JCPSLP
Volume 16, Number 1 2014
15
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
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
Miranda Rose
(top) and Bena
Cartmill
