A Peer Reviewed Publication of the College of Allied Health & Nursing at Nova Southeastern University

Correspondence:
Peter J. Thomas, BPHTY (Hons)
Royal Brisbane and Women’s Hospital
Department of Physiotherapy
Level 2 - Ned Hanlon Building
Royal Brisbane Hospital
Herston QLD 4029 Australia
PeterJ_Thomas@health.qld.gov.au

Citation:
Thomas, P., Williams, M., Lipman, J. Influence of academic qualifications, place of employment and prior research experience on physiotherapy research practice. The Internet Journal of Allied Health Sciences and Practice. July 2005. Volume 3 Number 3.

Introduction
The last decade has seen many professions, including physiotherapy, take a more active role in research and evidence-based practice. With more physiotherapists conducting rather than just consuming research, there is a greater need for an understanding of the principles of ethical practice specifically related to research. Research training curricula in undergraduate and/or postgraduate allied health education traditionally incorporate principles such as research design, methodology, data collection and analysis. However, it is unclear whether research education is equally as thorough in presenting and exploring issues affecting project planning, resources and ethical guidelines. Inadequate research training in these areas may increase the likelihood of projects being significantly delayed, interrupted or abandoned prior to completion. In terms of risk management, insufficient attention to the ethical issues associated with research involving humans, has the potential to result not only in an increased number of formal complaints but also medico-legal litigation. In addition, ethical and scientific deficiencies impact upon the likelihood of successfully disseminating research findings via publication. The overall awareness and understanding among physiotherapists of good research practices is unknown. The aim of this study was to investigate the current knowledge and practice of research management among Australian physiotherapists and how research experience, academic qualifications and place of employment influence this.

Method

The Royal Brisbane and Women’s Hospital HREC reviewed and approved the research protocol and all participants provided informed consent.  A closed response questionnaire was designed and tested prior to administration (Appendix 1). The questionnaire sought demographic information about the respondent’s education, employment and research experience. Respondents were then invited to answer a series of closed response questions by selecting a response which best reflected their beliefs. The content of these questions embodied four domains: knowledge of ethical guidelines; ethical review and informed consent; project development and resources; and reporting and publication. Best practice in these areas was identified from the internationally accepted “Good clinical practice consolidated guideline” and the Australian National Health and Medical Research Council's "National statement on ethical conduct in research involving humans" (NHMRC statement).^1,2 The NHMRC statement originates from the Declaration of Helsinki and governs the conduct of human research within Australia.³

Face/content validity was achieved through consultation and development of the questionnaire with twelve physiotherapists of varied research experience. Test-retest validity for the questionnaire was established by eight physiotherapists of varied research experience who completed the survey twice, two weeks apart, with an average of 88% agreement (range 74 – 97%) for the 33 questions.

All physiotherapists who submitted abstracts to a scientific committee of an Australian Physiotherapy Association (APA) conference in 2003/2004 were considered eligible for the study. These conferences included the National Cardiothoracic, Neurology, Pediatric and Musculoskeletal specialty group’s conferences and the 8^th International Physiotherapy Congress. With permission of the APA, each conference organizing committee was approached with a request to access the list of delegates, who had submitted abstracts. The survey was then distributed by mail (specialty group abstracts) or by e-mail (congress abstracts). Due to the scheduling of conferences over 2003/2004, survey distribution was staggered so that the time between conference abstract submission and survey completion was minimized. Physiotherapists whose papers had not been accepted for presentation were not surveyed due to their removal from the mailing lists held by conference organizers. If a physiotherapist had submitted more than one abstract to a conference they were asked to complete the survey related to the abstract with the most robust research design. Due to privacy protection of mailing lists, we were unable to prevent some physiotherapists receiving an invitation to participate in the survey more than once as they submitted abstracts to more than one of the targeted conferences. In these cases, as only one response per physiotherapist was sought, we requested physiotherapists who had already completed the survey to return a form indicating their earlier participation.

Descriptive data was analyzed by calculating frequencies and means. Chi square tests were used to determine the relationship between factors likely to influence the knowledge and research practices of respondents such as research experience, academic qualifications and place of employment (alpha level = 0.05).

Results
Overall, 331 surveys were distributed and 184 returned (response rate = 55%). The average time since graduation of respondents was 14.6 years (SD = 9.3). A diverse range of current employment sites was reported by the respondents, with 29% (n = 54) at universities, 44% (n = 80) at hospitals, 15% (n = 27) in private practice, 7% (n = 13) in community-based settings and 5% (n = 10) were unemployed or provided no response.

In describing their extent of prior involvement in research, 4% (n = 7) of respondents reported no research experience, 2% (n = 3) had exposure only as a subject of a research study, 13% (n = 23) had assisted in a research study (data collection or screening and recruitment of subjects), 45% (n = 83) were experienced researchers without publications and 36% (n = 66) indicated that they were experienced researchers with publications.

In terms of qualifications, 38% percent of respondents were physiotherapists holding or currently completing PhDs (n = 69). Other respondents held or were completing a masters degree (research or coursework) (20%, n = 36) and honours, masters-qualifying or post-graduate certificate qualifications (14%, n = 25), whereas 28% of respondents were physiotherapists without postgraduate academic qualifications (n = 52). Physiotherapists holding or completing PhDs were primarily employed in university and hospital settings (58%, n = 40 and 23%, n = 16 respectively). Respondents in the masters degree category were employed in universities (22%, n = 8), hospitals (47%, n = 17) and private practices (26%, n = 7). Respondents in the honours, masters-qualifying or post-graduate certificate category and those without postgraduate academic qualifications were primarily employed in hospital settings (56%, n = 14 and 62%, n = 32 respectively). 

The study designs of papers submitted to the conferences are presented in Table 1. The majority of papers accepted for presentations at conferences were for the oral format (83%, n = 153) and 16% (n = 29) accepted as poster presentations.

Table 1: Summary of abstract content and attainment of HREC approval.

*Calculation of percentage excludes literature reviews and discussion papers from total population i.e. n = 184 – 37 = 147.

Both prior research experience and postgraduate academic qualifications were related to presentation of an oral paper. Physiotherapists with previous research experience (with and without publications) presented 87% of all oral presentations (n = 71 and 61 respectively) and had a greater proportion of oral to poster presentations (90%, n = 132, (X²₍₄₎ = 23.6, p < 0.001)). Physiotherapists who held or were currently completing PhDs presented more of the oral presentations (42%, n = 64) and were less likely to present a poster. Approximately half (55%,
n = 16) of the poster presentations were delivered by physiotherapists without postgraduate academic qualifications. Place of employment (academic, hospital, community) was not related to the type of presentation (X²₍₄₎ = 4.2, p = 0.385).

Knowledge of ethical guidelines
The Declaration of Helsinki and the NHMRC statement were familiar to 73% (n = 127) of all respondents. A greater proportion of university staff (93%, n = 50) reported awareness of these documents when compared to all other categories of employment (mean 64%, n = 77, X²₍₄₎ = 18.1, p= 0.001). Physiotherapists experienced in research and with prior publications had greater awareness (89%, n = 59) than physiotherapists experienced in research without publications (72%, n=58) and those with no or little previous research experience (44%, n = 4, X²₍₄₎ = 31.7, p < 0.001). Similarly, postgraduate qualifications influenced the proportional awareness of these documents, with 96% (n = 66) of physiotherapists currently completing or holding a PhD, 88% (n = 30) of physiotherapists holding a masters degree, 48% (n = 12) of physiotherapists holding honours, masters-qualifying or post-graduate certificates and 45% (n = 23) of physiotherapists without postgraduate qualifications indicating awareness of these documents (X²₍₃₎ = 50.3 , p  < 0.001).  

While the majority of all respondents indicated that they were aware of these governing documents, fewer physiotherapists indicated that they had actually read or referred to these ethical documents (47%, n = 83). University staff (76%, n = 41) were more likely to have read or referred to the documents than physiotherapists in all other categories of employment (mean = 42%, n = 42, X²₍₄₎ = 29.1, p < 0.001). Physiotherapists experienced in research and who had published (70%, n = 46) were more likely to have referred to these documents than physiotherapists experienced in research without publications (42%, n = 34) and physiotherapists who had assisted with research (23%, n = 5, X²₍₄₎ = 28.5, p < 0.001). No physiotherapists with limited or no involvement in research indicated that they had read or referred to these ethical guidelines. Significant differences between postgraduate qualification categories were also seen, with 78% (n = 54) of respondents who held or were currently working toward a PhD, 44% (n = 15) of respondents with a masters degree (research or coursework), 16% (n = 4) of respondents with a honours, masters-qualifying or post-graduate certificate qualifications and 24% (n = 12) of physiotherapists without postgraduate qualification indicating that they had read or referred to these documents (X²₍₃₎ = 48.0, p < 0.001).

For guidance on ethical concerns related to research, overall respondents indicated reliance on colleagues (30%, n = 53), their local HREC guidelines (36%, n = 65) and to using a combination of both their local HREC guidelines and other relevant ethical documents, such as the NHMRC statement (32%, n = 58). Place of employment (X²₍₁₂₎ = 25.4, p = 0.013), postgraduate academic qualifications (X²₍₉₎ = 34.5, p < 0.001) and prior research involvement (X²₍₁₂₎ = 38.6, p < 0.001) significantly influenced the primary source accessed for ethical guidance (Table 2).

Table 2. Primary source accessed for guidance on ethical conduct related to research.

Place of employment (X²₍₁₂₎ = 25.4, p = 0.013). Prior research involvement (X²₍₁₂₎ = 38.6, p < 0.001). Academic qualifications (X²₍₉₎ = 34.5, p < 0.001). Bold, underlined data highlight the most marked differences in observed data within employment, research and academic categories.

Ethical review and informed consent
Excluding literature reviews and discussion papers, the majority of conference papers submitted by physiotherapists involved research with human participation (95%, n = 140) (Table 1). Respondents indicated that HREC review and approval was sought for 89% (n = 124) of these studies. Of the 16 papers involving human participation but without HREC approval, eight were quality improvement activities which respondents indicated did not require HREC review and approval. The remaining eight papers conducted without HREC review or approval were a survey of physiotherapy practice, three single case studies and four experimental research studies (Table 1).  

The majority of respondents indicated they had experience in obtaining informed consent (84%, n = 155). In gaining informed consent, 86% (n = 158) of respondents indicated that they would provide verbal information on the study to participants and 96% (n = 177) would provide an opportunity for the participants to then discuss the trial with an investigator. The provision of a copy of any written information was reported by 95% (n = 174) of respondents but only 63% (n = 115) indicated they would provide a copy of the signed and dated consent form to participants. Overall, 57% (n = 102) of respondents indicated that they routinely practiced all four requirements for consent (providing both verbal and written information, an opportunity for discussion and a copy of the signed consent to the participant). However, compliance with three or more of these requirements was indicated by 89% (n = 164) of respondents. Place of employment, prior research involvement and the attainment of a postgraduate qualification did not influence the completion of components essential to gaining consent (X²₍₄₎ = 2.5, p = 0.64; X²₍₄₎ = 2.6, p = 0.62; X²₍₃₎ = 2.4, p = 0.49 respectively).

Project development and resources
The majority of respondents (60%, n = 106) indicated that they could access a range of multi-disciplinary colleagues with interest, and/or research experience (e.g. other physiotherapists, medical staff, scientists, statisticians). There was a significant association with place of employment (X²₍₁₂₎ = 23.8, p = 0.02) but not postgraduate academic qualifications (X²₍₉₎ = 11.0, p = 0.28) or prior research involvement (X²₍₁₂₎ = 14.1, p = 0.29). As could be expected, a greater proportion of respondents working in university (70%, n = 38) or hospital settings (58%, n = 46) reported stronger research networks than those respondents who worked in private practice (52%, n =14) and community settings (46%, n =6).

Overall, respondents indicated a high awareness of potential funding opportunities for research activities (82%, n = 145). This awareness was significantly greater among university employed respondents (96%, n = 52, X²₍₄₎ = 11.2, p = 0.024), physiotherapists with research experience and publications (97%, n = 63, X²₍₄₎ = 20.4, p < 0.001) and physiotherapists currently completing or holding a PhD (99%, n = 68, X²₍₃₎ = 29.5, p < 0.001).

Approximately half of all respondents indicated that they felt they had the ability to actually identify and apply for these funding opportunities (55%, n = 96). University employed physiotherapists (78%, n = 42, X²₍₈₎ = 25.0, p = 0.002), physiotherapists experienced in research with publications (74%, n = 48, X²₍₈₎ = 41.8, p < 0.001) and physiotherapists currently completing or holding a PhD (77%, n = 53, X²₍₃₎ = 48.0, p < 0.001) were significantly associated with confidence in identifying and applying for funding opportunities. The majority of all respondents indicated that they felt inadequate funding opportunities existed for physiotherapy research (83%, n = 139), with the sentiment shared across all places of employment (X²₍₄₎ = 2.6, p = 0.63), levels of prior research involvement (X²₍₄₎ = 2.6, p = 0.62) and postgraduate academic qualifications (X²₍₃₎ = 0.6, p = 0.906).

Reporting and publication
At the time of the survey, 17% (n = 31) of all papers were in press or published in a peer-reviewed journal and 16% (n = 29) were under review for publication. Approximately half of respondents indicated that they intended to publish the full paper of the abstract presented at the conference but had not yet submitted for publication (47%, n = 87). No intention to seek publication was indicated by 20% (n = 36) of respondents.

Of the abstracts presented by respondents at conferences, experimental research studies were more likely to be in press or submitted for review for publication (Table 3). Respondents presenting papers on literature reviews, discussion papers and quality improvement projects were less likely to consider submitting these for publication. Place of employment (X²₍₁₂₎ = 37.5, p < 0.001), academic qualifications (X²₍₉₎ = 51.0, p < 0.001) and prior research involvement (X²₍₁₂₎ = 81.8, p < 0.001) all influenced the intent to pursue publication (Table 4).

Table 3: Stage of publication by abstract content.

X²₍₁₅₎ = 77.7, p < 0.001. Bold, underlined data highlight the most marked differences in observed data.

Table 4. Stage of publication by employment, research experience and postgraduate education.