Please give a brief background: (Employment , interests of study, special honors/ certifications etc.)
I originally trained as a speech-language pathologist, and thought I would probably end up working with people with aphasia. However, for my final clinical placement, I ended up in an acute care hospital working closely with a clinician whose primary caseload was dysphagia. I became fascinated by this topic area. Upon graduation, I got a job working in a large long-term care facility for elderly people and the bulk of my referrals were for swallowing assessment.
Over the course of that first position and a subsequent position in an acute care hospital where I was responsible for dysphagia, I became passionate about pursuing excellence in swallowing assessment. I also became frustrated by the fact that we essentially seemed to have a single default approach to dysphagia management, namely providing texture modified foods and thickened liquids. After almost 10 years of clinical practice, I returned to school to pursue my PhD.
I thought that I would run a clinical trial of a dysphagia treatment for my dissertation, but I quickly discovered that more foundational work was needed to establish clear principles upon which dysphagia interventions could be designed. My dissertation ended up being a study of tongue and jaw movement in healthy swallowing. Shortly after completing my PhD, I was hired into a clinician scientist position at a large rehabilitation hospital and I received a research grant to continue investigating tongue movement and function in swallowing – both in healthy adults and individuals with neurological diseases.
Almost 17 years later, I am still busy with my research. During that time frame, I have been fortunate to be part of the development of the International Dysphagia Diet Standardisation Initiative (IDDSI) and I continue to do research on how swallowing is impacted by differences in bolus consistency. I also continue to pursue questions regarding dysphagia treatment outcomes. I have been active in professional leadership throughout my career – with ASHA, IDDSI, the Dysphagia Research Society and local groups. I am committed to pursuing important clinical questions in my research and to disseminating results in a way that will advance best clinical practice. One of the most rewarding aspects of my research is seeing the work have an impact on care at the front lines.
If you could conduct any research study on any topic/issue (meaning money/funding, time, subjects, IRB etc. are NOT a problem!), what would it be? In other words, what’s your dream study?!
This is actually a difficult question to answer! I think my dream study would be one that is able to clearly show the benefit of physiologically targeted intervention on swallowing outcomes in people with dysphagia. There are lots of barriers here – but it is still a dream.
If you could change ONE thing about having to do research, what would it be?
Research for me is about pursuing answers to important questions – and about learning and challenging what we think we know based on new information. I hope we will always continue to do this.
I think the thing that frustrates me the most is the fact that some researchers spend huge time and money on questions that don’t have sufficient grounding, and then use non-rigorous methods to explore those questions. It is really frustrating to see those studies get published (usually in low quality journals). The fact that a study gets published does not mean it was a good or important study – and today, a great deal of junk gets published.
What’s one thing you think researchers should be excited about in our field regarding clinical practice?
I think it is crucial that researchers understand the clinical “so-what” of their research questions. One of the most exciting parts of my research is the dialogue I have with clinicians, discussing what the meaning of our research might be for clinical practice, and developing resources and tools that will enable clinicians to advance their practice based on our work. The clinicians in my world ask questions that are often challenging for me to consider – but wrestling with these questions and being able to come up with answers, or design new studies that will address gaps in our ability to answer those questions, is probably one of the most meaningful things in my job.
I feel the Results section of studies can be the most misunderstood or difficult to navigate through, what tidbits or tips/tricks can you share to help clinicians process these section?
This is a great question, and I think there are several components here. First, I would encourage clinicians to go back to the Methods section and make sure they understand exactly what the clinicians have done. It is important for clinicians to be able to scrutinize methods and know whether the researchers have been rigorous and have used selected tests or instruments correctly.
When it comes to the results, I think it is important for readers to look at the figures and tables in an article and to ask “what does this mean?” and “does it make sense?”. If the article does not provide enough information to help you understand the figures and tables, then it has not been well written. Third, look for a limitations section to understand the constraints that apply to the results. If an author has not acknowledged limitations, this is a 🚩red flag🚩. All studies have constraints and limitations – and the author should declare these up front. Finally, remember that statistical significance by itself does not mean that the findings have clinical significance.
Unfortunately, a lot of research with incorrect or inappropriate statistics still gets published – and just because an author has managed to get a statistically significant result does not mean it is valid or important. If the article seems to be making leaps of faith when it comes to discussing what the findings mean, be wary!
Could you pick one technical-jargon (e.g. “linear regression” “ANOVA” “two-tailed test” etc.) to explain in a relatable and easily understandable way (real-life, simple examples get bonus points😉)?
Understanding statistics takes time. One of the most helpful resources we use in my lab is a website called Laerd Statistics, that provides step by step guidance on when to choose particular tests, how to perform them and how to interpret them. For now, I think I will simply say that one of the most important things I think people need to know about statistics is that there are three main types of data: categorical, ordinal and interval (also known as continuous).
Knowing what kind of data a person has collected is critical for determining which tests to use. For categorical data, the most appropriate types of tests to look at is frequencies (that is, the number of cases in each category).
For interval data, at the other end of the spectrum, one can look at the values of the scores that are in the dataset, and ask whether scores for one group or one condition are similar or different to the scores for other groups or conditions. Here, understanding the distribution of scores is important – particularly what the most common or typical scores are. In between are ordinal data, which are numerically ranked categories of scores, but for which there are no decimal places in between. Here, either frequency based or rank-based statistics can be used to understand differences between groups.
What’s the ONE thing you think is important for practicing clinicians to know/understand when reading research?
Statistically significant findings are not necessarily clinically significant.
What’s ONE thing you think is important for researchers to know/understand about clinical practice?
The same: statistically significant findings are not necessarily clinically significant.
What is something you believe RESEARCHERS could do better to #bridgethegap?
Have a clinician advisory group and discuss findings with them before publication, to make sure the clinical implications messages are properly thought through.
What is something you believe CLINICIANS could do better to #bridgethegap?
Join a journal reading club and ask questions. AND, if you think you have a research question you might like to pursue, find a research mentor to help guide you to do it properly!
Can you provide your contact email if clinicians want to reach out? (Honors system for everyone to be respectful of your time)
Yes. We are happy to receive questions from clinicians at firstname.lastname@example.org
For more information on Dr. Steele and her work, visit:
(Even a Google search pull up enough of her amazing work that will keep your brain busy and engaged for days!!😉🤓)
Big thanks to Dr. Steele for taking the time to share!!