Quo vadis Indian Therapist?
Around June 2013, V Prakash posed a question to me when we were having our
daily end of the day conversation- the question was “how many studies have we
(Indian therapist) done till today”. He also added that we should find it and
post it FB so that we will all know where we are standing. We both agreed it was an idea worth pursuing.
When we started
searching, we landed with a huge number of hits in the Medline including
dental, yoga studies and what not. We thought we are making a mistake in search
terms. We wrote to Medline help desk and
they also said it is difficult to search specifically for Indian therapists and
studies done by them. From the 934 hits
we had from the search string we gave (please refer to the article for details) hand searched each
article for PT author- hours and hours of staring and searching for authors if they were therapist or someone
else. Well at this point we thought well if we are going to pursue this we need
to do this as a bibliometric study rather than as a small blog on FB.
We were at this point joined by J Sarvankumar and we started to code around 165 articles using the methodology of a previous study . This was just tedious work as we did not have web of science access which would have made the task simpler and we would have run the data from it through bibliometric software. Well we didn’t have the resource. (We will publish the whole study in a few months as it is under peer review in a journal.)
When we were looking in to the coded data we found there was a steady increase in the RCTs. We wanted to know what are the quantity and quality of them (RCTs) alone. We know RCTs are very difficult to do and publishing them is a herculean task. We wanted to highlight the production of our therapists, at the same time wanted to know the quality of those trials.
We were at this point joined by J Sarvankumar and we started to code around 165 articles using the methodology of a previous study . This was just tedious work as we did not have web of science access which would have made the task simpler and we would have run the data from it through bibliometric software. Well we didn’t have the resource. (We will publish the whole study in a few months as it is under peer review in a journal.)
When we were looking in to the coded data we found there was a steady increase in the RCTs. We wanted to know what are the quantity and quality of them (RCTs) alone. We know RCTs are very difficult to do and publishing them is a herculean task. We wanted to highlight the production of our therapists, at the same time wanted to know the quality of those trials.
More data analysis,
finding full text and this time we had to read the whole thing to code it and
analyze it. Luckily many of the journals
did give us free access and some we would not find it. 2 instances I remember
are one from Recoup (Dr. Sharan and his team) and one from my
friend Harpreet Singh readily sent us the full text when we would
not find it by ourselves, my sincere thanks to them both. We also could not
find some full text and after repeatedly mailing the authors I would not get it
(hence you will see some missing data in the study).
What did we find? Just
the key findings
1.
We are
getting better at producing RCTs- especially - Manipal university (don’t know
what the hell universities with huge resource are doing or the all the
government institutions).
2.
I have a
great deal of respect for people who can do RCT- we are trying do for quite
some time hence I know the pain and difficulty, but some of the studies could
have been done with better methodology and
better reporting. In one study it was written as double blinded but we
just would not find what they blinded by reading the article.
3.
We did not
report it in the publication- but the explanation of the intervention was very
poor. For example reporting that “…we
did tailor made exercise for improving symmetry…” does not help us to replicate
it in the clinical setting. (Click here for reference). At the same time, one of the earliest trials done by a Indian therapist was reported very
well in terms of explanation of the interventions. (the trials were coded for explanation
of intervention according to Hoffmann et
published criteria)
4.
I
personally don’t like studies on “healthy people”- the sports studies. In a
country as large and with so much of burden of illness why waste our
intelligence, time and money and making people run faster- when millions are
suffering from LBP, stroke and other cardiac conditions. I would urge Therapist
to do more RCTs based on the burden of NCDs (Non Communicable Diseases) of
India. The wonderful example I can point to, are the studies done on people
with diabetes, a condition with huge burden in India- which was studied in one
RCT (click here for the study)
5.
I am going
to get into trouble for saying this- anyhow- I found one study done on a group
of basket ball players and published as 2 trials – just the outcome measure is
different. I think this is just useless waste of time and looks like borderline
….. well I don’t want to say it. Please look into both the studies and you
decide- (click here for study 1 and click here for study 2).
6.
We should
be proud and bow our head to all the people who have contributed to the
production of RCT- as most of them have done without no funding, no mentoring
and against all odd.
7.
I know lots
of these journals do not insist on CONSORT guidelines on how to report a RCT; I just hope our hard
working researchers anyway follow it while writing. As a primer we can insist
our PG students to follow it as a practice while doing there dissertation.
8.
We had so
much difficulty in publishing this because- who the hell cares about Indian
therapist research production. After finishing the study it took us many months
to get a journal with relevant scope and we ended with Perspect Clin Res. It is
time we develop a proper high quality peer reviewed journal.
Additional reading:
2.
Read
our article @ Quantity and quality of randomized controlled trials
published by Indian physiotherapists
Love
K.
Hariohm
