Please give a brief background: (Employment, interests of study, special honors/certifications etc.)
I am an Adjunct Assistant Professor in the Communication Sciences and Disorders Department at the University of Alberta and CPO for True Angle. I am a clinician-researcher and have worked for over a decade assessing and treating swallowing difficulties in patients with a history of head and neck cancer. My doctoral research directly influenced the design and development of a mobile swallowing therapy device called Mobili-T, now a product of True Angle. In my doctoral work, I was extremely fortunate to receive a few awards and fellowships that made my work possible, such as the Clinician Fellowship from Alberta Innovates Health Solutions and the Dr. Alice E. Wilson Award from the Canadian Federation of University Women. Most recently, I received the 2020 Michael Donovan NFOSD Innovation Award at the Dysphagia Research Society conference.
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?!
There are many on my wish list! I would be interested in identifying the physiological impacts (if any) of each individual dysphagia exercise we have in our repertoire, for different types of dysphagia subpopulations. Then, I would strive to determine if these impacts are meaningful to patients in light of the dose required to achieve them. Many clinician-researchers have pointed out this gap in our field, with Dr. Alicia Vose (2018) putting it best,
“In fact, many studies in the swallowing literature report only immediate and not long-term effects, include only healthy subjects, and/or omit the use of a control group, thus limiting our ability to determine if specific treatments are truly effective in a dysphagic population (Langmore & Pisegna, 2015).” (https://pubmed.ncbi.nlm.nih.gov/30458527/)
If you could change one thing about having to do research, what would it be?
I would love for research to be collaborative rather than competitive☮️. Our field, in particular, is much too young and we have so much to learn – there is no room to be anything but supportive of one another!
What’s one thing you think clinicians should be excited about in our field regarding research?
Clinical research cannot happen without the buy-in and vested interest of clinicians. Knowing this means that every clinician out there has the potential to spark a new idea, a new hypothesis, a new research study, and a new discovery.🤓
What’s one thing you think researchers should be excited about in our field regarding clinical practice?
Clinical research has the potential to see a fast knowledge transfer: ideas generated by clinicians are shared with researchers, and research findings are implemented in clinic immediately. Many times clinical activities can operate in tandem with research studies. Hence, we have the potential to make quick discoveries with impacts that can be experienced by our future, but also our current patients. I was extremely fortunate to experience this model as a clinician at iRSM; it was there that many ideas for my future PhD work were formed.🤩
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?
Read the Abstract section first😉. It will set a framework for you to understand the information that is about to be presented in the Results section. It will also highlight for you the results the authors deemed most important. Finally, have a look at the original aims, objectives, and hypotheses laid out by the authors. Check to see if these were confirmed or not by the results.🤯
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😉)?
I am surprised how often p-values are misunderstood. Here is the scoop: P-values are not the same thing as effect size, nor are they the same thing as clinical significance.😮
To use a relatable example (especially for the 2020 sourdough craze), imagine I wish to bake the best sourdough there is, and I’m wondering if Tom Papa’s approach of misting the dough a couple of times before putting it in the oven will generate more air holes in my bread.🍞
Null Hypothesis: Misted sourdough and Unmisted sourdough will have the same number of bread holes when all other variables are held constant.
Alternative Hypothesis: Misted sourdough and Unmisted sourdough will NOT have the same number of bread holes when all other variables are held constant.
I could make 1,000 loaves, 500 misted and 500 unmisted, and find statistical significance (i.e., a p-value that’s so small that our findings are extremely unlikely if the Null Hypothesis were true). But what if misted loaves only have, on average, 2 extra air holes over the unmisted loaves? Would you care? This is effect size.
Now, let’s say that it takes 25 more air holes in a loaf of bread for my friends to even notice a difference in bread texture so they may compliment my baking skills😊. Would the 2 extra air holes (albeit statistically significant) matter?? Not if I can’t get the kudos for it! This is clinical significance (or real-world significance).
As consumers of research findings, we must take all of these concepts into account: statistical significance (is the null hypothesis rejected?), effect size (what was the difference?), and clinical significance (does the difference matter to a patient or a clinician?).
If none of this made any sense🙃, then just remember this: p-value is not treatment effect. It is the probability of observing a treatment effect. The p-value can be impressively small & significant, but your treatment effect can also be small …and therefore insignificant.
Here is a fun widget if you’re a visual learner: http://rpsychologist.com/d3/NHST/
What’s the ONE thing you think is important for practicing clinicians to know/understand when reading research?
Research is an approach, that when used properly, will get us closer to the truth. This means that clinicians will need to be patient with research findings. We may not have all the answers now, but we’re always a little bit closer to the truth.
I always use the Matt Might visual explanation when I teach future clinicians: http://matt.might.net/articles/phd-school-in-pictures/
When you scroll all the way down to the bottom, you’ll see an extra visual that’s not included with all the others. It’s a little circle of knowledge, outside of the big circle of what we already know🧠; this little circle is labeled: “Knowledge needed to save my son’s life.” This speaks volumes to me and I hope it will to others as well.
[FYI the visual is actually really cool to think about and visualize🤓!!]
What’s ONE thing you think is important for researchers to know/understand about clinical practice?
Clinicians love to help, but they face many challenges. Some of those challenges are due to limited resources (funding, time, equipment) and some are administrative (time breakdowns, approval processes). Many clinicians put in overtime just to cope with their clinical caseload. They will often be expected to keep pace with new findings and literature on their own time, attend conferences using vacation time, and participate in research🙋♀️. This is a large ask. We should strive to make research as translatable, as easy to apply, and as engaging as possible. And we should always try to work with anyone who is excited by discovery and not scared by the process.
What is something you believe researchers could do better to #bridgethegap?
We could make our research translatable. If clinicians don’t understand how our findings relate to them and their patients or what they mean, that’s on us.😓
What is something you believe clinicians could do better to #bridgethegap?
Try to run at least one or two research studies in your clinical career. It will give you an appreciation for the process of creating knowledge! If all clinicians did this, we would not only have more clinical data and research out there, but we would also have buy-in for some level of standardized clinical outcomes reporting. This may seem trivial, but it can make substantial contributions to retrospective research studies!
Can you provide your contact email if clinicians want to reach out? (Honors system for everyone to be respectful of your time)
I’m sure we all cannot wait to see more contributions to our field from Dr. Constantinescu!!🤩❤️