Written by Kristine Hamman
Throughout the last month, the Vet Rehab Summit Qualifiers on Facebook have been an incredible inspiration and source of knowledge. One of the most information-filled lectures with Dr Nicole Rombach focused on research; what it is, why we want to do it and how we can undertake it while practising as clinicians.
By understanding the different methods of conducting research, why it is so essential to our industry, and how we can practically perform research within our clinical and working lives, we can take the necessary steps to conduct our own research project/s.
Below is a brief overview of Dr Rombach’s lecture.
What is Research and Why Do We Do It?
Research helps us to gain a better understanding of our field, pushing us closer to our goal of being evidence-based in our practice. It helps us to answer the ‘why?’ questions that we and our owners ask every day, and it aims to develop an objective way of measuring and answering these questions.
There are different types of research, such as clinical vs epidemiological research, that vary according to the way we structure our studies. Clinical research is more experimental; here we would be applying a specific intervention and evaluating the outcome. It is conducted with a very specific methodology and study design, which may involve lab trials or clinical trials. It also has a low risk of bias – an important concept in research studies.
Epidemiological research, on the other hand, is very much observational; it is usually carried out through the use of questionnaires and looks at patterns and trends following a particular intervention. Epidemiological research is great for retrospective or prospective studies, helping to define the study subject, but they also carry a greater potential for bias.
The Fundamentals of Conducting Clinical Research
To find out whether a specific treatment or intervention is effective, we need to formulate a very precisely worded question. This question gives rise to our hypothesis, a statement that predicts what the outcome of the research will be. Our research will reveal whether the hypothesis stands or falls.
Based on our initial research question and hypothesis, we develop our objectives: With the data we collect from our research, do we want to answer a single question or multiple? This will determine whether ours is a single or multiple objective study. If there are many questions, state them all clearly.
We then consider our methodology or study design, which is our intervention, treatment or observation. It is important that our methodology is clear, so that the research is repeatable and reliable. This means that if someone else did the same study later on, they would achieve the same results. In our methodology we want to compare our intervention to something else; so we would evaluate and compare a patient before and after the administration of an intervention. We might also want a control group; a group that looks the same as the subject group but does not receive the intervention. All the animals involved in the study, both subject and control groups, make up our sample population.
We can then look at the intervention and compare it to what has already been done in previous research, and build on it. This is why solid methodology is so important; new research studies build on previous studies, so the methods of previous studies need to be reliable. Our own study may in turn be used by someone else as a building block or foundation for a new study in a new setting.
When it comes to choosing the members of the study or the study population, we want to control as many of the variables as possible, keeping the animals included as similar as possible; the same age, height and weight, and involved in the same work programme, for example. This is why it is so easy to conduct studies on racehorses. We also want to have as large a study population as possible. These two factors – the size of the population and the conformity of the population, may need to be balanced in a clinical setting. If we increase the number of horses included, but also increase the variables between the horses included, the study reliability and statistical significance will be reduced. Likewise, if our population is too small, the statistical significance will be reduced.
It is important to clearly define what you will be measuring. This we call the measurement outcome, and forms part of our data. Ideally, we want to introduce an element of blinding into our study, so that participants (in this case, their owners) are not aware of what we are evaluating, since such awareness can cause bias. In human medicine, we see trials where the subject group receives a pharmaceutical drug and the control group receives a placebo, but the patients are not aware of which group they are a part of. Blinding can also be applied to data collectors, if they are involved, so that before they evaluate, they are not aware of which patients have received the intervention and which have not. Blinding helps reduce bias and improves the reliability of a study.
The Challenges of Undertaking Clinical Research
There are a number of challenges associated with undertaking clinical research, these are the ones that stand out to me:
- Finding a homogenous sample group. This may be limited in a field setting as you are bound to the cases that come in.
- The limitation of no verbal feedback from animals in animal studies. We need to be more creative with how feedback or data is collected.
- Subjectivity can creep in if there is not enough blinding in the study, which can lead to a bias in the study outcome.
- Client compliance, or a lack thereof, can significantly confound findings and add variables to a study.
Setting Up Your Research Study
The number one tip that Dr Rombach gave for conducting research in practice, was keeping it simple and using the clients you are already seeing, as this is the easiest way to gain a study population and collect data. Look at your patient population; what cases are you regularly seeing? Then think about what questions you have or what questions owners have asked you – let this guide the development of your study question. The simpler the objective of the research, the more user friendly it will be.
Educate yourself on what is already known on the topic you wish to research, and then see how you can carry that knowledge into the field. How will you treat a certain case? What do you look at after you have treated? How do you measure results? How long do the changes in the patient last? To answer these questions and possibly help you refine them, it is important to do a literature review. Once you have read as much as possible on a topic, you can relate what you learn to the questions you are posing and see what has not yet been answered. When doing this, be cautious about drawing conclusions from the abstracts of research articles. Although the abstract lists the significant findings, you need to read the full paper to fully understand any study.
You will then need to define your type of study. For example, you could do an epidemiological study looking at a specific type of surgical recovery, and send out questionnaires at a certain point post-surgery to ask owners whether there has been a reduction or improvement in the overall performance of the patient. If you have access to radiographs or ultrasound measurements, you could use these to see what the trend was in patients with specific issues over X amount of years, which may lead to a prospective study.
Be aware, however, that there is no guarantee about the number of patients you will find with the desired condition within these parameters, so these types of studies may take a bit longer than anticipated.
With an experimental study, you want to choose an appropriate control measure; in some cases, a single patient is the control, but for other studies, you will need a control group. Here you want to reduce your variables as far as possible. You also want to look at what your outcome measure will be: What are you going to need? What equipment are you going to use? What form of diagnostics are you going to use to measure outcomes? Are you going to look at physiological variables? It is important to be clear about what you will measure and to make these measurements standardised and quantifiable, so that they may be repeated. Dr Rombach suggests labelling or coding all your variables and outcome measures right from the start.
When setting up your research project, be sure to consider the ethics and always get consent from owners. And if stats are not your strong point, work with a statistician from the beginning and involve them in the study development. This is the simplest way to ensure that the correct stats are carried out.
‘This is the beauty of research; to create building blocks so that we can build a greater understanding of the topic at hand.’ Dr Nicole Rombach
Don’t simply take a finding as finite fact – it is our responsibility to grow the knowledge of our respective fields, and with that knowledge to challenge products and interventions that make claims without feasible evidence to back them up. By continually striving to ask the ‘whys’ we will keep providing our patients with the best, most relevant clinical reasoning.
If you would like to find a mentor as you embark on your research project journey, join the Vet Rehabbers Research Group with Kirsten Haussler.