A well-worn but nonetheless truthful military adage known as "The 7 Ps" states, "Prior proper planning prevents pitifully* poor performance."1 This phrase emphasizes the critical contribution of preparation to eventual success, whatever the objective. It is an easy-to-remember axiom used by trainers in many fields in addition to the military, and has been often been tailored to more suitably fit specific uses. For example, the word "performance" has been altered to "production" for employee training in the manufacturing sector. Here, I have customized this saying to "Prior proper planning primes publication possibilities" as the title for this Editor's Message addressed to authors who seek to publish their manuscript(s) in the Journal of Geriatric Physical Therapy (JGPT).
As the Editor-in-Chief, I read every manuscript submitted to the JGPT that appears appropriate to the scope of the physical therapy profession and mission of this journal. That is now well over 300 manuscripts per year. This initial editor's review serves as the first phase in our three-stage review process. Following this review, about 50% of submitted manuscripts are rejected outright, often times for "fatal flaws" that cannot be resolved once the study has been completed. Each of the remaining manuscripts is sent back to the author with requested changes to improve language and writing, correct manuscript formatting, and address content concerns. Writing can be improved, and formatting errors can be fixed, but revisions to respond to content concerns require by far the most time and effort. Resubmitted manuscripts undergo a second editor's review. If the requested changes have been made in a satisfactory manner, the manuscript is then assigned to a "handling editor" for the second phase of the review process. Otherwise, the manuscript is either rejected or sent back to the author for another attempt to make requested changes.
Prior proper planning can prevent many rejections and time-consuming revision cycles. Everyone involved in the submission and review process - authors, editors, peer-reviewers - would benefit from improved preparation on the author's part. Authors aiming to submit manuscripts that will progress quickly and successfully through the three-stage review process are encouraged to read further. The most common "fatal flaws" that could be avoided through "prior proper planning" are described below, along with recommendations for improved future preparation in study design.
"Fatal Flaws" lead to immediate rejection because they cannot be corrected once the study has been completed
As we are a journal of geriatric physical therapy, emphases on "geriatric" and "physical therapy", the research question(s) and study population should match the journal objectives. Studies that do not include at least one group of older adults (typically, having a minimum mean age of 65 years or older, with some exceptions) are rejected. Studies in which the findings are not applicable within the physical therapy scope of practice (e.g., nursing practices, medication management, etc.) are rejected. Intervention studies that do not include at least one group with a clinical problem appropriate for referral to physical therapy management are rejected. Proper planning for manuscript submission includes careful selection of journals that best match the study as it was conducted.
The JGPT publishes study manuscripts that address important clinical problems and present novel findings that bridge critical knowledge gaps. Studies with limited potential to directly and positively impact physical therapy practice are judged to have low clinical relevance and are rejected. For example, several fall risk screening tests with good prospective prediction already exist. A manuscript reporting a new fall risk screening test with only retrospective discrimination and relatively lower predictive validity would not advance clinical practice, while a similar study reporting prospective predictive validity superior to existing tests would. Proper planning requires the identification of knowledge gaps detrimental to clinical practice so that important clinical research questions may be developed.
We require preregistration of clinical trials and systematic reviews. Failure to preregister prior to data collection or literature search, respectively, is an oversight that cannot be remedied. Proper planning for these study designs includes early registration.
To reduce bias in intervention studies, we require at least these two control strategies: First, that a "no intervention" control or "usual care" group be included in the design. For comparative effectiveness intervention studies, if prior research has established conclusively that some or any intervention is better than no intervention, then a "no intervention" control group is not required but a "usual care" or alternative intervention/dose group is required. Second, that study personnel conducting baseline and outcomes assessments are blinded to group membership. Proper planning for intervention study designs includes random assignment of participants to more than one group, and blinding of assessment administrators to group membership.
In rehabilitation research, it is imperative to select standardized outcome measures shown to be valid and reliable, with the ability to measure change over time, in the population under study. In addition, because normal data distributions are desirable, the use of tests with known ceiling and floor effects should be considered cautiously. Likewise, the challenge level of selected measures should be matched to the ability level of the study population. Tests that are "too easy" for higher functioning older adults will yield high baseline scores that leave little room for improvement, while tests that are "too hard" for lower functioning older adults will produce data sets with many missing values. Proper planning involves careful selection of psychometrically sound measures appropriate for, and matched to the ability level of, the study population.
A parallel issue involves choices regarding intervention mode, dose, and difficulty level. It is not valid to conclude that an intervention is ineffective when the intervention was not delivered in an evidence-based manner. Three examples follow: first, failure to target the intervention in a task-specific manner to the clinical problem, e.g., use of seated strength exercises to improve upright balance and gait. Second, failure to provide the intervention with sufficient frequency, intensity and duration, e.g., two 30-minute sessions/week for 4 weeks when evidence suggests a minimum of 50 hours of practice over a two to three month period is necessary to reduce fall risk. Third, failure to match and/or progress the challenge level of the intervention to the ability level of each study participant, e.g., high functioning community-dwelling participants held on to a chair for all balance exercises. Often in these cases, the design of intervention delivery appears to have been shaped by resource limitations rather than evidence, and the negative study outcomes are predictable given the delivery constraints. Proper planning demands a strong grasp of the evidence relevant to intervention design, an honest assessment of available resources, and the pursuit of research that can be conducted appropriately given existing resource limitations.
To ensure that study findings are valid and can be interpreted without confusion, we require control for both Type 1 (false positive) and Type II (false negative) errors. While failure to adjust the significance level to control for Type I error can usually be remediated by reanalysis of the data (often leading to different results and thus a time-consuming revision of the manuscript), failure to recruit and retain a sufficiently large study sample size to achieve an adequately powered study cannot be addressed at the time of submission. Proper planning includes an a priori estimation of needed final sample size that is appropriate to the study design (e.g., multivariate estimation for a multivariate study design). And, in anticipation that some participants will not complete the study, recruitment of an ample number of participants so that the necessary final number remains after drop-outs.
Benjamin Franklin has been quoted as saying "By failing to prepare, you are preparing to fail."2 Authors can significantly improve the possibility that they will achieve publication success through prior proper planning that avoids the fatal flaws discussed above.
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