Therapeutic Horsemanship in Veterans

Study Overview
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Brief Summary
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The project partnered with U.S. military veterans with a premier accredited therapeutic riding center for six weeks. The veterans interacted with horses by grooming and learning about them, as well as riding them for one hour per week during which they gained a variety of skills. We hoped the veterans would experience a reduction in Post Traumatic Stress Disorder (PTSD) symptoms, depression, and loneliness, while improving their social and emotional health and self-efficacy.

Detailed Description
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Large numbers of post-deployed U.S. veterans diagnosed with Post Traumatic Stress Disorder (PTSD) and/or Traumatic Brain Injury make effective interventions urgent, to reduce symptoms and increase veterans' coping. PTSD includes anxiety, flashbacks, and emotional numbing. Symptoms expand health care costs for stress-related illnesses making veterans' civilian life difficult. The proposed study used a randomized experimental design with repeated measures and waitlist control group testing the efficacy of a 6-week human-horse interaction and systematic therapeutic horseback riding program in: decreasing PTSD symptoms, increasing coping self efficacy, emotion regulation, and social engagement. The Riding Group spent one hour weekly interacting with and riding the same horse at one of two PATH-accredited riding centers in Mid-Missouri supervised by an Occupational Therapist, Profession Association of Therapeutic Horsemanship (PATH) International-certified instructor, leader and side walkers as needed. Riding was directed by a systematic lesson plan. Data collection occured at baseline, 3 weeks, and 6 weeks. The Control Group was assessed at the same intervals and again 3 weeks and 6 weeks after joining the Riding Group.

Official Title
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Effects of Equine Assisted Activities on PTSD Symptoms, Coping Self-efficacy, Emotion Regulation, and Social Engagement in U.S. Military Veterans

Conditions
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Post Traumatic Stress Disorder, Traumatic Brain Injury

Intervention / Treatment
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* Behavioral: Therapeutic Horseback Riding
* Other: Standard Care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 18 years or older Veterans, left active military service (not serving in reserve units.) Diagnosed with Post Traumatic Stress Disorder/Traumatic Brain Injury or both according to ICD-9 diagnostic codes. Weight less than 220 pounds. Able to walk at least 25 feet without the assistance of a person (but potentially with assistive devices). Willing to interact with and ride a horse. Have not ridden a horse in the past year. Care Provider assent Exclusion Criteria: Age less than 18 years Veterans in active military service (including reserve units). No diagnosis of PTSD/TBI or both according to ICD-9 diagnostic codes. Weight greater than 221 pounds. Unable to walk at least 25 feet without the assistance of a person (but potentially with assistive devices.) Unwilling to interact with and ride a horse. Have been riding a horse in the past year. Care Provider unwilling to provide assent

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Therapeutic Horseback Riding<br>Therapeutic Horseback Riding: Veterans were matched to a horse by the instructor and occupational therapist for best fit and the same horse was ridden each week | Behavioral: Therapeutic Horseback Riding<br>* Veterans were matched to a horse for best fit and the same horse was ridden each week. The warm-up exercises involved various repeated physical movements while the horse was walking or standing steady, such as head rotations, lifting arms, rotating ankles, flexing toes. The exercises began with riding at a walk during the early weeks, learning reining skills and riding positions, and progressed to light trotting. Veteran participants were able to build on skill sets related to grooming, tacking, mounting, and riding that were introduced in prior weeks. Skill progression was based on individual abilities and safety as determined by certified riding instructor and occupational therapist.<br>|
| Other: Standard Care<br>Participants received standard care. | Other: Standard Care<br>* Standard Care: Participants received standard care<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Coping Self-Efficacy Scale (CSES) | 26 item, 11 point analog scale | Day 1, 3 weeks and 6 weeks | 
| Change in Post-Traumatic Stress Disorder Checklist-Military Version (PCL-M) | 17 item, 5 point scale | Day 1, 3 weeks and 6 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Social and Emotional Loneliness Scale for Adults (SELSA) scale | 15 item, 7 point Likert-type scale. | Day 1, 3 weeks and 6 weeks | 
| Change in Difficulties in Emotion Regulation Scale (DERS) | 36 item, 5 point Likert-type scale | Day 1, 3 weeks and 6 weeks |