PTJ Has No Silo
===============

* Rebecca L. Craik

This is my last editorial as editor in chief (EIC). I had a wonderful 10 years. I learned so much and will sorely miss the opportunity to preview emerging science, highlight new clinical issues, and push “hot topics.” I worked with an outstanding interprofessional and global team of experts devoted to **PTJ**'s mission: to engage and inspire an international readership on topics related to physical therapy, to publish innovative and highly relevant content for both clinicians and scientists, and to use “a variety of interactive approaches to communicate that content, with the expressed purpose of improving patient care.” My vocabulary is insufficient to describe the qualities of the team with whom I have worked.

During my tenure, **PTJ** was served by 52 Editorial Board members. We evolved from an Editorial Board consisting of US-based physical therapists (and one Canadian) to a board comprising international leaders in physical therapy, medicine, biomechanics, and nursing. Dr. Daniel Riddle is the only Editorial Board member who was with me since the beginning. As deputy editor, he was invaluable in helping to ensure that the journal's content is innovative *and* rigorous. **PTJ**'s Editorial Board members have extraordinary expertise, wisdom, and passion for physical therapy and rehabilitation. We worked well together to improve scientific rigor and attract established and emerging scientists and clinicians to contribute to an exploding body of evidence. Supporting our efforts are hundreds of manuscript reviewers who have volunteered countless hours poring over manuscripts to provide reviews that are timely, constructive, and kind.

APTA staff Steve Brooks, Karen Darley, Steve Glaros, and Managing Editor Jan Reynolds have been with me from the beginning and have managed both the growth of submissions and the big changes in scholarly publishing that coincided with my tenure. **PTJ** established its full-service website and an “app” to share the most recent issue on iPads and iPhones. In 2007, **PTJ** began posting discussion podcasts to highlight clinical implications and research trends; in later years, we embedded video demonstrations in articles and published “raw” accepted manuscripts online to transmit the latest information to readers ASAP. We also added cover art that depicts perceptions of movement and provides a visual tie-in with physical therapists' expertise in the movement system.

I love data, so I will reflect on my tenure with some statistics: 

*   In 2006, my first year as EIC, **PTJ** received 380 new (original) manuscripts; in 2014, **PTJ** received 600; and, in 2015 so far, **PTJ** has already exceeded that number.

*   The acceptance rate decreased from 32% in 2005 to 27% in 2014, and the number of published manuscripts increased from 85 to 154.

*   The average time from original manuscript submission to initial decision decreased from 83 days for manuscripts submitted in 2006 to 42 days for manuscripts submitted in 2014, and the average time from acceptance to online publication decreased from 90 to 9 days.

*   In 2014, **PTJ** published manuscripts from 38 different countries, with 31% of all submissions being from the United States.

*   We moved from single physical therapist authors to interprofessional teams submitting manuscripts. In 2014, for instance, **PTJ** author teams included 128 physicians, 19 occupational therapists, and 8 nurses, along with a pharmacist, a geneticist, and several epidemiologists and exercise physiologists.

*   Total accesses to **PTJ**'s online content increased exponentially over the decade, with approximately 2.2 million downloads of full text and approximately 3 million downloads of PDFs in 2014.

*   In 2008, we began direct deposit of National Institutes of Health–funded articles into PubMed Central, and the article embargo was reduced from 12 months to 6 months for any articles funded by NIH or other funders, including Wellcome Trust and the European Research Council.

The variety of topics published in **PTJ** expanded and ranges from a Perspective article suggesting that exercise dose should be modified based on the genetic variants of brain-derived neurotrophic factor (BDNF) to a descriptive report of physical therapists serving as the primary point of care in the emergency department for musculoskeletal conditions.

**PTJ** published 16 special series during my tenure, and in 2006 we began hosting the Rothstein Debate/Roundtable—honoring my predecessor, the late Dr. Jules Rothstein—every year at the June APTA conference. The special series and the Rothstein Roundtables have served to introduce evidence to support APTA concerns, such as the role of physical therapists in critical care, health services research, and interprofessional education. In previous writings, I discussed the dramatic change in critical care practice and research during the past 10 years. The 2007 Rothstein Roundtable emphasized the lack of evidence to support the role of the physical therapist in the acute care setting1; a 2012/2013 special series presented evidence to support the role of the physical therapists in critical care2,3; and, in 2015, the body of research for continues to expand, citing practice patterns, underutilization, and new outcome measures.

Similarly, we began the Health Policy in Perspective feature in 2009, hosted a Rothstein Roundtable to emphasize the need for health services research in 2013,4 and now, in this very issue, launch a special series on healthy policy and health services research that will continue into 2016. Look also for the upcoming special series on regenerative rehabilitation and genomics, a new frontier for clinical practice with opportunities for exciting discoveries. In 2010, we launched a feature that illustrates the application of Cochrane systematic reviews to patient care (Linking Evidence And Practice, or LEAP).

The *International Classification of Functioning, Disability and Health* (ICF) was embraced as a framework for research design and clinical reporting in **PTJ**. Identifying personal factors that mediate clinical outcome has been fascinating reading. For example, the 2011 special series on psychologically informed practice (low back pain) and the concept of “blue flags” marked the beginning of myriad articles discussing the role of personal factors including motivation, confidence, and fear, with growing emphasis on cognitive-based intervention regardless of medical diagnosis.5 The emergent evidence that cries for a dramatic change in practice away from “traditional” pain management strategies grows out of incredible research tools that have expanded our knowledge of nervous system structure and function.

I could go on and on. My main point is that **PTJ**'s research reports, perspectives, and other published papers suggest an *exponential* growth in evidence, with a push by collaborative teams that are conducting research to help define best practice, identify underlying mechanisms, and highlight the utility of tracking meaningful outcome measures.

The number of submitted randomized controlled trials (RCTs) and systematic reviews has increased, and we have seen reports using innovative research methods, including umbrella reviews, pragmatic trials, mixed methods, and quality improvement designs. The quality of manuscript submissions also has increased dramatically. **PTJ** was among the first rehabilitation journals to require clinical trial registration and to comply with *Uniform Requirements for Manuscripts Submitted to Biomedical Journals* as recommended by the International Committee of Medical Journal Editors (ICMJE). Author guidelines are provided for RCTs (CONSORT), diagnostic studies (STARD), observational studies (STROBE), qualitative research studies (QUALRES), quality improvement studies (SQUIRE), and systematic reviews (PRISMA). APTA hosted 2 webinars for the World Confederation for Physical Therapy's International Society of Physiotherapy Journal Editors (ISPJE), a group that seeks to elevate the quality of published physical therapy research worldwide, and **PTJ** copublished 2 editorials to explain trial registration and uniform requirements for publishing. The complex research designs, multifactorial analyses, and model building have required us to expand our team to include several statisticians.

I also am delighted with the growth in the number and quality of qualitative manuscripts and with the immediate clinical relevance of the reported findings. And I am proud that we published our first clinical practice statement with APTA's Academy of Geriatric Physical Therapy6 and our first section-generated clinical practice guideline with APTA's Cardiovascular & Pulmonary Section.7 

As **PTJ**'s EIC, I have had no silo. The Journal has an impressive breadth, publishing reports in each area of physical therapist specialization. I didn't look for the paper that speaks to pediatric physical therapist, for example. I observed themes emerging across silos of specialization and encourage our readers to do the same. Patient classification (identifying characteristics of subgroups who may or may not respond to an intervention), practice variation, adequate dose of intervention, the recognition that motor learning requires task- and context-specific repetition, personal and contextual factors that mediate outcome—these themes are relevant to all of us, regardless of medical diagnosis. If physical therapists are movement specialists and the human movement system is our content expertise, why should we be limited to a silo of specialization? Global professional themes emerge as well and include addressing health disparity, defining new roles for therapists working on collaborative teams, and exploring innovative teaching methods.

Like all professional and scientific journal editors, **PTJ**'s new EIC, Dr. Alan Jette, will face a new level of challenges beyond attracting the best evidence to support the role of physical therapists in this rapidly changing global health market: 

*   Governments that fund research are demanding that the research products be published in open access venues, and some scientists are posting their results directly on university websites for public access, bypassing the peer view process.

*   Journals with immediate open access are proliferating at an exponential rate (and at extremely variable levels of quality) and potentially will compete for authors, Editorial Board members, and reviewers.

*   Clinicians seek fast, immediately relevant, and synthesized “bottom line” answers to clinical questions rather than results from a single experiment.

*   Implementation scientists continue to demonstrate that publishing best practice evidence and guidelines is only the first step in clinical translation.

*   The cost of producing a journal has risen exponentially, and the prestigious medical journals still produce print issues in addition to electronic.

It is unclear what role journals will serve in the future. In my opinion, journals will always serve as a repository for scientific evidence for the scientists. But will other vehicles better serve clinicians' needs?

It has been a great privilege to work with an incredible team to attract the best research and share the latest evidence with scientists, clinicians, patients and clients, and other consumers. I now pass the Journal to the capable hands of Dr. Jette. I hope he will enjoy the view, unobstructed by silos, as much I have.