Rehabilitation Medicine Summit

The Rehabilitation Medicine Summit: Building Research Capacity (Summit) was held in Washington, DC, on April 28–29, 2005, with the general objective of advancing and promoting research in rehabilitation by making recommendations to expand research capacity. The idea of convening a research summit was conceived in 2002 by the Foundation for Physical Medicine and Rehabilitation (PM&R). Under the leadership of Dr Gail Gamble, the Foundation invited the American Academy of PM&R, the American Congress of Rehabilitation Medicine, and the Association of Academic Physiatrists to meet and discuss the concept of a national research summit to address issues related to building research capacity in rehabilitation. The group established a Summit Steering Committee composed of the leaders of the 4 organizations. The Summit Steering Committee then appointed a multidisciplinary Summit Program Committee (Program Committee), which included Walter Frontera (Chair, Harvard Medical School/Spaulding Rehabilitation Hospital), Leighton Chan (University of Washington), Rory Cooper (University of Pittsburgh), Pamela Duncan (University of Florida), Marcus Fuhrer (National Institutes of Health), Alan Jette (Boston University), John Kemp (Powers, Pyles, Sutter & Verville, PC), Kenneth Ottenbacher (University of Texas Medical Branch/Galveston), P Hunter Peckham (Case Western Reserve University), Elliot Roth (Rehabilitation Institute of Chicago), and Denise Tate (University of Michigan). The Program Committee wrote the executive summary that begins on …

IntroductionBuilding research capacity within the radiation therapist workforce/profession is essential to guarantee research is embedded into core practices. Assessment of current capacity levels within organisation, department and individual domains needs to occur to establish a baseline and ensure research capacity building (RCB) strategies will be targeted successfully. This exploratory study aimed to identify the areas within each domain where radiation therapists would benefit from extra research assistance, that being research support and process changes, particularly in relation to the workplace and health sector.MethodsPractising radiation therapists (RTs) within Australia were recruited through professional organisations and invited to complete the online Research Capacity Culture Tool (RCCT). The survey was conducted using Qualtrics with data exported to SPSS.V27 for analysis. Descriptive statistics and the Radiation Therapy Specific Survey Analysis Approach (RTSSAA) for the Research Capacity and Culture Tool were used to analyse and report the results.ResultsSurvey participation rate was 121/2640 (4.6%). Within the Organisation and Department domains, the most research assistance was required in infrastructure (n = 92–37) and support (n = 66–45) categories, respectively. Participants from private sector (Organisation: 42.7%, Department: 53.7%) and metropolitan centres (Organisation: 32.6%, Department: 47.5%) required a higher rate of assistance when compared to their counterparts in both categories. The individual domain showed similar levels of assistance required across health sectors and work locations. Workplaces showed similar levels of complexity of research activity; private sector (62.5%) recorded the highest level of no research activity.ConclusionThis study has provided insight into how the research capacity and culture of organisations and departments in which individuals' work will influence their abilities and opportunities to perform research.

Research capacity building (RCB) in Australia has recently focussed on strategies that take a whole of system approach to developing research culture at individual, team and organisation levels. Although a theoretical framework exists, no tool has been published that quantitatively measures the effectiveness of RCB interventions aimed at these three levels. A sample of 134 allied health workers was used to validate the research capacity and culture (RCC) tool. Item level analysis was undertaken using Cronbach's α and exploratory factor analysis, and test-retest reliability was examined using intra-class correlations (ICC). The tool had one factor emerge for each domain, with excellent internal consistency for organisation, team and individual domains (α=0.95, 0.96 and 0.96 respectively; and factor loadings ranges of 0.58-0.89, 0.65-0.89 and 0.59-0.93 respectively). The overall mean score (total) for each domain was: 5.4 (inter-quartile range 3.9-7.7), 4.4 (IQR 2.6-6.1) and 3.9 (IQR 2.9-6) for the organisation, team and individual domains respectively. Test-retest reliability was strong for each domain: organisation ICC=0.77, team ICC=0.83 and individual ICC=0.82. The RCC tool has three domains measuring research capacity and culture at organisation, team and individual levels. It demonstrates excellent internal consistency and strong test-retest reliability.

In the field of rehabilitation science, the number of qualitative studies published in journals of rehabilitation has increased significantly over the past two decades. The six key areas of opportunity and difficulty include paradigm shifts, advances in methodology, emerging technology, advances in quality evaluation, the growing popularity of mixed-methods approaches, and evolving approaches to knowledge translation. Qualitative research plays an important role in the development of rehabilitation science, and it is crucial that qualitative researchers and methods continue to evolve. The objective of qualitative research in medical rehabilitation is to comprehend the experiences and perspectives of patients and healthcare professionals in relation to medical rehabilitation. It entails collecting data using techniques such as interviews, focus groups, and observation, and analyzing the data to identify themes and patterns. 2 Qualitative research can provide valuable insights into the patient experience, including the patient's beliefs, attitudes, and rehabilitation-related behaviors.

This editorial focuses on capacity building, its definition and the evidence that has been published in support of its necessity for future research on nursing management. I acknowledge Erik Elgaard Sørensen, clinical nurse researcher at Aalborg University Hospital, Denmark, who in May 2013 invited clinical nurse researchers to join the Nordic Health Research and Innovation Network (NRI-Nursing) in Norway. The purpose was to establish a network of nursing researchers at Nordic Hospitals and provide an opportunity for clinical nurse researchers to participate in a forum committed to nursing research. There had been no previous opportunity for clinical nurse researchers to jointly explore aspects of the research process or share ideas and knowledge. It was hoped that the academic workshop would make it possible to share new clinical research knowledge and discuss current and future opportunities and challenges (Sørensen et al. 2011, E. E. Sørensen, Unpublished presentation). The conference was very interesting and creative in terms of developing best nursing practice and nursing research. There are several answers to the question of how to resolve the challenges that will face clinical nurse researchers in the future, one of which is capacity building. Alleyne and Mansour Olawale (2007) defined capacity building as an essential process for the survival of any individual or organization. Capacity is thereby the sum of processes, values and climate within an organization. In practice, the processes of capacity building and capability development are complex, iterative and spiral. Clinical nurse managers and researchers are the leaders of tomorrow. What do clinical nurse researchers need in terms of knowledge, leadership, academic supervision and financial resources to be able to drive research in the future? At present, clinical nurse researchers do not have sufficient resources such as time and infrastructure and in my opinion they are not valued as highly as they should be. Several questions need to be answered before clinical nurse researchers can be successful in developing and disseminating clinical research. Examples of capacity building can be found in the literature. McCance et al. (2007 p.57) identified three key areas that have implications for building research and development (R&D) capacity in the disciplines of nursing and midwifery. These three areas, which will serve as the structure of this editorial, are: (1) strong and visible leadership, (2) research expertise that enables the nursing profession to deliver research programmes and (3) increased capacity of individuals and organisations to engage in development activities. Capacity building has the potential to enhance the performance of R&D (McCance et al. 2007). Thus, it is closely linked to research capacity, i.e., the ability to conduct research by developing new knowledge using scientific methodologies and approaches (McCance et al. 2007). A gap exists due to the lack of empirical studies necessary for understanding the situated process of implementing and evaluating capacity building. Leadership as well as health care reforms and innovations are absolutely necessary. Innovation requires knowledge such as clinical guidelines for its implementation. Implementation research is closely related to policy reforms that impact on the effectiveness of care, as well as on the organization of health care, resources and collaboration. In this issue Begley et al. explore the views of key health care policy-makers on the impact of clinical specialist, advanced practice and midwifery roles. On municipal level the concept of collaboration is often described as interaction and cooperation (Liljegren 2013). However, research has demonstrated that reforms and innovation do not always lead to the intended changes. This can be explained by nurse leaders' capacity, styles and behaviours associated with relational, emotionally intelligent transformative leadership (Battilana et al. 2010). The term ‘management’ is very closely related to leadership and in health care includes an impersonal, system-based and practical approach. In this issue Zhu, Rodgers and Melia's grounded theory study explores why nurses leave nursing practice in China. The main category was nurses' loss of confidence in the safety and quality of health care. When nurses could not meet this essential prerequisite, some of them were unable to compromise their nursing values and left voluntarily to avoid the physical and mental stress. Thus, strong and visible leadership is of the utmost importance for preventing a shortage and high turnover of nurses. Evidence from our study suggests that research barriers are related to factors perceived by nurses as hindering the implemention of research findings in practice due to individual, socio-political, contextual and knowledge production aspects (Akerjordet et al. 2012). Clinical nurses want to become involved in research, identify an actual research area and design a research project over the course of 2 years (Akerjordet et al. 2012). However, barriers exist in the clinical setting due to lack of designated time, knowledge, research supervision and support. In general, clinical nurses' research-related knowledge, education and research culture are insufficient. This indicates a basic knowledge need and a growing interest in learning more about research and its utilisation, which will contribute to improved health care outcomes as well as patient safety. A well-known and acknowledged fact is that clinical nurse researchers rely on grants or funding to develop research. They are also dependent on the political will, long-term commitment and investment as well as environmental support. Clinical nurse researchers need access to a research infrastructure, computers, data programs, personal support and mentoring strategies to balance research and teaching as well as clinical and administrative demands. In addition, they need to develop supervisory skills to guide research staff and ensure strong role models for nurse-led research teams (Edwards et al. 2009). The work of clinical nurse managers and researchers is of major importance and must be supported. Successful planning is therefore an essential part of the phenomenon of capacity building. Who will come next, who will follow us and how can we inspire them to develop research in a range of clinical areas? Research capacity that has taken years to develop can be easily destroyed through inadequate support, poor management or negativity associated with both the internal and the external environment. Thus, capacity building is a challenge for research managers. In management terms, capacity building reflects a commitment to quality improvement and characterizes a learning organization (Senge 1991). My definition of the term ‘research’ is holistic: it is the basis of effective and efficient health care that reflects the growing recognition of an evidence-based approach. The quality of management can make or break research capacity. Prioritizing and fostering research at national and organisational levels require appropriate structures (Segrott et al. 2006) that facilitate the investment of vision, time and energy, thus gradually leading to successful outcomes. An effective team needs good organizational management, in which the members share knowledge and are committed to development, quality improvement and mutual negotiation (White 2002). What competence is required to effectively influence others to achieve goals? Intelligent use of the Internet, replacing text books by international journals, educating research managers and creating an atmosphere characterised by freedom from fear of failure as well as acceptance of uncertainty are essential components (White 2002). The development of grant application writing skills should also be included. Grant application writing workshops can strengthen research activity in an institution and raise the standards of internal peer review (Segrott et al. 2006). Leadership should be seen as a dimension of practice for all nurses, not just those in formal leadership roles (Scott & Miles 2013) and consequently as part of becoming an expert nurse. Research managers and clinical nurse researchers have an obligation to publish their findings in journals. They must also communicate with the public through press releases. This requires both the development of a dissemination plan and following it through. Knowledge and improved practice strengthen research capacity but require just as much attention to good management practices as to the research itself in addition to mentorship by senior nurse leaders (McPhee et al. 2011). In conclusion, the future perspectives of nurse researchers working in clinical practice are related to capacity building to facilitate evidence-based clinical nurse leadership. In order to lead the research of tomorrow, maintain quality of care and patient safety, clinical nurse researchers need knowledge, leadership, academic supervision, mentorship and financial resources. The questions are: How can nurse leadership capacity be improved? and How can we encourage our national leaders to become aware of the importance of building research capacity?

Purpose: The purpose of this multimethod study was to evaluate the institutional research capacity building and infrastructure model (IRCBIM), an emerging innovative and integrated approach designed to build, strengthen, and sustain adequate disability and health research capacity (i.e., research infrastructure and investigators’ research skills) at tribal colleges and universities (TCUs) and other minority-serving institutions. Methods: A qualitative case study design was used to evaluate the model based on the perspectives of three different study participant groups (i.e., faculty members, staff/administrators, and students). Semistructured interviews, document review, and observation were used to collect data. Results: The IRCBIM showed promise in improving learning and retention outcomes, creating a pipeline for producing new Indigenous researchers and contributing toward their graduate schools success, and building institutional research environment and prestige. The challenges category addresses overall issues deemed to impede and limit the institution’s disability and health research capacity. Conclusions: The findings support IRCBIM as a promising institutional research capacity building approach. Such sustained efforts, coupled with synergistic long-term federal research agency (i.e., National Institute on Disability, Independent Living, and Rehabilitation Research) sponsorship, could empower TCUs to make “new knowledge” contributions to improving employment, community living and participation, and health outcomes among tribal community members with disabilities.

Walter R. Frontera MD, PhDa*, Marcus J. Fuhrerb, Alan M. Jettec, Leighton Chand, Rory A. Coopere, Pamela W. Duncanf, John D. Kempg, Kenneth J. Ottenbacherh, P. Hunter Peckhami, Elliot J. Rothj & Denise G. Tatedka Harvard Medical School/Spaulding Rehabilitation Hospital,b National Institutes of Health, USAc Boston University,d University of Washington,e University of Pittsburgh,f University of Florida,g Powers Pyles Sutter & Verville PC,h University of Texas Medical Branch/Galveston,i Case Western Reserve University,j Rehabilitation Institute of Chicago,k University of Michigan,

Chiropractic is a popular health care choice in Australia and yet major gaps in our empirical understanding of this area of practice remain. Furthermore, while some research excellence exists, a largely uncoordinated approach to research activity and development has in effect led to silos of interest and a lack of strategic ‘big-picture’ planning essential to producing a sustainable research culture and capacity for the profession. This commentary identifies the significance of a number of key features - including a national, coordinated focus, and a rich engagement with the practitioner and patient base amongst others – arguably important to the future development of research and research capacity within Australian chiropractic. The design features and phases of the Australian Chiropractic Research Network (ACORN) project are also outlined. ACORN is one contemporary initiative specifically developed to address chiropractic’s research and research capacity building needs and help grow a broad evidence-base to inform safe, effective patient care.

"Research Opportunities" is a regular feature of the Journal that attempts to provide readers with relevant information regarding funding opportunities, policy changes, and future initiatives of the major sources of support for basic and applied research in spine and musculoskeletal rehabilitation. We welcome reader responses and suggestions concerning future topics for this section. This issue's section provides a description of the National Center for Medical Rehabilitation Research, a newly created unit of the National Institutes of Health, established in 1990 to provide leadership in the conduct and support of research in medical rehabilitation.

<p>The National Prehospital Research Strategy was published in 2008, which aimed to gauge current levels of prehospital research activity in Ireland; ascertain the research strengths that exist in the Irish prehospital community; pinpoint the obstacles to high quality research in the prehospital arena; determine the building blocks for a national prehospital research culture; outline an implementation plan for the strategy; and, identify expected and measurable short and long-term outcomes of implementing the strategy.</p><p>The characteristics of systems that facilitate research productivity include: the promotion of a research culture; mentoring by established scholars; communication with a professional network; rewards for research; and brokered opportunities.</p><p>Almost ten years later, the development of research capacity within the practitioner cohort has not progressed as much as hoped. A culture of research provides a supportive context in which research is uniformly expected, discussed, produced, and valued. We propose that a culture of research does not yet exist among Irish prehospital practitioners. </p>

Capacity for conducting family medicine research has grown significantly since the specialty was founded. Many calls to increase this capacity have been published, but there has been no consistent, systematic, and longitudinal assessment. This survey was designed to gather baseline data with an easily replicable set of measures associated with research productivity that can guide and monitor the impact of efforts to build research capacity in US departments of family medicine (DFMs). We surveyed family medicine department chairs regarding departmental research capacity using well-established empirical measures of capacity (trained research faculty, infrastructure, research leadership, and funding) and a self-assessment. We used bivariate analyses to assess correlation between the empirical measures and the self-assessed stage of research capacity. Self-assessed capacity was significantly associated with every empirical measure. High-capacity departments have more research-trained faculty, more faculty effort, utilize more research "laboratories," have more faculty serving on federal peer-review panels, more faculty as principal investigators, devote more internal funding to research, and garner larger amounts of funding from more external funding sources than moderate or minimal-capacity departments. US DFMs have made great strides over the past half century in building research capacity. However, much more capacity in family medicine and primary care research is needed to produce new knowledge necessary to improve the health and health care of the nation. Periodic measurement using the simple, replicable, and valid minimum measures of this study provides an opportunity to establish longitudinal tracking of change in research capacity in US DFMs.

The Centre for Remote Health Alice Springs (a University Department of Rural Health) was contracted by the then Commonwealth Department of Health and Aged Care to develop a submission to strengthen research and evaluation capacity at the primary level of care in the Northern Territory. This paper describes the process and outcomes of the research that formed the basis for the development of the strategy. Methods: National and international literature was reviewed. Interviews, consultations and workshops were conducted over a three-month period in the two major regions of the Northern Territory. Results: Stakeholders identified major barriers to research and evaluation implementation at the primary level of care. Barriers to implementation were identified in terms of the organisational structure of primary care and the professional culture of the research and health service communities. Three strategic directions were identified for research capacity building. These included (1) strengthening research collaborations; (2) trialling models of care that take into account the social determinants of health; and (3) developing the skills of general practitioners, other primary care providers, Indigenous researchers and communities to develop project proposals based on locally developed research priorities and questions. Conclusion: The central aim of the Primary Health Care Research, Evaluation and Development Strategy reflects an expressed need to bring research and evaluation capacity closer to the practice and community level. In doing so, the strategy has the potential to fill major identified gaps in applied and interventions-based research. The shift to community-based and prioritised research and evaluation was viewed as a strategy that has the potential to address the fundamental issue of widening health inequalities in the Northern Territory.

Purpose: The article outlines select individual and institutional factors that could contribute to rehabilitation, disability, and health research productivity among minority-serving institutions (MSIs; i.e., historically Black colleges/universities, Hispanic-serving institutions, and American Indian tribal colleges/universities). Method: We conducted 1 focus group with 12 faculty members from MSIs to identify their perceptions on research productivity factors. Both purposive and convenience sampling techniques were used to recruit participants. Data were audio-recorded and transcribed. An open coding approach was used to generate themes and codes, and the analysis was completed using NVivo (Version 10). Results: Focus group discussion led to the identification of several factors that influence rehabilitation, disability, and health research productivity at MSIs. Such identified factors included, but were not limited to, heavy teaching and service loads, time management issues, lack of collaboration, limited mentors, insufficient financial resources, inadeqaute administrative and research culture, and insufficient state and donor funding. Focus group participants also suggested relevant topics and sources as informational materials for improving scientific productivity. Conclusion: The findings point to the need for MSIs to make greater financial and intellectual investments in their research infrastructure and culture. Moreover, federal research agencies should also consider making greater research capacity building and research and development funding investments at these institutions.

BackgroundThere are substantial gaps in our knowledge regarding the aetiology of mental, neurological and substance use disorders in sub-Saharan Africa, and the cost-effectiveness and scalability of interventions to reduce the burden of these conditions on the continent. To address these gaps, international investment has focussed on building research capacity, including funding doctoral students in African countries, to support development of high quality, contextually relevant interventions. Absent, however, is an understanding of how capacity building feeds into research careers.MethodsWithin a broader mental health research capacity-building initiative (African Mental Health Research Initiative), we conducted 52 qualitative interviews with early-career researchers, policymakers, academics, and service users from four African countries (Ethiopia, Malawi, South Africa, and Zimbabwe) and with international funders of mental health research. The interview guide focused on the research context, planning, and priorities and how respondents perceive research careers and funding. Thematic analysis was applied to the transcribed interviews.ResultsFive components of a research career emerged: (i) research positions; (ii) research skills; (iii) funding; (iv) research commitment from African countries; and (v) advocacy. All stakeholders wanted more high-impact African researchers, but few saw a clear, replicable track for developing their careers within universities or their Ministries of Health in their African countries. This stemmed, in part, from the lack of support for infrastructure that enables high-quality research: grants administration, mentorship, university leadership, research culture, and open communication between policymakers and researchers.ConclusionsThis study highlights the importance of developing research infrastructure alongside capacity-building efforts. International funders should invest in grant management at African universities which would place them at the centre of research initiatives. African universities should prioritise the creation of a research culture by developing and promoting well-defined research tracks for both clinicians and academics, investing in grant management, and raising the profile of research within their institutions.

Sub-Saharan Africa (SSA) experiences an acute dearth of well-trained and skilled researchers. This dearth constrains the region’s capacity to identify and address the root causes of its poor social, health, development, and other outcomes. Building sustainable research capacity in SSA requires, among other things, locally led and run initiatives that draw on existing regional capacities as well as mutually beneficial global collaborations. This paper describes a regional research capacity strengthening initiative—the African Doctoral Dissertation Research Fellowship (ADDRF) program. This Africa-based and African-led initiative has emerged as a practical and tested platform for producing and nurturing research leaders, strengthening university-wide systems for quality research training and productivity, and building a critical mass of highly-trained African scholars and researchers. The program deploys different interventions to ensure the success of fellows. These interventions include research methods and scientific writing workshops, research and reentry support grants, post-doctoral research support and placements, as well as grants for networking and scholarly conferences attendance. Across the region, ADDRF graduates are emerging as research leaders, showing signs of becoming the next generation of world-class researchers, and supporting the transformations of their home-institutions. While the contributions of the ADDRF program to research capacity strengthening in the region are significant, the sustainability of the initiative and other research and training fellowship programs on the continent requires significant investments from local sources and, especially, governments and the private sector in Africa. The ADDRF experience demonstrates that research capacity building in Africa is possible through innovative, multifaceted interventions that support graduate students to develop different critical capacities and transferable skills and build, expand, and maintain networks that can sustain them as scholars and researchers.