Group Title: Journal of NeuroEngineering and Rehabilitation 2006, 3:1
Title: Rehabilitation medicine summit: building research capacity Executive Summary
CITATION PDF VIEWER THUMBNAILS PAGE IMAGE ZOOMABLE
Full Citation
STANDARD VIEW MARC VIEW
Permanent Link: http://ufdc.ufl.edu/UF00100266/00001
 Material Information
Title: Rehabilitation medicine summit: building research capacity Executive Summary
Series Title: Journal of NeuroEngineering and Rehabilitation 2006, 3:1
Physical Description: Archival
Creator: Frontera WR
Fuhrer MJ
Jette AM
Chan L
Cooper RA
Duncan PW
Kemp JD
Ottenbacher KJ
Peckham PH
Roth EJ
Tate DG
Publication Date: 38720
 Record Information
Bibliographic ID: UF00100266
Volume ID: VID00001
Source Institution: University of Florida
Holding Location: University of Florida
Rights Management: Open Access: http://www.biomedcentral.com/info/about/openaccess/

Downloads

This item has the following downloads:

rehabilitation_medicine ( PDF )


Full Text


Journal of NeuroEngineering and 0

Rehabilitation Bioed C



Commentary

Rehabilitation medicine summit: building research capacity
Executive Summary
Walter R Frontera* Marcus J Fuhrer2, Alan M Jette3, Leighton Chan4
Rory A Cooper5, Pamela W Duncan6, John D Kemp7,
Kenneth J Ottenbacher8, P Hunter Peckham9, Elliot J Roth10 and
Denise G Tate"


Address: 'Harvard Medical School/Spaulding Rehabilitation Hospital; Boston, MA, USA, 2National Institutes of Health; Bethesda, MD, USA,
3Boston University; Boston, MA, USA, 4University of Washington; Seattle, WA, USA, 5University of Pittsburgh; Pittsburgh, PA, USA, 6University of
Florida; Gainesville, FL, USA, 7Powers Pyles Sutter & Verville PC; Washington, DC, USA, 8University of Texas Medical Branch/Galveston;
Galveston, TX, USA, 9Case Western Reserve University; Cleveland, OH, USA, 10Rehabilitation Institute of Chicago; Chicago, IL, USA and
"University of Michigan; Ann Arbor, MI, USA
Email: Walter R Frontera* wfrontera@partners.org; Marcus J Fuhrer fuhrerm@mail.nih.gov; Alan M Jette ajette@bu.edu;
Leighton Chan leighton@u.washington.edu; Rory A Cooper rcooper@pitt.edu; Pamela W Duncan pwduncan@phhp.ufl.edu;
John D Kemp john.kemp@ppsv.com; Kenneth J Ottenbacher kottenba@utmb.edu; P Hunter Peckham pxp2@case.edu;
Elliot J Roth ejr@northwestern.edu; Denise G Tate dgtate@umich.edu
* Corresponding author


Published: 03 January 2006
journal of NeuroEngineering and Rehabilitation 2006, 3:1 doi:l0.1 186/1743-0003-3-


Received: 01 December 2005
Accepted: 03 January 2006


This article is available from: http://www.jneuroengrehab.com/content/3/I/I
2006 Frontera et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.



Abstract
The general objective of the "Rehabilitation Medicine Summit: Building Research Capacity" was to
advance and promote research in medical rehabilitation by making recommendations to expand
research capacity. The five elements of research capacity that guided the discussions were: I)
researchers; 2) research culture, environment, and infrastructure; 3) funding; 4) partnerships; and
5) metrics. The 100 participants included representatives of professional organizations, consumer
groups, academic departments, researchers, governmental funding agencies, and the private sector.
The small group discussions and plenary sessions generated an array of problems, possible
solutions, and recommended actions. A post-Summit, multi-organizational initiative is called to
pursue the agendas outlined in this report (see Additional File I).


The advancement of medical science depends on the pro-
duction, availability, and utilization of new information
generated by research. A successful research enterprise
depends not only on a carefully designed agenda that
responds to clinical and societal needs, but also on the
research capacity necessary to perform the work. Research
that is likely to enhance clinical practice presupposes the
existence of a critical mass of investigators working as
teams in supportive environments. Unfortunately, far too
little research capacity of that kind exists in rehabilitation
medicine to ensure a robust future for the field. The
"Rehabilitation Medicine Summit: Building Research


Capacity" was conceptualized as a way of fashioning a
long-term plan to foster the required developments (see
Additional File 1).

Objectives
The general objective of the summit was to advance and
promote research in medical rehabilitation by making rec-
ommendations to expand research capacity. More specific
objectives were to: 1) bring together leaders in medical
rehabilitation research to characterize current research
capacity in the field and identify obstacles to expanding
that capacity; 2) propose specific actions and mechanisms


Page 1 of 6
(page number not for citation purposes)


central


^^3







Journal of NeuroEngineering and Rehabilitation 2006, 3:1



to enhance research and the development of capacity; 3)
formulate an action agenda for use by stakeholders in
medical rehabilitation to enhance existing research and
training programs or to create new ones; and 4) stimulate
federal agencies and foundations to support the needed
elements of rehabilitation research and training. Although
the purpose of the summit was not to discuss a specific
research agenda, the above objectives were considered in
the context of five research categories: 1) basic science, 2)
clinical research (including clinical trials), 3) outcomes
research, 4) health services research, and 5) engineering
and technology development.

Research capacity: operational definition and
elements
For the purpose of the discussions, building research
capacity was defined as, "a process of individual and insti-
tutional development which leads to higher levels of skills
and greater ability to perform useful research" [ 1]. Five ele-
ments of research capacity were identified and used to
guide the pre-Summit work and the Summit discussions.
These included: 1) researchers (their training, mentoring,
recruitment, and retention; the value of a career in
research and incentives for research); 2) research culture,
environment, and infrastructure (academic institutions,
the creation and maintenance of core facilities, the role of
chairpersons and deans, collaborations, institutional
research administration and social culture, and policies
governing incentives and job security); 3) funding
(sources, advocacy for changing policies, peer-review pro-
cedures, funding mechanisms, grantsmanship and fund-
raising, timing of funding requests, and conflicts of
interest); 4) partnerships with other disciplines and disa-
bility consumer groups (the purposes of these partner-
ships; choices of research topics, disciplines, and
consumer groups; modes of participation; and potential
conflicts of interest when partnering with industry); and
5) the metrics of research capacity (quality and quantity of
the pool of available researchers, the productivity of their
research, and its impacts).

Methodology
Several important activities took place before the Summit
convened. The Program Committee had extensive discus-
sions about existing research capacity. Key bibliographic
references were identified on the topic of building
research capacity and made available to all participants. A
special article on the history of rehabilitation research was
commissioned. Recognized experts were invited to write
articles on each of the five elements of research capacity to
serve as a basis for discussion during the Summit. These
articles were peer-reviewed and five additional experts
wrote detailed responses to them. The Research Commit-
tee of the American Academy of Physical Medicine and
Rehabilitation (AAPM&R) conducted a survey of research-


http://www.jneuroengrehab.com/content/3/1/1


ers in the field to identify problems of research capacity
and their potential solutions. Several funding agencies
submitted reports of their efforts to build research capac-
ity. Finally, participants were given access to a website
where all key information was posted, including the arti-
cles mentioned above was posted.

The summit consisted of keynote lectures, paper presenta-
tions, and small-group working sessions that took place in
Washington DC on April 28 and 29, 2005. Invited partic-
ipants included leaders in the field, senior and junior
researchers, department chairs, deans, research directors,
professional organizations (12), government agencies
(10), disability consumer groups (6), and multiple medi-
cal specialties (7). For the group discussions, the partici-
pants were divided into 10 small groups, 10 participants
per group, making sure that different points of view were
represented in each group. Each element of research
capacity was discussed independently by two different
groups that were charged with identifying problems, solu-
tions, and recommended actions. Their reports were inte-
grated prior to the Summit's final session that was devoted
to presenting the reports to the larger group and to dis-
cussing additional recommendations. The following sec-
tions summarize the groups' conclusions with respect to
each of the five elements of research capacity. A more
detailed summary of the problems, solutions, and recom-
mended actions identified by the five integrated groups is
available from the corresponding author.

Problem identification
Researchers
Capacity building requires the development of a pool of
well-qualified researchers. To accomplish this task, issues
such as training, mentoring, and placing new investigators
must be addressed, as do other issues concerning the
recruitment and retention of established investigators.
The ideal trainee must have a strong commitment to
inquiry and the desire and skill to collaborate with others.

Defining the domain of medical rehabilitation research
was singled out as being a paramount requirement for
expanding research capacity. The field is inclusive by
nature because it receives contributions from the physical,
biological, psychological, engineering, and social sci-
ences, hence, the difficulty in delineating it. This predica-
ment is reflected in the different conceptual models that
are frequently invoked in discussing the field, including
the Institute of Medicine's Enabling-Disabling [2] model
and the World Health Organization's International Clas-
sification of Functioning, Disability and Health [3].

Difficulties in developing, promoting, and retaining
greater numbers of skilled rehabilitation researchers were
highlighted as well. Far too few programs exist that pro-


Page 2 of 6
(page number not for citation purposes)







Journal of NeuroEngineering and Rehabilitation 2006, 3:1



vide optimal training in medical rehabilitation research.
Reasons for the dearth of training opportunities include a
lack of training funds from government agencies and pri-
vate institutions, a paucity of program models for foster-
ing interdisciplinary collaboration, a lack of appropriate
mentoring coupled with standardized training curricula
for preparing individuals to be competitive as researchers,
and inadequate attention to promoting the retention of
minorities, women, and individuals with disabilities.

Research environment, infrastructure, and culture
Research environment, infrastructure, and culture repre-
sent a matrix of complex factors essential for excellence in
generating medical rehabilitation research, training,
recruiting researchers, and in conducting research involv-
ing people with disabilities.

A major problem is the lack of recognition of research and
scientific discovery as an institutional, organizational, and
professional core value. In too many instances, scientific
discovery is not an explicit priority in the vision and mis-
sion statements of clinical and professional organizations
with national memberships. Consequently, the strategic
plans of these organizations do not promote collaborative
or interdisciplinary research, and they are not expressly
supportive of the necessary investments in scientific train-
ing, the development of grant writing skills, and the men-
toring of promising research faculty. The human and
physical resources to accomplish these tasks are unavaila-
ble in many academic rehabilitation environments. Mech-
anisms to recognize research productivity in formal and
informal evaluation and reward systems are frequently
lacking as well.

Funding
Significant funding must be specifically assigned to build-
ing research capacity. However, the current economic
environment is likely to result in flat or even reduced
funding for medical rehabilitation research, at least in the
near future. This unfortunate financial picture exists at a
time of increasing need associated with the growing
number of individuals with disabilities, and of unparal-
leled opportunities to improve their lives by means of new
knowledge generated by research.

The biggest problem is lack of a coherent strategy for
advocating the needed research support. Stakeholders in
medical rehabilitation research are fractionated in their
efforts to obtain larger expenditures. The austerity of the
current funding environment underscores the importance
of organizations bringing their advocacy efforts together
under common goals.

The problem of generating adequate funding for medical
rehabilitation research exists at three levels. At the federal


http://www.jneuroengrehab.com/content/3/1/1


level, the field lacks visibility as being a worthy object of
support when strategic funding decisions are made. At the
local level, only a handful of academic programs have the
research infrastructure required to produce successful
research, and very few new programs have been developed
in the past decade. This partially reflects the fact that many
academic medical centers invest most of their resources in
expanding the ability of their extant programs to generate
research funds, rather than in developing promising new
programs such as ones in medical rehabilitation. Finally,
at the level of individual researchers, proposed research
too frequently lacks the quality to merit being funded.
Additionally, some researchers fail to take advantage of
existing opportunities for funding, simply because they
do not know of their existence.

Partnerships
Partnerships with scientists in other disciplines, academic
departments, and institutions, and with consumers with
disabilities, among others, are vital to enhancing the
capacity for conducting high quality, meaningful research.
Several factors have limited the development of those
partnerships. Because of the diversity of stakeholders and
stakeholder objectives, a common framework has been
lacking upon which to build funding, policy, program-
matic, and marketing messages regarding research. Nor
have consistent efforts been made to ensure the meaning-
ful participation of individuals with disabilities in the
research process.

Metrics
Concerted efforts to enlarge the capacity of medical reha-
bilitation research must be complemented by an ability to
assess that capacity over time in order to gauge progress.
No constitutive definition of research capacity appears to
have won broad endorsement in the health sciences liter-
ature, and little guidance exists for deciding on the metrics
and measures for its principal domains. Notwithstanding
the lack of precedence, the meaning of medical rehabilita-
tion research capacity must be understood with precision
if that capacity is to be rigorously and comprehensive
assessed.

Solutions and recommended actions
Although each group worked independently on its
assigned problems, many of the solutions and recom-
mended actions they identified were quite similar. This
section integrates the solutions and recommended
actions.

Coalition
Several discussion groups suggested the formation of a
coalition of professional groups and consumer organiza-
tions. This coalition would create a national agenda
addressing the issues of funding, capacity-building needs,


Page 3 of 6
(page number not for citation purposes)







Journal of NeuroEngineering and Rehabilitation 2006, 3:1



and public education and awareness. It would develop
specific objectives and action plans regarding 1) funding
targets for research and research training, 2) needed
changes in funding agencies' policies and practices, and 3)
initiatives to educate the public about the importance and
societal benefits of rehabilitation research, and it would
coordinate efforts to address those issues.

Training
A high priority area is the training of new investigators. To
accomplish this goal, training curricula need to be created,
and funding needs to be expanded for rehabilitation
research training programs across disciplines and at mul-
tiple levels, including undergraduate students, students in
professional training program, faculty, and department
chairs. Special efforts should be made to recruit and train
women, students with disabilities, and minorities.

Career paths
Researchers need support at different stages in their
careers. Current funding sources fail to provide the
needed continuity of support as their careers evolve. To
foster researchers' development and their retention in the
field, funding opportunities must be increased for pre-
doctoral students, post-doctoral fellows, junior faculty,
and established faculty transitioning into new investiga-
tive areas.

Partnerships to conduct research
To assure its scientific importance and clinical relevance,
rehabilitation research requires both interdisciplinary and
multi-stakeholder partnerships. Collaborations among
researchers of different scientific and professional disci-
plines need to be promoted and cultivated. The required
initiatives must come from individual researchers as well
as from professional organizations that encourage joint
scientific meetings and discussions of interdisciplinary
research issues. Partnerships are vital, too, to assure that
rehabilitation research is informed by the perspectives of
its intended beneficiaries individuals with disabilities,
their family members, and rehabilitation practitioners.
Principal investigators should implement Participatory
Action Research (PAR), making it an integral part of med-
ical rehabilitation and disability research. Greater empha-
sis should be placed as well on providing people with
disabilities with the training and support necessary for
them to assume leadership roles in rehabilitation
research.

Infrastructure
Currently, only a handful of departments or centers have
the research personnel, equipment, space, and support
staff that constitute a strong infrastructure for medical
rehabilitation research. Many more such programs must
be established before the aggregate research capacity is


http://www.jneuroengrehab.com/content/3/1/1


commensurate with existing knowledge needs. Inevitably,
that will require host institutions to invest in establishing
new rehabilitation research programs or in strengthening
ongoing ones. A growth strategy should be pursued con-
currently of building intra-institutional partnerships that
facilitate access to the infrastructure available to col-
leagues in other scientific and professional disciplines.

Message to funding agencies
Funding agencies do not assign sufficiently high priority
to medical rehabilitation research. Within the NIH, this
can be rectified by establishing an independent institute
dedicated to rehabilitation research. Actions are needed as
well to expand the participation of rehabilitation scien-
tists in scientific review panels, and to generate more
requests for applications that focus on interdisciplinary
rehabilitation research. A farther-reaching possibility is
creation of an independent agency for disability issues
within the Department of Health and Human Services.
Advocacy directed at federal agencies must be comple-
mented by initiatives aimed at increasing support from
private-sector sources such as third party payers.

Rehabilitation science model
It is generally accepted that the field lacks a unified scien-
tific model. A consortium of experienced researchers
should be created to develop this model and to define the
domains and boundaries of rehabilitation research.

Mission statements and strategic plans
Scientific discovery is not always recognized as an institu-
tional or organizational core value. Professional organiza-
tions should include research as an important component
of their mission statements. This should be reflected in
their strategic plans and used as a means to promote inter-
disciplinary and collaborative research.

Metrics
Both long-term and short-term perspectives are called for
to meet the challenges of assessing medical rehabilitation
research capacity. The long-term perspective highlights
the definitional and operational challenges that must be
addressed eventually if that capacity is to be rigorously
conceptualized and comprehensively assessed. The short-
term outlook emphasizes that some information gather-
ing can and should begin immediately in the following
four areas.

1. Rehabilitation Research Trainees. Information to be
tracked includes: the number of funded post-doctoral
positions available in rehabilitation and the distribution
of fellows across rehabilitation disciplines; the proportion
of trainees who come through research training programs
and who become researchers full, part-time, or none;
the research products that the trainees generate, as well as


Page 4 of 6
(page number not for citation purposes)







Journal of NeuroEngineering and Rehabilitation 2006, 3:1


Figure I
A taxonomy of research capacity as a guide for knowing what
to measure.


their extramural and intramural levels of funding. Possi-
ble action steps include defining who is considered as a
core rehabilitation professional, exploring and using
where possible existing methodology, and enlisting the
cooperation of funding agencies to collect and share this
information.

2. Size of the Rehabilitation Research Cadre. Information to
be tracked includes the size of academic departments rel-
evant to medical rehabilitation (e.g., number of research
fellows, filled and unfilled faculty positions), and the
amount of time rehabilitation professionals, broadly
defined, spend in research, e.g., half-time or more, part-
time, or none). Professional organizations should be
enlisted to collect this information on a regular and stand-
ardized basis.

3. Productivity. The information to be monitored includes
citations of published articles, extramural and intramural
levels of research funding, and the types of research
designs appearing in the rehabilitation literature. Action
steps include specifying the kinds of articles and the jour-
nals to include, and searching by professional organiza-
tion memberships, institutions, or by disciplines or
countries. Professional organizations should be enlisted
to collect this information on a regular and standardized
basis, using existing methodology where possible.

4. Federal Agency Expenditures on Rehabilitation Research.
Expenditures allocated to rehabilitation research in spe-
cific content areas should be monitored. A recommended
action step is to identify agency contact points to secure
these data on an annual basis.


The longer-term challenge is to develop a consensually
acceptable definition of medical rehabilitation capacity,
and then to operationalize each of its key components.
Domains that are likely to be encompassed in that defini-
tion include funding, qualified researchers, institutions,
research training, research methods, an applicable knowledge
base, an encompassing research agenda (including topics, their
relative priority, and funding levels), knowledge translation
activities, defined consumer demand and need, and political
advocacy. The figure is an attempt to organize those
domains within a coherent framework. Each domain is
assigned to one of three categories the Research Agenda,
Research Environment, or Researchers or to the conjunc-
tion of two of these groups. Steps should be taken to
refine that schematization along with the separate
domains comprising it. Additionally, feasible means must
be identified to 1) quantify each domain and 2) character-
ize its quality of achievement (against some standard or
norm). It will be necessary then to establish the psycho-
metric properties of the key indicators, e.g., their validity,
reliability, and sensitivity.

A post-Summit, multi-organizational initiative is called
for to pursue the agendas outlined above. Data-gathering
efforts should be launched as soon as possible to charac-
terize current research capacity as a baseline for assessing
possible future gains. Those efforts should draw on find-
ings of the Survey on Academic Leadership and Research
Development conducted by the Research Advisory &
Advocacy Committee of the AAPM&R, and be imple-
mented by either 1) an ensemble of federal agencies sup-
porting rehabilitation research, or 2) a consortium of
rehabilitation-related voluntary organizations such as
those represented at the Summit.

Editor's note
This article will be published almost simultaneously in
the following journals: American Journal of Occupational
Therapy; American Journal of Physical Medicine and
Rehabilitation; American Journal of Speech Language
Pathology, Archives of Physical Medicine and Rehabilita-
tion; Assistive Technology; Bum Care and Rehabilitation;
Disability and Rehabilitation; Journal of Musculoskeletal
Pain; Journal of NeuroEngineering and Rehabilitation
(online); Journal of Rehabilitation Research and Develop-
ment; Journal of Spinal Cord Medicine; Neurorehabilita-
tion and Neural Repair; OTIR: Occupation, Participation,
and Health; Physical Therapy; The Journal of Head
Trauma and Rehabilitation; Topics in Stroke Rehabilita-
tion








Page 5 of 6
(page number not for citation purposes)


http://www.jneuroengrehab.com/content/3/1/1








Journal of NeuroEngineering and Rehabilitation 2006, 3:1


Additional material


Additional File 1
A table outlining the Final Action Plan of the Rehabilitation Medicine
Summit: Building Research Capacity held on April 28-29, 2005 in
Washington, DC.
Click here for file
[http://www.biomedcentral.com/content/supplementary/1743-
0003-3-1-S1.doc]




Acknowledgements
The Summit was organized by the Foundation for Physical Medicine and
Rehabilitation, the American Academy of Physical Medicine and Rehabilita-
tion, the American Congress of Rehabilitation Medicine, and the Associa-
tion of Academic Physiatrists.

No commercial party having a direct financial interest in the results of the
research supporting this article has or will confer a benefit upon the
authors or upon any organization with which the authors are associated.

References
I. Trostle J: Research capacity building in international health:
definitions, evaluations, and strategies for success. Soc Sci Med
1992, 35:1321-1324.
2. Brandt E, Pope A, Eds: Enabling America: Assessing the Role of Rehabili-
tation Science and Engineering Washington, D.C.: National Academy
Press; 1997.
3. World Health Organization: International Classification of Functioning,
Disability and Health: ICF Geneva: World Health Organization; 2001.


Page 6 of 6
(page number not for citation purposes)


Publish with BioMed Central and every
scientist can read your work free of charge
"BioMed Central will be the most significant development for
disseminating the results of biomedical research in our lifetime."
Sir Paul Nurse, Cancer Research UK
Your research papers will be:
available free of charge to the entire biomedical community
peer reviewed and published immediately upon acceptance
cited in PubMed and archived on PubMed Central
yours you keep the copyright
Submit your manuscript here: BioMedcentral
http://www.biomedcentral.com/info/publishingadv.asp


hftp://www.jneuroengrehab.com/content/3/1/




University of Florida Home Page
© 2004 - 2010 University of Florida George A. Smathers Libraries.
All rights reserved.

Acceptable Use, Copyright, and Disclaimer Statement
Last updated October 10, 2010 - - mvs