The potential usefulness of standardized assessments to measure participant outcomes of adaptive/therapeutic horseback riding: a survey study.

Adaptive or therapeutic riding (A/TR) is a recreational activity which provides mounted and ground-based horsemanship opportunities adapted to the abilities of the participants. A/TR provides physical and psychological benefits to participants with diverse disabilities, including physical, developmental, cognitive, and age-related disabilities, promoting higher quality of life. A/TR professionals may be limited in their capacity to implement outcome assessments and report the benefits of their community-based A/TR services to a broad audience. The purpose of this study was to identify whether and how A/TR professionals currently measure participant outcomes; benefits and barriers to implementing standardized assessments in A/TR; and characteristics which would make assessments useful in the community-based A/TR environment. To address this purpose, we conducted a survey among A/TR professionals. We found that while A/TR professionals measure outcomes among their participants, they typically do not use standardized assessments. Survey respondents believed benefits of implementing standardized assessments included bolstering the A/TR profession, acquiring funding, and communicating about A/TR services to a broad audience. Respondents also identified several barriers to implementing standardized assessments including time, systemic, and expertise constraints. Respondents reported that useful standardized assessments would be relevant to all age groups and populations who receive A/TR services. Finally, respondents shared that for standardized assessments to be useful, they would need to be low-cost, require less than 10-20 min, and available in either paper or computer format. This study revealed that standardized assessments may be a strong support to the A/TR profession; however, assessments must meet the unique needs of A/TR professionals.

Feasibility of an adaptive riding pilot study and acceptability to dementia care partners: "Your spirits are lifted".

OBJECTIVES: We sought to assess the feasibility and acceptability of an adaptive riding program with dyads (persons living with dementia, family care partners) and a gardening comparison condition. DESIGN: This is a two-arm (adaptive riding and adaptive gardening), mixed methods, convergent, feasibility study that occurred February 2019-June 2019. INTERVENTIONS: Upon enrollment, dyads (n=9) self-selected into either community-based adaptive riding (n=5) or adaptive gardening (n=4), two complementary interventions in Northern Colorado. Interventions occurred for hour-long, weekly sessions for eight weeks. OUTCOME MEASURES: Feasibility was measured with recruitment (actual/planned, response rate, participants enrolled/month) retention, adherence to study procedures (attendance, retention, fidelity), and data collection processes (planned versus collected); and analyzed with descriptive statistics. Acceptability of adaptive riding was measured with pre/post care partner interviews and analyzed using thematic analysis. Afterwards, findings were converged. RESULTS: We recruited n=10/24 dyads (6 dyads per month), with the highest response rates for referrals and in-person events, n=9 dyads enrolled. We adhered to study procedures with attendance (6/8 gardening, 8/8 riding), retention (100%), fidelity (100%) and data collected (98%). Care partners (n=5) found the adaptive riding intervention acceptable with two themes Overall hopes: "Joy in the present moment" and "Experience as a Whole: "Your spirits are lifted," affirming quantitative attendance and retention data. CONCLUSION: Findings underscore the feasibility and acceptability of including care partners of persons living with dementia in complementary interventions involving horsemanship activities. Feasibility data can guide study designs and implementation processes for other nature-based complementary interventions for this population.

Reducing Anxiety and Stress among Youth in a CBT-Based Equine-Assisted Adaptive Riding Program.

Reining in Anxiety (RiA) is a therapeutic program for youth with mild to moderate anxiety delivered in a therapeutic riding setting by Certified Therapeutic Riding Instructors. RiA was developed after a review of the evidence base for youth anxiety, is manualized, and includes five core CBT components: in vivo exposure, cognitive restructuring, youth psychoeducation, relaxation, and caregiver psychoeducation about anxiety. This study extended findings from a prior RCT that examined (1) the feasibility of collecting saliva samples from horses and children to measure stress (cortisol) and relaxation (oxytocin); (2) whether changes in stress and relaxation occurred both during each lesson and over the course of the 10-week intervention for horses and youth; (3) whether changes in anxiety symptoms, emotional regulation, and self-efficacy found in the first trial were comparable; and (4) if fidelity to the program was reliable. Youth participants (n = 39) ages 6-17 with caregiver-identified mild-to-moderate anxiety participated in a ten-week therapeutic intervention (RiA), which combined adaptive riding and components of CBT. Physiological data and self-report measures were taken at weeks one, four, seven, and ten for the youth and horses. Saliva assays assessed cortisol as a physiological marker of stress and anxiety, and oxytocin as a measure of relaxation. Fidelity data were recorded per session. Anxiety, as measured by caregiver self-reporting, significantly decreased from pre- to post-test, while emotional regulation scores increased. No significant changes in self-efficacy from pre- to post-test were observed. Saliva samples obtained from participants before and after riding sessions showed a consistent decrease in cortisol and a significant increase in oxytocin at two of the four timepoints (Week 1 and Week 7), but no overall pre- to post-test changes. Horse saliva data were collected using a modified bit; there were no significant changes in oxytocin or cortisol, suggesting that the horses did not have an increase in stress from the intervention. RiA may be a promising approach for reducing anxiety and stress among youth, as measured both by self-reported and by physiological measures. Collection of salivary assays for both youth and horses is feasible, and the intervention does not increase stress in the horses. Importantly, RiA can be delivered by adaptive/therapeutic horseback riding instructors in naturalistic (e.g., non-clinic-based) settings. As youth anxiety is a growing public health problem, novel interventions, such as RiA, that can be delivered naturalistically may have the potential to reach more youth and thus improve their quality of life. Further research is needed to examine the comparative value of RiA with other animal-assisted interventions and to assess its cost-effectiveness.

Therapeutic Riding or Mindfulness: Comparative Effectiveness of Two Recreational Therapy Interventions for Adolescents with Autism.

Therapeutic riding (THR) and HeartMath (HM) mindfulness-based interventions have promise for reducing stress in adolescents with autism spectrum disorder. In three 10-week periods, this study compared THR, HM, and control on salivary cortisol, self-reported stress, parent-reported social responsiveness, and heart-rate variability. This crossover design included 27 participants (12-21 years) randomly assigned to order of intervention. Findings suggest that HM and THR manualized protocols are equally beneficial in decreasing cortisol levels immediately following a session, but HM sessions had more impact on heart-rate variability. There was no significant effect on follow-up cortisol levels within a week after either intervention, but THR had more impact on decreasing some self-reported stressors.

A Survey of Horse Selection, Longevity, and Retirement in Equine-Assisted Services in the United States.

Little published information exists on the horses in equine-assisted services (EAS), particularly their selection, longevity, and retirement. The purpose of this study was to characterize horses and procedures used in EAS. A pilot survey was developed using focus group discussions and distributed to Professional Association of Therapeutic Horsemanship, International (PATH Intl) centers in Florida (n = 45, Part I) before further modification and distribution to members of PATH Intl., American Hippotherapy Association (AHA), eagala, and Certified Horsemanship Association (CHA) (n = 26,000, Part II). Response rates were 36% (Part I) and 0.7% (Part II). Centers report a median of 10 (Part I) or 9 (Part II) horses and ponies. Selection procedures included initial screening (Part I = 100%, Part II = 96%), pre-purchase or pre-donation exam (I = 64%, II = 60%), acclimation period (I = 100%, II = 84%), trial period (I = 91%, II = 90%), and other (II = 11%). Horses remained active in programs for less than a year to over 20 years with the greatest number working 7-10 (Part I) or 1-6 (Part II) yr. In Part I of the study, behavior (44%) was the leading cause of retirement followed by unsoundness (33%). In Part II, unsoundness was the highest ranked response followed by behavior. Behavior, soundness, and health emerged as key factors in horse selection and retirement. Future work should focus on investigating these issues at an individual horse level.

Effectiveness of equine-assisted therapies for improving health outcomes in people with multiple sclerosis: A systematic review and meta-analysis.

BACKGROUND: Scientific evidence has shown that equine-assisted therapies (EAT) lead to improvements in the physical function and the quality of life (QoL) of people with disabilities through the practice of hippotherapy or therapeutic riding (TR). There is a need to confirm whether people with multiple sclerosis (PwMS) can also benefit from its practice. This review aimed to systematically evaluate and meta-analyze the available data on the potential health benefits of EAT in PwMS. METHODS: Four electronic databases (MEDLINE/PubMed, Web of Science, SPORTDiscus, and Scopus) were searched systematically from their inception until June 2021 for randomized controlled trials (RCTs) and comparative studies that provided information regarding the effects of EAT on PwMS. The studies' methodological quality assessment was performed using the PEDro and the MINORS scales. For the meta-analysis, heterogeneity across studies was quantified using the I2 statistic. Fixed-effect or random-effects models were applied to obtain the pooled results in the case of low (I2 < 30%) or high (I2 > 30%) heterogeneity values, respectively. Standardized mean differences (SMD) and 95% confidence intervals (CIs) were calculated to assess the change in each outcome. RESULTS: After removing duplicated studies, 234 results were retrieved by the literature search and 11 were eligible for full text search. Finally, 9 studies with a methodological quality ranging from good to low quality met the inclusion criteria. Six of them focused on hippotherapy and 4 of them were included in the quantitative analysis. Totally, 225 PwMS patients were evaluated. Findings from the meta-analysis indicated that this therapy improved static (SMD = 0.42; 95% CI: 0.05, 0.78) but not dynamic balance (SMD = 0.51; 95% CI: -0.04, 1.06), while significant benefits were observed on the patients' QoL (SMD = 0.37; 95% CI: 0.00, 0.73). Hippotherapy showed effectiveness for reducing self-perceived fatigue (SMD = 0.70; 95% CI: 0.33, 1.07), while TR showed mixed effects on balance and QoL. CONCLUSION: The actual evidence on the effectiveness of EAT in PwMS is mainly limited to hippotherapy. This rehabilitation approach seems to have beneficial effects on static balance, QoL and fatigue, but not directly on gait and dynamic balance. Altogether, the findings suggest that hippotherapy could be incorporated as a complementary therapy when developing comprehensive care plans for PwMS.

Comparing training methods to improve volunteer skills during therapeutic horseback riding: A randomized control trial.

Although in-vivo behavioral skills training (BST) is often effective, it may be too resource-intensive for organizations that rely on volunteers. Alternatives to in-vivo BST include video models or interactive computer training (ICT), but the utility of these procedures for training volunteers remains largely unknown. We used a randomized control trial to teach multiple skills to new volunteers at a therapeutic riding center. A total of 60 volunteers were assigned to one of three groups using block randomization. Depending on group assignment, volunteers received instructions and modeling through in-vivo interactions, a video model, or ICT. All volunteers completed in-vivo role plays with feedback. Skills were measured by unblinded observers during role plays. There were no statistically significant differences in accuracy of role-play performance between volunteers in the in-vivo BST and ICT groups, but both outperformed the video-model group. The ICT and video model required statistically significantly less time from a live instructor than did in-vivo training. Thus, although in-vivo BST remains best practice, ICT may be a viable alternative when training resources are limited.

A comparison of quality of life indicators during two complementary interventions: adaptive gardening and adaptive riding for people with dementia.

OBJECTIVES: We sought to provide a fine-grain description and comparison of how people living with dementia responded to adaptive gardening and adaptive riding through durations of their observed participation and emotional well-being, two dimensions of quality of life. DESIGN: A descriptive case study design enabled in-depth description and comparison of participation and emotional well-being, two quality of life indicators, observed during four videotaped sessions of adaptive gardening and adaptive riding. INTERVENTIONS: Eight people living with dementia self-selected into one of two complementary interventions, community-based adaptive gardening (n = 4) or adaptive riding (n = 4), in Northern Colorado. Both occurred for hour-long, weekly sessions for eight-weeks. OUTCOME MEASURE: Durations of observed quality of life indicators of participation and apparent affect were documented using a modified version of the Activity-in-Context-in-Time on 31 hours of videotaped data. Durations for each quality of life indicator were averaged per participant and aggregated by group for comparison using a Wilcoxon Mann-Whitney U test RESULTS: Both interventions supported emotional well-being and participation. Longer durations of active participation were observed during adaptive riding with significantly higher durations of complex active participation (U = 16, p= 0.029). CONCLUSION: Both interventions supported quality of life and merit continued development. Adaptive riding appeared to support longer durations of active participation with more complex forms when compared to adaptive gardening. Findings can inform healthcare providers' recommendations for adaptive gardening and adaptive riding for people with dementia. More research is needed with a larger sample size to further examine similarities and differences.

Optimal Terminology for Services in the United States That Incorporate Horses to Benefit People: A Consensus Document.

Objectives: To recommend (1) the adoption of optimal terminology for referring to services in the United States that incorporate horses and other equines to benefit people, and (2) the discontinuation of especially problematic terminology. Design: A diverse multidisciplinary consortium of individuals, including representatives of relevant national organizations, participated in an inclusive, systematic, and comprehensive 2-year consensus-building process. Results: Twelve specific types of services were identified that relate to one of three broad areas of professional work: therapy, learning, or horsemanship. Related to the area of therapy, five distinct types of therapies were identified: counseling, occupational therapy, physical therapy, psychotherapy, and speech-language pathology. Therapy-first language is recommended that foregrounds the exact therapy (e.g., physical therapy) and adds precise equine-related descriptors as warranted (e.g., physical therapy using equine movement). Related to the area of learning, three distinct types of nontherapy services were identified. The recommended terminology for referring to these services is equine-assisted learning in education, equine-assisted learning in organizations, and equine-assisted learning in personal development. Related to the area of horsemanship, four distinct types of nontherapy services were identified. The recommended terminology for referring to these services is adaptive equestrian sports, adaptive riding or therapeutic riding, driving, and interactive vaulting. The plural term, equine-assisted services, is recommended as a concise shorthand for easily referencing multiple services that differ from each other, yet share the horse as a common thread. Terms recommended for discontinuation include equine therapy, equine-assisted activities and therapies, equine-assisted therapy, equestrian therapy, hippotherapist, hippotherapy clinic (program), horse therapy, horseback riding therapy, and therapy riding. The consensus-building process culminated in extensive but not unanimous endorsements of all terminology recommendations. Conclusions: Terminology recommended for adoption clearly describes and distinguishes 12 distinct types of services. Terminology recommended for discontinuation was found to be ambiguous, misleading, no longer useful, or to have adversely affected stakeholders. It is hoped that all recommendations will prove useful and serve to enhance the professionalism and viability of specific identified services. It is also hoped that improved precision and clarity in terminology for naming specific services will advance their future scientific development and reliable measurement of effectiveness. Not all terminology-related challenges were resolved, however, and new challenges will likely arise as services continue to evolve and diversify. Significant impacts, if any, of the terminology recommendations herein merit ongoing monitoring and the question of optimal terminology merits revisiting in the foreseeable future.

Autism and Equine-Assisted Interventions: A Systematic Mapping Review.

This systematic mapping review mapped current knowledge of equine-assisted interventions for people with autism to help guide future practice and research. Thirty-three studies including children and adolescents with autism, 3 of which confirmed diagnoses, were reviewed. Five types of equine-assisted activities were identified across 25 studies, with reported improvements in behavior, social interaction, and communication. Four types of equine-assisted therapies were identified across 8 studies, with reported improvements in motor control and self-care. Different approaches to therapeutic riding and hippotherapy, the most studied interventions, were evident. While this literature reflected early scientific development, it offered broad proof of concept that equine-assisted interventions can benefit children and adolescents with autism. Promising outcomes support continued investigation focused on standardization, appropriateness, and efficacy.

Revisão sistemática sobre avaliação psicológica nas pesquisas em equoterapia: a systematic review / Psychological assessment and therapeutic riding: una revisión sistemática / Evaluación psicológica y equitación terapéutica

O presente artigo teve como objetivo investigar as pesquisas empíricas em equoterapia publicadas entre 2004 e 2014. Buscamos verificar características das amostras, construtos psicológicos avaliados, instrumentos de avaliação utilizados e resultados psicológicos atribuídos ao tratamento de equoterapia. Foram analisados 20 estudos empíricos, e a grande maioria deles foi realizado com crianças e adolescentes, seis estudos foram realizados com pessoas com Transtorno do Espectro do Autismo. As técnicas de mensuração utilizadas foram técnicas de entrevistas, observação do comportamento, questionários, escalas de qualidade de vida, de funcionalidade e para grupos específicos. Os resultados mais evidentes da equoterapia no âmbito psicológico envolveram a diminuição da ansiedade e os ganhos em relacionamento social. Os ganhos em aspectos cognitivos não ficaram claros. Comparando os estudos brasileiros e internacionais, a necessidade de sistematização da busca por medidas mais fidedignas ocorre em ambos, porém no Brasil parece não haver uma cultura de psicologia baseada em evidências na equoterapia.

This paper aims at investigating empirical researches on therapeutic riding published between 2004 and 2014. We seek to verify characteristics of the samples, psychological constructs assessed, assessment tools, and psychological effects attributed to the processing of therapeutic riding. We analyzed twenty empirical studies, the vast majority of them were held with children and adolescents, six studies were done with people with Autism Spectrum Disorder. The measurement techniques mostly used were: interviewing techniques; behavioral observation; questionnaires; quality of life scales; functionality scales and specific groups scales. The most obvious results of therapeutic riding in the psychological context involved decreased anxiety and gains in social relationship. Gains in cognitive aspects were not clear. Comparing Brazilian and international studies, we have a lack of control group and of reliable measurements in both cases, but Brazil, does not seem to have a psychology culture in use research based on evidence in therapeutic riding.

Este artículo tiene como objetivo investigar estudios sobre equitación terapéutica publicados entre 2004 y 2014. Buscamos características de las muestras, constructos psicológicos evaluados, instrumentos de evaluación utilizados y resultados psicológicos atribuibles al tratamiento de equitación terapéutica. Se analizaron 20 estudios empíricos, la mayoría fueron llevados a cabo con niños y adolescentes, seis estudios con personas con Trastorno del Espectro Autista. Las técnicas de medición utilizadas fueron las técnicas de entrevista, la observación del comportamiento, cuestionarios, escalas de calidad de vida, la función y para grupos específicos. Los resultados más evidentes de la equitación terapéutica en el contexto psicológico fueron disminución de la ansiedad y las ganancias en las redes sociales. Las ganancias en los aspectos cognitivos no eran claras. Comparándose los estudios brasileros e internacionales hay necesidad de sistematizar la búsqueda de medidas más fiables en ambos, pero en Brasil no parece haber la cultura de estudios basados en la evidencia.

Brief Report: The Effects of Equine-Assisted Activities on the Social Functioning in Children and Adolescents with Autism Spectrum Disorder.

Equine-assisted activities and therapies are increasing in popularity for treatment of ASD symptoms. This research evaluated effects of a 5-week programme of therapeutic riding on social functioning of children/adolescents (N = 15) with ASD. The effectiveness of the programme was evaluated using the autism spectrum quotient, the Vineland Adaptive Behaviour Scale and the empathising and systemising quotient. Results established that the TR intervention increased empathising and reduced maladaptive behaviours. The findings also indicated that specific adaptive behaviours like socialization and communication were not affected by the intervention. Thus, a complex picture of the effects of this intervention emerges: while TR does not change all of the child's behaviour, it can improve specific aspects of social functioning and also reduce maladaptive ASD traits.

Effectiveness of equine therapy in children with psychomotor impairment.

INTRODUCTION: Equine therapy, an intervention method that has been practiced for decades around the world, is used to treat patients susceptible to psychomotor delays. OBJECTIVES: We examine development of gross motor function compared to other psychomotor skills in patients undergoing this therapy, and analyse how this improvement affects general health status and quality of life. MATERIAL AND METHODS: The study includes 11 children with delayed psychomotor development (aged 8.82 ± 3.89; 6 boys, 5 girls). The main study variables were gross motor function (GMFM-88) and perceived quality of life (Pediatric Quality of Life Inventory, PedsQL). Three measurements were performed: before and after a period of inactivity, and once again 2 months after the second measurement, following completion of a sustained period of therapy. RESULTS: We observed significant differences in overall results on the GMFM-88 between the initial and final tests and between the intermediate and final tests. Regarding the PedsQL quality of life scale, no statistically significant results were recorded. CONCLUSIONS: Noticeable changes in motor control were recorded throughout the course of the intervention, which suggests that equine therapy may be appropriate treatment in cases of delayed psychomotor development.

Hypotheses about the psychological benefits of horses.

BACKGROUND: In the last few decades, therapeutic horse-riding has become recognized as a progressive form of therapy, particularly for people with disabilities. Although there is a substantial amount of literature that supports the physical benefit of therapeutic riding, only anecdotal evidence exists in relation to its psychological benefits. OBJECTIVE: The purpose of this article is to develop hypotheses about the mechanisms by which therapeutic riding might have a beneficial psychological effect. These hypotheses can then be tested, leading to a more detailed knowledge base. DATA SOURCES: PsychINFO, MEDLINE, PROQUEST, Scopus, Web of Science, and CINAHL. STUDY SELECTION: Data sources were searched for studies that (a) were related to the psychological effects of therapeutic horse-riding, (b) focused exclusively on therapeutic horse-riding, (c) described, explicitly or implicitly, the mechanism by which therapeutic riding had a beneficial psychological effect. Studies were limited to those published between 2008 and 2012. DATA EXTRACTION: Data were extracted by two authors independently. DATA SYNTHESIS: Thirty articles met the inclusion criteria. Three potential hypotheses emerged from the literature, namely, (1) the psychological benefits of therapeutic riding are actually unrelated to the horse, (2) the horse provides a particularly positive context within which psychological gains are facilitated, and (3) the horse itself has specific therapeutic qualities that bring about unique changes not otherwise likely to occur. CONCLUSION: The challenge for researchers in this area is to design studies that adequately test these competing hypotheses.

Hypothalamic-pituitary-adrenal axis responses of horses to therapeutic riding program: effects of different riders.

In order to determine whether therapeutic riding could result in higher levels of stress than recreational riding, hypothalamic-pituitary-adrenal (HPA) axis response was evaluated in six horses by monitoring circulating ß-endorphin, ACTH and cortisol concentrations. Horses were already accustomed to be trained both for therapy and riding school activity since 2004. Intervention consisted of 60-minute therapeutic sessions, two times per week for 6weeks with different riders: disabled and recreational riders (session A and B respectively). The therapeutic riders' group (A) consisted of six children with psychomotor disabilities; the recreational riders' group (B) consisted of six healthy children without any previous horse riding experience. Horses were asked to perform the same gaits and exercises at all sessions, both with disabled and healthy users. The statistical analysis showed that during both sessions the mean basal ß-endorphin and ACTH levels of horses did not show any significant changes, while the one way RM-ANOVA showed significant effects of sessions A on the cortisol (F=11.50; P<0.01) levels. Horses submitted to sessions A showed lower cortisol levels both at 5min (P<0.001) and at 30min (P<0.005) after therapeutic sessions than those after session B. Results suggest that in tested horses and for the variables settled, HPA axis was less responsive to disabled than healthy, recreational riders. Among the endocrine responses, cortisol was one of the indicators of HPA axis stress response.

Influence of equine conformation on rider oscillation and evaluation of horses for therapeutic riding.

To obtain basic knowledge about selecting horses for therapeutic riding, the influence of equine conformation on rider oscillation and relationships between these factors and the evaluation on horses as the therapeutic riding were studied. Thirty-five riding horses were used. Equine conformation was estimated by 24 indices. Rider oscillation was measured by an accelerometer fixed at the rider's waist. The spatial position of the oscillation was estimated by a double integration of the acceleration. Horses were evaluated for therapeutic riding by a Riding for the Disabled Association instructor as a rider. Evaluations were on a scale of 1 to 5, with 5 being the highest score for 27 items. Horses were classified into 4 groups: the short and narrow (SN), short and wide (SW), tall and narrow (TN), and tall and wide (TW). The frequencies of rider oscillation both at walk and trot were higher (P<0.01), and the vertical (P<0.01) and longitudinal (P<0.05) amplitudes at trot were smaller, on short horses than on tall horses. The vertical amplitude at walk was smaller (P<0.05) and the lateral amplitude at trot was larger (P<0.01) on wide horses than on narrow horses. Short horses could be used for the rider who requires side walkers. Wide horses could be used for relieving muscular tension and for the rider who could not maintain good balance on the horse. Short and wide horses should be suitable for therapeutic riding.