Knowledge is a powerful driver of change

 

When Claire Baldwin stepped onto the stage as a ballerina in her teens, little did she know her dream of becoming a physiotherapist for the Australian Ballet would change and lead her down a very different path—creating positive changes through research and education on the world stage. 

As an early graduate, Claire Baldwin, APAM, wasn’t heading directly towards a career in research.

With an honours degree and a few years of hospital-based clinical practice under her belt, she decided the way to move forward was specific research training in a PhD.

She says completing this in a full-time capacity enabled her to take a deep dive into learning new skills and gaining knowledge in research and practice.

‘Looking back, it was such a precious time and a real gift to have that dedicated experience. I think that’s similar to when you win a grant, like the PRF, it’s really enabling. It gives you the space and time to work on something really deeply and to get some progress on the board.’

While it may have been logical to go down the path of a research fellowship and becoming a full-time researcher following her PhD in 2013, her love of education and clinical practice led to an academic career where all three areas of expertise—clinical, research and education—intersect.

One of the first major grants Claire received was a PRF Tagged Grant in 2013, which she says was critical to progressing her career.

‘It allowed me to show independence and to develop and apply project management skills comprehensively across the whole life cycle of the project,’ she says, ‘from the inception of the idea and design, to working with other collaborators, going through ethical approval, conducting the project, completing grant reporting and then, importantly, disseminating the findings out the other side.

‘For me, it was a really important step to moving from a student researcher to an independent researcher and starting to build collaborative networks.’

Claire is passionate about why research matters.

‘It’s a core part of our code of conduct and who physiotherapists are expected to be.

'Research helps us fulfil our obligations around continually improving practice. Research helps to build trust, collaboration and respect, which are core parts of our profession. It’s about all of those things,’ she says.

‘Developing the research base is part of contributing to and advancing the common good for individual patients, but also our communities and health systems more broadly.

'Thus research doesn’t always need to focus at the individual patient level. The potential for physiotherapy to contribute is much, much bigger than that.’

Additionally, Claire says research has a good return on investment.

‘Some overseas research suggests that acute hospitals that are active in clinical research may have better patient satisfaction and outcomes.

'I think that valuing research, being research- engaged and active, speaks to a broader culture around quality and a desire to continually evaluate and improve practice that feeds into all aspects of patient care.’

A strong research culture within hospitals, departments or work places and individual clinicians reflects these core values.

‘When I’ve made time to advance my knowledge in research and reflect, I’ve seen my own clinical practice and problem-solving abilities in non-research-related activities improve as well.’

Claire warns that without clinical engagement, it is difficult for research to go anywhere.

‘There’s a whole science behind knowledge translation, theories around how we get research into practice and understanding how to shift professional cultures and local contextual issues that might inhibit changes in practice.

'I think knowledge translation is a really exciting field in itself. The projects I’m most enjoying working on at the moment are those with an overlying knowledge translation strategy in addition to the project itself, and engaging clinicians and stakeholders are a really key part of that.’

Claire recognises the positive aspect of the PRF’s focus on knowledge translation as part of its strategy.

In her view this indicates that the PRF values funding research that engages clinicians on research teams or has a clinician lead and involves consumers.

The interest lies in how a given project will be translated, disseminated and communicated, right from the start of the project design all the way through to the end.

‘I think having those elements within the PRF processes should encourage people in clinical practice that it’s been actively pursued, to try and achieve the most that can be achieved with the donations to the PRF.’

Claire is seeing positive change in the outcomes of her PRF-funded research, which focused on using activity trackers to show how inactive ICU survivors are over their acute hospital stay.

Her research has contributed to recognising the multifaceted issues that survivors of a critical illness can face, issues that have been brought to the fore with the COVID-19 pandemic.

Claire hopes that increased public awareness of critical care services and recovery will also present important opportunities to move research forward for all of the physiotherapists who are working so hard in this area.

Claire cites the leading research coming out of Australia as another reason why the PRF is so important—it allows Australian physiotherapy researchers to push forward and be world leaders.

‘Using a different example, social movement campaigns can be really key in creating a shift that’s needed to get some momentum for everyone doing research in a particular area, like the #EndPJParalysis campaign.’

In November, the PRF released the latest episode of the Talking Physio podcast series—Talking End PJ Paralysis—in which Claire, along with Christina Ekegren and Dawn Simpson, discusses how this groundbreaking campaign has contributed to other efforts to address the stubborn problem of getting patients in hospital moving.

The remit of the Caring Futures Institute at Flinders University, where Claire currently works, is to tackle real world and complex problems by studying self-care and caring solutions leading to better lives, better communities, better care and better systems.

To enable this, Claire says, ‘there are really great knowledge translation experts and opportunities for upskilling within the university.

'I’ve found the opportunity to learn and apply knowledge translation thinking in research to be a really useful perspective in progressing my research learning and thinking about how we can amplify and sustain the impact of our research.’

Aside from providing funding opportunities, Claire acknowledges the positive impact of the PRF.

‘When an important study is published, being able to promote it through APA channels is a really useful avenue to demonstrate that we are trying to get research out there in nonconventional ways.’

Along with the PRF research translation podcast series and infographics, Claire is a fan of the animation videos.

Recently, her students were required to do a presentation for their research reports and as an example she showed them the ‘Mobilisation with movement after distal radius fracture animation’, which was based on the Journal of Physiotherapy paper.

‘That was really useful because we looked at the article, we practised appraising it and then we talked about the communication of findings at the end of it.’

Claire advocates that knowledge is a powerful driver of change. Beyond using research videos as a teaching tool, she can see potential to utilise them to create changes in clinical practice.

The recently released animation, ‘Cost-effectiveness of preoperative physiotherapy’, is an example.

‘Imagine presenting that to a hospital or surgeons, in a proposal to run and fund a pre-op clinic, give them the paper and the video. It’s such a good tool,’ she says.

‘If you want to communicate to change a service, present the evidence. You have to be inspiring and communicate research in a way that makes people say, “Yes, that makes sense to me and yes, we can do it”.’

Check out the fractured radius animation here and PRF research translation resources here.

The building blocks of research and collaboration

Receiving a PRF Tagged Grant early in her career enabled Claire Baldwin to assert independence and successfully collaborate, which, she says, has been important for future opportunities.

Claire believes that the PRF research has contributed to the growing field of physical activity research in people in hospital and recovering from a critical illness. And it extends beyond the initial research.

Her team conducted a systematic review alongside their PRF-funded study which identified not only how little research had used accelerometers to describe activity in the ICU population, but also the commonality of inactivity and prolonged sedentary behaviour across acutely hospitalised patient groups, and particularly for older adults.

‘So that’s really shaped the directions of research that I’ve been working and collaborating on going forward.

'It’s really under that broader picture of helping the most at-risk patients in hospital get moving, and the groups that we’re most interested in at the moment are ICU survivors and older adults that are admitted with a general medical condition.’

Claire’s research continues to focus on helping at-risk groups in hospital get moving, looking at innovative new approaches to interventions that start in hospital and continue for patients at home.

While looking at the individual level, Claire says, ‘we are also interested in the bigger picture, because we know how much policy and upstream influences can drive practice.

'We’re looking at recommendations to support multidisciplinary clinicians and older adults in what they can do—evidence- based recommendations for supporting physical activity and minimising sedentary behaviour in clinical practice.’

The draft recommendations paper—‘Recommendations for older adults’ physical activity and sedentary behaviour during hospitalisation for an acute medical illness: an international Delphi study’—has been published and additional grant funding means Claire’s team are continuing this work.

She is hopeful early outcomes will be piloted and tested within the next two years.

Interdisciplinary research and collaborators have been key for Claire throughout her career.

‘I love being a physio, and I want to be a fierce advocate for the role of physiotherapy, but if we really want to try and understand and solve complex, big problems around health and wellbeing, we do need to keep some of that professional pride in check, and it shouldn’t compromise our ability to collaborate with other people or to actually come up with a solution to a problem.’

Claire can see opportunities for physiotherapists to contribute to collaborations that extend beyond conventional health disciplines.

These include the intersection of health with engineering or health technologies, how environments are constructed and their impact on whether it is supportive or inhibitory of people being active.

She also sees value in the intersection between education and health policy and even arts in health.

‘Depending on where you’re work in physio, I think there’s certainly another layer where we could extend collaborations.’

Read Claire Baldwin’s PRF-funded paper here and the draft recommendations paper here.

 

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