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
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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