What is translational research?

Translational research does what it says on the tin: it takes findings from controlled clinical studies – so-called ‘bench to bedside’ research – and seeks to translate them to real-world community or health settings.

For University of Sydney Professor of Public Health Don Nutbeam, translational research is also about accelerating innovative interventions in health care to reach patients as quickly as possible. “Statistically, it takes on average about 17 years for a medical innovation to make it into clinical practice,” he says. “The goal of a lot of translational research is to significantly reduce that period.”

For instance, even though an intervention exists, it doesn’t mean everyone who needs it will get it. Take hepatitis C treatment. People with the blood-borne liver disease can be cured entirely with antiviral therapies that have been available since the early 2010s.

But most people with chronic hepatitis C are people who inject drugs – and in 2015, the Australian Needle and Syringe Programs survey found only 11% of people who inject drugs who knew they had hepatitis C ever received antiviral therapy.

“So the translational challenge there wasn’t ‘does it work?’, but ‘how do we get the treatment to the people that need it?’” Nutbeam says.

In March 2016, hepatitis C antiviral therapies were made available on the Australian Government Pharmaceutical Benefits Scheme. And in the most recent survey, conducted in 2019, nearly two-thirds of people who inject drugs and who have hepatitis C reported receiving treatment at least once.

Despite the population-wide benefits of translational research, there’s still a substantial gap between research evidence generation and its practical application, says Andrew Milat, Director, Evidence and Evaluation at the NSW Ministry of Health.

In a recent review of National Health and Medical Research Council translational research grants, Milat and colleagues found only around 30% had a discernible effect on policy or practice. “In that same review, using a similar set of criteria for NSW Health’s translational grants, closer to 70% of the grants had impacts,” Milat says.

NSW Health’s annual Translational Research Grant Scheme has been able to achieve this success rate and translate more clinical discoveries into practical applications, by providing funding for projects led by staff within the State’s health system, such as nurses, paramedics and allied health professionals.

Partnering with stakeholders from other sectors, such as academics and policy-makers, is a requirement to strengthen translational research projects, Milat says.

“Establishing those partnerships from the beginning helps us focus on the right questions, develop a shared understanding of research objectives and enhance our understanding of the application of that research to policy and practice.”

NSW Health also provides support and information for those interested in undertaking translational research, with detailed guidance on aspects such as study design.

Five phases to translational research design

While translational research aims to decrease the amount of time between discovery and applications, designing a translational research project is a carefully planned and considered process, Nutbeam says.

NSW Health’s translational research continuum comprises five phases following the initial idea that ascertains what intervention may solve a problem. Each phase must be completed before researchers can move onto the next.

First, feasibility studies test an intervention’s practicality and acceptability. Then efficacy studies test if that intervention works in a well-organised, controlled trial under ideal conditions. This is followed by replicability and adaptability studies, which ensure the intervention’s efficacy is not a one-off result and evaluate if it’s successful under a few other conditions.

Effectiveness studies take this a step further and test the intervention’s efficacy under real-world conditions, and scalability studies examine how well an intervention can be embedded into the broader health system.

“It is an extraordinary waste of research effort and resources if we don’t take something shown to be feasible and effective, and look to see how we optimise the benefit of a potentially efficacious intervention to a much larger population,” Nutbeam says.

At the same time, rushing the process is also likely to waste time and money, he adds. “If we seek to translate across the system without having established that things can be reproduced, that they are effective when reproduced, and can be scaled up into the system, there are a lot of errors that can occur along the way.”

A significant challenge is the “adaptation-fidelity conundrum”, Milat says. “That’s when interventions in the efficacy phase are done with such a high level of resources that they’re not necessarily feasible in the real world.

“Often, a research study will show there are five key elements to the intervention you must implement. But the reality is when we hit the ground, it might be very challenging to implement all five, so we may implement four instead.”

For information and resources to support your translational research project visit NSW Health’s Translational Research Grant Scheme and/or educational resources webpages.