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The clinical therapist/researcher disconnect

So one thing that I’ve found fascinating during my time as a researcher is the disconnect that sometimes occurs between therapists working clinically and researchers studying clinical treatments. Some of the recent posts on the recent WCPT conference have captured this idea of disconnect through discussions of therapists saying, “I know this treatment works” and researchers saying “I’ve tested this treatment and I know it doesn’t work (e.g. it isn’t any better than placebo or usual care)” with both speaking of the same treatment.

The interesting thing is that the disconnect goes both ways. I’ve spoken to therapists who start a research career and who start to work academically and they say that their previous clinical colleagues immediately assume that they no longer know how to treat a patient, or that they are far removed from the clinical world. And you speak to researchers who disregard anything a clinical physiotherapist has to say, because they don’t ‘understand’ research.

Now obviously these are extremes, but I feel these varying levels of disconnect can sometimes be very dangerous. Now I can’t talk for physios working clinically as I currently don’t and I won’t likely again. However, I can speak from my view as a researcher. First, we know so little about so many musculoskeletal pain conditions. Often we don’t even properly know what causes the pain. Now if this is the case, any hypothesis we have on how a treatment works is, at best, an educated guess. So as researchers, if we continue to test treatments based on these ‘guesstimates’ of mechanisms of action, we can be missing a massive part of the picture. I strongly feel that we have to go back to the patient and see how and what they are presenting to us to try to develop alternate hypotheses and develop new treatments.

To me this is where an alliance with clinical physiotherapists is vital to researchers (who don’t work clinically). Clinical physios are the ones who will treat a million people with a condition and notice the strange things that sometimes occur that can present us, as researchers, with ideas for new hypotheses. This is the fascinating part of research and what I’d argue, imperative to move the field forward.

I’d appreciate others’ opinions on this and of course, any experiences that you may have had.