Staying Current with the Research

Take it easy

By Erik P. Meira, PT, DPT*

Hands down the most common question I field is this: How does one stay current with the research?

The answer is easy. Read everything that has ever been published from cover to cover, analyzing the statistical accuracy of their findings and the true clinical significance of their conclusions. While you’re at it, you might as well also develop supernatural powers in order to look into the future and read all of the articles that are going to be published. What’s the matter? Too busy?

Okay, so let’s try that. Let’s look at what was published on the anterior cruciate ligament last year (2016). Oh. Only 1542 articles on one ligament of one joint? You’ve got some serious catching up to do . . .

See if this sounds familiar: “Come on! I really need to stay current on the research.” You set the most recent journals on your desk in a “to do” pile. Every day you glance at the pile as you are running from one patient to the next. One month goes by and the next group of journals comes in. You add them to the stack. By the time you finally have a moment for journal reading, the stack is huge and you give up discouraged. Going about it that way is just not going to work, at least not at first.

We are talking about a lifestyle change, so let’s compare this to another lifestyle change-like diet. If you tried to go from unlimited gorging on snacks and junk food to nothing but celery in one day, you would fail miserably, right? You will then see the endeavor as hopeless and give up. What you need to do is go easy on it. Set easy-to-reach goals and stick with them.

Here’s how to get started.

1. Choose four journals that apply to your practice. Decide which physical therapy journals are most specific to your own setting. But I recommend that at least one (preferably two) of your four choices should be a medical or surgical journal. Do not become too insulated within the physical therapy viewpoint. As an example, if you are a sports physical therapist (PT) like me, you might pick these four:

• Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
• Sports Health
• American Journal of Sports Medicine
• Anthroscopy

Another sports PT might choose four other journals that would be just as good. These journals might include more on chronic pain, or workers compensation, or be dedicated to one part of the body. Fit your journals to your practice.

2. Visit the website of one of those journals once a week. I recommend that you do this at a set time, maybe while eating lunch at your desk every Thursday or while you are watching your favorite TV show. Whatever you do, set a regular time and stick with it. Don’t just say, “Whenever I have a free moment”—that ain’t gonna happen. Each week visit a different journal’s site. After one month (four weeks), start over with the first journal, which should now have a new issue out. But what are you going to do on that website?

3. Read the titles of the articles in the current issue. Think of it as like reading newspaper headlines. If you are reading the headlines each day, you gain a sense of what is going on in the world. Similarly, if you read the titles of what is being published in the literature, you have a sense of what is going on in the research. This is important as you head to the next step.

4. When a title piques your interest, read the abstract. Ideally, this title should go against what you would have expected instead of reinforcing a previously held belief (more on this soon). Or it’s on a topic that you keep seeing over and over again, maybe a hot topic in the literature right now. Click on the title and up pops the abstract, which is a brief synopsis of the study. Read that. Ponder it. Then move on. Don’t overthink one article. (Ignore the “You can’t just read the abstract!” person. Again, I’ll get to that.)

5. When you have found a really interesting abstract, get the whole article. Reading titles and abstracts is free and only takes a few minutes. Getting the full article means taking out a subscription and therefore money, right? Not always. Some journals are open source and free to access. Your membership in the American Association of Physical Therapy (APTA) gives you automatic access to many journals, depending on the APTA section. You may have a friend you can email who has university access and can send you a copy. When all else fails, go back to that abstract. See that email address at the top? That’s the author(s). Send them an email and ask them nicely for a copy of their article, expressing your strong interest in learning more. They are usually excited to share.

Once you get that pdf, use a free research organizer like Mendeley or Zotero to automatically organize all of your research articles into a searchable database, which is much better than having those pdfs randomly scattered all over your desktop and document folders.

6. Think about the article. There are a couple of basic things to remember here. First, what exactly is research? It is the systematic investigation into and study of materials and sources in order to establish facts and reach new conclusions.¹ In our case this is the science of medicine. and I’ll let Kimball Atwood of ScienceBasedMedicine.org describe researching science: “When you think of science, please think of it first as a way—the only accurate way that we have—to understand nature. If, instead, you think first of P-values or confidence intervals or randomization or blinding or allocation concealment, you’re misled.”

The other thing to remember is that you can find an article that supports anything you want to believe, but you need to leave your confirmation bias at the door. As a matter of fact, science is not for you to confirm what you believe, but to challenge what you believe and expand your knowledge by studying different approaches to a question. When you find yourself getting excited with agreement, pause and reflect. Ask yourself: “Can these findings be explained in another way? What else might be at play?”

Don’t get too bogged down in statistics. Before you even consider study design and statistical analysis, consider whether or not the study is posing a scientific question and whether or not the initial premises are sound. Sadly, many studies fail to stand up to this examination. Also, some studies will simply be over your head. Don’t sweat it. That article isn’t for you. There are plenty of others for you to read.

Science is a dialogue. Anyone who tells you that you cannot trust an abstract is misguided even though they are correct. First, they are basically telling you that if you don’t have time to read an entire article and critically analyze the design and statistics of the study and so on, then don’t even bother. Of course those things matter but that mindset is just not helpful. It has the effect of actually dissuading people from familiarizing themselves with the research.

Yes, you should not trust an abstract, but you also should not trust an entire well-conducted study in isolation, either! A great study only answers one very focused scientific question. It must be corroborated by other similar studies, and then later studies will build on that idea over time. First and foremost, be aware of the dialogue. This doesn’t mean you need to “catch up” on previous literature, unless you have an interest in how a particular area of research has developed. Just start today. As time goes on you’ll start saying, “I’ve seen this kind of thing before,” or “Whoa, this explains some old concepts in a whole new light.” Time and exposure to the research will give you that; you can’t learn it overnight.

Don’t…

• …rely on social media for research information. Social media is the worst place to get your research. What you will get is the cherry-picked greatest hits from people you already agree with. Huge mistake. Remember, in order to find the truth you need to challenge your beliefs, not confirm your biases. You need a more complete exposure.
• …dismiss the skeptics. They are friends of the profession, not enemies. Hear them out. Listening to them doesn’t mean they are necessarily correct, but they will help you keep your biases in check. As Aristotle said, “It is the mark of an educated mind to be able to entertain a thought without accepting it.”
• …be easily swayed by one study. Read it. Ponder it. Then move on. Don’t have a knee-jerk reaction. Remember that science is a dialogue and an ongoing endeavor; consider all of the evidence. Beware the person who cites the same study over and over again. One thing I have said many times before: “If one study changes everything for you, it is because you only read one study.”

Do…

• …start today. As I said, the longer you pay attention to the dialogue (keep reading those titles), the more comfortable you will be with the discussion. Sure, I have more than 20 years of practice experience but, more importantly, I have more than 20 years of following the research discussion. Every article I read today is put into the context of all that history.
• …attend professional conferences. Go to Combined Sections Meeting (CSM). Sure, there are some great educational sessions and preconference courses at CSM that summarize current concepts but you always need to take the summarizing of concepts with a grain of salt. There are also platform sessions. Watch the researchers present their abstracts and then discuss their findings with other researchers. You get to see the dialogue in action.
• …want to know the truth more than be proven right. Put your ego aside. Have a humble desire to know what is really going on, not just to prove that you “knew it all along.” No one cares if you were right.
• …keep it simple. Take it easy. You have a long career ahead of you. Just read those headlines and keep an open mind. As you get more comfortable, expand to eight or so journals a month (two a week). No, you can’t follow every journal. If an idea is important enough, it will drift into your reading list eventually. Don’t worry.
• …stay skeptical. Remember: The most obvious answer is almost never the right answer.

Be consistent, have a desire to learn, pay attention, and keep evolving.

Erik P. Meira is the owner and clinic director of Black Diamond Physical Therapy in Portland, Oregon. His other writings and course schedule can be found on his website, thesciencept.com, and he can be reached at emeira@blackdiamondpt.com

*The author has a vested interest in the subject of this article.