve it.
- Don’t worry about everything you’re missing (FOMO). You won’t be able to read everything. It’s okay.
- Don’t change your practice based on one article but change at some point. Don’t be the therapist who’s just now finding out that faith-based therapy doesn’t work.
- Read critically. Don’t skip the results and discussion. That’s the best part! You should read the entire article if the article interests you. Read the abstract and conclusion to see if the article interests you.
The four-hour researcher
I call this overarching method “The Four-Hour Researcher” because it’s catchy (like the international bestseller book The Four-Hour Workweek by Tim Ferriss) and it’s a plan to keep you informed in as little time as possible. Remember, reading all the new research would be a full-time job. Because you already have a full-time job and other commitments, you will not read all of the best research. Time is scarce and life is short. Don’t worry about that. Be consistent and read an article a day.