Examining effects of equine-assisted activities to help combat veterans improve quality of life

Abstract

INTRODUCTION It is well documented that a high number (24%) of veterans returning home from military deployments in Iraq and Afghanistan experience varying degrees of posttraumatic stress disorder symptoms and impaired quality of life [1-2]. Helping veterans successfully reintegrate into civilian life has become a focus of both the military and private psychological services, as well as other community-based groups. While psychological treatment for veterans is provided by the Department of Veteran Affairs, the Department of Defense, and private services, many veterans do not seek the help they need out of fear of the negative stigma associated with mental health care [1]. Recently, efforts have been made to reduce barriers to treatment by developing interventions that are more friendly, such as educating unit members about mental health issues and including them in the treatment. In addition, soliciting the support of leaders and supervisors in the identification and assistance of veterans receiving treatment is proving to be beneficial [2]. One specific intervention that incorporates fellow veterans and leader support in the treatment is the Professional Association of Therapeutic Horsemanship (PATH) International Equine Services for Heroes program (formerly known as the Horses for Heroes program). This unique program includes a horse as part of the treatment, with the goal to help wounded military service personnel and veterans improve both physically and mentally [3]. The therapeutic effects of interacting with a horse on the ground or riding on top of the horse are not new and date back to earlier times. The ancient Greeks gave horseback rides to raise the spirits of the chronically and incurably ill [4-5]. It was not until 1875, however, that the first systematic study of therapeutic riding (TR) was reported. After prescribing pony riding as a treatment for a variety of conditions, French physician Chassaign concluded that riding was helpful in the treatment of certain types of neurological paralysis. He noted improvement in posture, balance, and joint movement and a striking increase in morale [6]. The PATH International Equine Services for Heroes program, built on these early findings, is a broad program designed to help veterans through the use of a variety of equine-assisted activities and therapies (EAATs). In an effort to understand how an intervention that partners a veteran with a horse may help improve quality of life, we examined a specific EAAT known as TR. TR uses equine-assisted activities (EAAs) for the purpose of contributing positively to the cognitive, physical, emotional, and social well-being of people with disabilities [3]. Because this program is fairly new, officially started in 2007, little research has been conducted to determine the therapeutic effects on quality of life for veterans. Anecdotal evidence reported by individual riding centers from Web sites, newsletters, and press releases suggests positive outcomes in both physical and mental health from participating in this program, but more research is needed to validate the efficacy of the program. Furthermore, a recent Tricare decision that classified hippotherapy (a specific EAAT program designed to improve physical mobility) as investigational and not reimbursable makes it even more imperative to start the research conversation about the efficacy of using EAAT programs to treat combat veterans with mental and physical wounds. STUDY The purpose of our exploratory study was to begin to address the need for research in EAA by assessing the changes in quality of life indicators and depression symptoms of veterans participating in a PATH International Equine Service for Heroes TR program. Our research design included both qualitative and quantitative data collection over a 24 wk period with 13 veterans. We chose the 36Item Short Form Health Survey version 2 (SF36v2) and Beck Depression Inventory-2nd edition (BDI-II) to assess changes in health behaviors and depression symptoms. …