Saturday, 18 July 2009

Something for FREE

And an allegory from the world of horse-riding

The journal Developmental Medicine and Child Neurology is one of the world's foremost paediatic journals. It currently has a promotional offer running on the Internet a selection of 'key articles available to read on line FREE until 31 July 2009.

Some readers of Conductive World may wish to avail themselves of all seven of these articles. In the light of current discussions about models for researching Conducive Education, however, a multi-authored, randomised, comparative outcome study from Australia (Davies, 2009) might prove of particular interest.

It concerns the 'therapeutic horse-riding' and here is its abstract:

This randomized controlled trial examined whether therapeutic horse riding has a clinically significant impact on the physical function, health and quality of life (QoL) of children with cerebral palsy (CP). Ninety-nine children aged 4 to 12 years with no prior horse riding experience and various levels of impairment (Gross Motor Function Classification System Levels I-III) were randomized to intervention (10wks therapeutic programme; 26males, 24 females; mean age 7y 8mo [SD 2y 5mo] or control (usual activities, 27 males, 22 females;mean age 8y 2mo [SD 2y 6mo]). Pre- and post-measures were completed by 72 families (35 intervention and 37 control). Children’s gross motor function (Gross Motor Function Measure [GMFM]), health status (Child Health Questionnaire [CHQ]), and QoL (CP QoL-Child, KIDSCREEN) were assessed by parents and QoL was assessed by children before and after the 10-week study period. On analysis of covariance, there was no statistically significant difference in GMFM, CP QoLChild (parent report and child self-report), and CHQ scores (except family cohesion) between the intervention and control group after the 10-week study period, but there was weak evidence of a difference for KIDSCREEN (parent report). This study suggests that therapeutic horse riding does not have a clinically significant impact on children with CP. However, a smaller effect cannot be ruled out and the absence of evidence might be explained by a lack of sensitivity of the instruments since the QoL and health measures have not yet been demonstrated to be sensitive to change for children with CP.

The full article is available on line, but only until 31 July.

Horses for courses

I carry no torch for 'therapeutic horse-riding', 'riding for the disabled', 'hippotherapy' nor indeed for any kind of equine persuits, for anybody or for any purpose. Dangerous, smelly and expensive the lot of them, as far as I am concerned, and I am not enamoured of the sort of people that they attract either.

None of this blinds me to the self-evident fact that things 'horsey' bring an awful lot of satisfaction and pleasure to an awful lot of people and, if a competant psychologist or other social scientist were to care to operationalise this in all its dimensions and ramifications then this would be a complex task indeed, but not an unfamiliar one.

On the other hand, few will wish to bother, and fewer still to pay for such research. The equine industry get on with its business notwithstanding. Little children who wish to be horsey may face many barriers but no one is going to demand results from randomised outcome studies to justify the funding that they will require. And riding instructors and the people who train jockeys and cavalrymen, will likely hone their skills without benefit from medical-modelled research.

Some horsey folk have wanted to extend the pleasures and benefits of their interests to marginalised groups such as disabled children (not with just horses but donkeys too). I have no feelings about that, one way or the other. Good luck to them. If some children and their parents experience positive outcomes, especially outcomes that are further experienced as granting potentially systemic benefits, then all the better still. And if some feel the need to evauate outcomes of these activities, and of their systemic effects, then good luck to them too: it might be a hard call but there are doubtless appropriate methodologies to be adapted to this task.

A problem, however, that arises from a notion (that might have seemed a good idea at the time that it was thought up) to adopt the word 'therapeutic' to describe horse-riding for disabled children. Ordinary folk do horse-riding but disabled folk may do therapeutic horse-riding. Once something is 'therapeutic' then it sound medical. It may gain status or attract other initial advantages for its advocates but pay-back time comes with quasi-medical research such as reported here.

The outcome of this present study

The killer blow is delivered on page 116:

Inconsistent with anecdotal evidence, the results demonstrated the therapeutic horse riding programme did not increase QoL [quality of life] or health.

Ergo, the 'anecdotal evidence' must be wrong. But such evidence was neither properly reported nor analysed here. Three parental quotations cannot stand in the stead of this. The logical possibility, that the anecdotal evidence might represent material phenomena worthy of serious examination appears not to have been entertained.

But what is the reality?

Maybe 'therapeutic horse-riding' does benefit disabled childen. Maybe it doesn't. The present study does not answer this other than in the reseachers' own terms. One has to question whether further such studies, with larger numbers and more sensitive measuring 'instruments' might be expected to come up with any more certain knowledge about what happens in the world of reality, rather than in the world as construed in the manner reprted here.

There are always ways in which such studies might be improved according to their own paradigm. For example, some attempt at manualising the actual interventions provided might lend credence to the very specific-sounding statistical tables in the present study. Here the section headed 'Procedure' gives no information at all about what was actually done by anyone involoved in the activities involved (and one has here presumably to include the horses involved!) that would permit this study to be replicated in a meaningful way. The people who do systematic reviews may come up with further examples

A petty quibble but that is one of the rules if one wishes to play the game of positivist science.

A different kind of investigation?

A petty quibble? Such a 'quibble' seriously undermines the credibility of such a study on its own terms. But to implement proper manualisation (specifying what would be and done, and what was actually done too) might introduce hideous and disproportunate complications. This raises at a very practical level the question of whether such studies are doable at all.

Or methodologically, are these just the wrong kind of study. Might one have to go back to the methodological drawing board to answer meaningful questions about possible benefits for disabled children and their families from the children's experience of riding? More studies of much the same kind, with more refined measuring instruments of the same kind may persist on coming up with the same kind of results. There may even come a point at which the question arises of different kinds of investigations, carried out by different kinds of researchers.

If one really wants to advance human knowledge in this field, then qualitatively different investgation may be required.

So what do people in Conductive Education deduce from this...?

Online offer


Reference

Davies, E., Davies, B., Wolfe, R., Raadsveld, R., Hene, B., Thomason, M., Dobson, F., Grahame, H. K. (2008) A randomized controlled trial of the impact of therapeutic horse riding on the quality of life, health, and function of children with cerebral palsy, Developmental Medicine and Child Neurology, vol. 51, pp. 111–119

4 comments:

  1. Thank you Andrew for this inspiring posting.

    What it inspired can be seen at:

    http://www.susie-mallett.org/2009/07/quality-of-life.html

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  2. Hardly inspiring, I am sure, in many people's eyes.

    By chance, his morning, I stumbled upon this video on Facebook. It is a good, recent news report of a study into hippotherapy at Washington State Uuiversity:

    http://www.youtube.com/watch?v=UHUIZGF4o3U

    I don't have time to trace it back to the study itself but, if anyone does so, please share this information.

    You will see a quite different research design and, along with this, different means of measurement, both far superior in my view to those in the Australian study mentioned above (and no, in writing this I am not dazzled by the gizmos).

    BUT, and it is a very big BUT, listen out for the pervasive model in which movement, its development are construed, and the unquestioning biologism of this.

    It does seem that the children involved learned to balance on horseback, they and their folks seemed very pleased with the whole business and everyone enthused anew about their potential for change...

    I share their joy in this discovery.

    Is it really worth while labouring the point?

    I do hope that the cash is available next year that these lucky children and their families might have another such experience.

    But, oh dear, I do wish...

    Andrew

    PS And if you haven't realised it, this study 'proves' nothing, one way or the other.

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  3. Apologies.

    Washington University, not Washington State University.

    Andrew.

    ReplyDelete
  4. I must say, someone that negative towards hippotherapy must have had a really bad experience. I would like to know why they were attending it and is it anything that is even treatable by hippotherapy. remember this is just another form of treatment and it does not work for everyone, however i have yet to see a child not improve from it yet.

    ReplyDelete