The imperative of evidence-based practice (EBP) must be supported by research that can be applied to clinical decisions. Unfortunately, many research efforts do not have clear relevance to every day practice, and many clinical questions remain unanswered. Our EBP efforts can be stymied by a lack of meaningful and useful research to support our clinical efforts.
The term translational research refers to the direct application of scientific discoveries into clinical practice. Often described as taking knowledge from “bench to bedside,” this process is actually much broader in scope. Although certainly not a new concept, the healthcare community has experienced a renewed emphasis on the application of findings from laboratory and controlled studies to clinically important problems in real-world settings.
The purpose of this chapter is to describe the scope of translational research, including methods of efficacy and effectiveness research, and the importance of implementation research to make EBP a reality.
All too often, the successes of scientific breakthroughs in the laboratory or in animal models have not translated into major changes in medical or rehabilitative care for humans in a timely way. Of course, there are many notable success stories of research that has resulted in exceptionally important medical treatments, such as the discovery of penicillin in 19281 and the subsequent development of techniques to extract the antibiotic. Similarly, the discovery of insulin and its use in treating diabetes is a landmark achievement that has resulted in significant changes in medical care.2
There are many more examples, however, of lag times from 10 to 25 years or more for a discovery to reach publication, with several estimates of an average of 17 years for only 14% of new scientific discoveries to eventually reach clinical practice.3 Given that these estimates are primarily based on publication records, it is likely that they are underestimates of true translation to health outcomes and impacts (see Focus on Evidence 2-1).4 The NIH Roadmap, proposed in 2002, has called for a new paradigm of research to assure that “basic research discoveries are quickly transformed into drugs, treatments, or methods for prevention.”5
Focus on Evidence 2–1
A Translation Journey: The Lipid Hypothesis
It was more than 100 years ago, in 1913, that a young Russian experimental pathologist named Nikolai Anitschkow reported that feeding rabbits a high-cholesterol diet produced arterial plaques that resembled those in human atherosclerosis.6 The disease had been well described in the medical literature by then, but was considered to be a predictable and nontreatable consequence of aging. At the time, one of the leading hypotheses as to its pathogenesis was that it was the result of excessive intake of animal proteins, and several scientists were attempting to provide evidence by feeding rabbits diets rich in milk, eggs, and meat, which did lead to vascular abnormalities. And ...