Equine Assisted Therapy: A Systematic Review of Interventions to Improve Outcomes in Adults

Saturday, 7 November 2015

Sharon A. White-Lewis, MSN, RN
School of Nursing, Saint Luke's College of Health Sciences, Kansas City, MO, USA
Cynthia Russell, PhD, RN, ACNS-BC, FAAN
School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, MO, USA
Rebecca A. Johnson, PhD, RN, FAAN, FNAP
School of Nursing and College of Veterinary Medicine, University of Missouri in Columbia Missouri, Columbia, MO, USA
Nancy L. Mueller
Department of Veterinary Medicine, University of Missouri in Columbia, Saint Louis, MO, USA

Problem:  Half of all adults, over 117 million, have one or more chronic illnesses. A new intervention, equine assisted therapy, is an approach that uses unique qualities of a horse to provide improvement in gross motor, quality of life and self-help skills.  No comprehensive systematic reviews have been conducted on equine assisted intervention studies targeting adults.

Purpose: To synthesize equine assisted therapy intervention studies.

Theoretical/Conceptual Framework: A research methods quality framework was used. CONSORT guideline criteria were used to judge randomized controlled trial study quality while STROBE guideline criteria were used for quasi-experimental studies.

Methodology/Design: Using a systematic review design, a search of multiple databases was performed using selected search terms.  Databases included ProQuest, CINAHL, Medline, Google Scholar, ERIC, PEDro Database, DOAJ, Cochrane; Psych Info, and DARE, and The DELTA Society’s list of equine research articles. Study eligibility criteria included: adult sample 16 years of age or older, sample size of 5 or greater, quasi-experimental or experimental design, intervention involving a living horse or horses and articles published in English. Data were reviewed and scored by two independent reviewers.  

Results/Analysis: Twenty three studies met inclusion criteria, representing 450 subjects from 9 countries. Sample size ranged from 7 to 32. Ages ranged from 16 to 85 years.  Diseases studied include multiple sclerosis, cerebral palsy, brain disorders, stroke, balance deficits and spinal cord injury. Primary dependent variables’ measures focused on balance, cadence and stride of gait, stability, spasticity, self-efficacy and quality of life/well-being.  Randomized controlled trials (39%) and quasi-experimental (61%) were included. Treatment interventions ranged from hippotherapy programs (goal directed therapy with a licensed interventionist) to therapeutic horseback riding classes (directed at improving horse riding skills and exercise movement). Statistically significant improvements were reported in main outcomes of 17 of 18 (94%) studies. Study methodological limitations included: small sample sizes, no power analysis, inconsistent use of measures, lack of randomized controlled trials and long-term follow up.  

Interpretation of results: Equine assisted therapy, a non-pharmaceutical modality, shows promise as an intervention to improve psychological, social and physical outcomes in adults. This translates into improved morbidity and mortality in those with chronic conditions.