JCPSLP Vol 16 Issue 1 2014

clinical setting where implementing the scientific principles of rigour, such as randomisation and waitlist controls, may not be ethically sound or clinically viable. At times it might seem easier for academics to conduct research within the university setting where environments and systems are known and control more easily exercised, but academics must weigh this against pressures to “get the study out there” and ready for clinical translation. Experiences of Dr Miranda Rose Dr Miranda Rose is an academic who has implemented clinical research throughout her career with a view to enhancing translation of research into practice. We provide her story as a real-life example of an academic successfully engaging in clinical research. I am currently a senior research fellow at La Trobe University and over the past 15 years my research has focused on the broad area of aphasia rehabilitation. The three main research threads have been gesture production in people with aphasia, community aphasia groups and their impacts on living well with aphasia, and the comparative efficacy of various aphasia treatments for improving communication for people with aphasia. To date, the majority of my aphasia treatment efficacy research has been conducted within people’s own homes or in community-based clinical facilities. In this way I have been researching in a “clinical setting”, that is, outside of the “ideal, laboratory-type” research setting and in the at times “messy” clinical environment. I chose to situate my studies in the clinical setting for three main reasons. First, my studies have involved prolonged engagement with people with aphasia (between 20 and 60 hours of treatment, with assessments spanning many months to address maintenance questions) and thus successful recruitment was more likely if participant travel burden was minimised (e.g., Rose & Sussmilch, 2008). Second, I had a strong desire to work within participants’ functional communication environments (choosing motivating treatment targets is a lot easier when you are sitting in someone’s home than when in a research lab). Third, I wanted easy translation of the research results to clinical practice. Collecting data in the environment where the results will be utilised removes one possible translation barrier. There are of course several important limitations to research done in clinical environments. First, the researcher has less control over the environment. In some projects this may be minimally disruptive, but for others it becomes very significant. For example, the majority of the baseline and post-treatment assessments in my treatment studies have been carried out in people’s own homes. This usually means the participants are relaxed and have access to their usual communication supports. However, it also means that children, animals, friends and relatives often appear during these sessions, and other everyday household activities may take place in the background of the “research”. In such situations, decisions need to be made about the validity of the gathered data or the need to postpone data collection. Second, the relationship between the researcher and participants often takes on a more informal tone. I do not find this a limitation per se but it is an element that needs monitoring and at times, management. For example, when a participant comes to a research

laboratory the roles and expectations of researcher and participant are fairly well established. However, when the research encounter occurs in the home, and the researcher is then party to the wider life of the participant, it is not uncommon for the boundaries of the roles to be challenged. This is no different to situations encountered by community-based therapists working in homes but it does need acknowledgment and preparation, especially for novice researchers. My clinical research endeavours to date have been overwhelmingly positive. Recruitment has been successful and adherence to study timelines and at times intensive treatment schedules has been excellent. We have been able to manage the environment so as to minimise disruption and gather valid data, and participants have reported being comfortable in the research setting, finding the home or near-by clinic attendance extremely convenient. Further, the results, gathered in this clinical world, can be easily applied to clinical practice. Most recently, we ran a treatment comparison study comparing two intensive treatments (Constraint Induced Aphasia Treatment Plus [CIAT Plus] and Multi-Modality Aphasia Treatment [M-MAT]; Rose, Attard, Mok, Lanyon, & Foster, 2013). We decided to situate one arm of the study in a community health centre. We also decided to employ one of the centre’s clinicians as a research associate to assist in providing the treatment and data collection. This was an extremely positive experience whereby the clinician helped us navigate the policies and procedures of the health centre, coped easily with the logistics of the environment, and provided greater access to local participant recruitment opportunities. In turn, her involvement in the project enabled a greater understanding of the treatments under investigation and the research process in general, both of which she was then able to share with her departmental colleagues. She was also able to provide insightful feedback as to the potential translation barriers that we can consider addressing in future studies. One final benefit of home-based clinical research is the opportunity for the data collectors to see the impacts of the interventions first hand in a functionally relevant environment. For the research assistants working on my projects that has been an important motivating and grounding experience. Factors influencing the involvement of clinicians in clinical research Similarly to academics, clinical SLPs also face a number of factors that impact upon their ability to initiate, engage in or drive clinical research. Many of these factors are individual and as such remain unknown; however, some factors have been identified in the literature. In Onslow’s (2008) paper on clinical translation research he highlights the differences in reasoning between clinical researchers and clinicians. He states that researchers are interested in scientific reasoning, reasoning which generates generalisations (i.e., whether a certain treatment can be applied in the remediation of a certain disorder), while clinical SLPs are interested in clinical reasoning (i.e., how treatment techniques can be tailored for the individual clients). Based on Onslow’s (2008) work, a

Miranda Rose (top) and Bena Cartmill

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JCPSLP Volume 16, Number 1 2014

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