Abstract
PICO question
 In horses with acute laminitis, does cryotherapy of the distal limbs applied after onset of clinical signs lead to improved clinical outcomes compared to horses treated without cryotherapy?
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 Four papers were critically appraised; there were three randomised, controlled trials, and one retrospective cohort study.
 Strength of evidence
 Weak
 Outcomes reported
 There were reduced histological changes and lamellar injury in limbs treated with cryotherapy in the randomised controlled trials and reduced clinical severity of laminitis in horses treated with cryotherapy in the retrospective cohort study.
 Conclusion
 In horses with acute laminitis there is weak evidence to suggest that cryotherapy of the distal limbs is an effective treatment option when applied following onset of clinical signs. Further randomised, controlled trials should be performed to assess clinical outcomes of cryotherapy in order to draw definitive conclusions.
 
 How to apply this evidence in practice
 The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.
 Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.
 
Highlights
Cases were divided into two groups: o Group 1 of 53 horses that were not treated with cryotherapy. o Group 2 of 32 horses that were treated with cryotherapy
Of the horses in Group [1, 33] were graded as low-severity laminitis and were treated conservatively. 19 horses were graded as medium–high severity, and one as high severity, and these were treated surgically. 22 horses underwent partial or complete wall ablations, 14 underwent a deep digital flextor tendon (DDFT) tenotomy, and seven underwent transcortical casting
This study provides moderate evidence for the use of cryotherapy of the distal limbs as an effective treatment for laminitis, limited by the lack of clinical progression of the cases as the horses were euthanised before this could be assessed
Summary
In horses with acute laminitis there is weak evidence to suggest that cryotherapy of the distal limbs is an effective treatment option when applied following onset of clinical signs. The evidence A literature search returned a total of 302 papers, of which four met the inclusion criteria These papers consisted of three prospective, blinded, experimental, randomised controlled trials (RCTs) (Van Eps et al, 2014; Dern et al, 2018; and Dern et al, 2017), where laminitis was induced in horses using the oligofructose model and the effects of cryotherapy studied. The retrospective cohort study will have produced weaker evidence than the RCTs (Cockcroft, 2019) due to both the nature of the cohort study design and the fact that it was retrospective, meaning that many variables were not able to be controlled and so significant biases, such as selection bias, may have interfered with the results (Sauerland et al, 2002) For these reasons, the retrospective cohort study included is likely to have yielded weak evidence
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