This transcript has been lightly edited for length and clarity.

APTA: Welcome to this APTA Podcast. Welcome to the PTJ Podcast, where you can get the story behind the research with insights into clinical application, study design, and future projects planned. Now here's editor-in-chief Steven George.

Steven George: Hello everyone and welcome to this PTJ Podcast. Today, we are highlighting APTA Honors & Awards recipients that have linkages to the journal, and what better way to do that than to spend some time with the most recent Jules M. Rothstein Golden Pen Award for Scientific Writing, Dr. Richard Shields. Dr. Shields is at the University of Iowa and is the Gary L. Soderberg Endowed Professor in Physical Therapy and Rehabilitation Science. He's also the Chair and Department Executive Officer of the Department of Physical Therapy and Rehabilitation Science.

Welcome Rich to the podcast. We're very happy to have you. And just to kick things off, I wanted to remind our listeners that the Rothstein Golden Pen Award recognizes superior writing skills in one or more articles published in PTJ. And it also has the bit with collaborating with or encouraging others to make similar contributions to PTJ. Rich is a very worthy recipient of this. So, I wanted to get your thoughts Rich and reflections on what it means to be selected for this award, maybe starting with your own work and then - and then going from there.

Richard Shields: Yeah, you know, this is really a great honor. In fact, I would put this at maybe even the top of recognitions through APTA and others just because, you know, it's a judgment of often a lifetime of work or, you know, what you write is there forever. And to have the opportunity to have peers and others judge it as worthy of this award is really, really exciting. And, you know, I'm sure it would have been difficult to identify me for this. Perhaps I'm not even worthy of it. But, you know, when I think about it, I've always kept a couple of lines of investigation. And that's - that's kind of been a part of my upbringing. You know, I was very much involved with clinical research and clinimetrics. When I finished a degree, I wrote a grant to the Robert Wood Johnson Foundation and I didn't have a master's degree, I didn't have a PhD.

And I was awarded $35,000 to study pressure ulcers. And that got me into the road of research and then writing about it. And it was at that time I met Alvan Feinstein, who had written the book called “Clinimetrics.” He was from Yale. And so, I was infatuated with the clinical side. I practiced in the area of spinal cord injury, that was my focus for many, many years. And, you know, with that, I learned a lot about physiology and so forth. Went on, did a PhD, but I think the real key to my research was that, you know, there was a fork in the road, in that there was the National Institutes of Health that we were, for the first time, trying to penetrate. And then there was my clinical research, which the foundation had gone on and funded, and we developed the first national database in physical therapy. But NIH was a funding source and so, that fork in the road took me in the direction of where I was able to get some R01 funding that was sustained for, you know, over 25 years.

That actually was an important fork, but I've never lost sight of the importance of the clinical side. So, things were going along well and then I became chair and that was in 2006. And I saw the same fork in the road. Because the first thing I did, I hadn't paid a lot of attention to all of what goes on with accreditation and educational work. And when I looked at it and I said, well, I've got to write a self-study. But what measurements do we use? And so, I was back in that fork in the road. I was keeping my NIH work, which is in the area of physiology and muscle and genomics and epigenomics, and that type of thing. But I said, how can I write a self-study if I can't benchmark what we do here at Iowa relative to the constellation of schools out there to know if it's really worthwhile? So, in 2006, I said, you know what? I can benchmark. I can't benchmark the physical therapy, but I can benchmark the medicine. Because I'm in medicine, and I get access to all their educational metrics. I can dovetail with what they're doing nationally and then benchmark to them.

And so that's what we did. We published that work. And then that triggered a lot of schools to contact us and say, hey, can we use that assessment? And I said, yeah, you can, but maybe if we centralize it and develop a central hub and build the first database in education, then everybody could theoretically, when they write their self-study, benchmark to some norms or some values that are out there that at least keep us in the ballpark. And so, you know, both avenues of research have stayed very patent during this time. And so, it was out of the need to be a department chair that, you know, I went down this road of education. And then obviously, my funding in the area of spinal cord injury has just spawned a lot of different ideas and directions. And so, you know, I was happy with the special issue that we put into physical therapy. You know, having to do with, you know, circling back to this idea that there's not that much difference.

You know, we always used to put the social factors over here and the biological factors over here. And a lot of students seemed to come out confused as to whether it's the social sciences or the biological sciences, when in fact, there's no better way to introduce the underlying science than through the social determinants of health. And that's where it's just the biological tagging of lifestyles and behaviors influence health care. And in fact, I can even connect the dot from epigenetics to mistreatment in academia and the level of stress that that induces and how that can play into even epigenetically tagging certain things related to cortisol and other high stress gene responders and so forth. So, you know, while we think the world is different in different types of research, I've been pretty fortunate into being able to see the links between the two. And, you know, that became very important. And I guess, you know, it would be really important. Anytime you see a chair that is productive in research, look to their faculty, look to their administration, because the only reason, you know, this award that I received really needs to be shared with all my collaborators, my colleagues that, you know, have been every step along the way with me, or none of this honestly is possible.

George: No, that's great to hear. And, you know, there's a bunch of great, you know, I think for people listening, the career path there is really important because, you know, it is a bit of navigating what needs to be done versus what, you know, what your interests are. And I think you've obviously done a really nice job with that. One of the things that caught my ear is the mention of “Clinimetrics” because that was a book I bumped into, you know, at the University of Pittsburgh. It was in Delitto's office, Tony Delitto's office. And I think that would be surprising, you know, when I saw you present at CSM, I think it was related to the special issue. I was surprised you started, I think it was a TENS example you used …

Shields: Yeah.

George: In Iowa. You know, that was a little surprising to me knowing where I came in to doing research and knowing you more for the physiology spinal cord injury. So that was, you know, that to me was really interesting to see, you know, and mentioning that work that you had done with TENS and pain relief, I think it was at the Iowa clinics. And now, you know, that makes total sense when you mentioned exposure to the clinimetrics and measuring and seeing what actually is happening in a real world, you know, data set before people really knew what real world research was. So, I thought that was very interesting. And hearing your progression and then in the education scope, I think that's great.

And certainly, keeping the relevance to physical therapy is at the heart of this. Can you talk a little bit because you know, you're prolific scientist, what do you think about when you know, you're getting ready to publish something? What drives you know, for other investigators that are trying to be active inside and outside of the profession, what do you use to guide whether something, you know, maybe goes to PTJ versus, you know, a physiology journal or a spinal, maybe something more in the neuro realm? Are there, have you thought about that before? And what are some, you know, kind of tips you can pass along, maybe?

Shields: Yeah, you know, I think it is important to publish in a variety of journals because that gives you perspective through the lens of somebody else. We recently published our tolerance for ambiguity work in Academic Medicine, which has created a stir comparing physical therapy to the medical students. Having said that, I, you know, I really love submitting to Physical Therapy [PTJ: Physical Therapy & Rehabilitation Journal], because it's not so, I mean, you really get the lens of a lot of different viewers. And it's in the, you know, all you have to do is pick up the journal and you look at the breadth of what's in that journal. And so, I mean, it's really a straightforward thing to, you know, include, let's say, educational research in the journal. But, you know, the response that I've received from, you know, the epigenetics and so forth, and bringing what appear to be complex areas into the mindset of a clinician is what attracts me to the PT journal.

And you might say, well, does a clinician really, you know, they learn basic science, but do they really need the basic science? And that's a question that is, you know, gone through all of medical education and so forth. And what some data suggests is that what keeps us from burning out is our capacity to think about what might be underlying causes to some things that we see. And that's true whether we're doing clinical-based research or even applied physiological research. We see things all the time in the clinic that, you know, if we have the capacity to question what physiologically might be driving that, and then take the time to translate that to the client, that's when I think physical therapy is at its best. It's very difficult to, or you make mistakes if you summarize complex things into simplistic things if you don't understand the complexity first.

And so, the reason I really have always, that's what I think about when I write in particular for PTJ. You know, so if you're talking to a client about an intervention, you know, what in this paper could assist the clinician in bridging the gap between the knowns and unknowns that patients struggle with? And, you know, obviously, the more that a client understands about something, there's fear in the unknown. And so, the fact that we can help bridge that gap in our underlying applied physiology is something that I think about. And I think about that even if it's going into a molecular journal, that it's my responsibility because I carry a license to actually do the same thing for the more applied or basic science world. It's incumbent upon me to lay out why this has importance beyond the molecular plasticity or some other adaptation that's being seen. So, I would say that probably gives the, you know, best guideline as to what I use.

George: No, thanks. And I, you know, I think I looked at some of the precision medicine articles before, and I think those thread that needle nicely that you were just talking about. Those are, in my mind, kind of hybrid, you know, articles that try to introduce some concepts that maybe, like you said, you wouldn't expect to see in PTJ, but need to be introduced to the clinician mind because these are explanations that they should be thinking about or will become part of their explanations hopefully in the near future. So, I think, you know, that for people that haven't seen that, that are listening, that's, I think, a really good example of what you were just talking about. So, I do want to shift gears just a second, go back to the award name and the editor-in-chief that it was named after. I'm just curious, you know, that name comes, you know, with some weight perhaps depending on how long you've been in the profession. And I'm just wondering, you know, were there any connections to Jules Rothstein that give this award any additional meaning?

Shields: Yeah, when I said that, I think this award for me sits at the very top in terms of an honor. It's because of who it's named after. And, you know, to be quite honest, when we developed the first computerized medical record, and it was in the late 80s, we developed consensus across our PT department, 40 therapists. We went online. It was a mainframe. We had the only electronic medical record in university hospital. We had to print off those records and then run and put them in the paper chart. So, we were kind of leading on that fund. And Jules found out about it, and he had me at the University of Illinois several times. And he was actively recruiting me to come to Chicago via every best restaurant there is in - in Chicago. I mean, Jules was just such a joy, a breath of fresh air, straightforward. You knew what he was thinking.

And because of that, you know, he advanced our field. And I think, you know, the one thing back when I was in the clinimetric world, you know, even, you know, he had written a lot of things that were provocative and really moved our field forward. But the one that I, you know, really resonated with me early on was this notion of the Kudzu weed. And he wrote that in an editorial that he was distinguishing between what's objective and what's subjective. And he put forth the notion that this idea that objective and subjective is like this weed that you can't get rid of. You cut it back and it just comes back. It's aggressive in its ability to grow back. And how we in our field use the word subjective to mean something that has less meaning and objective to have something with more meaning. And what he was getting at, and it made a tremendous impact on me, in that, you know, you can have subjective phenomena, but, you know, it can be, have a quality that's objective based on its psychometrics and reproducibility and terms like that as to how it's measured.

And you can have what might be viewed as objective measurements, because in those days, we were starting to get things out of computers, so they must be objective. But they could have a very subjective quality. And, you know, that, it must have just been the timing of things that I was going through at that time and so forth. But, you know, I was struck by the fact that how did he come out just to lead that discussion from the, you know, this Kudzu weed that's found in one part of the country. So, you know, that's just one example. But if you really want an education, you know, go back and read. And, I mean, it almost reminds me that, you know, the reason history tends to make the same mistakes over is sometimes we don't reflect on what happened in the past. Like sometimes, I remind students all the time, you know, if it didn't, if it wasn't published in the last five years, they don't want to read it. But maybe that's why we repeat in some of our errors. And sometimes I think reading some of the things that Jules put out there many years ago are so profound.

And, you know, to circle back to your question, that's why this award does carry special meaning because of, you know, my relationship with Jules. He never got me to leave Iowa, but he did get me as one of his real close friends. And I have to tell you one other story because we were in a softball game together and Jules was on second base. Somebody hit a ball, the score was tied, and he was rounding third. And he was the winning run and he got halfway down the line and he slipped, and he hit the ground hard. And everybody was going, come on get up Jules, get up. End of the story. He crawled, hit the base before they got him out. And we would reflect on that story laughing so many times. So, you know, it's not just the science side, but it was the personal side of Jules that really, you know, we miss and why this award is such an honor to receive, so ….

George: No, that's great. And thanks for sharing. That's a, you know, such a tremendous connection. And as someone who still has occasional dreams about getting thrown out from first to third, I can totally, totally relate to that - that softball story there, so that, but that's wonderful, and thanks for sharing. And I certainly share your view of the editorials and particular things I like to look at. And, you know, so many of them are still relevant. And like you said, that doesn't, just because they haven't been published in the last five years, doesn't mean that they can't have relevance for issues that are going on right now.

And the subjective-objective one is a great one for someone like me who studies pain. I mean, I spend half my time people saying there's a difference between subjective and arbitrary. And, you know, that is an important distinction, so, that's a great, great example. Just to wrap up, we just got, you know, one or two more minutes. I'm just curious about how, from your perspective, either what's changed notably in the peer review process since you've been active, not in PTJ or beyond or, you know, what do you see in the future for peer review? You know, either one, it can be dealer's choice type of thing, but, you know, someone who's been as active as you have in peer review and been in the game, you know, what do you think has changed or what are you looking for on the floor that's either encouraging in the future that's either encouraging or concerning? And we'll use that as the wrap-up question.

Shields: Yeah. Well, there are, I mean, there are a lot of items, there are a lot of journals, there's a lot of access. I mean, in the days when we went and lived in the halls of the libraries, part of remembering something was you remembered the aisle that you went to pull that journal down and you had to work to get that information. And now, it's at our fingertips. And so, I think sometimes there's a lot taken for granted. And because of that, sometimes I think in peer review, reading isn't done as carefully. Sometimes the real kernels were embedded in the discussion of a paper that may not adequately be found today. And so, for that, I think, I mean, something for the future, I think we need to, you know, continue to adapt to how do we put those kernels that might be in a discussion, move them to the forefront, so that they're found. Or, you know, maybe even, you know, we have lots of opportunities to in, for example, in PTJ to do a perspective or to do some other point of view or a letter to the editor or, you know, but some way to create the dialogue about, and I thought, you know, your paper did a nice job of that recently with respect to the movement system.

I mean, to me, that's going to win the day in the future to take it to a concise, but meaningful discussion that is okay. I mean, that's the one thing, if you go back in time and you read some of Eugene Michels and others, Steve Rose, you know, we have to feel comfortable in putting out there what we think and have the dialogue because all are struggling. And so, I think the future, something that I'd like to see across all journals, and this isn't easy or trivial to do, but, you know, the notion of, you know, creating that dialogue and what's, you know, what do we want in a perspective versus a brief report? And couldn't a perspective really be a brief report? And, you know, then what triggers the discussion, let's say, to the editor or things like that? So, I think the more dialogue, the more we can tease out, that may be a way to get at those kernels that a lot of times are lost in a lengthy discussion of a paper in particular.

So, I'll stop there. And let me just say thank you for what you do and Jan [Reynolds, former managing editor] and your team, because the greatest test is - is consistency over a long period of time. And while I suspect the journal is going to change under your leadership, I see that as a good thing. And every generation of editor should and will bring about a flavor that helps us with our trajectory into the future. And so, I really thank you for, you know, what you've done in number one, taking this on, and of course, Jan for all that she's done with the journal for many, many years. So, thank you.

George: Uh-huh, well, I appreciate that. And yeah, it's, you know, it's a responsibility and opportunity and something I'm looking forward to. And the journal was in very good hands, and I hope to, you know, keep it in that standing and improve it and be responsive to the time, so I appreciate your support. And I echo, you know, Jan has been a fantastic partner to help me as the newbie editor-in-chief, even though I have been involved with the journal for a little while, it's a new perspective being the editor-in-chief and, you know, her guidance and help along the way has been invaluable and made the transition that much easier. So, thank you for those kind words. Briefly, I agree with you 100% on the dialogue. I hope it's not only on the movement, you know, I hope we have other examples, but I have been encouraged, several people have reached out and said they really enjoyed that.

Shields: Yes.

George: And not because, you know, it's like, who's right, who's wrong, it's the dialogue, you hit it on the head, people enjoy the back and forth. And the fact that two people or two groups are very comfortable disagreeing on something in a way that is, you know, a debate that a lot of people are seeing in other areas of our society right now to say it as, you know, tactfully as possible. So, you know, we hope to continue that in the pages of the journal because I think that's what keeps it alive and keeps it interesting. So, I'm glad you noticed that. And we'd love to talk to you about anything you'd like to stir the pot or, you know, start some of those conversations. Your contributions have been, you know, very meaningful to the journal and, you know, congratulate you on the Rothstein Golden Pen Award. And thank you for your time in joining us today and discussing a little bit about what this award means to you and some of your more general thoughts about peer review. I really, really appreciate it.

Shields: Well, thank you for having me.