By Lori Garone, MS, PT, HPCS
“Sometimes the questions are complicated and the answers are simple” – Dr. Suess
I was given the honor to represent AHA, Inc. this past summer at the Horses in Education and Therapy International (HETI) Conference in Dublin, Ireland. The focus of the conference was “Striking the Balance” and the topic of my presentation was, “Terminology and its Global Impact on Reimbursement and Research.” In research- where the goal is to test hypotheses through systematic investigation to reach new conclusions-there appears to be an essential need for a database of common terminology. Clear language facilitates reliable research, and we need reliable research for appropriate reimbursement. When we use inconsistent terms in research across industries or develop language tailored to our own concepts, then we are potentially creating a bias. Title protection laws exist to establish specific terms as they relate to an industry or profession in order to protect the general public. Similarly, we need to create a database of terminology that is specifically defined in order to compare results and protect the validity of the research completed.
In the physical therapy, occupational therapy and speech-language pathology professions, therapists and researchers implement tools to validate study results with high precision (confidence level) to establish data that is valid, reproducible, and can confidently be reported as statistically significant (P value). This can only be accomplished when we use standardized measures relevant to the implementation of a plan of care within the scope of practice of the therapist.
When research is conducted using terminology or tools from other professions, the result is inconsistent data and inability to accurately prove statistical significance. This could be likened to measuring carry-over from adaptive basketball or skiing to improve balance, speech, or hand-eye coordination for a person with special needs. If adaptive sports alone could rehabilitate an impaired body system in those domains, then why would a person need the skilled service of a therapist? The adaptive sports industry provide quality of life and social community to those who may not otherwise be able to participate in those activities. However, the coaches, instructors, and sports officials are not trained in the realm of rehabilitation, and therefore the outcomes of research in this area may not be relevant to therapy.
Internationally, challenges exist with translations and terminology definitions. “Therapeutic riding” may be used in one country as an overall description for anyone who uses horses, whether in a riding lesson or with therapy service. In another country, it may specifically mean that a therapist is providing therapy services using the movement of the horse. While I was teaching in another country I asked the therapists to translate the term “hippotherapy” and it literally translated into english as “riding therapy” or therapeutic riding.” When I asked them to translate “equine movement” it translated as “equine movement,” and “skilled equine movement.” BAZINGA!
Terminology in research needs an international database to define what each term means and ensure that terms translate correctly from country to country. Then, the tools used to measure effectiveness in research need to be standardized for that particular industry and observed by independent evaluators.
When terminology is not consistent, it is not useful for any industry and it waters down the bank of available research. Skilled therapy services offered by physical therapy, occupational therapy, and speech-language pathology professionals are based in science, medicine, and research. All three are required in order to establish evidence-based practice.
Let’s approach this issue from a global, inter-industry perspective. There is room for everyone to play in the sand box together, but clarity, transparency, and ethical representation is necessary.