Research Agenda for Physical Therapy From the American Physical Therapy Association

Abstract

 

Research agendas play an important role in directing scholarly inquiry in a field. The Research Agenda for Physical Therapy From the American Physical Therapy Association (APTA) outlines research priorities that are vital to advancing physical therapist practice and the profession. The development of the research agenda included multiple iterative steps and feedback from stakeholders. A research agenda subgroup (n = 6) of the APTA Scientific and Practice Affairs Committee (SPAC), with APTA staff support, gathered information on existing research agendas, developed draft priority descriptions, and gathered feedback via surveys. The subgroup first conducted an environmental scan of the research agendas in the physical therapy and rehabilitation fields. To gather information about research priorities, APTA’s Technology and Organizational Performance department distributed a survey to 3 samples. APTA staff organized the feedback, and SPAC edited and synthesized a draft agenda. This draft was sent out in survey form to the original samples and to members of the APTA Academy of Research. Concurrently, a repeat environmental scan was conducted. A final draft of the research agenda was sent for final review to a smaller cohort (n = 95) that included content experts in each of the main categories of the agenda as identified by the APTA Academy of Research. The SPAC research agenda subgroup reviewed and incorporated the information into the final draft. The final research agenda includes priorities in topical areas (population health, mechanistic research, clinical research, education/professional development research, health services research, and workforce development) identified as key in the evolution of our profession.

Impact

The Research Agenda for Physical Therapy From APTA identifies research priorities within the profession vital to advancing the practice and profession of physical therapy. The research agenda has 6 key areas of focus: population health research, mechanistic research, clinical research, education and professional development research, health services research, and workforce research. Researchers, funding agencies, and public policy makers can use the research agenda to concentrate research efforts around these areas.

Introduction

Physical therapy is a profession with a theoretical and scientific base that is dynamically evolving. Physical therapists are health professionals who diagnose and manage movement dysfunction to restore, maintain, and promote optimal physical function for the health and well-being of individuals, families, and communities.¹ Physical therapist assistants assist a physical therapist in the provision of physical therapist services. Physical therapists possess knowledge and skills that are derived and supported by research.² As the physical therapy profession advances, our research priorities must evolve to substantiate our progress. The Research Agenda for Physical Therapy From the American Physical Therapy Association (APTA) outlines the research priorities that APTA believes are vital to advancing physical therapist practice and the profession.

A central observation from 2 previous research agendas is that the focus and scope of research agendas have continuously evolved with the physical therapy profession. In 2000, the first published research agenda—the Clinical Research Agenda for Physical Therapy³—focused on clearly defined research questions in the clinical realm. The primary goal of this original research agenda was to promote research that helps clinicians optimize clinical practice. The second agenda, the Revised Research Agenda for Physical Therapy,⁴ published in 2011, proposed broader research priorities, demonstrating the growth in the research mindset within our profession. This second agenda recognized the pragmatic purpose of the original agenda and its role in guiding key clinical questions for researchers to prioritize along with providing insights to key funding agencies. The authors of the second agenda acknowledged that many of the priorities from the initial agenda had been addressed, and, with the growth of the profession and health care as a whole, the authors realized that an updated agenda was necessary to stay current. As we have learned from these previous agendas, the next agenda also needs to promote current and anticipated future research demands of the profession. As such, the Research Agenda for Physical Therapy From APTA further expands on our profession’s continued advancement and considers current issues, new innovations, and forward-thinking viewpoints, including the need to develop a broad range of research questions. Although no formal evaluation has been made of the impact of previous agendas, there is some evidence that the previous agendas may have had a positive impact on our profession, as seen through continued advancement of physical therapy research, combined with resolution of many of the topics posed in previous agendas.

Beard et al⁵ stated that research agendas should provide “The Idea.” The Idea is the initial element in the cascade of events that lead to innovative research and practice change. In this new research agenda, we seek to germinate innovative research by presenting broad ideas originating from and reviewed by clinicians and researchers within our profession. Our overall goal is to stimulate research that advances the APTA vision statement of transforming society by optimizing movement to improve the human experience. Additionally, this agenda aims to: (1) promote partnerships and collaborations to answer these critical questions; (2) assist the APTA Board of Directors in linking research priorities with APTA initiatives; (3) influence funding agencies’ support for key practice and research initiatives identified by physical therapists as essential for the advancement of the profession; (4) provide a benchmark of the changing research priorities of the profession over time; and (5) provide a framework on which APTA components and rehabilitation-focused organizations can build their research priorities.

Development Process

The development of an updated research agenda (Supplementary Appendix) included multiple iterative steps and consolidation of items and feedback from various interested parties at various stages of development. This work was initiated by the APTA Scientific and Practice Affairs Committee (SPAC), which consists of 14 APTA Board–appointed members representing active research programs, Foundation for Physical Therapy Research, APTA, academy and state professional leadership and advocacy, academic institutions, clinical facility leadership, and multiple clinical specializations. Throughout the process, environmental scans were performed, which involved combining inputs from various sources related to research, funding, and global health issues to assist in decision making. A research agenda subgroup (n = 6) of SPAC, with APTA staff support, performed the synthesis of these inputs.

First Environmental Scan and Category Revision

In November 2019, the entire SPAC and APTA staff performed an environmental scan of the research agendas in the physical therapy and rehabilitation fields. Sourced documents included APTA’s Clinical Research Agenda for Physical Therapy³ and the Revised Research Agenda for Physical Therapy,⁴ “Education Research in Physical Therapy: Visions of the Possible,”⁶ The APTA Academy of Pediatric Physical Therapy (APTA Pediatrics) Research Agenda,⁷ Academy of Orthopaedic Physical Therapy and Academy of Neurologic Physical Therapy research interests,^8,9 the Occupational Therapy Research Agenda¹⁰ and the Occupational Therapy Education Research Agenda–Revised,¹¹ Center on Health Services Training and Research funding priorities,¹² and the National Institutes of Health Research Plan on Rehabilitation.¹³ The review of these resources identified the need to create a conceptual framework to support the organization of the research items and minimize redundancy.

The group proposed and finalized a research agenda purpose statement to anchor the agenda, with overt reference to its intended purposes and consideration of its intended audiences (Supplementary Appendix). The initial intended audience comprised APTA leaders, member groups, related organizations, program boards, and commissions. The audience expanded to include APTA components (academies, sections, and state chapters), the American Council of Academic Physical Therapy, the Foundation for Physical Therapy Research, the Commission on Accreditation in Physical Therapy Education, and the American Board of Physical Therapy Residency and Fellowship Education.

The research agenda subgroup reorganized the 2011 Revised Research Agenda for Physical Therapy⁴ into updated categories. Through consensus decision making, the subgroup proposed eliminating areas that were no longer relevant and adding missing areas. Missing areas included health disparities, research design, implementation science, genomics, population health, and patient experiences. The review allowed the remaining research areas to be allocated under the 6 major categories seen in the final agenda: population health research, mechanistic research, clinical research, education and professional development research, health services research, and workforce research. Definitions were created for each category and approved by all SPAC members.

Research Question Content Generation

As with previous research agenda efforts, input from interested stakeholders was critical to creating an agenda that will help guide the profession. To formally gather input on the agenda, an electronic survey was conducted by APTA’s Technology and Organizational Performance department from July to October 2020. The survey requested a review of the research categories and nomination of 2 or 3 top research priorities in each individual category. This information was utilized in the iterative process for developing the research agenda. In addition, an open-ended comment area provided an opportunity for feedback on the 6 categories and their corresponding definitions. The survey was distributed to 2 separate samples; duplicate email contacts were eliminated for those in overlapping groups. Sample 1 (July 8–14, 2020) included all SPAC members (n = 14). Sample 2 (August 19 – September 11, 2020) and Sample 3 (October 9–29, 2020) included the presidents/research chairs of the 18 APTA sections and academies and 51 chapters, APTA Board–appointed councils (Rehabilitation, Science, and Technology; Health Systems; and Health Promotion and Wellness), Foundation for Physical Therapy Research board members, the American Academy of Orthopaedic Manual Physical Therapists, the Catherine Worthingham Fellows of APTA, and the APTA House of Delegates (n = 731). Because the response rate on the second sample was low, a third request was conducted. Before the third sample survey was launched, SPAC members sent a communication to nonresponders to further encourage participation. Total response rate was 12.7% (N = 93). Even though the response rate was low, the diversity of responses from the interested parties was high, which helps add to the depth of responses provided and minimize the risk of weak points.

The results of all 3 surveys were collected and collated into 1 document. APTA staff reviewed the data and organized the feedback, and the SPAC research agenda subgroup edited and synthesized the list, organizing it within the main categories to create a draft research agenda. This draft agenda was shared directly with APTA payment and government affairs staff and select policymaker contacts with an open question for feedback on the draft agenda items. They were asked to identify any missing research priorities that would influence the policy landscape. The missing priorities could be related to value, payment, or research targets that would provide scientific data to better understand policy gaps and the role of rehabilitation, to ultimately improve the health of society. Their feedback was incorporated into the draft agenda for use in the subsequent survey.

Draft Agenda Survey

As with past research agendas, the draft of this agenda was sent out in survey form to the original sample plus all members of the APTA Academy of Research. The survey questioned if an item was unclear or redundant and if something was missing, and it included an area to nominate new research priorities. The survey was open from December 3, 2021, to January 2, 2022, to a sample of 2019. The response rate was 5.7% (N = 116). Respondents of this survey included APTA Academy leaders representing their members in addition to individual responses. Results of this survey were incorporated into the draft agenda for consideration for inclusion.

Repeat Environmental Scan

Concurrently, a repeat environmental scan to survey the landscape of the research agendas in the physical therapy and rehabilitation fields was completed to identify any additional research priorities for consideration. The second environmental scan also included a review of active grants within National Institutes of Health (NIH) RePORTER.¹⁴ Search terms “physical therapy,” “physical therapist,” “physiotherapy,” “physiotherapist,” (or) resulted in 232 project titles, terms, and abstracts. Projects were classified into categories and reviewed to identify missing/gap areas for consideration in the most recent draft agenda. This same process was completed for research projects funded by the Foundation for Physical Therapy Research in 2020, 2021, and 2022. Finally, the Disability & Rehabilitation Research Coalition research priorities¹⁵ and the World Health Organization research priorities¹⁶ were evaluated to capture national or global occurrences and focus that could impact the need for physical therapy research. This environmental scan identified 3 missing research priorities and contributed to revisions of 5 others.

The research agenda subgroup of SPAC incorporated the information from the draft agenda survey and the environmental scan into the final agenda draft. The group identified areas of consolidation and minimized redundancy within and among the research priorities in the 6 major categories.

Final Research Agenda Draft Survey

The final draft was sent to a smaller cohort for final review (N = 95). This group included content experts in each of the main categories of the agenda as identified by the APTA Academy of Research. It also included all members of SPAC; the Public Affairs and Policy Committee (PPAC); the APTA Diversity, Equity, and Inclusion Committee (DEIC); and APTA component presidents/research chairs. The respondents were asked to provide any revisions and identify any missing priorities. The total survey response rate was 26.3% (N = 25).

Final Research Agenda

The research agenda subgroup of SPAC reviewed and incorporated the information into the final research agenda. The entire SPAC recommended the research agenda for approval by the APTA Board of Directors. The agenda was approved at the November 2022 APTA Board meeting (Supplementary Appendix).

The agenda includes research priorities in 6 categories (population health, mechanistic research, clinical research, education/professional development research, health services research, and workforce development) (Fig. 1) identified as key in the evolution of our profession. Each category has a narrative description of the topic and a series of research priorities within each topic. Population health research consists of 12 major research priorities seeking to characterize, explain, or influence the levels and distributions of health within and across populations—such as among groups—as well as across time and generations. Mechanistic research consists of 9 priorities designed to understand a biological or behavioral process, the pathophysiology of a disease, or the mechanism of action of an intervention. Clinical research has 20 priorities focused on investigating the safety, effectiveness, and efficacy of diagnosis and diagnostic procedures, interventions and protocols, devices, and technology intended for human use. Education and professional development research has 7 priorities focused on examining education and learning processes and the human attributes, interactions, organizations, and institutions that shape educational outcomes across the learning continuum. Health services research consists of 11 priorities focused on the investigation of how social factors, financing systems, organizational structures and processes, health technologies, and personal behaviors affect access to health care, the quality and total cost of health care, and, ultimately, health and well-being. This area covers the domains of individuals, care partners and significant others, organizations, institutions, communities, and populations. Finally, workforce research consists of 11 priorities focused on investigating the health professionals labor force, including examination of the inflow and outflow of workforce, proper demographics and characteristics, organizational structure and practice environment, geographical distribution of providers, and utilization of services. The Table displays the timeline for the research agenda development, and Figure 2 describes the research agenda development pathway.

Figure 1.

Categories and definitions for Research Agenda for Physical Therapy From the American Physical Therapy Association.

Table.

Development Timeline for Research Agenda for Physical Therapy From the American Physical Therapy Association^a

Date	Activity
November 2019	First environmental scan performed by SPAC
January 2020	Purpose statement, audience, and stakeholders generated by SPAC
February 2020	Research categories determined by SPAC
March 2020	Research descriptions completed by SPAC
July 8–October 29, 2020	Survey executed (samples 1, 2, and 3) with APTA interested parties
October 30–November 4, 2020	Survey results synthesized and compiled by SPAC subgroup
November 5–15, 2020	SPAC: Reviewed the results Created and edited a list of key priorities for all research categories Identified and nominated missing priorities
December 8, 2020	SPAC subgroup completed draft of all categories received by SPAC
July–October 2021	Input received from APTA payment and government affairs staff and selected policy makers incorporated into Draft Agenda by SPAC subgroup
December 3, 2021–January 6, 2022	Draft agenda survey conducted of APTA interested parties and APTA Academy of Research members
March–July 2022	Second environmental scan conducted by SPAC subgroup
April–August 1, 2022	Final research agenda draft edited by SPAC subgroup
August 9–28, 2022	Final research draft survey conducted of content experts in identified research areas, SPAC, PPAC, DEIC, and APTA component leaders
November 2022	Research agenda approved by APTA Board of Directors

^a APTA = American Physical Therapy Association; DEIC = Diversity, Equity, and Inclusion Committee; PPAC = Public Affairs and Policy Committee; SPAC = Scientific and Practice Affairs Committee.

Figure 2.

Development process for Research Agenda for Physical Therapy From the American Physical Therapy Association. Sample 1: select APTA interested parties included presidents/research chairs of the 18 APTA sections and academies and 51 chapters, APTA Board–appointed councils (Frontiers in Rehabilitation, Science, and Technology; Health Systems; and Health Promotion and Wellness), Foundation for Physical Therapy Research board members, the American Academy of Orthopaedic Manual Physical Therapists, the Catherine Worthingham Fellows of APTA, and APTA House of Delegates (N = 731; responders = 93). Sample 2: sample 1 participants plus APTA Academy of Research members (N = 2019; responders = 116). Final content expert review: Content experts in each of the main categories of the agenda as identified by the APTA Academy of Research, SPAC, the Public Affairs and Policy Committee, the APTA Diversity, Equity, and Inclusion Committee, and APTA component presidents/research chairs (N = 95; responders = 25).

Discussion

“Vision without action is merely a dream. Action without vision just passes the time. Vision with action can change the world.”  ¹⁷ Prior to the establishment of our first professional research agenda, there was certainly action in the physical therapy research space, with research being published; however, there was not yet a collective vision for the profession in the form of a consensus document with research priorities to drive physical therapy research forward. The physical therapy profession’s first clinical research agenda was published in 2000³ with the goal of building a collective vision for physical therapy research that would solidify our professional research foundation and enhance practice for all physical therapist clinicians. Although we cannot establish a causal link between the publication of the agenda and the maturation of our science, we know that there were significant advancements in physical therapy science over the course of the next decade, as evidenced by growing publications and an increase in funded research. A new agenda was needed to reflect a more refined vision for the profession. The subsequent revised research agenda was published in 2011⁴; and, since that time, we have continued to see incredible growth in our profession’s research foundation as well as significant changes within the profession of physical therapy.

During the more than 20 years since our first clinical research agenda was published, our profession has become more external facing in its focus. For example, APTA’s vision for the profession in 2000 was more inward-focused and had goals related to achieving direct access, utilization of evidence-based practice, becoming a doctoring profession, and autonomous practice. The current vision statement has a greater public health orientation with the goal of “transforming society by optimizing movement to improve the human experience.” The Research Agenda for Physical Therapy From APTA is truly reflective of this shift in our profession as evidenced by the breadth and greater complexity of topical areas covered (population health, mechanistic research, clinical research, education and professional development research, health services research, and workforce development research) and by the focus on social determinants of health throughout the agenda.

Although broad input from the physical therapy community was sought in the development of all 3 of our profession’s research agendas, current members of our profession see very different challenges on our present research front based on the items included in this agenda. This agenda is very much reflective of the broader health climate nationally and globally. Our profession’s scientific needs have grown and evolved over time, as is appropriate. For example, in the Clinical Research Agenda of 2000, there were priorities related to the effectiveness of interventions that were narrower in focus and not patient centered. Specifically, “What is the effect of exercise (duration, intensity and type) on bone density?” and “Are manual techniques effective in the treatment of impairments and functional limitations?” These priorities demonstrated the state of our science at that time. In the 2023 research agenda, the intervention priorities have a broader and richer focus, such as, “Explore the role and value of artificial intelligence in improving and customizing patient care” and “Evaluate the impact of clinical practice guideline implementation on the patient care experience, population health, and economic outcomes.”

The authors of the original agenda asserted that “the Clinical Research Agenda can serve as a benchmark for the systematic progression of physical therapy science.”³ The wisdom and truth of this assertion is clearly evident when comparatively examining the foci of the original research agenda with those of the updated versions over the ensuing 20-plus years. For instance, it is noteworthy that we have moved well beyond the need to list research agenda items focused on establishing the psychometric properties (eg, reliability and validity) of tests and measures, as we did in the first agenda. It is no longer a priority for our profession to be so prescriptive in suggesting future directions for the scientific pathways that our investigators choose. There is currently a recognition that our scientists do not need to be coached on methodological approaches to answering questions; rather, the agenda is designed to inspire our scientists to answer groundbreaking questions that will change the standing of our profession in the greater health care landscape.

The creation of this most recent agenda provided an opportunity for us to benchmark our scientific growth in comparison to our past agendas. It will be important to continue to chart our scientific evolution in this manner with future research agendas. Clearly, the physical therapy profession has made systematic progress in its scientific foundation, thus improving the long-term sustainability of our profession within the health care landscape. Although the purpose of the agenda is to provide a framework for researchers and APTA constituents to build their individual research priorities, this agenda also sets the importance of some of the key areas of focus through the 6 topic areas. The addition of population health research in this agenda demonstrates the movement of the profession into the broader landscape of health care to include health disparities, social determinants of health, and other global health initiatives.

In addition to publication of this research agenda, APTA will support initiatives to disseminate it to interested parties. The agenda will be presented at various meetings with rehabilitation funders, researchers, and their collaborators to promote partnerships and to provide a framework on which rehabilitation-focused organizations can build their future research priorities. The agenda will be shared widely among funding agencies. Because it is approved by the APTA Board of Directors, the agenda will be referenced as a guiding document for APTA to inform research priorities and initiatives. This agenda will replace the previous research agenda as part of the funding criteria for the Foundation for Physical Therapy Research in its proposal review process.

One of the challenges in developing a research agenda is to identify the optimal method for evaluating how it has impacted the profession and its scientific foundation. To date, there has been no systematic evaluation of the previous 2 agendas. The lack of evaluation is likely tied to the significant challenges in measuring the impact because it is extremely difficult to attribute temporally distant outcomes to an intervention such as the publication and dissemination of a research agenda. Furthermore, the most distal outcomes of interest (eg, research productivity, grant funding, resultant practice change) will undoubtedly be affected by a multitude of other influences, thus making it nearly impossible to attribute global scientific progress within physical therapy solely to the research agenda. But it is possible to measure the direct influence of the research agenda on more proximal outcomes, such as the number of times the research agenda is cited or the number of different dissemination activities undertaken to proliferate the vision set within the research agenda. In this vein, we could annually assess which research agenda items are represented in research funded by the Foundation for Physical Therapy Research, or whether the research priorities for the different APTA components and academies align with the research agenda.

As we attempt to understand the more indirect influences of the agenda on the key outcomes of interest (research productivity, grant funding, resultant practice change), we would be better served by focusing on the contributions of the research agenda, rather than attempting to focus on the idea of its direct attribution. Then we will be positioned to qualitatively assess the contributions of the research agenda to our outcomes of interest in a systematic fashion. To this end, we could regularly conduct case studies to understand how research that aligns with the agenda has been used to advance the profession. For example, the APTA Strategic Plan for 2022–2025 has an explicit goal to “drive demand for and access to physical therapy as a proven pathway to improve the human experience.”¹⁸ In the health services research section of the agenda, there are several items that set pathways in place for achieving this goal, such as “Explore methods for increasing access to physical therapist services within different socioeconomic and racial groups.” Over time, APTA could conduct a descriptive analysis to understand what progress has been made in terms of this goal regarding demand and access and could explore what research related to these research agenda items has been put forth to reach said goals. This type of assessment does not provide direct attribution but gives us an opportunity to understand the contributions that the agenda makes to meeting our association’s goals. Although this method of evaluation cannot be fully validated, future iterations of the research agenda—and ongoing retrospective assessment of the progress on the association’s goals—will help to provide an assessment of the utility of this process. Of course, this process has the limitation of relying on hindsight to view its success or failure over time.

Conclusion

The Research Agenda for Physical Therapy From APTA includes priorities identified as key in the evolution of our profession. Researchers can use the areas and associated priorities to help refine their individual research agendas and scientific queries and adapt what is important to the profession to their specific research area. The research agenda provides guidance across the continuum of research from bench science to translational projects, bringing the science into clinical practice and the community. As the profession moves forward, an assessment of the influence of this research agenda on the profession will be important to inform future research agendas.

Author Contributions

Jennifer Stevens-Lapsley (Conceptualization-Equal, Data curation-Equal, Project administration-Equal, Writing – original draft-Equal, Writing – review & editing-Equal), Gregory Hicks (Conceptualization-Equal, Data curation-Equal, Project administration-Equal, Writing – original draft-Equal, Writing – review & editing-Equal), Kory Zimney (Conceptualization-Equal, Data curation-Equal, Project administration-Equal, Writing – original draft-Equal, Writing – review & editing-Equal), Emily Slaven (Conceptualization-Equal, Data curation-Equal, Project administration-Equal, Writing – original draft-Equal, Writing – review & editing-Equal), Tara Manal (Conceptualization-Equal, Data curation-Equal, Project administration-Equal, Writing – original draft-Equal, Writing – review & editing-Equal), Lynn Jeffries (Conceptualization-Equal, Data curation-Equal, Project administration-Equal, Writing – original draft-Equal, Writing – review & editing-Equal).

Funding

There are no funders to report for this submission.

Data Availability

Data are available from the authors upon reasonable request.

Disclosure and Presentations

The authors completed the ICMJE Form for Disclosure of Potential Conflicts of Interest and reported no conflicts of interest.

T.J. Manal is an employee of the American Physical Therapy Association.

The research agenda will be presented at the 2024 American Physical Therapy Association Combined Sections Meeting; February 15–17, 2024; Boston, Massachusetts.