Precision in Language

Language is obviously important as words are the basis of explicit communication. As is such, specificity in language and word definitions is vital to interaction. But also, specificity in meaning is required for accurate scientific research. Thus, terms are often operationally defined in studies. It is an attempt to clearly communicate how the researchers are defining, utilizing, and investigating a construct. Hopefully, ensuring appropriate interpretation and application of results while bundling theoretical constructs through explicit definitions.

I’m no expert in linguistics, philosophy, or even language, but I think this is an important professional topic. Now, admittedly, physical therapists deal with complex physiologic systems and phenomena. Some concepts can elude specific definitions physiologically and linguistically. Pain is a perfect example.

The lived pain experience is an emergent, individually experienced phenomena dependent on a myriad of interacting physiologic, psychologic, environmental, social, cultural, and linguistic components. It’s not merely resultant from nociception nor tissue damage or even injury. Yet, the presence of such complex systems and phenomena should not preclude striving for specificity of language. Vagueness does not help us. Investigating form, meaning, and context of language assists in research, education, and patient interaction. Luckily, the International Association for the Study of Pain created a taxonomy, and is attempting to more robustly define terms related to the painful experience. The list includes hyperalgesia, hyperesthesia, noxious stimulus, peripheral sensitization, central sensitization, and neuropathic pain among others. Some terms, such as allodynia (“pain due to a stimulus that normally does not provoke pain”), are considered “clinical terms” and purposefully absent of proposed mechanisms. Other terms, such as nociceptive stimulus (“an actually or potentially tissue-damaging event transduced and encoded by nociceptors”), are mechanistically more specific.

As a more concrete, basic science example, what would result if 100 physical therapists & 100 physicists  were charged to define strength, power, acceleration, stability and balance? How many definitions? How much similarity would they display?

@Jerry_DurhamPT has a hypothesis…

101 definitions.

One, exact definition (and likely a formula) from the 100 physicists. And, likely 100 separate, but similar, definitions from 100 physical therapists. These words have explicit definitions and equations within the realm of physics (classical mechanics). As Erik Meira asserts robust, specific definitions are absolutely necessary for science:

I’m not trying to get metaphysical here but we must define our terms in order to be scientific…Poorly defined statements are inherently not scientific. Just because it’s published does not make it science.

Specificity and discipline in language is a necessary first step. It is required for accurate discussion and collaboration within research, clinical practice, and between professionals. This includes other professions (and not just healthcare). But, unfortunately, appropriately defining and subsequently understanding definitions does not account for, nor address, how other healthcare professionals, disciplines, patients, and society perceive certain words. What are their definitions? As an example, lets explore the word “prevention.”

Prevention: the action of stopping something from happening

Within healthcare and physical therapy, true prevention by definition, is kind of a misnomer. But, the health care system, patients, and consumers utilize the term prevention differently. Usually, the concept of “prevention” is actually used to mean “risk reduction.” Thus, the “functional definition” within the context of healthcare and patient interaction is slightly altered. What is actually meant by ACL injury prevention is reducing the likelihood of an ACL tear. Epidemiology provides some insight…

In epidemiology, the absolute risk reduction, risk difference or excess risk is the change in risk of a given activity or treatment in relation to a control activity or treatment. It is the inverse of the number needed to treat. -Wikipedia

In epidemiology, the relative risk reduction is a measure calculated by dividing the absolute risk reduction by the control event rate.

The relative risk reduction can be more useful than the absolute risk reduction in determining an appropriate treatment plan, because it accounts not only for the effectiveness of a proposed treatment, but also for the relative likelihood of an incident (positive or negative) occurring in the absence of treatment. -Wikipedia

Currently, there are no singular interventions to fully prevent the occurrence of most diseases and injuries in normal life situations. In being alive, there is always risk.

So what to do? If other disciplines such as mathematics, physics, or psychology have defined a certain term or construct, I propose it necessary to understand and utilize that definition accurately in professional discourse. The terms above, which originate from classical mechanics, immediately come to mind. We should challenge and operationally alter definitions from other fields only if strong data and logic warrant modification. Further, in research, discussion, and education the most specific, accurate definitions should be sought after. If unknown, questions should arise, discussion should ensue, and operational definitions provided. Science requires precision in language: exact terms. Lastly, the patient and consumer’s definition of certain words needs to be ascertained. Where feasible, more appropriate explanations should be provided to improve public and professional understanding of terminology. Communication is strained, and collaboration limited, if we are essentially “speaking different languages.”

A physical therapist does not need to be an engineer, but understanding the language of mechanics allows for true discussion between fields. It opens the door for increased collaboration.

A physical therapist does not need to be a psychologist, but knowledge of psychological constructs allows for evolved ways of conceptualizing and treating patients. It lends itself to improved research and clinical practice.

A physical therapist does not need to be a linguist, but explicitly defining words is necessary. It helps us understand form, meaning, and context.

We need specificity and discipline in our language. Combining our expertise with the language and concepts from other disciplines fosters the ability to more robustly communicate and subsequently collaborate. This allows us to identify the grey, and step into uncertainty. For then we can truly start to explore the chaos, slowly illuminating specificity. Vagueness, after all, is beyond the limits of logic and reason.