A Randomized Controlled Trial Comparing Equine-Assisted Therapy and Exercise Education for Adults and Older Adults with Arthritis
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Arthritis creates pain, stiffness, and decreased functionality affecting adults’ and older adults’ quality of life. Equine-assisted therapy provides unique movements to the rider’s joints and muscles improving pain, range of motion, and 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 pilot study of a convenient sample was to assess the feasibility and acceptability of conducting a randomized controlled trial comparing an EAT intervention with an exercise education attention (ExEd) control intervention. A review of literature, methods, settings, procedures, results, discussion, limitations, and conclusions are included. This study was registered with clinical trials.gov, approved by the University of Missouri-Kansas City Institutional Review Board, and followed Consolidated Standards of Reporting Trials guidelines. Settings included a Professional Association of Therapeutic Horsemanship International (PATH)-certified riding stables with PATH-certified riding instructors administering the EAT intervention, and Saint Luke’s College of Health Sciences for the ExEd attention controlled intervention. Twenty-one consenting participants were randomized and single-blinded to assignment. Dose consisted of a one hour intervention, once a week for six weeks. Measurements occurred at baseline, three weeks, and six weeks. Outcomes included back, knee, hip, and shoulder pain, and range of motion, quality of life, and enjoyment of nature. Biomarkers measured cartilage and muscle status. Results supported the feasibility and acceptability of the research design, protocol, and methods. Findings indicated significant improvements in back, hip, and shoulder pain, and back and hip range of motion. Quality of life measures had significant improvements over time for upper limb, lower limb, and affect, but not for symptoms and socialization. No significant results were obtained in Cartilage Oligomeric Matrix Protein biomarkers, serum troponin T, and enjoyment of nature. Limitations include small sample size, confounding variables, and threats to validity. The protocols and methods were feasible and acceptable. Continuing EAT after the study was not acceptable. Biomarkers may not be sensitive or specific enough for this research. A tool to assess the barn environment should be developed. Large multi-center trials will provide important generalizable information in future EAT researchers.
Table of Contents
Introduction -- Review of literature -- Theoretical framework and methodology -- Results -- Discussion -- Appendix A. Visual Analog Scale -- Appendix B. AIMS-2 SF Arthritis Impact Measurement Scales 2 Short Form -- Appendix C. Engel’s Biopsychosocial Model, Debuse’s Model, and Proposed EAT Model -- Appendix D. Equine-Assisted Therapy for Adults and Older Adults with Arthritis EAT Intervention Group Curriculum -- Appendix E. Exercise Training for Adults with Arthritis -- Appendix F. Range of Joint Motion Evaluation Chart -- Appendix G. Facilities/Support -- Appendix H. Opt-in form -- Appendix I. Screening tool -- Appendix J. Consent forms -- Appendix K. H.E.A.T. Study Protocol Impediment/Violation Form -- Appendix L. Exit surveys -- Appendix M. Engel’s Biopsychosocial Concept – Dependent Variables -- Appendix N. Environmental Attitude Inventory Scale – Enjoyment of Nature -- Appendix O. Protocol steps -- Appendix P. Safety training -- Appendix Q. Data analysis