[version 1; peer review: 1 not approved]
No competing interests were disclosed.
This narrative review examines differences in research visibility between academic and clinical physical therapists, explores structural barriers that limit research engagement in clinical settings, and considers the contribution of practice-based inquiry to the profession’s evidence base.
A narrative synthesis was undertaken using published literature on scholarly productivity, bibliometric performance, research participation, evidence-based practice, and research barriers among physical therapy academics and clinicians across multiple international contexts. Relevant papers were identified from major health and bibliographic databases and by screening reference lists of eligible articles.
Academic physical therapists consistently demonstrate higher measurable bibliometric output than clinicians, although performance varies across institution type, region, and research infrastructure. In contrast, clinicians across several countries report recurring barriers to research engagement, including heavy workload, limited protected time, inadequate research training, and insufficient institutional support. Despite lower publication visibility, practice-based clinical inquiry generates contextually relevant, patient-centred knowledge that supports the implementation of evidence and service improvement. Clinician-scholars also serve an important bridging role between knowledge generation and clinical application.
Research visibility in physical therapy is shaped by structural conditions rather than scholarly interest alone. Conventional bibliometric measures privilege academic environments and do not adequately capture clinicians’ practice-based contributions. Broader evaluative approaches that recognise clinical audit, quality improvement, and implementation activities are needed to more equitably represent professional contribution and strengthen the discipline’s evidence base.
Research visibility is often assessed using publication counts, citation metrics, and indices such as the h- and g-indices. Across healthcare disciplines, these indicators are often treated as markers of professional value and scholarly influence. In physical therapy, however, such measures tend to favour academic practitioners, whose roles are more closely aligned with research production, publication, and citation accumulation.
Academic physical therapists typically work in environments where research activity is institutionally rewarded through promotion pathways, tenure expectations, accreditation standards, and access to research infrastructure. In contrast, clinical practitioners often work in service-oriented settings characterised by high patient volumes, productivity demands, and limited protected time for scholarship. As a result, the visible outputs commonly used to assess academic contribution may not reflect the full range of professional knowledge generation within the discipline.
This distinction matters for several reasons. First, bibliometric indicators were designed primarily to assess academic productivity and may be less suitable for evaluating clinically embedded scholarship. Second, the growth of physical therapy depends not only on generating new knowledge in academic settings but also on interpreting, adapting, and applying it in routine practice. Third, an increasingly narrow reliance on publication-based metrics risks undervaluing clinicians whose work meaningfully contributes to patient care, quality improvement, and evidence implementation.
This narrative review, therefore, aims to characterise the bibliometric landscape of academic physical therapy, examine structural barriers to research engagement among clinical physiotherapists, and highlight the value of practice-based inquiry as an important yet often under-recognised form of scholarly contribution.
A narrative review approach was used to synthesise published literature on research visibility in physical therapy. Electronic databases, including PubMed/MEDLINE, CINAHL, and Scopus, were searched to identify studies on scholarly productivity, bibliometrics, evidence-based practice, research barriers, and research capacity in physical therapy. Reference lists of eligible articles were also examined to identify additional relevant sources.
Studies were considered eligible if they reported bibliometric data on academic physical therapy or Doctor of Physical Therapy faculty, or examined research participation, research barriers, or engagement in evidence-based practice among clinical physiotherapists. Review articles addressing knowledge translation, training programmes, or research capacity in physiotherapy and allied health were also considered if directly relevant to the aims of this paper. No geographic restrictions were applied, allowing comparison across different healthcare and educational systems.
The identified literature was reviewed and thematically organised into three domains: bibliometric output among academic physical therapists, barriers to research engagement among clinical physiotherapists, and the value of practice-based clinical inquiry. As this article is based on a narrative synthesis of published literature, ethical approval was not required.
Published bibliometric studies indicate that academic physical therapists generally have higher measurable scholarly output than clinicians. A national analysis of Doctor of Physical Therapy faculty in the United States reported median values of seven publications, 42 citations, an h-index of 2, a g-index of 5, and an e-index of 5.4.
Regional analyses offer additional perspective. In the south-eastern United States, tenure-track Doctor of Physical Therapy faculty with a promotion had a median of 4 publications, an average of 12.4 citations, and an h-index of 3.
These differences suggest that bibliometric performance is shaped not only by individual scholarly activity but also by institutional conditions, including access to research infrastructure, mentorship, funding opportunities, doctoral training, protected time, and a supportive academic culture. In this context, high research visibility is partly a function of structural opportunity.
In contrast, the literature consistently shows that clinical physiotherapists face significant barriers to engaging in research. Clinicians often work in environments shaped by heavy patient load, service delivery pressures, limited time, insufficient research training, and restricted access to research resources. These constraints reduce opportunities to conduct formal research even when interest in evidence-based practice is present.
In Kuwait, only a minority of clinical physiotherapists reported active research participation, with lack of time, heavy workload, and limited access to library resources identified as major barriers.
A systematic scoping review of training programmes aimed at improving evidence uptake among physiotherapists found that barriers to knowledge translation are not solely research-specific but also reflect wider organisational and professional cultural factors.
Although clinicians often have lower bibliometric visibility, practice-based inquiry contributes in important ways to the profession’s evidence base. Clinical audits, outcome monitoring, quality improvement initiatives, and service evaluations frequently address questions that arise directly from patient care. Physiotherapists’ perceptions suggest that engagement increases significantly when research is seen as personally meaningful and directly relevant to practice.
Practice-based evidence has distinct strengths. It reflects the complexity of routine care, captures context-specific service realities, and engages with patient populations that may be underrepresented in tightly controlled research settings. It can therefore complement formal academic research by helping bridge the gap between published evidence and everyday practice.
Clinician-scholars occupy a particularly important position in this process. By working across the boundaries of service and scholarship, they help translate research findings into practical protocols and generate clinically relevant questions for further investigation. Their contribution is central to evidence implementation, yet it is often inadequately represented in publication-focused evaluation systems.
This narrative analysis reveals that the difference in research visibility between academic and clinical physical therapists stems from structural imbalances rather than from varying levels of scholarly dedication. Academic environments reward and enable bibliometric output through institutional mandates, protected time, and research infrastructure; clinical environments do not. Bibliometric indices, designed to measure academic productivity, are therefore inadequate and potentially misleading tools for evaluating clinicians’ professional contributions.
This interpretation is supported by the remarkable consistency of barrier-reporting across culturally distinct settings.
Furthermore, the current prioritisation of publication-based metrics risks creating a distorted professional taxonomy where academic researchers are systematically valued more than clinical practitioners, regardless of the impact on patient outcomes. This distortion has real-world effects: it can discourage skilled clinicians from choosing practice-focused careers, hinder collaboration among different professionals, and limit the diversity of evidence within the profession. Physical therapy advances by generating new knowledge in academic settings and refining and applying it in clinical practice. Evaluation systems that focus solely on the former overlook the importance of practical application and continuous improvement in clinical settings later.
This review has several limitations. Although the narrative synthesis method is suitable for the review’s scope and aims, it lacks a systematic risk-of-bias evaluation and may be affected by publication bias. Studies identified through database searches might underestimate clinical settings where research culture is still developing or absent, possibly leading to an overestimation of the worldwide prevalence of positive research attitudes. Additionally, comparing the studies directly is challenging due to differences in methods, sample characteristics, and measurement tools. However, the main findings are consistent across diverse healthcare systems and professional groups, supporting the strength of the core conclusions.
Research visibility in physical therapy is skewed towards academic practitioners primarily because of structural factors, not because of differences in attitude. Bibliometric metrics often fall short in fully capturing the contributions of clinical physiotherapists, as their practice-based inquiry produces contextually important, patient-centred insights. Advancing the profession involves expanding evaluative frameworks to acknowledge all forms of scholarly contributions, such as clinical audit, quality improvement, and evidence implementation. It also requires addressing institutional barriers that hinder clinical research participation. Supporting clinician-led research through dedicated time, mentorship, and organisational backing will strengthen the evidence base in physical therapy and promote equity in a field that depends on both academic rigour and clinical expertise.
During the preparation of this manuscript, the authors used ChatGPT (OpenAI, paid version) and Grammarly Premium to assist with grammar checking, language refinement, content review, and restructuring for clarity and readability. These tools were used solely to improve the manuscript’s presentation. All suggestions and edits were carefully reviewed, verified, and approved by the authors, and the authors take full responsibility for the final content of the manuscript.
No new underlying data are associated with this article. This manuscript is based on a narrative synthesis of previously published literature, all of which is cited in the reference list.
No extended data are associated with this article.
None.
The manuscript addresses an important and under-discussed issue in physical therapy: the structural imbalance between academic and clinical environments in opportunities for research engagement and in recognition of that engagement. The paper is strongest when discussing the institutional barriers faced by clinicians, including lack of protected time, limited infrastructure, and insufficient organisational support for research participation. However, in its current form, the manuscript conflates several distinct concepts that would benefit from clearer separation and more precise terminology.
I would encourage the authors to separate their argument into three distinct claims.
1. Structural barriers limit clinicians’ ability to conduct traditional research
This is, in my opinion, the manuscript’s clearest and most persuasive argument. Academics are typically employed within systems that provide protected research time, mentorship, funding pathways, and promotion structures tied to scholarly output. Clinicians, by contrast, often work in environments dominated by patient throughput and service delivery pressures.
As a result, clinicians may preferentially engage in lower-resource activities such as audits, quality improvement projects, and service evaluations because these are feasible within real-world clinical constraints. This is an important structural observation and does not require broadening the definition of scholarship to make the point.
2. Clinicians contribute important implementation and evidence-translation work that currently receives limited professional recognition
This is a distinct argument from the first and should be framed separately.
The manuscript currently risks implying that activities such as audits, QI projects, outcome tracking, and evidence implementation are equivalent to traditional scholarly outputs. Many readers will not accept this equivalence because these activities are often locally focused, methodologically limited, and typically do not generate knowledge that is generalisable to other institutions.
However, there is a strong and defensible argument that clinicians perform critically important implementation-supportive work that is undervalued within existing professional reward structures. Research investment ultimately has limited value unless clinicians:
remain current with the evidence, interpret it appropriately, and integrate it into patient care.
This translational and implementation role is essential to the profession and arguably under-recognised.
That said, the manuscript currently does not operationalise what form this proposed “recognition” should take. Should these activities influence promotion criteria? Credentialing? Professional awards? Institutional KPIs? The paper would benefit from specifying how broader recognition might realistically and rigorously occur without collapsing distinctions between research productivity and high-quality clinical practice.
3. Supporting clinician-led research is likely to strengthen the profession
The manuscript would also benefit from more explicitly acknowledging that clinician-led research can make uniquely valuable contributions to the literature.
Some of the most clinically meaningful research arises from clinician-researchers because they are closely engaged with patient priorities and everyday care challenges. Clinician-researchers are often well positioned to identify questions that matter directly to patients and frontline practitioners. In contrast, academic research agendas may at times be shaped by funding availability, methodological feasibility, or institutional publication pressures rather than immediate clinical relevance.
At the same time, it is important not to romanticise clinician-generated work. Not all clinician-led projects are rigorous or impactful, and some audits/QI activities are undertaken primarily because they are achievable within constrained environments rather than because they advance knowledge substantially. A more balanced discussion acknowledging both realities would strengthen the manuscript considerably.
Additional conceptual issue
I would also encourage the authors to reconsider the term “research visibility.” At several points, the manuscript appears less concerned with visibility of research than with recognition of clinically valuable professional activity. The current terminology sometimes obscures whether the manuscript is arguing:
that clinicians conduct scholarly work that is insufficiently recognised by bibliometric systems, or that clinically valuable activities deserve broader professional recognition even when they are not traditionally scholarly.
Clarifying this distinction would improve precision and reduce conceptual ambiguity.
Overall, I believe the manuscript addresses an important issue and could make a worthwhile contribution if the authors more clearly distinguish between research production, evidence implementation, and clinical service contribution, while also clarifying the specific forms of recognition they propose.
Is the review written in accessible language?
Partly
Are all factual statements correct and adequately supported by citations?
Partly
Are the conclusions drawn appropriate in the context of the current research literature?
Partly
Is the topic of the review discussed comprehensively in the context of the current literature?
Partly
Reviewer Expertise:
I do my own clinical research in respiratory physiotherapy. I mentor clinicians in the public hospital system who are seeking to do research alongside their clinical roles. I do research into the methodological standards of physiotherapy research. I am the editor of the top-ranked physiotheray journal. I co-direct the Physiotherapy Evidence Database.
I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.