Stats & facts observerfpa journal.org12 journal of financ

1. Stats & FactsOBSERVER
FPAJournal.org12 Journal of Financial Planning | August
2016
OBSERVER
“With the
fi nalization of
this rule, we are
putting in place
a fundamental
protection into
the American
retirement
landscape.”
—Thomas Perez,
U.S. Secretary of Labor,
referring to the DOL’s
Confl ict of Interest Final
Rule, ThinkAdvisor
How to Evaluate
Research-Based Writing
Retreat attendees. “They know how to
conduct research, but they don’t always
know what the critical questions are
that you need answers to.”

2. EVERY MONTH you get the Journal,
you may wonder about the academic
contributions. Most likely they are help-
ful to you, but perhaps there are times
when you aren’t quite sure what to make
of that research.
The Journal’s practitioner editor Dave
Yeske, DBA, CFP®, co-owner of the
planning fi rm Yeske Buie, notes that
in order to become a true profession,
advisers need to base their practices on
research-based writing. And in order
to do that, advisers need to understand
how to evaluate such writing.
At FPA Retreat in April, Yeske gave a
presentation on how to read and apply
research-based writing. He provided
eight questions to ask yourself in order to
better evaluate research-based writing.
1. What is the problem or ques-
tion? What are the researchers
trying to address?
2. How did they conceptualize that
problem; how did they structure
it? Look for what the researchers are
measuring. For example, client trust
and relationship commitment have
become well-represented measures
in fi nancial planning literature.
3. What are the key fi ndings from
prior research? Good research
will build on research that came

3. before to lay the foundation for the
current research to build upon.
4. What was their methodol-
ogy? Does it seem like the
researchers make sense?
5. What were the results of the
testing? A formal academic paper
will never prove anything, Yeske
said. Rather, it will fail to disprove
something.
6. Were the results compelling? Do
the authors connect all the dots for
you? Does their data answer the
question?
7. What are the practical applica-
tions? Do the researchers tell you
how you could use this informa-
tion? If not, are you still able to
fi nd a practical use for the data that
is being presented?
8. Will this change the way you
practice? Will you be able to
incorporate this into your practice?
“As a profession we need to all
become better at recognizing research-
based writing and [being] able to apply
it,” Yeske said.
For more information on applying
theory to practice, visit the FPA Theory

4. in Practice Knowledge Circle, www.
OneFPA.org/Community/Knowledge-
Circles.
“We need to deepen our connection
with academics,” Yeske said to FPA
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Research
H o w To R ead a
Research Article
b y Brian K. W alsh, MBA, RRT-NPS, FAARC
There are several reasons why a respiratory therapist
should read a research article. This article will review a
few to highlight the importance of reading and under-
standing research articles.
The first, and likely the best, reason to read is the pro-
fessional obligation to m aintain competence. Respira-
tory care is a profession and one of the aspects of being a
professional is the capability to self-teach, self-learn and
evolve your practice. Respiratory therapists are accused

5. of practicing the same way they were taught in respira-
tory school. If you ever wonder why our practice varies,
it’s likely because of the influence of research articles. To
maintain relevance, we must review scientific articles.
The second reason to read research is to review an
article in preparation for an upcoming meeting or dis-
cussion. Our practice should be reviewed as part of a
comprehensive quality-improvement process. This is
healthy, and we should always look to improve our prac-
tice and associated outcomes.
The third reason is for the joy of it. Now, I know you
are starting to laugh, but I really do enjoy exploring re-
search articles. It’s not the reading or mental exercise I
enjoy, it’s the practice change that improves the care we
provide that warms my heart.
Now that you have picked a research article to read
from the reasons above or others, I have a few sugges-
tions in how to tackle a research article.
Be skeptical or suspicious
Read critically. I often skip the abstract and go right
to the introduction. Within the introduction the authors
are tasked with introducing the problem or topic and
convincing you there is a problem and that they believe
a new way is needed. Often, if you first read the abstract
and stop there, you miss the full message. The abstract is
the h a rd s e ll, is word limited and often very dense. If the
introduction doesn’t pull you in, then you should move
on to another article that does. If the authors’ introduc­
tion pulls you in, then continue on, but don’t assume the
authors are right — critically critique their assumptions,
logic, and reasoning.

6. Identify the question
Summarize the introduction in a few sentences. I
often highlight three or four sentences and rewrite the
question to fully synthesize the problem and ques-
tion. The research question should be toward the end
of the introduction. Rewriting the question helps you
identify possible conclusions. I even list some possible
conclusions.
A newer section most journals are offering now is
a quick look or brief summary section th at helps you
identify within a few sentences the current practice and
what this paper contributes to our understanding.
Identify the method to their m adness
The m ethods section often intimidates the reader.
This section is responsible for the perception you are
either a researcher or a genius to be able to understand
a research article; this is simply not true. The methods
section is typically action packed and may take some
work to understand, but it can be done. Certain proce-
dures or methods may be understood by the authors
and even reviewers. However, this can translate within
the authors’ mind that everyone understands the m eth­
ods when the reader does not. This leads to the occa-
sional miscommunication, but don’t let th at stop you.
To truly understand, you may have to look up referenced
methods if they aren’t explained completely. Diagram-
ming each experiment and the order of events can help.
I am a visual thinker and this often helps me more fully
understand the results.
Read creatively

7. Based on your experience and expertise, start to take
a guess at the results or conclusions. It’s easy to find
fault, but there comes a time in the article to get excited
about the opportunity and switch to a more creative or
positive evaluation. What are some of the opportunities?
Could you implement changes in your practice? Could
this help your patients?
3 2 AARC T im e s M a rc h 2 0 1 6
R e s e a r c h
Drumroll please
The results are often sentences of facts and very
dry to read. Because our mind can out process (out-
put) our reading speed (input) this becomes a source
of confusion. Since your mind is already creating a dia-
log and developing conclusions before you completely
read the results, you m ust try not to jump to conclu-
sions. Focus on words like “significant” or “non-sig-
nificant.” Check out the graphs and tables — they are
often the best way to fully understand the data. Sta-
tistical analysis is standardized by study design and
data type. Don’t be afraid to look up these methods,
as they have strengths and weaknesses that should
be understood. Look for p-values < 0.05. P-values less
than a given significance level (0.05) suggest that the
observed data is inconsistent with the null hypothe-
sis. Some researchers refer to p-values of 0.05-0.1 as a
trend. If it didn’t reach statistical significance but was
coming close, this may be something to watch or to
consider studying in the future.

8. Explore the gab section
The discussion section is a
very valuable section of the au-
thors’ thoughts and limitations.
This section is a synthesis of
the introduction, methods, and
results that won’t be in the con­
clusion. The discussion section is
a place to find some of your u n -
answered questions. Authors will
elaborate on design strengths or
weaknesses, unexpected results,
and possible future directions.
Read the conclusion last
I know this is likely contrary
to what others have taught, but
reading the conclusion first often
leads to im proper conclusions.
The conclusion can only be read
in the context of the entire study.
If you are provided proof, it’s time
to turn your healthy skepticism
to acceptance and get to work al-
lowing the research to positively
influence your practice.
Compare results
If possible, look up the refer-
ences or similar research. Learn
what others think of the research.
Is this sim ilar or different to

9. what others have found? If the research paper is a lit-
tle older, is it cited in review articles? Editorials are
a wonderful source to see experts in the profession
debate relevance and impact. Not all research articles
will have an accompanying editorial, but if they do, it’s
worth the extra read.
Research manuscripts are the most common way
scientific information is distributed because reading is
the most common and universal way we learn. In this
information age, new knowledge is being published
every day, and it can be overwhelming. Reading a re-
search article takes work, but there are a few tricks
that can help improve your efficiency.
• Develop a method of reading that works for you.
Set aside time each week to read or work on your
method to improve yourself professionally. This is
one of the healthiest habits you can develop.
• Skim titles in journals. Respiratory Care is a won­
derful resource and is our profession’s science jour­
nal. Skim the titles and read every month. The editors
and reviewers have your best interest in mind. Each
month they prepare state-of-the-art articles for your
viewing pleasure. If you only had
time to read one journal, Respira-
tory Care would be my choice.
• Use technology. Technology can
help identify and sort informa-
tion. Most major medical search
engines allow you to set up an
account with notifications. When

10. articles are published that meet
your search criteria, you will re-
ceive a notification. Most jour-
nals have Facebook or Twitter
accounts th at you can follow to
get the latest updates. I also use
apps like UpToDate and Docphin
to help organize topics and re-
view hot topics more efficiently.
While technology is positively
impacting our research productiv-
ity and acquisition of knowledge,
there is no replacement for critical
and creative reading of research
articles. There are no fancy short-
cuts and, unfortunately, know-
ing the literature alone will not
improve your practice. The best
achievable result is being able to
apply your newly found knowl-
edge from reading a research arti-
cle to your daily practice. ■
ABOUT THE AUTHOR
B rian K. W alsh , MBA, RRT-
NPS, FAARC, is clin ical
r e s e a rc h c o o rd in a to r
in th e d e p a r t m e n t o f
a n e s th e s ia , d iv isio n o f
c ritic a l care, a t B o sto n
C h ild re n ’s H o sp ital
in B oston, MA, a n d a
PhD s t u d e n t a t R ush
U n iv e rsity in C hicago,
IL. He is th e AARC’s

11. p re s id e n t- e le c t.
34 AARC Times March 2016
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individual use.
EVERY MODERN HEALTH CARE
PRACTITIONER IS SURELY FAMILIAR WITH
DAVID SACKETT’S 1996 DESCRIPTION
OF EVIDENCE-BASED MEDICINE AS “THE
CONSCIENTIOUS, EXPLICIT, AND JUDICIOUS
USE OF CURRENT BEST EVIDENCE IN MAKING
DECISIONS ABOUT THE CARE OF INDIVIDUAL
PATIENTS. The practice of evidence-
based medicine means integrating
individual clinical expertise with
the best available external clinical
evidence from systematic research.”1

12. The intent of evidence-based practice
(EBP) was to marry the best and most
current quantitative scientific research
evidence with the clinical experience
of the practitioner, earned through
clinical practice with patients, to
create optimal decision-making for the
treatment of a problem.
Evidence-based rigidity
Over the years, however, critics of EBP
have argued that this approach turns
clinicians into technicians who follow
a recipe, with individual patient and
CHECKING THE EVIDENCE
Patient-centered chiropractic care and emerging
treatments call for your own evidence-informed inquiry
when evidence-based research falls short
B Y S T E V E A G O C S , D C
TIME TO READ: 10-12 MIN.
T H E T A K E A W A Y
Evidence-informed practice is gaining popularity among
chiropractors and health care
providers over evidence-based practice, especially when it
comes to newer procedures
with little existing peer-reviewed research. Evidence-informed
practice advocates using
conventional wisdom and common sense, and giving higher
value to qualitative studies,
case reports, scientific principles and expert opinions.

13. RESEARCH
RESULTS
40 C H I R O P R A C T I C E C O N O M I C S • M A R C H
1 1 , 2 0 1 9 C H I R O E C O . C O M
http://ChiroEco.com
RESEARCHRESULTS
practitioner values, as well as the circum-
stances of each patient, being lost in
the mix.2 The majority of providers, left
to their own devices, would probably
not express this tendency. However, the
adoption of evidence-based practice
guidelines such as the American College
of Occupational and Environmental
Medicine or Official Disability Guidelines
that dominate the third-party pay struc-
ture has certainly contributed to the
idea that the research component of
EBP is what really matters and the other
factors are less important. One could
make the argument that, over time, EBP
became research-focused rather than
patient-focused.
Any chiropractor who has been told
they have six visits to make significant
changes with a patient with low back pain
or else their care is the wrong option, for
example, understands the frustration
that can come with EBP guidelines. It is
easy to see how practitioners can have a

14. negative outlook on the evidence when it
is used to guide care (or the lack thereof)
for patients who depend on third-party
pay structures.
Also inherent to evidence-based
practice is the type of research that is
considered. Practice guidelines like the
ACOEM or ODG mentioned previously,
systematic reviews and meta-analyses
get the highest ranking. However, as with
any type of research these can have their
own inherent biases and are not without
problems, especially when being applied
to a patient whose circumstances may
not exactly match the research inquiry.
In practice, EBP tends to put the highest
value on these types of research,
assessment and diagnosis, and factors
like prevalence.2 Rarely, however, does a
patient’s presentation exactly match the
inquiries of EBP and the evidence, and
so, how does a provider use all of the
available research to better serve the
patient at hand?
Evidence-informed, patient-centered
In more recent years the term “evidence-
informed practice” (EIP) has found
One could make the
argument that, over
time, evidence-based
practice became
research-focused rather

15. than patient-focused.
C H I R O E C O . C O M M A R C H 1 1 , 2 0 1 9 • C H I R
O P R A C T I C E C O N O M I C S 41
http://www.mybreakthrough.com/mdp?utm_source=chiroeco&ut
m_medium=display&utm_campaign=issue4
http://ChiroEco.com
RESEARCHRESULTS
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its way into the lexicon of health care
providers. While it may seem like mincing
words, there is a significant difference
between what has become evidence-

17. based practice and this newer approach.
Proponents of EIP suggest that the goal
of collecting evidence to help inform a
provider on a particular case should go
further than the singular goal of reducing
bias and that a wider range of research
information should be used. Estabrooks
advocated that providers add “some
of our own conventional wisdom and
common sense” and give higher value to
qualitative studies, case reports, scientific
principles and expert opinions.3 Miles
and Loughlin have promoted the use
of evidence-informed practice to mean
the process is person-centered rather
than research and evidence-focused4
and this is, perhaps, the most important
distinction between evidence-informed
and evidence-based practice styles.
To better illustrate the differences in
evidence-based and evidence-informed
practices, let us consider two therapies
gaining popularity among manual
therapists and chiropractors: cupping
and compression “flossing.” Cupping
gained wide popularity in the United
States during the 2016 Olympics when
U.S. swimmer Michael Phelps was seen
with the now-familiar cupping marks
on his shoulder and back. The media
exploded with curiosity about cupping
therapy. Of course, the endless debates
about “if it works” or not came with it.
Cupping and

18. compression-band flossing
Cupping has been used for more than
3,000 years throughout Asia, Greece,
Egypt and the Saharan region, Iran, and
throughout the Muslim world. A medical
textbook published in Europe in 1694
shows an illustration of a man having
cupping performed on his buttocks.
Yet, a 2014 systematic review of cupping
concluded that, “because of the unrea-
sonable design and poor research quality,
the clinical evidence of cupping is very
low,” and a 2011 review found that, “the
effectiveness of cupping is currently not
well-documented for most conditions.”
Compression-band flossing, aka
“voodoo flossing,” has quite a fuzzy
An evidence-informed
approach would combine
anecdotal evidence, the
potential underlying
mechanisms, risk and
reward analysis, and
would balance these
against EBP guidelines
that suggest that an
intervention for low
back pain, for example,
should yield significant
objective changes within
a trial of six visits.
42 C H I R O P R A C T I C E C O N O M I C S • M A R C H
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19. http://www.activator.com?utm_source=chiroeco&utm_medium=
display&utm_campaign=issue4
http://ChiroEco.com
RESEARCHRESULTS
history; however, there is clear evidence
of it being utilized in powerlifting gyms
before gaining popularity in the CrossFit
community through the book and videos
of physical therapist Kelly Starrett. Today
it is rare to not see it being practiced by
laypeople in these settings.
A Pubmed search performed by this
author found only two peer-reviewed
articles on flossing. The first had to do
with ankle range of motion, jumping
and sprinting performance, and the
second was a follow-up to that study.
Compression flossing is widely used, yet
there is essentially no evidence for or
against it in the literature.
Strict adherents to EBP would
likely pass over both cupping and
flossing as options for patients with
neuromusculoskeletal problems. Flossing
has no apparent high-quality research
for or against it at all, and the systematic
reviews of cupping are not favorable.
Comparatively, the evidence-informed
approach would look at more types of

20. evidence. Cupping has been used in
a variety of cultures for thousands of
years and flossing, while much newer,
is commonly used in athletic circles. An
evidence-informed practitioner would
take this anecdotal evidence and use
into account.
Furthermore, an EIP approach takes
into higher account the principles
underlying these therapies. Both
therapies engage the skin and underlying
tissues like fascia and muscle. Cupping
creates decompression of tissues while
flossing creates compression. Providers
can manipulate the cups or floss once
they are placed, creating shear patterns
in the tissues; and it is known that
certain receptors (Ruffini endings) in
tissues respond favorably to shear and
compression and can create local and
global tissue tone changes.5
Cupping and flossing create increased
sensory input into the areas they are
applied to. Given that acute and chronic
pain has been shown to “smudge” the
sensory cortex’s representation of
affected body parts6 and have a negative
effect on tactile acuity,7,8 could adding
stimulation to these areas via cups or
floss have a beneficial effect for patients?
Cupping and flossing both allow for the
addition of active movement, creating
different types of strain, shear and the

21. potential for haptic feedback that allows
patients to use cups as targets for
movement patterns — or, when coupled
with compression bands, to maintain
body positions during movements in
tasks that make them maintain a certain
amount of tension in a band through a
movement.5
There is no evidence, for or against,
the use of cupping or compression
flossing when coupled with meaningful
movement; however, there is certainly
biological plausibility and foundational
science that supports the potential of
44 C H I R O P R A C T I C E C O N O M I C S • M A R C H
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isplay&utm_campaign=issue4
http://ChiroEco.com
RESEARCHRESULTS
R E FE R E N CE S
1 Sackett DL, et al. Evidence-based medicine: what it is and
what it isn’t. BMJ.
1996;312:71-72.
2 Woodbury GM and Kuhnke JL. Evidence-based practice vs.
evidence-informed
practice: What’s the difference? Wound Care Canada.
2014;12(1):18-21.

22. 3 Estabrooks CA. Will evidence-based nursing practice make
practice perfect?
Canadian Journal of Nursing Research. 1998;30(1):15-36.
4 Miles A and Loughlin M. Models in the balance: evidence-
based medicine
versus evidence-informed individualized care. Journal of
Evaluation in Clinical Practice.
2011;17:531-536.
5 Capobianco S. FMT RockPods and FMT RockFloss. Seminar
presented at the
meeting of RockTape Instructors, Cancun, Mexico. January
2019.
6 Schabrun SM et al. Smudging of the motor cortex is related to
the severity of low
back pain. Spine. 2017 Aug 1;42(15):1172-1178.
7 Harvie DS. Tactile acuity is reduced in people with chronic
neck pain.
Musculoskelet Sci Pract. 2018 Feb;33:61-66.
8 Adamczyk W et al. Lumbar tactile acuity in patients with low
back pain and
healthy controls: systematic review and meta-analysis. Clin J
Pain. 2018 Jan;34(1):82-94.
these therapies. An evidence-informed
approach would combine anecdotal
evidence, the potential underlying
mechanisms, risk and reward analysis,
and would balance these against
EBP guidelines that suggest that an
intervention for low back pain, for

23. example, should yield significant objective
changes within a trial of six visits.
Such an approach does not throw the
evidence that is available out the window,
nor does it so rigidly adhere to a certain
type of study that it stifles the potential
for outcomes in an intervention with the
patient. This type of approach is patient-
focused and outcome-focused and has
the best potential for putting the needs of
the patient first before all else.
STEVE AGOCS, DC, is assistant dean of
chiropractic education at Cleveland University-
Kansas City as well as a course instructor on
chiropractic history and technique. Agocs
is a post-graduate educator sponsored by
RockTape with an interest in movement,
instrument assisted soft tissue manipulation,
kinesiology taping, functional cupping, flossing
and pain science. He can be contacted at
[email protected]
C H I R O E C O . C O M M A R C H 1 1 , 2 0 1 9 • C H I R
O P R A C T I C E C O N O M I C S 45
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isplay&utm_campaign=issue4
http://ChiroEco.com
Copyright of Chiropractic Economics is the property of Doyle
Group and its content may not
be copied or emailed to multiple sites or posted to a listserv
without the copyright holder's

24. express written permission. However, users may print,
download, or email articles for
individual use.