Please give a brief background: (Employment, interests of study, special honors/certifications etc.)
I am currently employed in Dr. Bonnie Martin-Harris’s laboratory, the Swallowing Cross-Systems Collaborative at Northwestern University as a post-doctoral fellow and researcher. After I complete my post doc training I hope to obtain a tenure track faculty position in a Communication Sciences and Disorders department at a university that supports research.
I did my masters and doctoral (PhD) training at University of Wisconsin-Madison in Dr. Nadine Connor’s laboratory with additional mentorship from Dr. Nicole Rogus-Pulia. I also completed my CFY during that time at the UW Voice and Swallow Clinics and have my CCCs.
My areas of focus and interest relate to improving and developing novel approaches to exercise and behavioral-based interventions to treat dysphagia. A secondary and equally important interest lies in service delivery and improved implementation of these treatments, specifically related to understanding and improving patient adherence by way of clinician support of patients and caregivers.
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?!
Gosh, that would be fun!😄 I could also go on, and on, and on in response to this question. But I will keep it short and sweet. I would love to do a very large randomized trial (RCT) of tongue exercise dose – exploring variations in frequency, intensity, duration, and number of repetitions (that would be a ton of participants, a MEGA RCT) and examine the differences in lingual exercise dose on specific, valid, and reliable outcomes related to swallowing impairment, and do that in several different groups of patients!
One can dream!😁
If you could change ONE thing about having to do research, what would it be?
Grant funding – I actually enjoy the grant writing process (many other scientists might be saying, How?! Why?! since grant writing is a pain point for a lot of people). It forces me to sit down and really think about my research questions and defend why I think my work is important to a group of senior investigators, and one day peers. I think going through the revision and re-submission process of a grant is difficult, but ultimately only improves the science and hypotheses. However, I WOULD change the amount of funding available (if money grew on trees), so that there was enough to go around to fund everyone’s fabulous ideas.
What’s ONE thing you think clinicians should be excited about in our field regarding research?
While we still have a long way to go, there are so many exciting things happening with the ever-growing age of technology, big data, and cross-pollination with our field and other fields such as biomedical engineering, data scientists, and epidemiologists. In other words, now more than ever, other disciplines are getting interested in dysphagia research which is really great for moving our field forward. At least, this is what gets me excited about research still!🤓 Big things are coming!
What’s ONE thing you think researchers should be excited about in our field regarding clinical practice?
I think now more than ever, there is a focus on using “evidence-based practice” in making recommendations and developing treatment plans. As scientists and researchers, this is really exciting because it means that the papers we’re publishing and all the hundreds of thousands of hours that go into these projects are being consumed by clinicians who are all eager to put evidence behind what they are doing in the clinic. This is what gets me out of bed in the morning as a scientist – we can’t let our clinical colleagues down! It’s also what motivates us to use the most rigorous and careful methods to ensure we are providing our clinical counterparts with the most valid and reliable information to use with patients.
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 sections?
Agreed, and that’s coming from someone who took 3 semesters of doctoral level statistics *insert anxious looking emoji here, lols* 😅😓🙄 <–you got it!
Answer: Google. Google is your best friend these days. Although I know in high school our teachers said Google was not a reputable source, and while I agree if you are writing a term paper probably not the most citable source, but when it comes to trying to have a basic understanding of stats, it can be really useful. There are so many tutorial videos, statistical blogs, and explanations at your fingertips.
Look at the p-values (and r-values for correlations), or whatever statistic is being reported, and then Google how to interpret that kind of statistical test. You should have a better idea of what you’re looking at in a few short minutes of reading.[Editor’s note: Also don’t discount Youtube! Some great tutorials, mini-videos, and great visual explanations at channels like @Dr. Ianessa Humbert or just searching to get more familiar with any area like MBSS!!)
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😉)?
ANOVA stands for ANalysis Of Variance – this is a way of comparing whether or not 3 or more groups of data points are different from each other. It’s basically the “big daddy” version of a t-test, which compares differences between 2 groups of data.
For example, if we wanted to know if Group A was taller on average than Group B, a t-test is used to compare the mean (average) height of Group A to Group B. If we added a third Group C, we would have to use an ANOVA to compare Group A to Group B, Group A to Group C, and Group B to Group C. The more groups you add, the more comparisons you need.
You might also see a 2-way ANOVA – this would add another level of description in our Groups. So, let’s say in our Groups A, B, and C we had both Old Individuals and Young Individuals in each group. Now we want to know if people in Group A, B, and C have different heights, and if age has anything to do with those differences in height. These are called “categorical variables” and in this case, there are 2: Groups (ABC) and Age (Young/Old). Height is still our one “continuous variable” that the test is trying to determine a difference about, but now we have more information about people in each of the groups.
Both t-tests and ANOVAs account for the variability among heights of individuals in the different groups in determining if they are truly different, which is why ANOVA has it’s name.
What’s the ONE thing you think is important for practicing clinicians to know/understand when reading research?
First, make sure when you’re looking in the literature you’re thinking about several things:
- What’s your question – what outcome are you/your patient seeking?
- What population best fits your patient, what comorbidities do they have? (e.g. stroke, head and neck cancer, etc).
- Most important: What impairment are you targeting? You need an instrumental exam to start here.
Second, read everything with a 👀critical eye👀 . Just because it’s published in a journal doesn’t mean it’s best practice or that the science was rigorous. Things to look for when you are assessing an article critically, especially when it comes to whether or not you are deciding to use a treatment with your patient:
- Did the research only use healthy subjects?
- While this research is a great place to start to better understand normal swallowing, these treatments may look very different in a patient population, so make sure you are matching the population in the study to your patient (e.g. stroke, match with a paper that focuses on stroke rehab)
- What were the outcomes measured? Are they clinically meaningful?
- If the outcome you are seeking with your patient wasn’t well measured in the study, then it might not be truly reflective of improvement.
- Did the researchers report clear and reproducible methods?
- If the methods section is vague and you aren’t able to replicate this treatment, then you can’t evaluate if this is the best approach to take with your patient
What’s ONE thing you think is important for researchers to know/understand about clinical practice?
Clinicians are BUSY people!
When I am writing a research paper to publish, I always try to have a clinical deliverable – whether it’s a table, chart, or figure, I am always thinking about how I can represent my data more clearly so that a clinician who has 5 minutes to read my paper can easily access the important information to use in clinical practice. In one of my pubs, I even made a flier/hand out that was attached to the article as an addendum that people could print out and use with their patients to try to make things easier. (No one has ever told me if they use the flier, but regardless I like it😊)
(Editor’s note: And can I just say I along with many others appreciate this soooo much🙌👏👏!!!!)
What is something you believe researchers could do better to #bridgethegap?
Perhaps more engagement with the clinical community directly – focus groups and stakeholder meetings are a valuable thing. We should take advantage of this time when virtual meetings are the norm to reach out to clinicians to hear what questions they have about their clinical practice to see what they need to be supported to provide the best care for our patients. Some labs focus more on basic mechanistic work – which is WONDERFUL and so needed! But even the tiniest, most detailed mechanism exploration has to build toward a meaningful and clinically translatable purpose.
What is something you believe clinicians could do better to #bridgethegap?
I think doing more things like this group! We must push ourselves and our colleagues to explore the literature, read together, discuss, and then CHANGE the way we do things when presented with new evidence. Change is challenging for all of us, but if we don’t challenge and question the reasons (the why?) for doing things, we won’t ever discover new and better approaches to our current, limited interventions.
Can you provide your contact email if clinicians want to reach out? (Honors system for everyone to be respectful of your time)
Sure thing – I will direct people to my “older” email address – firstname.lastname@example.org, which I still monitor daily🙂
For more information on Dr. Krekeler and her work:
Thank you SO much to Dr. Krekeler for her quick replies and participation! 🙂
**Don’t forget to checkout SLP R&R’s review of a recent article from Dr. Krekeler But…Why? A systematic look if patients actually adhere to your recommendations!
Also! Dr. Krekeler has had some even more recent (and IMO, more awesome🤩) publications since this review!!
- [FREE ACCESS to ASHA members!)
And here’s a personal recommendation from Dr. Krekeler that gives “a deep dive into dose of exercise-based therapies to treat dysphagia and created a log of the current evidence to try and help clinicians think more critically about what exercises they are selecting and what dose to be prescribing to patients“