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Editor's Notes |
jules-rothstein@mediaone.net
Journals remain the primary source of biomedical information and, I believe, they will continue to play that role for the foreseeable future. Our Journal has a 2-fold challenge:
Data from readership and membership surveys indicate that now, far more than ever before, Association members are using the scientific literature published in the Journal to guide their patient management. This should be not only a source of pride for our profession, but an indication of how far we have come in developing a scientific basis for practice.
Nonetheless, many of our leaders and many of our leading researchers share the frustration that too much of practice is still based on anecdotes, authority, and other dubious sources of justification. I share this concern because, even though we have made dramatic and almost unprecedented advances in the use of research data, we still have a long way to go. The same is true of other health care professions, but we began from a weaker foundation than they did, and we literally have to play catch-up. The question for all of us is how we can explore new mechanisms for collegial interaction in the application of science for the best interests of our patients. On previous occasions in these notes, I have focused both on the need for practitioners to use data and on the need for authors to start communicating better.
A revolution has begun in scientific writing, and this Journal is committed to being an active participant. Articles that inform therapists about practice are of little value if they are structured like mazes and use words that are not only complex but vulnerable to multiple interpretations. This problem should be obvious. Other problems that create barriers to application are less clear, however.
The Journal continues to meet authors who believe that obtaining a finding of significance in hypothesis testing makes their research useful. It does not! Just because an intervention leads to a real change in a variable (which is all that significance testing tells us) does not make that intervention worthwhile. The worship of the P value—and the delight that authors take when it gets smaller and smaller (meaning they are less likely to have falsely rejected the null hypothesis)—persist, even though tests of statistical significance are little more than prerequisites to more important issues.
Statistical testing provides only some information. In no way does it tell us whether a treatment effect is large enough to be worthwhile. Similarly, there are no magic numbers that make a measurement reliable or valid. Research can tell us how much error is associated with a measurement, so that those who need to apply the measurement or use it in decision making can decide whether the error is acceptable. The statistical approaches and the forms of research design that many of us learned in college (or even graduate school) are not that relevant in the real world in which we now function. We need to learn much more about how we can better analyze our data and better design our studies.
Many of us never heard of "sensitivity" or "odds ratios" when we studied statistics and research. But these concepts are central to many forms of inquiry and are essential to the people who want to apply research data to the management of specific patients or the development of critical pathways or other more generic strategies for patient care. In view of this need, this Journal has a responsibility to make certain that our articles are clear. When articles contain what for many of us may be novel statistical approaches, these approaches need to be explained to some extent within the article. Although this places a burden on authors, it also offers them the opportunity to increase the access and utility of their work.
In what can only be considered a compliment to our readers, many authors (non–physical therapists in particular) tell me that the articles they have published in Physical Therapy ellicit more responses from readers than articles they have published elsewhere. Our readers seem to care about information more than readers of many other journals—and readers can't care about what they read unless they first understand it.
Although the application of science to practice may not be proceeding at the rate that some of us would like, the indications are clear that our profession is moving ahead. To help further that growth, I am asking for a community effort. When you see reference to techniques that cannot be easily understood, send me an e-mail message. Let me know when we can enhance the communication level and applicability of our papers. If you want to have some approaches explained, we will seek authors to write appropriate Update or Perspective articles. Research articles can never be solicited, of course; but we can solicit other types of articles to assist our readers. We need to hear from you!
We also urge authors to discuss with us how they can prepare their papers and format tables and results and discussion sections in a manner that maintains credibility while maximizing appropriate applicability. Many of us were trained in an era when scientific writing was different, and many of our authors are used to publishing in journals that are not targeted primarily to practitioners. Our Journal publishes both basic and applied research, and the differences for manuscripts dealing with practice are not always well understood by researchers who are more accustomed to publishing basic or mechanistic research articles here or elsewhere.
In this new age, we have the capability to apply data to practice and utilize evidence—which means that we all need to learn new ways to function. There is much to learn, and I'm certain that we will all make mistakes. I hope we realize that ultimately we have common interests. The important issue is that we collectively seek to communicate better than we ever have before and that we welcome dialogue with others—readers, authors, and editors. This is exciting! We all will grow through dialogue and the use of new knowledge, and our professional status will be enhanced. But the real winners will be our patients, who will be receiving the best possible care.
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