Effects of therapeutic horseback riding on post-traumatic stress disorder in military veterans

In the paper

“The Difficulties in Emotion Regulation Scale (DERS) contains 36 items measuring the “modulation of emotional arousal; awareness, understanding, and acceptance of emotions; and ability to act in desired ways regardless of the emotional state” and is scored on a 5-point Likert-type scale ranging from 1 (‘almost never’) to 5 (‘almost always’) [63].”

What the sources say

• Partly supported

  The available passage (unlabeled section; no page given) explicitly says the DERS has 36 items. It does not describe all the emotional capacities listed in the claim or specify a 5-point response scale, so those parts of the citing sentence are not supported by our copy. (LLM, conf=0.88)

  cites [63] Gratz KL, Roemer L. Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. J Psychopathol Behav Assess. 2004;26:41–54. https://doi.org/10.1007/s10862-008-9102-4 . sourceExperimental — accuracy not yet measured

In the paper

“THR has been implemented in adults and older adults with a variety of physical impairments [35–37] as well as defined physical and psychological disorders.”

What the sources say

• Partly supported

  The Abstract reports equine-assisted therapy in older adults, supporting its use in that age group. But the Selection of study group section describes independently functioning participants and excludes several disorders that cause balance problems; the Discussion calls the groups healthy. The paper therefore does not establish use in older adults with the variety of physical impairments attributed to it. The citation is attached to the physical-impairments clause, not the subsequent psychological-disorders clause. (LLM, conf=0.86)

  cites [35] Araujo TB, Silva NA, Costa JN, Pereira MM, Safons MP. Effect of equine-assisted therapy on the postural balance of the elderly. Braz J Phy Ther. 2011;15:414–9. https://doi.org/10.1590/S1413-35552011005000027 . sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [36] Farias-Tomaszewski S, Jenkins SR, Keller J. An evaluation of therapeutic horseback riding programs for adults with physical impairments. Ther Recreat J. 2001;35:250–7.
• ?Not checked — no full text of the sourcecites [37] Land G, Errington-Povalac E, Paul S. The effects of therapeutic riding on sitting posture in individuals with disabilities. Occup Ther Health Care. 2002;14:1–12. https://doi.org/10.1080/J003v14n01_01 . source

In the paper

“There were no statistically significant changes in the other primary and secondary outcome variables over time (i.e., coping self-efficacy, emotion regulation [mood], and perceived loneliness).”

• Also stated in: § Results · plain

  “Under the generalized linear model(GLM), our ANOVA findings for the coping self-efficacy, emotion regulation, and social and emotional loneliness did not reach statistical significance.”

In the paper

“The values for each instrument were as follows: PCL-M = 0.737, CSES = 0.868, DERS = 0.831, SELSA = 0.788.”

In the paper

“No phone calls were received addressing injuries or pains; the phone number was exclusively employed regarding scheduling issues.”

In the paper

“Changes in the SELSA were opposite the predicted direction (indicating increased loneliness).”

• Also stated in: § Results · plain

  “Results for emotional loneliness were opposite the predicted direction.”

In the paper

“the shorter riding group (1–3 weeks) did show a decline between the first and second measurement, but then showed a marked increase at the next measurement”

In the paper

“The fact that there was no change in these scores during the control period, but there was a positive change during the riding period would support this notion.”

In the paper

“Our findings show that our participants’ mean improvements in PTSD symptoms were 6 points at the 3-week data point and 13 points at the 6-week data point while riding.”

In the paper

“However, for PTSD symptoms, our findings demonstrated that 3 weeks was an effective intervention length and that even more improvement was noted at 6 weeks.”

In the paper

“Our findings regarding social and emotional loneliness were not statistically significant, and the trends were not in the predicted decreasing direction.”

In the paper

“Our findings for coping self-efficacy, emotion regulation, and social and emotional loneliness did not reach statistical or clinical significance.”

In the paper

“Globally, the highest level of PTSD symptoms was recorded at baseline, then there was a drop at 3 weeks of riding and a still further drop at 6 weeks of riding.”

In the paper

“Interactions between the veterans and the riding center and study staff were positive.”

In the paper

“Nevertheless, we did find statistical and clinical significance in lowering PTSD symptom levels.”

In the paper

“Those who rode for more sessions (4–6 weeks) evidenced much larger declines in PTSD scores than those who rode for fewer sessions, and the decline continued with each measurement.”

In the paper

“The participants expressed sadness that the THR program was ending.”

In the paper

“The study had the approval of the VA Research and Development Committee at the Harry S. Truman Memorial Veterans Hospital, the University of Missouri Health Sciences Institutional Review Board and the Animal Care and Use Committee of the University.”

In the paper

“The DERS was found to have a strong internal consistency (0.93) and tested well against the Negative Mood Regulation Scale (−0.69) [63].”

What the sources say

• Not checked yet

  Checked before — its earlier verdict is held back until a new check runs.

  cites [63] Gratz KL, Roemer L. Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. J Psychopathol Behav Assess. 2004;26:41–54. https://doi.org/10.1007/s10862-008-9102-4 . source

In the paper

“Riding center staff were not aware of who had been assigned to either group.”

In the paper

“All participants provided written informed consent, and their primary health care providers gave written assent for their participation in the THR program.”

In the paper

“The PCL-M has been found to have strong internal consistency (0.94–0.97), test-retest reliability (0.97 over 3 days), concurrent validity (0.77–0.93), and diagnostic efficiency with a sensitivity of 0.82 and specificity of 0.84 [60].”

What the sources say

• ?Not checked — no full text of the sourcecites [60] Weathers FW, Litz BT, Herman DS, Huska JA, Keane TM. Psychometric properties of nine scoring rules for the clinician-administered post-traumatic stress disorder scale. Psychol Assess. 1999;11:124–33. https://doi.org/10.1037/1040-3590.11.2.124 . source

In the paper

“We used a randomized wait-list controlled design with repeated measures of U.S. military veterans to address our specific aim to test the efficacy of a 6-week therapeutic horseback riding (THR) program for decreasing PTSD symptoms and increasing coping self-efficacy, emotion regulation, social and emotional loneliness.”

• Also stated in: § Statistical analysis · plain

  “The THR program was a randomized wait-list controlled design, in which participants rode a horse or were wait-listed for prescribed times.”

In the paper

“The instrument has strong internal consistency (0.80–0.91) and test-retest reliability (0.40–0.80) [62].”

What the sources say

• ?Not checked — no full text of the sourcecites [62] Chesney MA, Neilands TB, Chambers DB, Taylor JM, Folkman SA. Validity and reliability study of the coping self-efficacy scale. Brit J Health Psych. 2006;11:421–37. https://doi.org/10.1348/135910705X53155 . source

In the paper

“The scale was found to have an internal consistency ranging from 0.87–0.90, to be significantly correlated with the long-established UCLA-Loneliness Scale, and has been extensively tested against other established measures [64].”

What the sources say

• ?Not checked — no full text of the sourcecites [64] DiTommaso E, Brannen C, Best LA. Measurement and validity characteristics of the short version of the social and emotional loneliness scale for adults. Educ Psychol Meas. 2004;64:99–119. https://doi.org/10.1177/0013164403258450 . source

In the paper

“The PCL-M is a self-report measure of the 17 DSM-IV symptoms of PTSD asking about problems in response to “stressful military experiences” [59].”

What the sources say

• Not checked yetcites [59] U.S. Department of Veterans Affairs, National Center for PTSD. PTSD Checklist-Military Version (PCL-M). 2011. https://www.ptsd.va.gov/professional/assessment/screens/index.asp . Accessed 18 Oct 2017.

In the paper

“First, relevant assumptions were evaluated, including normality, linearity and homoscedasticity. Each were within acceptable parameters for analysis by variance statistics (i.e., ANOVA).”

• Also stated in: § Statistical analysis · plain

  “For inferential analyses, relevant statistical assumptions (including normality, linearity, homoscedasticity) were evaluated.”

In the paper

“They were randomly assigned to either the riding group (n = 15) or a wait-list control group (n = 14) based on their identification number (Fig. 1).”

In the paper

“One important case study of a 44-year-old veteran with a spinal cord injury demonstrated both functional improvements, including increased regular PA, along with increases in self-esteem, self-control, and sense of independence [49].”

What the sources say

• ?Not checked — no full text of the sourcecites [49] Asselin G, Ward C, Penning JH, Ramanujam S, Neri R. Therapeutic horse-back riding of a spinal cord injured veteran: a case study. Rehabil Nurs. 2012;37:270–6. https://doi.org/10.1002/rnj.027 . source

In the paper

“their individual relevance is perhaps less important than the complete THR experience because these components would not naturally occur in isolation.”

In the paper

“Lanning and Krenek [51] used a 24-week THR program in their study, which demonstrated improvements in veterans’ physical health and depression levels.”

What the sources say

• ?Not checked — no full text of the sourcecites [51] MacLean B. Equine-assisted therapy. J Rehabil Res Dev 2011;48(7): ix-xii. https://doi.org/10.1682/JRRD.2011.05.0085 . source

In the paper

“Veterans who participated in an equine assisted learning program (i.e., horses used to promote cognitive reframing and mindfulness) reported that the program had very positive benefits on their PTSD symptoms and coping skills [50].”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [50] Duncan CR, Critchley S, Marland J. Can praxis: a model of equine assisted learning (EAL) for PTSD. CMJ. 2014;14:64–9.

In the paper

“The Coping Self Efficacy Scale (CSES) is a 26-item 11-point analogue scale assessing individuals’ perceived ability to cope with life’s challenges or threats by using problem-focused coping, stopping of unpleasant emotions and thoughts, and getting support from family and friends [61].”

What the sources say

• Not checked yetcites [61] Bandura A. Self-efficacy: the exercise of control. New York: W. H. Freeman; 1997.

In the paper

“Afflictive behavior between person and horse has been identified as a vital component of best practices in veterinary medicine when veterinarians work with horses [71].”

What the sources say

• ?Not checked — no full text of the sourcecites [71] Payne E, DeAraugo J, Bennett P, McGreevy P. Exploring the existence and potential underpinnings of dog-human and horse-human attachment bonds. Behav Process. 2016;125:114–21. https://doi.org/10.1016/j.beproc.2015.10.004 . source

In the paper

“Moreover, the anxiety associated with PTSD is known to induce veterans to avoid social contexts, leading to further isolation [51].”

What the sources say

• ?Not checked — no full text of the sourcecites [51] MacLean B. Equine-assisted therapy. J Rehabil Res Dev 2011;48(7): ix-xii. https://doi.org/10.1682/JRRD.2011.05.0085 . source

In the paper

“Our previous research demonstrated that emotionally stressed adult cancer patients who interacted quietly with a companion animal reported the visiting dog provided them comfort and was a confidant who made them happy and gave them energy [73].”

What the sources say

• ?Not checked — no full text of the sourcecites [73] Johnson RA, Meadows RL, Haubner J, Sevedge K. Animal-assisted activity among patients with cancer: effects on mood, fatigue, self-perceived health, and sense of coherence. Oncol Nurs Forum. 2009;35:225–32. https://doi.org/10.1188/08.ONF.225-232 . source

In the paper

“Accessibility to riding centers may be an issue for veterans who wish to participate in THR.”

In the paper

“We suspect that the diminishing sample size may have limited our power to detect statistically significant changes in these two variables.”

In the paper

“The THR sessions were conducted by a PATH-certified riding instructor and supervised by an occupational therapist.”

In the paper

“What was done, however, was to objectively study the biophysiologic parameters at each phase of the THR process (e.g., driving to the stable) to better isolate the precise contribution of the actual time on the horse to the changes in the PTSD levels.”

In the paper

“We attempted to control for possible confounding effects of interpersonal interactions with riding center volunteers and study staff by instructing these individuals to minimize conversational initiation with the veterans.”

In the paper

“However, this exploratory study lacked a control condition, making effectiveness of THR difficult to evaluate.”

What the sources say

• ?Not checked — no full text of the sourcecites [52] Lanning BA, Krenek N. Examining effects of equine-assisted activities to help combat veterans improve quality of life. J Rehabil Res Dev. 2013;50(8): xv-xxii. https://doi.org/10.1682/JRRD.2013.07.0159 . source

In the paper

“THR may be a beneficial activity to reduce PTSD symptoms in veterans and also increase PA, reduce stress, enhance coping self-efficacy, and provide social support.”

In the paper

“This waitlist control design has been successfully employed in an equine program research with 131 adolescents in an 11-week equine facilitated learning program [55].”

What the sources say

• ?Not checked — no full text of the sourcecites [55] Pendry P, Carr AM, Smith AN, Roeter SM. Improving adolescent social competence and behavior: a randomized trial of an 11-week equine facilitated learning prevention program. J Primary Prevent. 2014;35:281–93. https://doi.org/10.1007/s10935-014-0350-7 . source

In the paper

“Veterans who took part in a THR program reported greater communication skills and self-awareness and self-esteem [51].”

What the sources say

• ?Not checked — no full text of the sourcecites [51] MacLean B. Equine-assisted therapy. J Rehabil Res Dev 2011;48(7): ix-xii. https://doi.org/10.1682/JRRD.2011.05.0085 . source

In the paper

“It is not realistic that each of these components could be studied separately in a randomized controlled trial”

In the paper

“Older veterans, such as the majority in our sample, may have been diagnosed with PTSD decades ago; THR may be particularly promising for them.”

In the paper

“A 10-point improvement is the minimum threshold for determining clinically meaningful improvement [66].”

What the sources say

• Not checked yetcites [66] U.S. Dept. of Veterans Affairs, National Center for PTSD [Internet]. PTSD Checklist for DSM-5 (PCL-5). 2016. https://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd-checklist.asp . Accessed 18 Oct 2017.

In the paper

“A 5-point decrease is the minimum threshold used to determine that an individual has responded to a treatment modality [66].”

What the sources say

• Not checked yetcites [66] U.S. Dept. of Veterans Affairs, National Center for PTSD [Internet]. PTSD Checklist for DSM-5 (PCL-5). 2016. https://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd-checklist.asp . Accessed 18 Oct 2017.

In the paper

“Other investigators have reported that human touch is an essential factor in the creation of human-horse affiliations [71].”

What the sources say

• ?Not checked — no full text of the sourcecites [71] Payne E, DeAraugo J, Bennett P, McGreevy P. Exploring the existence and potential underpinnings of dog-human and horse-human attachment bonds. Behav Process. 2016;125:114–21. https://doi.org/10.1016/j.beproc.2015.10.004 . source

In the paper

“Furthermore, the length of our THR program may have been too short.”

In the paper

“While our findings showed beneficial outcomes in PTSD at the 3-week measurement, longer participation (six weeks) was beneficial for self-efficacy and emotion regulation.”

In the paper

“A 3-week THR program was effective, and a 6-week program produced clinically significant outcomes in PTSD levels.”

In the paper

“Other investigators have advocated for an individualized approach to selecting “talkative volunteers” or less talkative volunteers as a match with each veteran’s needs, which may enhance veterans’ THR experience [51].”

What the sources say

• ?Not checked — no full text of the sourcecites [51] MacLean B. Equine-assisted therapy. J Rehabil Res Dev 2011;48(7): ix-xii. https://doi.org/10.1682/JRRD.2011.05.0085 . source

In the paper

“Previously, THR participants have characterized horses as accepting and nonjudgmental [54].”

What the sources say

• ?Not checked — no full text of the sourcecites [54] Bizub AL, Joy A, Davidson L. Demonstrating the benefits of therapuetic horseback riding for individuals with psychiatric disability. Psychiatr Rehabil J. 2003;26:377–84. source

In the paper

“which may have positively potentiated the effects of our intervention and is a strength of our design.”

In the paper

“THR may be more accessible to rural veterans who may have to travel long distances to reach VA treatment programs.”

In the paper

“A total summed score (possible range of 17 to 85) is obtained, and a score of at least 50 is indicative of a PTSD diagnosis [60].”

What the sources say

• ?Not checked — no full text of the sourcecites [60] Weathers FW, Litz BT, Herman DS, Huska JA, Keane TM. Psychometric properties of nine scoring rules for the clinician-administered post-traumatic stress disorder scale. Psychol Assess. 1999;11:124–33. https://doi.org/10.1037/1040-3590.11.2.124 . source

In the paper

“Physical benefits of THR include improved sitting posture [37], motor function [45], postural balance [35, 38], decreased muscle tension [38, 41], improved balance and gait [42], and reduction of pain [38, 46].”

What the sources say

• ?Not checked — no full text of the sourcecites [37] Land G, Errington-Povalac E, Paul S. The effects of therapeutic riding on sitting posture in individuals with disabilities. Occup Ther Health Care. 2002;14:1–12. https://doi.org/10.1080/J003v14n01_01 . source
• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [45] Henriksen JD. Horseback riding for the handicapped. Arch Phys Med Rehabil. 1971;52:282–3.
• Not checked yet

  Checked before — its earlier verdict is held back until a new check runs.

  cites [35] Araujo TB, Silva NA, Costa JN, Pereira MM, Safons MP. Effect of equine-assisted therapy on the postural balance of the elderly. Braz J Phy Ther. 2011;15:414–9. https://doi.org/10.1590/S1413-35552011005000027 . source
• ?Not checked — no full text of the sourcecites [38] Hammer A, Nilsagård Y, Forsberg A, Pepa H, Skargren E, Öberg B. Evaluation of therapeutic riding (Sweden)/hippotherapy (United States). A single-subject experimental design study replicated in eleven patients with multiple sclerosis. Physiother Theory Pract. 2005;21:51–77. https://doi.org/10.1080/09593980590911525 . source

In the paper

“Other research demonstrated that quietly petting a dog was associated with a relaxation effect (lower blood pressure and cortisol levels) [74].”

What the sources say

• ?Not checked — no full text of the sourcecites [74] Odendaal JSJ, Meintjes RA. Neurophysiological correlates of affiliative behaviour between humans and dogs. Vet J. 2003;165:296–301. https://doi.org/10.1016/S1090-0233(02)00237-X . source

In the paper

“Volunteering has been found to be a meaningful activity for veterans, particularly those who served in combat [76].”

What the sources say

• ?Not checked — no full text of the sourcecites [76] Nesbit R, Reingold DA. Soldiers to citizens: the link between military service and volunteering. Public Adm Rev. 2011;71:67–76. source

In the paper

“Another limitation is that it does not capture experiential isolation, which has been defined as failed inter-subjectivity [69].”

What the sources say

• ?Not checked — no full text of the sourcecites [69] Stein JY, Tuval-Mashiach R. The social construction of loneliness: an integrative conceptualization. J Constr Psychol. 2014;7:122. https://doi.org/10.1037/a0036936 . source

In the paper

“Our findings provide empirical evidence that THR is effective at improving coping skills and in lessening one’s difficulty with emotional regulation, especially with longer riding interventions.”

In the paper

“A common criticism of human-animal interaction research is that we cannot be sure that change is caused by only the animal because an animal handler is nearly always involved in such interactions.”

In the paper

“Participants attended THR classes once per week for 6 weeks in accordance with the systematized THR curriculum developed by the research team, which included 2 occupational therapists and 2 PATH-certified riding instructors.”

In the paper

“We did not use a longitudinal follow-up.”

In the paper

“THR is clearly not a replacement for conventional therapies used to treat PTSD, but as a complementary therapy, riding centers may be a readily accessible resource to veterans in rural areas.”

In the paper

“A single study was identified which showed quantitative decreases in depression and improvements in reported physical health due to a 24-week THR program [52].”

What the sources say

• ?Not checked — no full text of the sourcecites [52] Lanning BA, Krenek N. Examining effects of equine-assisted activities to help combat veterans improve quality of life. J Rehabil Res Dev. 2013;50(8): xv-xxii. https://doi.org/10.1682/JRRD.2013.07.0159 . source

In the paper

“The Social and Emotional Loneliness Scale for Adults-short version (SELSA) consists of 15 items assessing emotional, family, and romantic loneliness rated on a 7-point Likert-type scale ranging from 1 (‘strongly disagree’) to 7 (‘strongly agree’) [64].”

What the sources say

• ?Not checked — no full text of the sourcecites [64] DiTommaso E, Brannen C, Best LA. Measurement and validity characteristics of the short version of the social and emotional loneliness scale for adults. Educ Psychol Meas. 2004;64:99–119. https://doi.org/10.1177/0013164403258450 . source

In the paper

“Horses and THR have been previously used in treating PTSD; however, there are no randomized controlled trials studying the effectiveness of horses in reducing levels of PTSD [53].”

What the sources say

• Not checked yet

  Checked before — its earlier verdict is held back until a new check runs.

  cites [53] Cantin A, Marshall-Lucette S. Examining the literature on the efficacy of equine assisted therapy for people with mental health and behavioral disorders. Ment Health Learn. 2001;8:51–61. https://doi.org/10.5920/mhldrp.2011.8151 . source

In the paper

“One potential limitation of the SELSA with combat veterans is that loneliness, which may be associated with guilt and/or shame, is called spiritual or existential loneliness [56].”

What the sources say

• ?Not checked — no full text of the sourcecites [56] Johnson RA, Meadows RL. Dog-walking: motivation for adherence to a walking program. Clin Nurs Res. 2010;19:387–402. https://doi.org/10.1177/1054773810373122 . source

In the paper

“Psychological improvements due to THR include increased self-efficacy, motivation, and courage [41–44], reduced psychological distress [44], and enhanced psychological well-being [37, 44].”

What the sources say

• ?Not checked — no full text of the sourcecites [41] Lechner HE, Feldhaus S, Gudmundsen L, Hegemann D, Michel D, Zäch GA, et al. The short-term effect of hippotherapy on spasticity in patients with spinal cord injury. Spinal Cord. 2003;41:502–5. https://doi.org/10.1038/sj.sc.3101492 . source
• ?Not checked — no full text of the sourcecites [42] Ungermann CM, Gras LZ. Therapeutic riding followed by rhythmic auditory stimulation to improve balance and gait in a subject with orthopedic pathologies. J Altern Complement Med. 2001;17:1191–5. https://doi.org/10.1089/acm.2009.0708 . source
• ?Not checked — no full text of the sourcecites [43] Biery MJ, Kauffman N. The effects of therapeutic horseback riding on balance. Adapt Phys Q. 1989;6:221–9. source
• ?Not checked — no full text of the sourcecites [44] Keren O, Reznik J, Groswasser Z. Combined motor disturbances following severe traumatic brain injury: an integrative long-term treatment approach. Brain Inj. 2001;15:633–8. https://doi.org/10.1080/02699050118042 . source
• ?Not checked — no full text of the sourcecites [37] Land G, Errington-Povalac E, Paul S. The effects of therapeutic riding on sitting posture in individuals with disabilities. Occup Ther Health Care. 2002;14:1–12. https://doi.org/10.1080/J003v14n01_01 . source