Elsevier

Applied Nursing Research

Volume 49, October 2019, Pages 5-12
Applied Nursing Research

An equine-assisted therapy intervention to improve pain, range of motion, and quality of life in adults and older adults with arthritis: A randomized controlled trial

https://doi.org/10.1016/j.apnr.2019.07.002Get rights and content

Highlights

  • Equine-assisted therapy improved arthritic back pain and range of motion.

  • Equine-assisted therapy improved quality of life aspects: affect and upper limbs.

  • Shoulder and knee pain and range of motion did not improve.

Abstract

Research aim

To compare equine-assisted therapy to exercise education on pain, range of motion, and quality of life in adults and older adults with arthritis.

Background

Quality of life for adults and older adults is negatively impacted by arthritis pain, stiffness, and decreased function. Equine-assisted therapy provides unique movements to the rider's joints and muscles improving pain, range of motion, and quality of life and has improved outcomes in balance, gait, strength, functional mobility, and spasticity for older adults, stroke, spinal cord injury, and multiple sclerosis patients. No research has investigated the effects on adults and older adults with arthritis.

Methods

Twenty adults and older adults with arthritis recruited from rheumatology clinics participated in a randomized controlled trial for six weeks. Participants and research assistants were blinded to assignment. Standardized valid and reliable instruments were used to measure pain, range of motion, and quality of life targeting back, knees, shoulders, and hips.

Results

Mean age was 63.85 (SD 6.885, 53–75) years. Pain significantly improved in shoulders (p = 0.007), hips (p = 0.027), and back (p = 0.006), not knees (p = 0.061). Range of motion improved for back (p = 0.02), hips (p = 0.04), shoulders (p = 0.005) and not knees. Quality of life improved for upper limb (p = 0.002), lower limb (p = 0.021), and affect (p = 0.030), not social interaction and symptoms.

Conclusion

This randomized controlled trial provides evidence that equine-assisted therapy decreases pain, and improves range of motion, and quality of life for adults and older adults with arthritis. Further fully powered research with cost/benefit outcomes would be beneficial.

Section snippets

Research purpose

Osteoarthritis creates pain, stiffness, and decreased functionality affecting adults' and older adults' quality of life. No research has investigated the effects of equine-assisted therapy (EAT) on adults and older adults with arthritis. The purpose of this study was to assess the effects of an EAT intervention compared with an exercise education (ExEd) attention-control intervention on pain and mobility in the hips, knees, shoulders, and back of adults with nonspecific arthritis,

Background

In the United States arthritis accounts for $128 billion in lost income and medical costs (Centers for Disease Control and Prevention (CDC), 2013). Incidence of arthritis is increasing due to obesity and growing aging population (Bijlsma, Berenbaum, & Lafeber, 2011). Adults (40–65) and older adults (>65) with arthritis experience joint pain, stiffness, damage to cartilage, and decreased range of motion particularly in their hips, knees, shoulders, and back. Current arthritis interventions

Design

The study, which used a used two-armed parallel single blinded RCT approach, was registered at Clinical Trials.gov (NCT03141853) (National Institute of Health, 2017). Engel's Biopsychosocial Model which embraces physical, psychological, and social influences, guided the study (Engel, 1977).

Sample/setting

Twenty-one adults and older adults with arthritis were recruited from four arthritis clinics located in the Midwest and a Commemorative Airforce event and assigned to groups using 1:1 block randomization. The

Results

Fifty-one adults and older adults were contacted by the PI for screening. Twenty-one consented and 20 completed the study with an attrition of one participant (attrition rate 5%). Demographics are listed in Table 1 and the Flow Diagram of participant recruitment is listed in Table 2.

Results within and between group comparisons on the outcomes of pain and ROM for back, knees, hips, and shoulders, and QOL are outlined in Table 3. Significant improvement occurred at six weeks between groups for

Discussion

The EAT intervention improved back pain, and back and right hip, ROM. at 6 weeks, but not at 3 weeks, suggesting that the motion during EAT may take longer to impact ROM and, subsequently pain. The right hip improvements and left hip non-improvements were probably due to the stretching of the right leg over the saddle when mounting from the platform was required. EAT significantly improved back, hip, and shoulder ROM in the experimental group and not in the control group. Movement is known to

Limitations

Although threats to internal and external validity were partially mitigated with blinding, randomization, and consistency in horses and personnel, cautious interpretation of the results is warranted. Threats to external validity include a small sample, fewer males in the control group, and underrepresentation of African Americans and Hispanic arthritis sufferers. Threats to internal validity include an inability to control for extraneous exercise in participants over the six-week period.

Conclusion

The study's findings inform the science of human-animal interactions and contributes to the growing evidence of the benefits of EAT in adults with arthritis. The significant exploratory results reported here needs to be interpreted cautiously due to the limited sample and lack of sample diversity, and longitudinal measurement to identify how long positive effects of EAT may last. Future research should include large multi-center trials, increased sample diversity. Comparison of different doses

Funding source

This research was supported by Saint Luke's College of Health Sciences by financial support and with no other involvement.

Acknowledgments

We would like to thank Mary Sharp and Beth Knoy Brock at Due West Therapeutic Riding Center for their invaluable expertise and use of their facility. We would also like to thank Brie Cantrell, Brenda Stabler, and Janet Scalet for their insight and support. Additionally, we wish to thank Kansas City Physician's Partners and The Commemorative Airforce Wing for help with recruitment.

The authors have no competing interests to declare with this manuscript.

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