Research Roundup: Dr. Joshua A. Cleland, PT, PhD

Dr. Cleland is presently a Professor in the Doctor of Physical Therapy Program at Franklin Pierce University. He practices clinically in outpatient orthopaedics at Rehabilitation Services of Concord Hospital, Concord, NH.

Josh is actively involved in numerous clinical research studies investigating the effectiveness of manual physical therapy and exercise in the management of spine and extremities disorders. He has published over 200 manuscripts in peer-reviewed journals including Spine, Physical Therapy, the Journal of Orthopaedic and Sports Physical Therapy and Manual Therapy. He is an Editorial Review Board Member for the Journal of Orthopaedic and Sports Physical Therapy. He is currently an author/editor on four text books.

Dr Cleland is a well-know speaker at both the national and international level. He is the recipient of the 2015 Rothstein Golden Pen Award for Scientific Writing, the 2011 Chattanooga Research Award, the 2009 Eugene Michels New Investigator Award, and the 2008 Jack Walker Award all from the American Physical Therapy Association. Additionally, he received the 2013, 2014 and 2015 Rose Excellence in Research Award from the Orthopaedic Section of the American Physical Therapy Association, and the 2016 David Lamb Memorial Award, International Federation of Orthopaedic Manipulative Physical Therapists.

What inspired you to go into research?

It all stemmed from a passion I developed while pursuing my entry level degree. I remember numerous professors teaching particular interventions to be used in clinical practice. However, being quite inquisitive, I would often ask questions about why we should be using particular interventions. The response I often received was typically based on historical or authoritative sources of knowledge and very seldom was the answer grounded in the scientific method.When I was completing my clinical affiliations I continually wondered why I was using a particular intervention; simply because it was what I was told during my education or based on what was written in a book?

I felt compelled to challenge the status quo and investigate if the interventions I was using in clinical practice had any value in terms of improving patient centered outcomes.

I decided I couldn’t simply wait for someone to answer the many clinical questions I developed but that I had to actually be part of the process. This precipitated me to be a clinical scientist and to start participating in research, first in the roll of data collector, then co-investigator, and finally primary investigator.

Is there anything you wish you would have known before you became a researcher?

I think the biggest thing is I wish I knew how difficult it would be to carry out a randomized clinical trial with long-term follow-up unless the effort came from a team of passionate like-minded individuals. The time and effort devoted to identifying a strong collaborative team must not be underestimated. I am fortunate to have a group of colleagues around the world who are as passionate as I am about examining the effectiveness of commonly used physical therapy interventions.

What area of study has your recent research been on?  

I continue to examine the effectiveness off manual therapy (including dry needling as of recent) and exercise for the management of common musculoskeletal conditions of the spine and extremities. One study we are working on, which I am really excited to see the results, is examining the effects of manual therapy on patients with lumbar stenosis who received epidural steroid injections. This is a difficult population to manage as the condition is progressive and there are often multiple comorbidities. We hope we can identify interventions that can assist with not only maintaining patients’ baseline levels of function but also improve their overall quality of life. We have finished recruitment and are currently working on collecting 2 and 3-year follow-up data.

Can you describe how your research has evolved over the years, bringing you to where you are today?

About 10 years ago I began working on developing clinical prediction rules; however, this area no longer excites me as the profession has started to demonstrate many of the developed rules are not able to be validated and may have simply been the result of spurious findings.

For example, for my PhD dissertation, I performed a study to determine a clinical prediction rule to identify factors to assist clinicians in selecting which patients with neck pain are likely to respond favorably to thoracic spine manipulation. I then received funding from the Foundation for Physical Therapy to perform a follow-up validation study. The results found that the original clinical prediction rule could not be validated. Sometimes that is how the research process works. Despite the initial spurious finding the university fortunately didn’t revoke my degree!

What do you feel is the biggest hurdle between researchers and clinicians?  What are some solutions you see in overcoming these barriers?

I think the biggest issues are that both sides need to truly respect how much time and effort each is putting forth in their particular role.

As a clinical scientist I have and continue to be involved in both research and clinical practice. Researchers devote considerable time and effort in scouring the literature, putting together a research proposal, acquiring grant funding, acquiring Institutional Review Board approval, training clinicians, analyzing data and writing manuscripts. However, clinicians work at least as hard examining and treating patients, completing documentation, and keeping current through ongoing educational endeavors and their efforts in recruitment should not be underestimated.

Overcoming these barriers can be quite difficult. I think the first step for developing collaboration is the researchers contacting clinicians who are practicing full time in the clinic and ask them what clinical questions they are asking and want to know the answers to.

I think researchers often have difficulty asking a pragmatic and clinically appropriate question if they are not currently involved with treating patients. Working with the clinicians will assist in the development of clinically relevant projects where the research can develop the methodology and the clinicians can participate by providing facilities and recruiting subjects.

This is one of many reasons why I plan to continue maintaining my current clinical practice. Not only does this assist with development of questions but also provides me the opportunity to work side by side with many of the clinicians who are currently recruiting subjects on various trials.

Can you give advice to students/practitioners who may be considering a career in research, on how to how to find a school and researcher to work under?

Honestly, beyond identifying a University that will allow you to perform a dissertation with an area of focus you are interested in, I really don’t think the school has an impact in one’s success as a researcher.

In my opinion the most important thing in becoming an independent researcher is identifying strong mentorship.

It is important to have mentors who hold you to a very high standard and despite university requirements facilitate you to excel. I am greatly indebted to my mentors Dr. Julie Fritz and Dr. John Childs. If it was not for them I am not certain I would ever have achieved success, specifically in designing and carrying out clinic trials.

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