Enabling America Assessing the Role of Rehabilitation Science and Engineering (1997) / Chapter Skim
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8 TRANSLATING RESEARCH INTO PRACTICAL APPLICATIONS
8 TRANSLATING RESEARCH INTO PRACTICAL APPLICATIONS
Pages 191-216
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From page 191... ...
out of laboratories and into practical application. With companies, it means developing or obtaining new technologies for their business enterprises.
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From page 192... ...
In traditional pharmaceutical clinical research, after a drug is synthesized in the laboratory and tested with animal models or after the device is developed and bench tested, it is subjected to clinical (phase I to IV) trials research studies designed to address specific questions about the safety and effectiveness of new methods or tools in prevention or treatment supervised by the U.S.
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From page 193... ...
Research findings should foster high-quality care and services for people with disabling conditions, enable better disability prevention, build community networks of care to guide the development of effective and efficient rehabilitation services, and stimulate further research efforts. No organized mechanism for the development of rehabilitation science exists, however, nor does a formal mechanism for distributing the findings of rehabilitation science to those providing services.
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From page 194... ...
A model such as the Dartmouth Atlas of Health Care (Center for the Evaluative Clinical Sciences, Dartmouth Medical School, 1996) documents a substantial nationwide variability in many health care interventions and there is no reason to believe that rehabilitation interventions would be more homogeneous nationwide.
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From page 195... ...
159) believes that the agricultural extension model, which involves a research system, county extension agents, and state ex
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From page 196... ...
Most federal agencies apparently spend only about 4 to 5 percent of their research funding on transfer and diffusion activities, which is nowhere near the amount spent in the agricultural extension model. Several government agencies, such as the National Cancer Institute's Community Clinical Oncology Program, have tried to copy the agricultural extension model with mixed success.
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From page 197... ...
Thus' We research process requires consumer 1n
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From page 198... ...
Technology transfer and diffusion cannot proceed without customers. Even though there are millions of people with disabling conditions, their problems are individual and their resources for technology are limited, so markets are generally small and the products needed are extremely varied.
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From page 199... ...
Because, as noted earlier, most rehabilitation interventions do not require FDA approval, the federal control exerted in a program such as CCOP alone cannot work in transfer of rehabilitation technology. Controlling access to powerful anticancer drugs gives the government a lever to encourage patients to enroll in clinical trials; only in trials involving a medical device (e.g., prosthetic and orthotic)
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From page 200... ...
Two additional benefits could be achieved by having a technology transfer mechanism: · individuals with disabling conditions can function as consultants to centers to bring validity to the questions and methods used to identify and study the constructs, and · a registry of people involved in studies will bring together resources for long term follow-up and analysis. As noted at the beginning of this chapter, technology transfer is difficult and complicated.
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From page 201... ...
Because few rehabilitation procedures have undergone rigorous clinical trials, treatments are based on theoretical rationale rather than data from tests with people with disabling conditions. Most rehabilitation research to date has been focused at the pathology and impairment levels and not at the levels that relate to functional limitation and how people with disabling conditions interact with the environment (see Chapter 4 of this report)
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From page 202... ...
Practicing clinicians either spend their own money or decide to use a continuing education allocation for a given continuing education offering and therefore have a strong incentive to implement the findings described during a continuing education course. In rehabilitation in particular, continuing education courses are most often taught not by scientists or clinical researchers who have published peer-reviewed research articles, but by clinicians who often offer charismatic presentations based on dogma and their own anecdotal experience.
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From page 203... ...
Outcomes research usually encompasses treatment effectiveness and, in some cases, cost-effectiveness.
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From page 204... ...
However, the consequences of polio in an aging population remain untested and the side effects will remain unknown until large-scale studies, including phase I to IV clinical trials, are complete (Blaese et al., 1995~. Such bench-to-bedside translational research may bring a revolution to rehabilitation if familial diseases can be eradicated or ameliorated, but it is too soon to know the impact of such "cure" research.
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From page 205... ...
Such direct attachment devices have been used in Sweden since the early l990s, but they have yet to debut in the United States. More clinical research is needed to build firstclass rehabilitation science that can guide practice and that is equivalent in rigor, prestige, and funding to basic and other medical sciences.
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From page 206... ...
Because the federal government has neglected clinical investigations in rehabilitation for so long, some private foundations (e.g., the American Occupational Therapy Foundation) have developed mentored rehabilitation research funds and, indeed, NIH-like program project grants and clinical research centers (Foundation for Physical Therapy, 1994~.
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From page 207... ...
from research to implementation in clinical practice; the latter demonstrates how better treatment guidelines could save money, which could help fund best practice guidelines research. Currently, MCOs' interests may seem to be best served by playing Old Maid (a children's card game whose objective is to entice the competition to take the unwanted card)
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From page 208... ...
The federal government's interest in enhancing work opportunities for all Americans must be crafted into incentives that require people with disabling conditions to participate at all levels of society. Clinical Practice Guidelines Clinical practice guidelines, defined as "systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances," can be an integral part of technology transfer (Institute of Medicine, 1990, p.
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From page 209... ...
Clinical practice guidelines can have positive and negative impacts on patient care. By using currently synthesized scientific information and expert opinion, properly developed guidelines can provide clear information regarding clinical decisions.
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Thus, this relationship places the researcher in the role of learner as he or she better understands the participants' experiences with respect to their disabling conditions and other relevant issues. For some researchers, such collaborations are viewed as a waste of time and energy.
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From page 211... ...
NIH Mechanisms As mentioned above, NIH has several means of transferring research results. The Office of Technology Transfer and the Community Clinical Oncology Programs are two mechanisms for this.
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From page 212... ...
By making developed products available to the market and making research findings accessible to clinicians and physicians, the Veterans Health Administration transfers and disseminates rehabilitation products to the private sector, where they can reach the most veterans with disabling conditions. NIDRR Mechanisms Although most governmental sponsored technology transfer activities focus on a specific product or piece of research, some programs exist exclusively for the purpose of disseminating extant technology.
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From page 213... ...
A National Board of Directors provides technical assistance. The Rehabilitation Engineering and Assistive Technology Society of North America's also provide support to link relevant activities within Tech Act programs.
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From page 214... ...
In contrast to other medically oriented technology transfer methods, rehabilitation science and engineering requires transfer mechanisms that go beyond physicians to include the spectrum of rehabilitation professionals, as well as people with disabling conditions and their families, architects, engineers, and policy makers (including elected officials, insurers, and administrators)
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From page 215... ...
Characteristics of this paradigm would include: · effective intervention strategies that have been validated in outcomes andlor process-oriented research; · reliable and responsive measures of impainnents,functional limitations, disability, and quality of life that have predictive value for outcomes and which will promote standardization of rehabilitation services; · patients and clients who are empowered with a greater ability to manage the long-term consequences of disabling conditions; and · technology transfer mechanisms that provide incentives for practitioners to conform to best practice standards. At minimum, those health care programs that the federal government is currently in charge, including Medicare, Medicaid, VA, and CHAMP US (Civilian Health and Medical Program of the Unifonned Services)
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From page 216... ...
Recommendation 8.6 Clinical practice guidelines should be developed by the federal government that include not just diagnosisrelated guidelines but also guidelines for rehabilitation of impairments,functional limitations, and disabilities. Recommendation 8.7 University And federal researchers should seek partners in private industry to cooperate on the research and development of technologies that can ultimately benefit people with disabling conditions.
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