Is this helpful?

I was caught by the article headline in January’s edition of the Journal of Bodywork and Movement Therapies to which I subscribe and assist with editorial duties.

‘Relationship between handgrip isometric strength and Isokinetic moment data of the shoulder stabilisers’

My initial curiosity was aroused by the idea that it would be a useful exercise in clinical practice to evaluate handgrip strength in patients presenting with shoulder pathology.  My initial reaction was somewhat cynical as I took the view that even if there was a correlation between handgrip strength and Isokinetic shoulder strength data, it is highly unlikely in practice that one would ever use a grip strength measure as a substitute for assessing scapular stability.  This article did indeed go on to demonstrate that there was a correlation which had been noted in previous studies, but I couldn’t help thinking ‘so what’.  The argument was presented that because Isokinetic strength testing equipment is costly, laborious and time consuming an alternative strategy of using handgrip strength measure would be an attractive alternative.  Whilst this may well be the case, I would be curious to know if any of you would confidently rely on grip strength as an assessment of shoulder muscle function?

Of course we know the upper limb functions as an integrated unit with scapular control being an essential prerequisite for prehensile tasks involving the hand, but I am left wondering whether this was just research for the sake of research rather than answering a useful clinical question or influencing practice.  I raise this issue here, not to be critical of the authors (one of whom I know very well over many years), but to raise the wider issue of the direction in which academic journals are taking and the increasing trend for academic institutions to produce a target volume of research in order to secure funding regardless of the practical relevance in the real world.  I don’t want to enter the traditional debate of clinicians being delusional, egotistic and self-serving and academics being cocooned in an ivory tower because it’s a circular debate. Rather I would make a plea for research to be clinically focused or at least leading to some practical application. I do not subscribe to the view that learning research methodology for the sake of education is a worthwhile objective. If it is relevant to learn the true scientific method then it is equally relevant to apply it to something worthwhile.

I vividly remember one of my research supervisors many years ago suggesting that I alter my clinical research aspirations on the grounds of subject difficulty, non-cooperation, data corruption and compliance and stick to cadaveric work. This I dutifully did but doubt I contributed much too clinical management!

I, like many of you no doubt, have been in a position of undertaking clinically focused research, only to realise the complexity of the challenge and arrive at the conclusion that clinical research is hard, challenging and often needs to be done in bite size chunks as part of a collaborative program often extending over years.  As clinicians we often focus on seeking specific answers to questions, which we observe routinely in practice, only to discover that the research methodology required involves multiple stages to address the specific components of a complex hypothetical challenge.

What is also becoming more prevalent is that the opportunity and environment for expression of opinion is becoming more and more stifled, because unsubstantiated comments and opinions do not get past editorial evaluation.  In fact this was one of the main reasons why I started writing this blog and I would love to hear your thoughts and opinions.

Am I being harshly critical?

Should clinicians have a forum to express their ideas and concepts with the expectation that they maybe challenged or provide a basis for future research?

Should we wait for research to provide all the answers and not discuss clinical reality until there is a sufficient body of evidence to inform the debate?

Let us know what you think.

Enjoy the clinical challenge.

David.