A wise person recently said to me “Sometimes I think the translational issue is one where therapists don’t want to listen, and researchers don’t want to communicate.”
I find myself in an interesting position as both ‘therapist’ and ‘researcher’ and even more convoluted; both ‘basic scientist in neuroscience’ and ‘clinical researcher’. I appreciate the challenges to knowledge translation that he mentions. Research and the application of research to the clinical situation is a complicated issue that sometimes depends on the ‘hat’ you are wearing. When I wear my ‘scientist hat’ I think that clinicians should really seek out evidence-based practice however when I wear my ‘clinician hat’ I understand that in my hectic day I don’t have time to read the hundreds of articles published in my field every 6 months or so.
Researchers don’t seem to want to spend time synthesizing this research for me. Furthermore, in many cases, the studies are performed on specific patients in an ‘ideal’ environment that may or may not be applicable to my patients. The classic example of that is constraint-induced therapy which has been mostly studied in patients with very good hand recovery and no cognitive or memory impairments at all and no other health problems. These patients represent the minority of people I see. The clinician will argue that health researchers should really reach out and study what is really important on the frontlines. So I try not to get offended when wearing my hats. It is true that clinicians, basic scientists, clinical researchers, policy makers are all operating in their own silos and it takes quite a bit of momentum to get cross-talk. I know that the Heart and Stroke Foundation Partnership for Stroke Recovery and other organizations are working on this. I believe lack of communication has got to do with the comfort level that you have when finding yourself in an unfamiliar silo; sometimes you just have to admit that you really don’t understand the methods and applicability of someone else’s area. You just have to be open to learning and collaboration.
In terms of evidence-based practice, only a small fraction of what I do as a clinician has been tested and found effective in people with stroke. It is not that there is evidence to say that my technique does not work; there is just no evidence yet. I must rely on my clinical judgement as well as the advice from experienced and trusted colleagues and the outcomes I see right in front of me among the patients I work with. Researchers tend to study a discrete intervention, like muscle stimulation or treadmill training. Because patients are so different (I have never met two people with stroke who have the exact same recovery profile) I often have to take an eclectic approach derived from research in coaching/training and exercise, research in other conditions and my own creativity and ability to problem solve.True progress will happen when scientists, clinicians and patients collaborate to undertake studies that are grounded in real-world practices and challenges. You don’t have to be an expert in someone else’s area, you just have to be open to communication and sharing.