JCPSLP Vol 16 Issue 1 2014

Clinical insights

The changing face of clinical research Kyla Brown, Anne J Hill, Anna Copley, Miranda Rose and Bena Cartmill

Clinical researchers, academics and clinicians in speech-language pathology share the common goal of trying to improve the quality of life of those affected by communication and swallowing disorders. One way to meet this goal and to further our practice is to engage in clinical research. In this article the factors influencing the involvement of academics and clinicians in clinical research are discussed. Two stories are told illustrating clinical research in practice and the changing face and the future direction of clinical research are uncovered. M uch of the research in speech-language pathology falls under the term of clinical research, but what does this actually mean to those who are engaged in it? The National Health and Medical Research Council (NHMRC) definition of clinical research is: research involving human subjects in health and illness. It is done in response to a clinical research question, in order to inform clinical practice through the application of patho-physiological, population-based, behavioural or qualitative research methods. The research may be observational or interventional (NHMRC Clinical Research Working Group, 2001) The other term, which is increasingly used in relation to clinical research, is translational research. The NHMRC definition of translational research is: “exploring ways of applying evidence-based medicine, recommendations or guidelines to clinical practice. This research yields knowledge about how interventions work in real-world settings” (NHMRC Clinical Trials Centre, 2011). These definitions encompass all aspects of speech- language pathology research; however, it seems academic and clinical speech-language pathologists (SLPs) at times have conflicting views of what constitutes clinical research and its translation into practice. Clinical and academic SLPs are united by the common goal of improving the lives of those affected by communication and swallowing impairments. In order to achieve this goal we need an understanding of the influences and pressures that are being brought to bear on both sides. In this article we will discuss factors influencing the involvement of both academics and clinicians in clinical

research. We have chosen to focus on clinical research in health care settings, while acknowledging that many of the issues discussed could be applicable to other settings. Two stories will be shared, illustrating clinical research in practice. Finally, we will discuss the changing face and the future of clinical research and suggest a way in which we can find common ground in order to address our common goal. Factors influencing involvement of academics in clinical research A number of factors influence the manner in which academics approach clinical research. The move within universities to a business model, in which income generation is crucial, has dramatically changed the academic career structure. While research remains central to most academics, the imposed business model has led to pressures to generate income (e.g., commercial products or continuing education packages) as well as produce deliverables, such as graduates and higher degree graduates (Onslow, 2008). Indeed income for research- intensive universities (such as The University of Queensland, The University of Sydney, etc.) is inextricably linked to their outputs such as publications and commercialisation of intellectual property. Furthermore, current research funding models require a mix of feasible, yet innovative research, robust scientific methods and clear translation to practice. While these demands are achievable, the timeframe limits imposed by funding models do impact upon their success. Academics might therefore find it hard to “get off campus” to establish research projects in clinical environments. Developing trusting relationships with local clinicians who are overseeing such projects takes time and gaining ethical clearance for projects from hospital or clinical centres can also be costly and time consuming, holding up the commencement of research, and impacting on the timeframe available for data collection and evaluation. The demands of a business model have also dictated changes in the measurement of academic performance to one which values scientific quality measures, such as number of publications, journal impact factors, citation counts, grant success and student supervision. These measures typically relate to the impact the research has upon the academic community rather than the real world impact. Linked to this is the conflict between the need to produce the highest quality research evidence to satisfy academic requirements versus the need to research in a

KEYWORDS CLINICAL RESEARCH FUTURE SPEECH- LANGUAGE PATHOLOGY

(From the top) Kyla Brown, Anne J Hill and Anna Copley

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JCPSLP Volume 16, Number 1 2014

Journal of Clinical Practice in Speech-Language Pathology