Australian Journal of Physiotherapy 2007 Vol. 53 – © Australian Physiotherapy Association 2007 284 We thank Sandra Brauer and colleagues for their stimulating Editorial Fostering clinician-led research (Brauer 2007). Physiotherapy is a relatively young profession, comprising small numbers compared to nursing and medicine, and (anecdotally) has few research fellows funded by the health system. Hence it remains a challenge for clinicians to drive the physiotherapy research agenda and meet their research obligations. The profession, therefore, has had to be creative in achieving these aims. Clinical networks, as Brauer and colleagues observe, are vehicles through which clinician- led research is facilitated. The Editorial champions horizontal research collaborations through a network of clinicians and academics as being integral to the development of the profession. Less conspicuously, it recognises the mutual dependence of vertical (top-down and bottom-up) collaborations within health facilities in building research capacity. We would like to elaborate briely on this point. Consultation with ‘the executive’ in networking and research activities is now inevitable in NSW given current policy directives relating to management of both corporate and clinical risk (NSW Health 2005), together with Australian Council of Healthcare Standards (ACHS) new accreditation research standard (Standard 2.5, Criterion 2.5.1) (ACHS 2006). We believe formal engagement of ‘the executive’ should help secure research resources and support from policy-makers. Taking the observations of Brauer and colleagues one step further we suggest that networks not only facilitate clinician-led research, but also potentially bridge the philosophical and methodological chasm between research purists and quality framework advocates. The fast-emerging quality movement in health, otherwise known as clinical practice improvement (CPI), is quintessentially about implementing evidence-based practice and is central to contemporary health policy and that of health accreditation bodies. However, the quality ‘juggernaut’ is perceived to have been both ignored and criticised by academics and researchers (Sheldon 2005). CPI projects traditionally ignore experimental approaches (Ovretveit 2002, Sheldon 2005), partly owing to the complexity of evaluating system and organisational change (Eccles 2003), and are concerned with the implementation of what is known rather than with the acquisition of new knowledge (Davidoff 2005). By contrast, the traditional scientiic paradigm values the discovery of new knowledge. Thus, paradoxically, clinicians involved in CPI, whilst seeking to implement evidence, have not generally employed research methods that provide ‘evidence’. Engagement in CPI projects is obligatory within the health system and, since well-conducted trials are in the interest of all stakeholders, we believe that clinical networks engaging researchers and academics will enhance the scientiic standing of CPI projects. The beneit to these persons of course is that the projects will be publishable and relevant, and their links to patient cohorts enhanced. Conceivably, technically rigorous CPI projects could in fact spawn new knowledge as well, if not in the identiication of new treatments, in the understanding of how best to deliver them. Our group has established a physiotherapy clinical network for the management of joint replacement patients in Sydney’s South West. The case for building a network Appraisal Correspondence Clinical networks – bridging the research-quality chasm derived from an audit proiling physiotherapy services for joint replacement patients across the region and a national survey highlighting the disparity in down-stream physiotherapy services after knee replacement surgery (Naylor 2006). Like the Queensland Physiotherapy Rehabilitation Network described by Brauer et al, our network purposefully comprises complementary expertise: 18 senior clinicians from 10 hospitals, two university-based academics, and a senior research fellow funded by the health service. Governance comes from within, but direct links exist with general managers and regional physiotherapy and allied health directors; thus, network activities are ratiied at senior executive levels. A primary aim of our network is to promote and enhance CPI, using research models to guide interventions, and vice versa. A current clinician-led project involves the reining of the range of motion clinical indicators physiotherapists use following total knee replacement. The original indicators were developed in the early 1990s, when mean length of stay was double that of today, data collection was not standardised between facilities, and important confounding information (such as pre-operative lexion range) was not collected. We believe our current project, using a standardised research protocol, will provide scientiic and contemporary benchmark evidence to clinicians world- wide. Further, a randomised trial, investigating the eficacy of two rehabilitation modes post knee replacement, and deriving from members of this same network, won a 2007 NSW Health Quality Award. The treatment parameters and measured variables were determined by what is practicable in the resource-constrained public health system; thus, transfer of the evidence into practice should be facilitated. We believe that both these projects illustrate successful bridging of the research and quality chasm, courtesy of clinical networking. The political advantage to the profession in promoting successful networking through the quality movement is self-evident. Justine M Naylor 1,2,3 , Alison R Harmer 3 , Jack Crosbie 3 and Natalie Fester 4 1 Orthopaedics, Western Zone, SSWAHS 2 UNSW Clinical School 3 The University of Sydney 4 Fairield Hospital, SSWAHS References ACHS (2006) The ACHS EQuIP 4 Guide 2006. Sydney: ACHS. Brauer S et al (2007) Aust J Physiother 53: 143–144. Davidoff F et al (2005) Qual Saf Health Care 14: 319–325. Eccles M et al (2003) Qual Saf Health Care 12: 47–52. Naylor J et al (2006) Physiother Res Int 11: 35–47. NSW Health 2005 available at www.health.nsw.gov.au/ pubs/2005/pdf/corp_governance.pdf [Accessed September 2007]. Ovretveit J et al (2002) Qual Saf Health Care 11: 270–275. Sheldon TA et al (2005) Qual Saf Health Care 14: 3–4.