|FROM THE ISPRM PRESIDENT
|Year : 2018 | Volume
| Issue : 2 | Page : 4-8
The scientific article and the future of physical and rehabilitation medicine
Walter R Frontera
Department of Physical Medicine, Rehabilitation and Sports Medicine San Juan; Department of Physiology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico, USA
|Date of Web Publication||11-Jan-2019|
Walter R Frontera
Department of Physical Medicine, Rehabilitation, and Sports Medicine, University of Puerto Rico School of Medicine, PO Box 365067, San Juan, Puerto Rico 00936-5067
Source of Support: None, Conflict of Interest: None
Scientific research is the process by which new information and/or knowledge is generated. This knowledge can serve the purpose of supporting the practice of a medical specialty like physical and rehabilitation medicine (PRM). The research process consists of various steps including the dissemination of the findings in the form of a scientific article. Progress in science and medicine is communicated to others through the scientific article. The number of journals and articles in science in general and in the field of physical and rehabilitation medicine in particular has been increasing in the last few decades. This trend is expected to continue because of the expansion of research (including clinical trials) in the field and other activities such as the initiation of Cochrane Rehabilitation. Authors should understand the sections of a scientific article, the peer-review process, the hierarchy of levels of evidence, new rules regarding scientific reporting, and the need to prevent scientific misconduct through education.
Keywords: Journals, rehabilitation medicine, scientific publications
|How to cite this article:|
Frontera WR. The scientific article and the future of physical and rehabilitation medicine. J Int Soc Phys Rehabil Med 2018;1:4-8
|How to cite this URL:|
Frontera WR. The scientific article and the future of physical and rehabilitation medicine. J Int Soc Phys Rehabil Med [serial online] 2018 [cited 2019 Jul 22];1:4-8. Available from: http://www.jisprm.org/text.asp?2018/1/2/4/249850
| Introduction Research and Publishing|| |
Scientific research has been defined as a systematic exploration that generates new information and/or knowledge and leads to a better understanding of nature. This new knowledge is essential for the development and growth of any scientific or medical specialty including Physical and Rehabilitation Medicine (PRM) and depends, to a significant degree, on its capacity to foster, particularly among young professionals, an interest in the scientific basis of their specialty. The number of scientists in the world is increasing in all continents, particularly in countries that make serious investments in research and development, and it has been recently estimated at 8 million. The support of established researchers, the training of the next generation of researchers, and the promotion and conduct of research as a vital activity for the specialty should be very high on the list of priorities of leaders in PRM and rehabilitation in general. For these reasons, basic knowledge about research should be included in the educational curriculum of all PRM residency training programs, courses for medical students interested in PRM, and students of any rehabilitation-related profession. Furthermore, PRM researchers should establish partnerships with other researchers in rehabilitation and in closely related areas of inquiry.
The research process is composed of many activities and steps. Perhaps, one of the most important steps is the dissemination of the research findings in the form of a scientific article. The main objective of a scientific article (original research article or manuscript) is to communicate new scientific findings or ideas, while other types of publications such as book chapters summarize existing knowledge that, for the most part, has already been published. To learn how to write and communicate research findings is an important, but undervalued and underestimated, element of the work of a scientist., At the individual level, publications are important for personal/professional growth (writing becomes a tool for independent learning), academic promotion, recognition by peers, job searching, and securing financial resources for the conduct of future research. At the institutional level, publications are important to strengthen the knowledge base of a medical specialty, demonstrate its value in clinical settings and different levels of care, promote changes in clinical practice, boost the reputation of professional schools and academic institutions, influence policy experts and decision-makers, and earn the respect of colleagues, health systems, and national governments. At the societal level, scientific publications, when appropriately summarized in the news media, may contribute to the education of citizens, change behaviors that may be detrimental to health, strengthen society's confidence in science's objectivity, and result in a higher level of political and financial support for the scientific enterprise.
It is important to recognize that the incorporation of new knowledge in a publication to the accepted and standard clinical practice is a difficult and variable process that can take many years. The publication of a scientific article in a respected journal does not guarantee the immediate utilization of that knowledge even if there is recognition of its value among the members of the scientific community. This is why, in many instances, several scientific articles on a particular topic must be “translated” into standards of care and guidelines. It is the weight of the evidence published in several articles rather a single study that will change standard practice.
| The Scientific Article|| |
Most progress in science and in medicine is communicated to peers and to the general public through the scientific article. The scientific article, as we know it today, was born in 1665 with the foundation of two journals, Journal des sçavans (Journal of the Learned) in France and Philosophical Transactions in England. Since then, the function of the article as the conduit of information for argument and debate and for the enhancement of knowledge has changed very little. According to the 2015 report of the International Association of Scientific, Technical, and Medical Publishers, approximately 35,000 journals are published in different languages around the world, more than 25,000 in English. Together, these journals publish approximately 2.5 million scientific articles every year. At least between 20 and 25 of those journals are dedicated to the field of PRM with various degrees of national and international circulation. Dozen others are dedicated to other professions and fields of study related to rehabilitation such as engineering, speech pathology, occupational therapy, physical therapy, and other medical specialties that overlap with PRM such as orthopedics, neurology, neurosurgery, and pain medicine.
| The Physical and Rehabilitation Medicine Article|| |
Due to the interdisciplinary nature of PRM, it is very difficult to ascertain exactly how many articles are being published in the field. However, a search in PubMed for the number of articles published related to PRM and rehabilitation in 2017 resulted in 13,530 articles (search term = rehabilitation medicine) and 32,030 articles (search term = rehabilitation), respectively. In both categories, the number of articles has increased significantly in the last 17 years [Figure 1]. It is reasonable to suggest that this trend will continue because of the increase in research activity in both categories. For example, the number of clinical trials registered in the website and database clinicaltrials.gov in the category of “rehabilitation” has increased 172% from 2013 to 2018 (accessed August 2018). Further, the number of published randomized clinical trials included in PubMed in the same category (“rehabilitation”) has increased from 786 in 2000–2003 to 753 in 2015 (unpublished observations) [Figure 2]. It follows that to sustain this growth rate, more journals or more pages per journal have to be dedicated to rehabilitation research.
|Figure 2: Number of published randomized clinical trials in rehabilitation in PubMed|
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The sections of a PRM article are not different than those in other medical specialties and depend on the type of publication. Different types of PRM scientific articles (original research, case reports, reviews, letter to the editor, and others) have different functions, but they serve to, among other things, communicate and disseminate new evidence, summarize existing knowledge, and together, represent the body of knowledge that defines and identifies a field of inquiry such as rehabilitation in general or PRM in particular. PRM academicians, researchers, and clinicians use scientific articles to communicate their ideas and data to their peers within and outside of their area of expertise. It would be hard to make progress in the development of PRM without a collective effort to publish the results of our research. It is important to note that PRM researchers may want to publish their work in non-PRM journals because of their interest in reaching audiences that do not read PRM or rehabilitation journals on a regular basis or because the nature of their work is very relevant to fields that are not traditionally considered core areas of PRM research. In my opinion, this is a positive step because it extends our reach and stimulates partnerships and collaborations with other researchers who may find conducting research in PRM an interesting area for them to move into. A typical example of this crosstalk between two fields of study is the partnership between rehabilitation and engineering. In fact, some journals have been established to publish this type of work that overlaps two specialties or professions.
A final word about publishing in PRM journals. During the last few years, several rules have been applied to some aspects of the process of writing and publishing a scientific article. The authors should be aware of these if they want their work to be considered for publication in participating journals. For example, to be accepted for peer-review, clinical trials have to be registered and obtain an identification number. Some journals will reject articles reporting the result of such a trial without review if the trial has not been registered. The registration number must be provided at the time of submission for peer-review. In addition, the authors are required to use reporting guidelines for specific study designs such as clinical trials (CONSORT), systematic reviews and meta-analyses (PRISMA), case reports (CARE), and others. In 2014, a total of 28 rehabilitation journals agreed to implement these rules with the intention of elevating the quality of both, the research and the reporting of science in PRM and in rehabilitation.
| Peer-Review|| |
To evaluate the quality of a scientific article and decide whether the article should be published, journals use the peer-review process.,, Briefly, experts who are knowledgeable on the topic that is the subject of the article are invited to provide an opinion to the editor in writing and to recommend rejection, revision, or publication of the article. This process is usually done in a blinded fashion so that the reviewers do not know the identity of the authors. It must be recognized that blinding is not always easy and/or effective, but the idea is that the reviewers should evaluate the quality of the work and not the persons involved in the article. There is no perfect system to conduct reviews, and some authors have proposed that peer-review should be done in a more open manner and not blinded and that comments by the reviewers should be made publicly available. Independent of the future direction of peer-review, an important objective of the process is to enhance the quality of the article. Reviewers should be critical but make recommendations that will improve the quality of the reporting. In fact, reviewers can also benefit from their participation in peer-review and as good scientific citizens, should make a commitment to participate when invited if they feel confident they can provide an objective expert opinion.
Levels of Evidence
The evidence published in scientific articles may have different levels of strength or confidence. Some research studies generate information/knowledge that can be trusted more because of the study design and the methodology used to collect the data. Thus, to strengthen the evidence that supports the practice of PRM, we must conduct more studies that generate the strongest levels of evidence. Although all observations may contribute to the knowledge base, there is some debate about the feasibility of some types of studies in PRM including randomized and double-blind clinical trials. Nevertheless, randomized clinical trials, pragmatic trials, and systematic reviews with meta-analyses are considered by many as examples of studies that will generate some of the highest or strongest level of evidence. In this regard, the increase in registered clinical trials in rehabilitation and in PRM (see above) is an encouraging sign and suggests that the level of evidence in the field is higher now than a few decades ago. Finally, researchers should not be discouraged from publishing studies that have different study designs if the design is appropriate for the question or if these “gold standards” are not feasible because of ethical reasons. The publication of case reports and consensus statements may still be appropriate and useful.
| Cochrane Rehabilitation|| |
The multiplicity of journals (see above) and scientific publications creates important challenges for those who need to keep up to date with the latest information; in other words, all of us! This is the reason why reviews are so important and there is a need for publications dedicated to the synthesis of existing research. To synthesize existing knowledge, particularly if done with a critical approach, is a very important exercise. In other words, if taken together and analyze with appropriate methods, what does the preponderance of the evidence says? To synthesize evidence that informs and supports (or not) clinical practice is the purpose of Cochrane. Since 2016, Cochrane established a “rehabilitation field” that will focus on studies relevant to PRM and rehabilitation in general. To some degree, a systematic review with meta-analysis is a publication (or study) about other publications (or studies) and it has become a very important tool to summarize the scientific literature and inform decisions about individual patient care issues as well as issues relevant to health systems.
| Scientific Misconduct|| |
Due to the importance and impact of a scientific article, it is inevitable to consider situations where the rules of scientific research and publishing are not followed. Many of these situations can be classified under the category of “scientific misconduct.” Scientific misconduct has been defined by the Office of Research Integrity of the United States Department of Health and Human Services as the “fabrication, falsification, or plagiarism in proposing, performing, or reviewing research, or in reporting research results.” Honest error or differences of opinion are not included in this definition. It is not easy to know exactly the incidence of scientific misconduct. The process to investigate allegations of scientific misconduct is complex and requires time, in part because the consequences of proving misconduct on the researcher's career are quite significant. Although some cases are identified during the peer-review process, many are only revealed after publication. Fanelli conducted a systematic review and meta-analysis of 21 surveys and reported some disturbing figures; 1.7% of scientists admitted to fabricating or falsifying data at least once and 14.1% had observed colleagues falsifying data. Although not reaching the threshold for misconduct, it is worrisome that 72% of those surveyed had witnessed colleaguesengaging in questionable research practices. As a community, we need to address this issue because maintaining the trust in science of our patients and society in general is the only way to guarantee their high level of support.
The outcome of an investigation of allegations of scientific misconduct may be the retraction of a scientific article. Retraction of publications attributable to scientific misconduct is reported to be on the rise. In one study, 67% of the retractions were attributable to misconduct. Because a retraction may occur months or years after the publication of the article, fraudulent data may have been used in other research studies, cited in other publications, and/or applied directly to patient care with the potential to cause irreparable harm. Journal editors, reviewers, and the scientific community in general must pay attention to this problem and be serious about identifying and addressing such practices. In this regard, an excellent resource is the Committee on Publication Ethics (COPE), an organization established to provide advice and guidance to editors and publishers of scholarly journals on best practices for dealing with ethical issues (https://publicationethics.org/). This website has, among other resources, flowcharts that describe step by step how to evaluate allegations of misconduct in different situations.
According to the COPE, journal editors should consider three possible actions when considering a case of misconduct:
- A correction if a small portion of an otherwise reliable publication proves to be misleading (especially because of honest error), or the author/contributor list is incorrect (i.e., a deserving author has been omitted or somebody who does not meet authorship criteria has been included)
- An expression of concern if they receive inconclusive evidence of research or publication misconduct by the authors, there is evidence that the findings are unreliable but the authors' institution will not investigate the case, they believe that an investigation into alleged misconduct related to the publication either has not been, or would not be, fair and impartial or conclusive, or an investigation is underway but a judgment will not be available for a considerable time
- Retracting a publication if they have clear evidence that the findings are unreliable, either as a result of misconduct (e.g., data fabrication) or honest error (e.g., miscalculation or experimental error). Retraction is also appropriate in cases of redundant publication, plagiarism, and unethical research.
To avoid irreparable damage to the image of scientific research, the most important action is the prevention of misconduct. These programs should include education or training in the responsible conduct of research, mentoring and role modeling, policy development with institutional standards, compliance and oversight programs, the use of technology by journals to detect plagiarism, and perhaps, the auditing of data.
| Conclusion|| |
The development of PRM as a medical specialty and rehabilitation as a health strategy requires a variety of approaches and tools. The scientific article is one of the most important means to accomplish these two goals. We should all appreciate its value and support the journals that publish them.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Wilson EO. Letters to a Young Scientist. London, UK: W.W. Norton; 2013.
Ramón Cajal S. Advice for a Young Investigator. Cambridge, Massachusetts, USA: Massachusetts Institute of Technology; 1999.
Baumberg JJ. The Secret Side of Science. Princeton, NJ: Princeton University Press; 2018.
Frontera WR, Fuhrer MJ, Jette AM, Chan L, Cooper RA, Duncan PW, et al.
Rehabilitation medicine summit: Building research capacity. Am J Phys Med Rehabil 2005;84:913-7.
Goldbort R. Writing for Science. New Haven, Connecticut, USA: Yale University Press; 2006.
Dean C. Making Sense of Science. Cambridge, Massachusetts, USA: Harvard University Press; 2017.
Gross A, Harmon JE, Reidy M. Communicating Science: The Scientific Article from the 17th
Century to the Present. Oxford, United Kingdom: Oxford University Press; 2002.
Ware M, Mabe M. The STM Report: An Overview of Scientific and Scholarly Journal Publishing. 4th
ed. The Hague, The Netherlands: International Association of Scientific, Technical and Medical Publishers; March, 2015.
Gastel B, Day RA. How to Write and Publish a Scientific Paper. 8th
ed. Cambridge, United Kingdom: Cambridge University Press; 2017.
Chan L, Heinemann AW, Roberts J. Elevating the quality of disability and rehabilitation research: Mandatory use of the reporting guidelines. Am J Phys Med Rehabil 2014;93:279-81.
Frontera WR, Grimby G, Basford J, Muller D, Ring H. Publishing in physical and rehabilitation medicine. Am J Phys Med Rehabil 2008;87:215-20.
Twaij H, Oussedik S, Hoffmeyer P. Peer review. Bone Joint J 2014;96-B: 436-41.
Manchikanti L, Kaye AD, Boswell MV, Hirsch JA. Medical journal peer review: Process and bias. Pain Physician 2015;18:E1-14.
Wendler D, Miller F. The ethics of peer review in bioethics. J Med Ethics 2014;40:697-701.
Burns PB, Rohrich RJ, Chung KC. The levels of evidence and their role in evidence-based medicine. Plast Reconstr Surg 2011;128:305-10.
Kiekens C, Negrini S, Thomson D, Frontera W. Cochrane physical and rehabilitation medicine: Current state of development and next steps. Am J Phys Med Rehabil 2016;95:235-8.
Fanelli D. How many scientists fabricate and falsify research? A systematic review and meta-analysis of survey data. PLoS One 2009;4:e5738.
Fang FC, Steen RG, Casadevall A. Misconduct accounts for the majority of retracted scientific publications. Proc Natl Acad Sci U S A 2012;109:17028-33.
[Figure 1], [Figure 2]