Patient benefit of dog-assisted interventions in health care: a systematic review

The effect of animal assisted rehabilitation practices on symptoms of Alzheimer's patients: systematic review and meta-analysis

OBJECTIVE

To determine the impact of animal-assisted rehabilitation interventions on symptom management in Alzheimer's disease patients.

METHODS

This study is a systematic review and meta-analysis based on PRISMA 2022 guidelines, which adhered to the Cochrane 2021 guidelines. Databases including PubMed, Web of Science, and Cochrane Library were searched between February 1, 2023, and November 28, 2023. Two authors independently assessed the risk of bias using the Cochrane Collaboration tool. Review Manager 5.4.1 software was utilized for the meta-analysis.

RESULTS

Six randomized controlled trials were included. This meta-analysis demonstrated that animal-assisted rehabilitation interventions significantly impacted physical outcomes, such as improving physical competence and independence in basic daily living activities, as well as psychological outcomes, including reducing depression and enhancing mini-mental state examination scores in Alzheimer's patients.

CONCLUSION

This meta-analysis revealed that animal-assisted rehabilitation interventions effectively reduce cognitive decline and depression symptoms in Alzheimer's patients.

A bibliometric study for global hotspots and trends in animal-assisted interventions (1983-2023)

Background

As a therapeutic approach, Animal-Assisted Intervention (AAI) has gained increasing recognition for enhancing both psychological and physical health. However, bibliometric studies in this field remain scarce.

Methods

This study aims to analyze AAI-related research from 1983 to 2023 using bibliometric methods. It examines sources of literature, core journals, highly cited documents, country and institutional distribution, prolific authors, and high-frequency keywords while tracking the evolution of research themes in AAI. A thematic search using the Boolean operator "OR" and AAI-related keywords in the Web of Science database yielded 405 articles, and data mining and visualization of these results were performed.

Results

The findings reveal a substantial increase in the number of published articles and citations over the past decade, indicating a rising research interest in this field. The United States and Purdue University have played a leading role in this area. Currently, AAI research is shifting from basic studies to intervention strategies targeting specific populations and diseases. Future research trends may include enhanced international collaboration, standardization of research methods, and the development of more targeted interventions.

Conclusion

These findings provide researchers, funding agencies, and policymakers with scientific insights and recommendations for future research directions in AAI.

Therapy Dogs for Anxiety in Children in the Emergency Department: A Randomized Clinical Trial

Importance

Prior evidence suggests that the use of therapy dogs in emergency care reduces anxiety in adults, but no trial has tested the use of therapy dogs in emergency care of children.

Objective

To examine whether adjunctive use of therapy dogs in standard child-life therapy reduces child-reported and parent-reported child anxiety in a pediatric emergency department (ED).

Design, Setting, and Participants

This randomized clinical trial was conducted from February 1, 2023, to June 30, 2024, at an academic pediatric ED. Children (aged 5-17 years) with suspected moderate to high anxiety were included.

Intervention

All participants received standard child-life therapy, and the intervention group was randomly assigned to have exposure to a therapy dog and handler for approximately 10 minutes.

Main Outcomes and Measures

Anxiety was measured using the 0- to 10-point FACES scale (with 0 indicating no anxiety and 10 indicating very severe anxiety) and salivary cortisol concentrations. Measurements were obtained at baseline (T0), 45 minutes (T1), and 120 minutes (T2) for both child and parents.

Results

A total of 80 patients (mean [SD] age, 10.9 [3.8] years; 45 [56%] female) were enrolled (40 in the control group and 40 in the intervention group). At T0, the mean (SD) FACES scores were 5.4 (2.8) for child report and 6.4 (2.4) for parent report; the means were not different between groups. From T0 to T1, child-reported anxiety changed by a mean (SD) of -1.5 (3.4) points in the control group vs -2.7 (2.5) points in the intervention group (P = .02, Mann-Whitney U test); similarly, mean (SD) parent-estimated child anxiety changed by -1.8 (2.7) points in the control group vs -3.2 (2.3) points in the intervention group (P = .008). A total of 9 children (23%) in the control group had a greater than 2.5-point decrease in FACES score vs 18 (46%) in intervention group (P = .04, Fisher test). At T2, mean (SD) child-reported FACES scores decreased to 3.6 (3.4) points in the control group and 3.0 (2.7) points in the intervention group (P = .70). A total of 14 control participants (35%) received ketamine, midazolam, lorazepam, or droperidol vs 7 (18%) in the intervention group (P = .08, Fisher test). Child and parent salivary cortisol decreased from T0 to T1 in both groups but was not different between groups. Parental salivary cortisol was significantly consistently higher than their children's salivary cortisol (P < .001, unpaired t test, for comparisons of child vs parent at T0 and T1 in both groups).

Conclusions and Relevance

This study of adjunctive use of therapy dogs in standard child-life therapy found a modest but significantly greater reduction in both child-reported and parental-reported child anxiety in the pediatric ED for the intervention vs control group. These findings support the use of therapy dogs to help reduce pain and anxiety without the use of chemical or physical constraint.

Trial Registration

ClinicalTrials.gov Identifier: NCT03784573.

The Experience of Prisoners with Serious Mental Disorders Participating in a Dog-Assisted Therapy Program: A Qualitative Study

(1) Background: This study investigates the experiences of prisoners with serious mental disorders who participated in a two-month dog-assisted therapy program within a Spanish prison. The aim was to understand the emotional and psychosocial impacts of the program on this population. (2) Methods: A qualitative descriptive design was used with purposeful sampling of sixteen prisoners (mean age 43.4) who completed the program. Data were collected through in-depth interviews and analyzed using thematic analysis to identify key themes. (3) Results: Participants reported a positive emotional impact, highlighting the significance of bonding, love, and reciprocal affection with the therapy dog. They emphasized the dog's unconditional nature as a source of comfort and connection. The importance of supportive relationships with the therapists who guided the sessions was also noted. Additionally, participants reflected on their motivations for joining the program and described progressive emotional changes over the course of their participation. (4) Conclusions: Dog-assisted therapy shows potential as a psychosocial intervention to enhance the prison experience for individuals with serious mental disorders. By fostering emotional well-being and positive connections, it may contribute to improved rehabilitation outcomes and better quality of life for this population.

The supporting role of dogs in the inpatient setting: a systematic review of the therapeutic effects of animal-assisted therapy with dogs for children and adolescents in an inpatient setting

Animal-assisted therapy (AAT) is becoming increasingly popular. The possibilities and guidelines for interventions and methods are very diverse. Currently, published studies mainly concentrate on effects in paediatrics, outpatient therapy and schools. Specific recommendations for AAT in the context of inpatient child and adolescent psychiatry do not exist. This systematic review will attempt to evaluate the existing studies in terms of their methodological quality and specify positive and negative effects, aiming to provide a decision-making aid for everyday clinical practice. A systematic literature search (PubMed/MEDLINE, APA PsycINFO, PubPsych, ProQuest, Google Scholar, and Cochrane Library) according to the PRISMA criteria resulted in 1,908 identified hits, of which 49 articles were reviewed in full text. Three raters contributed to the review of the articles using a criteria-guided codebook. This systematic review is listed in the PROSPERO database (CRD42022358909). Quality analysis was conducted using Effective Public Health Practice Project (EPHPP). Five studies were identified. The majority of these showed deficits in quality. Therapeutic effects and positive influences on the psychopathological status, interpersonal relationships and subjective well-being or attitudes towards canine-assisted therapy (CAT) could be identified. Current studies indicate positive therapeutic effects of CAT in the inpatient treatment of children and adolescents. A cautiously positive perspective is warranted, but a general recommendation for CAT cannot be given. CAT should be carefully considered, planned, and implemented by professionals. For the future, further randomised controlled studies including follow-up studies, larger subject groups and clinically evaluated interventions are necessary to validate the current results.

The Impact of Dog-Assisted Therapy Among Children and Adolescents with Autism Spectrum Disorder: A Systematic Review

BACKGROUND AND OBJECTIVES

Animal-assisted therapies have been utilized in various profiles to improve people's quality of life. This systematic review aims to assess the impact of dog-assisted therapies (DAT) on children and adolescents with Autism Spectrum Disorder (ASD). The benefits provided, the feasibility of implementation, and potential limitations are analysed.

METHODS

An exhaustive search was carried out in the following databases: Web of Science (WoS), Scopus, ERIC, PubMed, PubPsych, CINAHL, PsycInfo and Dialnet. The procedure was preregistered on PROSPERO.

RESULTS

This review included 19 scientific articles. Of these, 84% suggest that DAT has a positive impact on communication and social interaction during the development of children and adolescents diagnosed with ASD. The dog is often perceived as a communication facilitator that serves as a reinforcer, capturing the individual's attention. Emotional benefits have also been reported, including reducing stereotyped and self-harming behaviours. Additionally, an increase in smiling frequency and self-esteem levels was observed.

CONCLUSIONS

These findings highlight the potential of DAT as a component of socio-educational intervention for children and adolescents diagnosed with ASD. However, further research is necessary due to the limited sample sizes in the studies reviewed.

Developing a research agenda on NATure-based and Animal-assisted Intervention Strategies (NATAIS) in people with neurodegenerative diseases with a specific focus on social isolation and loneliness: a group concept mapping procedure

BACKGROUND

Social isolation and feelings of loneliness are very prevalent in people with neurodegenerative diseases and are associated with a lower quality of life and other negative outcomes. These problems were increased during the COVID-19 pandemic resulting in initiatives to address social isolation. Given the potential benefits of nature-based and animal-assisted intervention strategies (NATAIS), it is crucial to further investigate if and how these strategies might minimize negative effects of social isolation and feelings of loneliness in this population. Therefore, the aim of this project was to develop a research agenda for NATAIS in people with neurodegenerative diseases, especially during challenging times, such as pandemics.

METHODS

This article outlines the process and results of a group concept mapping procedure aimed at developing a research agenda based on a logic model. In total, 19 work group members participated through a combination of in-person and online group meetings. Additionally, face-to-face group sessions were held at two international scientific conferences, during which feedback was solicited from 12 experts in the field of NATAIS and psychogeriatrics.

RESULTS

The group concept mapping procedure resulted in 14 clusters describing various future research topics, which were further refined and detailed during group discussions. The remaining eleven clusters, encompassing important research themes within the field of NATAIS, were organized into a logic model and summarized into the research agenda. The overarching cluster 'ethical issues, possible risk factors, and their solutions' was considered the most relevant during times of increased social isolation, such as during a pandemic, along with the necessity for more accessible NATAIS.

CONCLUSIONS

This project resulted in a research agenda, directing future research and fostering collaboration between practitioners and researchers in the field of NATAIS. Such an enhanced partnership between science and practice has the potential to significantly contribute to the well-being of people with neurodegenerative diseases, in their daily lives and also during pandemics.

Animal-assisted interventions in adult hospital rehabilitation settings: A scoping review

Animal-assisted interventions (AAIs) have the potential to enhance people's well-being and function and are increasingly being implemented across a range of settings. This scoping review explored how AAIs have been used in adult hospital rehabilitative care. Using JBI and PRISMA-ScR guidelines, a systematic search of four databases was undertaken. Inclusion criteria involved adults, aged >18 years, who had received AAIs in the hospital rehabilitation setting. Twenty-two articles met the inclusion criteria. Results identified two intervention types: visitation activities (n = 8 studies) and structured therapeutic interventions (n = 14 studies). Dogs were the most common animal species. Improvements in social and emotional well-being were reported across both types of interventions, with improvements in ambulation, motor skills, and verbal communication reported by those engaged in structured therapeutic interventions. Implementation challenges included a dependency on volunteer dog-handlers; the need for better recording of interventions in medical records to enable evaluation; and cost, safety, infection control, and animal welfare considerations. Strengthening the planning of AAIs is fundamental for the realization of potential outcomes from human-animal interactions in hospital rehabilitative care.

Evidence-based analysis of multi-pronged approaches for education and behavior management of autistic patients in a dental setting

BACKGROUND

Autism spectrum disorder is a neurodevelopmental condition which has posed a challenge to carers, pediatricians and dentists through the years. Over the last four decades, the disorder has been better understood and management techniques have evolved. In the field of dentistry, the autistic child presents difficulty in management, even for the simplest dental procedures. A comprehensive understanding of other psychoeducational and behavioral approaches to manage autism is very important. This article aims to introduce various important key techniques such as Applied Behavior Analysis, TEACCH, Sensory Adapted Dental Environment, Picture Exchange Communication System, and Animal Assisted Therapy and analyze their application in dentistry.

METHODS

A search of literature was carried out in Clinicaltrials.gov, Medline and Scopus with the search terms "Applied Behavior Analysis," "TEACCH," "Sensory Adapted Dental Environment," "Picture Exchange Communication System," and "Animal Assisted Therapy" along with "autism OR autistic," "dental OR dentistry OR oral health." After the screening for inclusion and exclusion criteria, 10 eligible articles were included, in English, published within the last 10 years.

RESULTS

Limited research was available regarding these lesser-known behavioral approaches in dentistry. The few that were available showed encouraging results. The different techniques proved useful in increasing acceptance of dental treatment and reducing behavioral disturbances. The patients experienced reduced dental anxiety, lesser discomfort, improved communication, and knowledge.

CONCLUSION

Pediatric and special care dentists are likely to benefit by incorporating the recommended comprehensive behavior management techniques in their practice. There is evidence that these techniques will reduce behavioral disturbances in autistic children thereby making primary dental care possible without the need for sedation or general anesthesia.

Developing and Planning a Protocol for Implementing Health Promoting Animal Assisted Interventions (AAI) in a Tertiary Health Setting

The Ottawa Charter identifies that multiple levels of government, non-government, community, and other organizations should work together to facilitate health promotion, including in acute settings such as hospitals. We outline a method and protocol to achieve this, namely an Action Research (AR) framework for an Animal Assisted Intervention (AAI) in a tertiary health setting. Dogs Offering Support after Stroke (DOgSS) is an AR study at a major tertiary referral hospital. AAI has been reported to improve mood and quality of life for patients in hospitals. Our project objectives included applying for funding, developing a hospital dog visiting Action Research project, and, subsequent to ethics and governance approvals and finance, undertaking and reporting on the Action Research findings. The Action Research project aimed to investigate whether AAI (dog-visiting) makes a difference to the expressed mood of stroke patients and their informal supports (visiting carers/family/friends), and also the impact these visits have on hospital staff and volunteers, as well as the dog handler and dog involved. We provide our protocol for project management and operations, setting out how the project is conducted from conception to assess human and animal wellbeing and assist subsequent decision-making about introducing dog-visiting to the Stroke Unit. The protocol can be used or adapted by other organizations to try to avoid pitfalls and support health promotion in one of the five important action areas of the Ottawa Charter, namely that of reorienting health services.

'Pawing' uncertainty! how dogs attenuate the impact of daily hassles at work on uncertainty

PURPOSE

This study relied on the integrative model of uncertainty tolerance to delineate an argument proposing that daily hassles trigger uncertainty, and this influences adaptive performance. Furthermore, relying on the "furr-recovery method" -where interactions with dogs allow dog owners to recover from negative situations or job demands - this study tested whether having a dog would moderate the relationship between daily hassles and uncertainty.

METHODOLOGY

To test this proposed model, daily data during ten working days was gathered with a sample of white-collar workers who were teleworking (N = 233 × 10 = 2,330).

FINDINGS

Multilevel results showed that daily hassles influenced adaptive performance via perceived uncertainty. However, the relationship between daily hassles and uncertainty was conditional on the ownership of a dog, in such a way that the relationship became weaker for those who had dogs. That is, those who did not have dogs had increased levels of uncertainty after daily hassles when compared to those who had dogs.

PRACTICAL IMPLICATIONS

Managers may consider the adoption of pet-friendly work practices (for instance, telework - working from home allow employees to work nearby and interact with their dogs during worktime) as dogs appear to have a beneficial effect to help employees effectively cope with daily hassles and reduce their uncertain reactions.

ORIGINALITY

This study advances knowledge regarding the pawing-effect (the reduced uncertainty to daily hassles on dog owners) on employees' uncertainty to daily hassles and opens new venues for research regarding their role in work-related outcomes. Further, future research could examine how human-dog interactions or the quality of their relationship may benefit owners and explore the benefits of bringing dogs to work periodically.

Dog assisted education in children with rheumatic diseases and adolescents with chronic pain in Germany

Objectives

Animal assisted intervention is an increasingly accepted tool to improve human well-being. The present study was performed to assess whether dog assisted education has a positive effect on children suffering from rheumatic disorders with pain and adolescents with chronic pain syndrome.

Design

Two groups of juvenile patients were recruited: 7-17-year-old children in children with rheumatic diseases and adolescents with chronic pain syndromes. Overall, n=26 participated in the intervention, and n=29 in the control group.

Setting

The intervention group met once a month, 12 times overall, for working with man trailing dogs in various locations.

Main outcome measures

The influence of dog assisted education on quality of life (PedsQLTM Scoring Algorithm), pain intensity, perception, coping (Paediatric Pain Coping Inventory-Revised), and state anxiety (State Trait Anxiety Inventory) was assessed.

Results

The quality of life increased significantly in the investigated period, but for both, the intervention and the control group. The state anxiety of children was lower after the dog assisted education than before. After the dog training sessions, state anxiety was 18% to 30% lower than before the intervention. Some participants noted subjectively improved pain coping and changes in pain perception, which were not found in the data.

Conclusion

Our results indicate that for children with rheumatic diseases and adolescents with chronic pain syndromes dog assisted education (1) might lead to an increase of the quality of life, (2) leads to decreased state anxiety from pre to post intervention and (3) does not influence pain perception, frequency and intensity.

Evaluation of Dog Presence as a Therapeutic Classroom Intervention

BACKGROUND

The American Association of Colleges of Nursing has called on nurse educators to increase mental health support for nursing students. Animal visit programs reduce stress, anxiety, and negative mental health feelings; however, most are intermittent and occasional. This pilot study explored the feasibility, acceptability, and outcomes of integrating a therapy dog into the classroom.

METHOD

This pretest-posttest, two-group design study included 67 baccalaureate nursing students. Two sections of a course were taught: one section included a therapy dog and one section did not.

RESULTS

At the end of the course, participants in the intervention group showed improvement in stress, anxiety, and happiness, whereas participants in the control group did not demonstrate any improvement. Students reported positive feelings and benefits from the presence of the therapy dog.

CONCLUSION

Integrating a trained therapy dog into the classroom is both feasible and acceptable, with students identifying positively with the experience. [J Nurs Educ. 2023;62(6):355-358.].

Immunocompromised Children and Young Patients Living with Pets: Gaps in Knowledge to Avoid Zoonosis

Methods

A cross-sectional, observational study was performed in a large tertiary hospital in Madrid, including immunosuppressed patients from different regions of Spain. The participants were asked to complete an online questionnaire.

Results

Two hundred and eighty-four responses were received: 62.3% solid organ transplantation (177/284), 22.8% hematopoietic stem cell transplantation (65/284), and 14.8% inborn errors of immunity (42/284). The median age was 11 years (interquartile range 5.9-15.4), and 55% were boys (156/284). Up to 45% (130/284) of the respondents lived with 201 pets (74% of them dogs and cats). Half of the patients owning dogs or cats did not comply with at least one of the recommendations regarding vaccination, deworming, feeding, and/or veterinarian recommended controls. The poorest findings were related to deworming regimens. Only 42.8% (117/273) of the participants received specific recommendations from their healthcare professionals about companion animals. However, up to 97% of the families considering acquiring a pet did so when the professional did not contraindicate it (31/32), while 72% of the families having pets got rid of their pets when they were advised against animals (8/11).

Conclusions

Pet ownership is frequent among immunocompromised children. They presented risky exposures for acquiring zoonoses, and basic veterinary recommendations were not frequently followed. The opinion of professionals significantly influenced the decision to acquire pets, but less than half of the families received recommendations in this regard.

Understanding the Role of Therapy Dogs in Human Health Promotion

Dogs may provide humans with a range of physical, mental and social benefits. Whilst there is growing scientific evidence of benefits to humans, there has been less focus on the impact to canine health, welfare and ethical considerations for the dogs. The importance of animal welfare is increasingly acknowledged, indicating that the Ottawa Charter should be extended to include the welfare of non-human animals supporting the promotion of human health. Therapy dog programmes are delivered across a variety of settings including hospitals, aged care facilities and mental health services, highlighting the important role they play in human health outcomes. Research has shown that that there are biomarkers for stress in humans and other animals engaged in human-animal interactions. This review aims to assess the impact of human-animal interactions on therapy dogs engaged in providing support to human health. While challenging, it is paramount to ensure that, within the framework of One Welfare, the welfare of therapy dogs is included, as it is a key factor for future sustainability. We identified a range of concerns due to the lack of guidelines and standards to protect the wellbeing of the dogs engaged in these programmes. Extension of the Ottawa Charter to include the welfare of non-human animals with leveraging through a One Welfare approach would promote animal and human health beyond current boundaries.

What are the effects of animals on the health and wellbeing of residents in care homes? A systematic review of the qualitative and quantitative evidence

BACKGROUND

There is some evidence to suggest that animal-assisted interventions can have beneficial impact for residents in long-term care, but the focus of the evidence has largely been on behavioural and psychosocial measured outcomes. Animals, either as companion animals or in the form of pet/animal-assisted therapy, may provide benefits in the form of social contact, as well as opportunities for sensory experiences and meaningful engagement not picked up by outcome tools. This review aimed to create a state-of-knowledge synthesis, bringing together qualitative and quantitative findings, on the impact of animal-human interaction on care home residents and care home staff.

METHODS

Fourteen databases were searched from inception to July 2020. Forward and backward citation chasing of included articles was conducted. Screening was undertaken independently by a team of reviewers. Thematic synthesis and meta-analysis were used to synthesise the qualitative and quantitative data.

RESULTS

Thirty-four studies, published in 40 articles (20 qualitative and 20 quantitative) were included. Five themes relating to resident wellbeing were identified in the qualitative evidence synthesis. These were animals as 'living beings', reminiscence and storytelling, caring (as 'doing' and 'feeling'), respite (from loneliness, institutionalisation, and illness), and sensory engagement. A sixth theme related to staff perceptions and wellbeing, and a seventh to animal health and wellbeing. Maintaining identity was identified as an overarching theme. The majority of randomised trials had small sample sizes and were rated as low quality, mostly showing no evidence of beneficial effect. There was, however, limited evidence of a positive effect of pet/animal interaction on outcomes of loneliness, anxiety and depression, supporting the themes of respite and sensory engagement.

CONCLUSIONS

The presence of animals can significantly impact the health and wellbeing of some care home residents. Residents had meaningful relationships with animals and derived pleasure and comfort from them. Interacting with animals offered residents a way to maintain a sense of self in the care homes, and with support, residents with dementia could also express their identities. Facilitating residents to interact with animals as part of person-centred care may also help residents to feel 'at home' in the care home.

TRIAL REGISTRATION

PROSPERO registration no: CRD42017058201.

Animal-assisted activities in the intensive care unit: A scoping review

BACKGROUND

Animal-assisted activities have demonstrated benefits for patients and clinicians in acute care settings. However, concern exists regarding the use of animal-assisted activities in intensive care settings.

AIM

To synthesise research evidence on animal-assisted activities in intensive care units.

METHODS

A scoping review of research literature published in English was undertaken. In May 2021, five databases (CINAHL, MEDLINE, Embase, Scopus and PSYCInfo) were systematically searched. Title, abstract and then full text screening was undertaken independently by the research team.

RESULTS

Six primary research studies were identified from the 1190 records screened. All six studies were of a feasibility or observational study design, with five of the studies published in the last three years, highlighting the emerging evidence base for this practice. This scoping review synthesises the key characteristics of animal-assisted activities in intensive care units, including risk mitigation strategies. Strong satisfaction with and support for animal-assisted activities was reported by patients, family members and clinicians. However, studies reporting biophysical outcomes were inconclusive due to small sample sizes.

CONCLUSIONS

Evidence supporting animal-assisted activities in intensive care units remains largely anecdotal. Further research is required to ascertain the feasibility, appropriateness, meaningfulness and effectiveness of animal-assisted activities for improving patient outcomes, and family members and intensive care clinicians' wellness.

Animal-Assisted Interventions Improve Mental, But Not Cognitive or Physiological Health Outcomes of Higher Education Students: a Systematic Review and Meta-analysis

Due to the high burden of mental health issues among students at higher education institutions world-wide, animal-assisted interventions (AAIs) are being used to relieve student stress. The objective of this study was to systematically review of the effects of AAIs on the mental, physiological, and cognitive outcomes of higher education students. Randomized controlled trials using any unfamiliar animal as the sole intervention tool were included in this review. Study quality was assessed using the Cochrane Risk-of-Bias tool. Where possible, effect sizes (Hedges' g) were pooled for individual outcomes using random-effects meta-analyses. Albatross plots were used to supplement the data synthesis. Of 2.494 identified studies, 35 were included. Almost all studies used dogs as the intervention animal. The quality of most included studies was rated as moderate. Studies showed an overall reduction of acute anxiety and stress. For other mental outcomes, studies showed smaller, but nonetheless beneficial effects. Studies showed no clear effect on physiological or cognitive outcomes. Strong methodological heterogeneity between studies limited the ability to draw clear conclusions.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11469-022-00945-4.

Pets for pediatric transplant recipients: To have or not to have

Pets have many health, emotional and social benefits for children, but the risk of zoonotic infections cannot be underestimated, especially for immunosuppressed patients. We report the recommendations given by health professionals working with pediatric transplant recipients to their families regarding pet ownership. An online survey addressing zoonosis knowledge and recommendations provided by health care practitioners regarding pets was distributed to clinicians treating pediatric transplant recipients. The European Society of Pediatric Infectious Disease (ESPID) and the European Reference Network ERN-TransplantChild, which works to improve the quality of life of transplanted children, allowed the online distribution of the survey. A total of 151 practitioners from 28 countries participated in the survey. Up to 29% of the respondents had treated at least one case of zoonosis. Overall, 58% of the respondents considered that the current available evidence regarding zoonotic risk for transplanted children of having a pet is too scarce. In addition, up to 23% of the surveyed professionals recognized to be unaware or outdated. Still, 27% of the respondents would advise against buying a pet. Practitioners already owning a pet less frequently advised patients against pet ownership, whereas non-pet-owners were more keen to advise against pet ownership (p = 0.058). 61% of the participants stated that there were no institutional recommendations regarding pets in their centers/units. However, 43% of them reported therapeutic initiatives that involved animals in their centers. Infectious disease specialists were more likely to identify zoonotic agents among a list of pathogens compared to other specialists (p < 0.05). We have observed a huge heterogeneity among the recommendations that health care providers offer to families in terms of risk related to pet ownership for transplant recipients. The lack of evidence regarding these recommendations results in practitioners' recommendations based on personal experience.

Fisioterapia com brinquedos e terapia assistida por cães em lactentes: estudo observacional

RESUMO O objetivo deste trabalho foi comparar a fisioterapia com brinquedos com a terapia assistida por cães no desenvolvimento neuromotor de lactentes de quatro meses de idade com e sem alterações neuromotoras. Trata-se de pesquisa descritiva e observacional de caráter qualitativo, realizada com 10 lactentes, que foram avaliados pela escala motora infantil de Alberta (EMIA), divididos em grupo 1 (G1) e grupo 2 (G1) e subdivididos em grupo brinquedo (G1B e G2B) e grupo cão (G1C e G2C) para a realização das intervenções quinzenais. O questionário Affordances in the Home Environment for Motor Development - Infant Scale (AHEMD-IS) foi escolhido para avaliar as oportunidades presentes no ambiente domiciliar. A análise de dados qualitativos foi feita por meio de fotos e filmagens. A presença do cão nos grupos G1C e G2C resultou em um ambiente descontraído e divertido, interesse dos lactentes em tocar o pelo do animal, movimentos alternados de membros, contato visual, emissão de sons, evolução na interação social e sentimento de segurança. Nos grupos G1B e G2B, constatou-se diminuição da motivação, ausência de emissão de sons pelos lactentes e contato visual e interesse pelo toque restrito a brinquedos que tivessem diversas cores e sons, havendo pouca agitação e motivação para as habilidades motoras nesses grupos. Conclui-se que a presença do cão promoveu melhores resultados motores, sociais, afetivos e cognitivos. A terapia assistida por animais pode ser um método eficaz para auxiliar na fisioterapia convencional de lactentes com atraso no desenvolvimento neuropsicomotor.

Physical therapy with toys and dog-assisted therapy in infants: observational study

ABSTRACT This study aimed to compare physical therapy with toys with dog-assisted therapy in the neuromotor development of 4-month-old infants with and without neuromotor alterations. This is a qualitative descriptive and observational study carried out with 10 infants, who were evaluated by the Alberta Infant Motor Scale, divided into Group 1 (G1) and Group 2 (G1), and subdivided into Toy Group (TG1 and TG2) and Dog Group (DG1 and DG2) for the performance of fortnightly interventions. By the Affordances in the Home Environment for Motor Development - Infant Scale, we assessed the opportunities present in the home environment. Qualitative data were analyzed using photos and videos. The presence of a dog in DG1 and DG2 resulted in a relaxed and fun environment, infants interested in touching the animal’s fur, alternating limb movements, eye contact, sound production, increased social interaction, and feeling of security. In TG1 and TG2, decrease in motivation was observed as well as the absence of sound production and eye contact by infants, and interest in touch restricted to toys that had different colors and sounds, with little agitation and motivation for motor skills in those groups. We concluded that the dog’s presence promoted better motor, social, affective, and cognitive results. Animal-assisted therapy can be an effective method to support conventional physical therapy for infants with delayed neuropsychomotor development.

Outcomes of a controlled trial with visiting therapy dog teams on pain in adults in an emergency department

CONTEXT

Pain is a primary reason individuals attend an Emergency Department (ED), and its management is a concern.

OBJECTIVES

Change in symptoms and physiologic variables at 3 time points pre-post a ten-minute St. John Ambulance therapy dog team visit compared to no visit in ED patients who experienced pain.

DESIGN, SETTING AND PARTICIPANTS

Using a controlled clinical trial design, pain, anxiety, depression and well-being were measured with the Edmonton Symptom Assessment System (revised version) (ESAS-r) 11-point rating scales before, immediately after, and 20 minutes post- therapy dog team visit with Royal University Hospital ED patients participating in the study (n = 97). Blood pressure and heart rate were recorded at the time points. Control data was gathered twice (30 minutes apart) for comparison (n = 101). There were no group differences in age, gender or ethnicity among the control and intervention groups (respectively mean age 59.5/57.2, ethnicity 77.2% Caucasian/87.6%, female 43.6% /39.2%, male 56.4%/60.8%,).

INTERVENTION

10 minute therapy dog team visit in addition to usual care.

MAIN OUTCOME MEASURES

Change in reported pain from pre and post therapy dog team visit and comparison with a control group.

RESULTS

A two-way ANOVA was conducted to compare group effects. Significant pre- post-intervention differences were noted in pain for the intervention (mean changeint. = -0.9, SD = 2.05, p = .004, 95% confidence interval [CI] = [0.42, 1.32], ηp2 = 04) but not the control group. Anxiety (mean changeint. = -1.13, SD = 2.80, p = .005, 95% CI = [0.56, 1.64], ηp2 = .04), depression (mean changeint. = -0.72, SD = 1.71, p = .002, 95% CI = [0.39, 1.11], ηp2 = .047), and well-being ratings (mean changeint. = -0.87, SD = 1.84, p < .001, 95% CI = [0.49, 1.25], ηp2 = .07) similarly improved for the intervention group only. There were no pre-post intervention differences in blood pressure or heart rate for either group. Strong responders to the intervention (i.e. >50% reduction) were observed for pain (43%), anxiety (48%), depression (46%), and well-being (41%).

CONCLUSIONS

Clinically significant changes in pain as well as significant changes in anxiety, depression and well-being were observed in the therapy dog intervention compared to control. The findings of this novel study contribute important knowledge towards the potential value of ED therapy dogs to affect patients' experience of pain, and related measures of anxiety, depression and well-being.

TRIAL REGISTRATION

This controlled clinical trial is registered with ClinicalTrials.gov, registration number NCT04727749.

Colonization of Dogs and Their Owners with Staphylococcus aureus and Staphylococcus pseudintermedius in Households, Veterinary Practices, and Healthcare Facilities

There are uncertainties with respect to the transmission of methicillin-susceptible and methicillin-resistant Staphylococcus aureus (MSSA and MRSA) and Staphylococcus pseudintermedius between dogs and humans. In this study, we investigated concomitant nasal colonization of dogs and humans in three cohorts. Cohort I, households owning dogs: In 42 of 84 households, 66 humans (36.9%) and 10 dogs (8.9%) carried S. aureus. MRSA, attributed to sequence type (ST) 22 and ST130, were detected in two (1.1%) of the humans but in none of the dogs. Typing by means of spa-typing and whole-genome sequencing (WGS) indicated eight transmissions of S. aureus between humans and dogs in 8 of 42 (19.0%) households with human S. aureus carriers, whereas in 11 of 38 (29.0%) households with ≥two persons and S. aureus colonization of humans, 15 human-to-human transmissions were observed (p = 0.43). S. pseudintermedius was isolated from 42 dogs (37.5%), but from only one human (0.6%). In this case, WGS-based typing indicated strong relatedness of this isolate with a canine isolate from the same household. Cohort II, dogs and their owners visiting a veterinary practice: Among 17 humans and 17 dogs attending a veterinary practice, MSSA was detected in three humans and two dogs, and S. pseudintermedius in only six dogs. Cohort III, dogs used for animal-assisted interventions in human healthcare facilities and their owners: MSSA was obtained in 1 of 59 dogs (1.7%) and in 17 of 60 (28.3%) of the dog owners, while S. pseudintermedius was isolated from seven (12%) dogs and one (1.7%) human owner. We conclude that the risk of exchanging S. aureus/MRSA between humans and dogs is higher than that for S. pseudintermedius.

Improving the Emotional Distress and the Experience of Hospitalization in Children and Adolescent Patients Through Animal Assisted Interventions: A Systematic Review

Introduction

Animal Assisted Interventions (AAIs) are increasingly common in pediatric care settings as a means to promote the physical, mental, and emotional well-being of hospitalized children and adolescents.

Objectives

The aim of this work was to review published studies implementing AAIs in hospital settings and to assess the effects of AAIs on the biobehavioral response to stress and pain, social behavior, quality of life and level of satisfaction with hospitalization in children and adolescents. Stress and burden, quality of life, mood and level of satisfaction with hospitalization in parents/caregivers as well as stress and burden, perception of the work environment and job satisfaction in hospital staff were also reviewed.

Methods

All published studies reporting quantitative assessments were systematically searched using PubMed, Scopus, ProQuest and Web of Science databases in accordance with PRISMA guidelines. The aim was to identify studies examining the effects of AAIs on behavioral, psychological and physiological responses to stress in children and adolescents (0-18 years) formally admitted to a hospital for a stay, as well as in those undergoing a visit for treatments or medical examinations.

Results

Of the 350 studies screened, 21 were eligible for inclusion. Most of them focused on stress, pain, and anxiety reduction in pediatric patients, and used both physiological parameters and behavioral and psychological observations/scales. All studies employed dogs. Results show the potential of AAIs to reduce anxiety and behavioral distress in pediatric patients while acting on physiological measures associated with arousal.

Conclusion

Although further, more rigorous studies are still needed, the findings of this review may have implications for clinical practices suggesting appropriate planning of AAIs by pediatric healthcare professionals.

Systematic Review Registration

[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=178993], identifier [CRD42020178993].

Pet therapy in the emergency department and ambulatory care: A systematic review and meta-analysis

BACKGROUND

Pet therapy, or animal-assisted interventions (AAIs), has demonstrated positive effects for patients, families, and health care providers (HCPs) in inpatient settings. However, the evidence supporting AAIs in emergency or ambulatory care settings is unclear. We conducted a systematic review to evaluate the effectiveness of AAIs on patient, family, and HCP experience in these settings.

METHODS

We searched (from inception to May 2020) Medline, Embase, Cochrane CENTRAL, PsycINFO, and CINAHL, plus gray literature, for studies assessing AAIs in emergency and ambulatory care settings on: (1) patient and family anxiety/distress or pain and (2) HCP stress. Screening, data extraction, and quality assessment were done in duplicate with conflicts adjudicated by a third party. Random-effects meta-analyses are reported as mean differences (MDs) or standardized mean differences (SMDs) and 95% confidence intervals (CIs), as appropriate.

RESULTS

We included nine randomized controlled trials (RCTs; 341 patients, 146 HCPs, 122 child caregivers), four before-after (83 patients), and one mixed-method study (124 patients). There was no effect across three RCTs measuring patient-reported anxiety/distress (n = 380; SMD = -0.36, 95% CI = -0.95 to 0.23, I²  = 81%), while two before-after studies suggested a benefit (n = 80; SMD = -1.95, 95% CI = -2.99 to -0.91, I²  = 72%). Four RCTs found no difference in measures of observed anxiety/distress (n = 166; SMD = -0.44, 95% CI = -1.01 to 0.13, I²  = 73%) while one before-after study reported a significant benefit (n = 60; SMD = -1.64, 95% CI = -2.23 to -1.05). Three RCTs found no difference in patient-reported pain (n = 202; MD = -0.90, 95% CI = -2.01 to 0.22, I²  = 68%). Two RCTs reported positive but nonsignificant effects on HCP stress.

CONCLUSIONS

Limited evidence is available on the effectiveness of AAIs in emergency and ambulatory care settings. Rigorous studies using global experience-oriented (or patient-identified) outcome measures are required.

A Systematic Literature Review of Animal-Assisted Interventions in Oncology (Part I): Methods and Results

Animal-assisted interventions (AAIs) use human-animal interactions to positive effect in various contexts including cancer care. As the first installment of a 2-part series, this systematic literature review focuses on the research methods and quantitative results of AAI studies in oncology. We find methodological consistency in the use of canines as therapy animals, in the types of high-risk patients excluded from studies, and in the infection precautions taken with therapy animals throughout cancer wards. The investigated patient endpoints are not significantly affected by AAI, with the exceptions of improvements in oxygen consumption, quality of life, depression, mood, and satisfaction with therapy. The AAI field in oncology has progressed significantly since its inception and has great potential to positively affect future patient outcomes. To advance the field, future research should consistently improve the methodological design of studies, report data more completely, and focus more on the therapy animal’s well-being.

Dog training as a complementary intervention to support Veteran mental health and well-being: A scoping review

BACKGROUND

Military veterans in the United States face a number of complex issues and barriers to successful civilian reintegration. Dog training programs offered to these individuals are being used as a complementary intervention to support multiple aspects of veteran reintegration. This scoping review explored the existing literature on dog training programs as a support for veteran mental health and well-being.

METHODS

A scoping review was conducted in accordance with PRISMA guidelines to analyze the existing research on this topic.

RESULTS

Five overarching themes were identified, including improvements to mental health, social benefits, a developed sense of purpose, differing impacts of training methods, and potential negative outcomes associated with stressful demands of training.

CONCLUSION

The results of this review suggested dog training programs have potentially positive effects on veteran mental health but also revealed a few potential negative impacts and the need for further research on this animal-assisted intervention.

Can dogs and cats really help our spinal cord stimulation patients?

OBJECTIVES

Pet ownership has been shown to decrease morbidity and mortality in several aspects of health but has not been studied in chronic pain patients. We evaluate whether subjects who underwent spinal cord stimulation (SCS) and own a pet have improved outcomes compared to non-pet owners.

METHODS

After obtaining IRB approval, we re-contacted 38 subjects who underwent SCS surgery with preoperative and 1-year postoperative data on Numerical Rating Scale (NRS), McGill Pain Questionnaire (MPQ), Oswestry Disability Index (ODI), Beck Depression Inventory (BDI), and Pain Catastrophizing scale (PCS). We examined influence of pets and pet ownership-specific behaviors on improvement in SCS outcomes.

RESULTS

Patients included 24 males/14 females with a mean age of 59.9 ± 11.5 years. At mean follow-up of 12.2 months (range 10-14), there were improvements in NRS, ODI, BDI, PCS and MPQ. Twenty subjects owned pets and 18 did not; all believed pet ownership could improve health. Pet owners improved more on NRS-right now (p = 0.05) and BDI (p = 0.05), and were more satisfied with SCS (p = 0.04). No significant improvement was seen in ODI, MPQ, or PCS. However, PCS did improve in pet owners who exercised their pet (PCS-total, p < 0.01; PCS-helplessness, p < 0.01; PCS-rumination, p = 0.05; PCS-magnification, p = 0.02).

CONCLUSIONS

We provide preliminary evidence that pet ownership is associated with improved pain, depression and SCS satisfaction. Exercising with a pet also appears to be beneficial in limiting pain catastrophizing. Pets show promise as a novel means to improve patient SCS outcomes.

Dog visits in nursing homes - increase complexity or keep it simple? A randomised controlled study

Objective

To compare the immediate response of nursing home residents to dog visits with or without an activity, and the impact of cognitive ability.

Methods

In a randomly controlled trial, 174 nursing home residents were allocated to 12 bi-weekly 10-minute visits: either ordinary dog visits (D, n = 57, 49 analysed), dog visits with an activity (DA, n = 56, 48 analysed), or visits with activity but no dog (A, n = 61, 54 analysed). We recorded frequency and duration of residents’ verbal and physical interactions with the dog and persons. Data were analysed in three periods of four visits (period 1–3) as binomial variables (generalised linear models) or durations (non-parametric statistics).

Results

Both visit type and impairment level affected the likelihood of interacting with the dog (D and DA). In some periods increased cognitive impairment lowered odds of touching the dog in DA visits (period 1: F_1,85 = 5.17, P < 0.05) and talking to it directly (period 1: F_1,90 = 4.60, P < 0.05; period 3: F_1,87 = 5.34, P < 0.05). Throughout, residents talked less to persons during DA visits compared to D and A (P = 0.01–0.05), and level of cognitive impairment correlated negatively with talk duration (P < 0.001). Generally, high cognitive impairment level lowered odds of interacting with (period 1: F_1,89 = 7.89, P < 0.01; period 2: F_1,97 = 6.76, P = 0.01; period 3: F_1,92 = 13.57, P < 0.001) and talking about the activities (period 1: F_1,89 = 13.78, P <0.001; period 2: F_1,88 = 3.27, P = 0.07; period 3: F_1,86 = 3.88, P = 0.05).

Conclusion

Visits without specific activities stimulated residents to interact with the dog, whereas increasing the complexity of dog visits by adding activities resulted in less interaction with the dog for severely impaired residents. The optimal dog visit for the less cognitively impaired residents could include activities and thereby a possibility to interact with the dog in different ways, whereas for severely impaired residents, just being with the dog seems more appropriate.

Benefits of Dog-Assisted Therapy in Patients with Dementia Residing in Aged Care Centers in Spain

(1) Background: Currently, the scientific evidence on the benefits of assisted therapy with dogs in dementia is not clear. In this study, we want to evaluate such benefits through a randomized controlled clinical trial in multiple centers across the country. (2) Methods: The participants were people over 65 years old with dementia, residing in senior centers in Spain (n = 334). The experimental group underwent assisted therapy with dogs based on the Comprehensive Cognitive Activation Program in Dementia, for 8 months, with weekly sessions of 45 min. Data were collected at the commencement, middle, and end of the program, to evaluate the aspects using the Mini-Examination Cognitive, the modified Bartell Index, the Cornell Scale for Depression in Dementia and the Neuropsychiatric Inventory. (3) Results: The results show significant improvements in the experimental group versus the control group in the affective (T1 = p 0.000; T2 = p 0.000) and behavioral (T1 = p 0.005; T2 = p 0.000) aspects, with the affective aspect displaying greater progress in participants with additional depressive (p = 0.022) or anxiety (p = 0.000) disorders, shorter institutionalization periods (r = −0.222, p = 0.004), and those undergoing complementary psychotherapy (p = 0.033) or alternative therapy (p = 0.011). (4) Conclusions: Dog therapy is effective in improving the affective and behavioral aspects of institutionalized patients with dementia.

Effect of Dog-Assisted Therapy on Psychomotor Development of Children with Intellectual Disability

BACKGROUND

Although dog-assisted therapy (DAT) has been used for years, there is still a scarcity of research findings confirming efficacy of the method. The current study was designed to assess effects of DAT on psychomotor development of children with mild intellectual disabilities.

MATERIAL AND METHOD

The study involved 60 children with mild intellectual disabilities, aged 10-13 years, divided into a group participating in a 10-month DAT program, and the control group. Four tests were applied, i.e., finger identification, postural imitation, kinaesthesia, and Bourdon-Wiersma Dot Cancellation Test. The examinations were carried out before the start and at the end of the DAT, and at a two-month follow-up.

RESULTS

The results obtained by the DAT group in all the four tests, at all the three timepoints, were not the same (p < 0.001). No statistically significant differences were found in the measurement at the end of the therapy between the DAT group and the controls. On the other hand, the DAT group achieved significantly better scores (p = 0.001 and p = 0.001), compared to the control, in the follow-up measurements two months after the end of the therapy in postural imitation and finger identification tests.

CONCLUSIONS

Some of the scores achieved by the children in the DAT group improved in the measurements performed over time. Two months after the therapy ended, the children in the DAT group presented greater gains in motor planning (postural imitation test) and in the sense of touch, attention, and concentration (finger identification test), compared to the control group. Although the measurement performed immediately after the therapy did not show significant differences between the DAT group and the controls, the examination carried out at the two-month follow-up identified long-term gains in the treatment group in the domain of motor planning (postural imitation test).

The effects of assistance dogs on psychosocial health and wellbeing: A systematic literature review

Beyond the functional tasks that assistance dogs are trained for, there is growing literature describing their benefits on the psychosocial health and wellbeing of their handlers. However, this research is not only widely disparate but, despite its growth, has not been reviewed since 2012. Our objective was to identify, summarize, and methodologically evaluate studies quantifying the psychosocial effects of assistance dogs for individuals with physical disabilities. Following PRISMA guidelines, a systematic review was conducted across seven electronic databases. Records were independently screened by two authors. Studies were eligible for inclusion if they assessed outcomes from guide, hearing, medical, or mobility service dogs, if they collected original data on handlers' psychosocial functioning, and if the outcome was measured quantitatively with a validated, standardized measure. Studies on psychiatric service dogs, emotional support dogs, and pet dogs were excluded. Of 1,830 records screened, 24 articles were identified (12 publications, 12 theses) containing 27 studies (15 cross-sectional, 12 longitudinal). Studies assessed the effects of mobility (18), hearing (7), guide (4), and medical (2) assistance dog partnerships with an average sample size of N = 83. An analysis of 147 statistical comparisons across the domains of psychological health, quality of life, social health, and vitality found that 68% of comparisons were null, 30% were positive in the hypothesized direction, and 2% were negative. Positive outcomes included significant effects of having an assistance dog on psychological wellbeing, emotional functioning, self-esteem, and vitality. However, it is of note that several methodological weaknesses of the studies make it difficult to draw any definitive conclusions, including inadequate reporting and a failure to account for moderating or confounding variables. Future research will benefit from stronger methodological rigor and reporting to account for heterogeneity in both humans and assistance dogs as well as continued high-quality replication.

Assessing the Outcomes of an Animal-Assisted Intervention in a Paediatric Day Hospital: Perceptions of Children and Parents

Simple Summary

Scientific evidence of the effects of intervention with dogs as a non-pharmacological distraction strategy in child hospital care is still small. In addition, the results of implementation of animal-assisted programmes at a paediatric day hospital are not known. Thus, in this pilot study, we conducted preliminary research on the efficacy of an intervention based on the use of therapy dogs at a Spanish day hospital. An intra-subject quasi-experimental longitudinal design was used. The study showed that implementation of an animal-assisted programme at a paediatric day hospital is feasible. Children and parents both gave this programme their highest satisfaction rating. The results portray a significant improvement in the child’s self-assessment of their emotional well-being. In parallel, the parents confirmed this significant improvement in the child’s mood. The research suggests that conducting an animal-assisted session just before an outpatient medical procedure is an effective approach in the promotion of emotional welfare, a compromised area for a high percentage of paediatric patients during hospitalisation periods.

Abstract

There is a growing interest in the use of animal-assisted intervention (AAI) as a non-pharmacological strategy to improve child welfare in hospitals. However, the efficacy of implementation of programmes based on activities with dogs in a paediatric day hospital is not known. An intra-subject quasi-experimental longitudinal design was used for the purpose of assessing the feasibility of such an intervention, as well as exploring the perceptions of its outcomes by children and parents/guardians. A total of 55 children in outpatient care at a paediatric day hospital participated in an AAI session. The application of this intervention was feasible. Self-assessment by the paediatric patients revealed a statistically significant improvement in their emotional state after the session, which was large in size. Parents confirmed this improvement in their child, perceiving significant changes in their mood, which were large in size. This study suggests that AAI is an effective approach when it comes to promoting the emotional welfare of children during their stay in hospital care environments. Participating in recreational occupations with dogs could contribute in a relevant and efficient way to the development of significant and gratifying experiences and to a more positive perception of healthcare centres on the part of children.

Acceptability of AAI from the Perspective of Elderly Clients, Family Members, and Staff-A Pilot Study

Although animal-assisted interventions (AAIs) are increasingly part of comprehensive rehabilitation and many of its effects are already well described, the methodology for performing AAI depends on the specific patient, animal, and treatment objective. Acceptability of AAI from all involved members is a little explored area. Thus, 214 respondents (32 AAI clients, 146 family members, and 36 healthcare and social care workers; 98 males, 116 females; mean age 46.3 years (±16.5 SD)) completed a list of statements focused on AAI with a dog. This list was distributed directly in nursing homes, retirement homes, and in households with home hospice care. All statements were rated on a Likert scale of 0-3. The results show that AAI is generally very well received, with over 90% of respondents considering AAI to be beneficial. The perception of AAI and trusting the handler with their dog was evaluated very positively, as well as possible concerns about hygiene. The results were in many cases affected by demographic factors of the respondents (age, gender, role in AAI, education, and size of settlement). It seems appropriate in future studies to focus on the attitude of individual groups, and thus advance the methodology of implementing AAI.

Animal-Assisted Therapy Improves Communication and Mobility among Institutionalized People with Cognitive Impairment

Disorders of communication, social relationships, and psychomotricity are often characterized by cognitive impairment, which hinders daily activities and increases the risk of falls. This study aimed to evaluate the efficacy of an animal-assisted therapy (AAT) program in an institutionalized geriatric population with cognitive impairment. The variables evaluated included level of communication and changes in gait and/or balance. We performed a two-arm, parallel controlled, open-label, nonrandomized cluster clinical trial in two nursing home centers from an urban area. Patients in the two centers received 12 weekly sessions of physiotherapy, but the experimental group included AAT with a therapy dog. The study included a total of 46 patients (23 Control Group [CG], 23 Experimental Group [EG]) with a median age of 85.0 years. Of these, 32.6% had mild-moderate cognitive decline (Global Deterioration Scale of Reisberg [GDS] 2-4) and 67.4% severe cognitive decline (GDS 5-6). After the intervention, patients in the CG and EG showed a statistically significant improvement in all the response variables. When comparing both groups, no statistically significant differences were found in any of the Tinetti scale results (measuring gait and balance). However, the communication of patients in the EG, measured on the Holden scale, showed a statistically significant greater improvement postintervention than that of patients in the CG. AAT can be useful as a complementary, effective treatment for patients with different degrees of cognitive decline.

Improving social participation of children with autism spectrum disorder: Pilot testing of an early animal-assisted intervention in Spain

Children with autism spectrum disorder (ASD) experience moderate to profound challenges in relation to the skills required for social participation. Animal-assisted intervention (AAI) is increasingly used within early community care. However, the results of its early application in this population group are not known. This pilot study aimed to explore the feasibility of an early intervention based on the use of therapy dogs and to examine their impact on communication and social interaction skills. A within-subject quasi-experimental longitudinal design was used. The instruments for measuring results were the Assessment of Communication and Interaction Skills (ACIS) and Animal-assisted Therapy Flow Sheet, both based on observation. A total of 19 children with confirmed or probable ASD (with mean age of 46.2 months), cared for in a Spanish therapeutic unit, participated in a median of nine AAI sessions, with a mean duration of 19.9 min per session. The total ACIS score increased significantly between the initial and final assessments of the study, with communication and social interaction skills improving with a large effect size. In the Animal-assisted Therapy Flow Sheet instrument, statistically significant improvements were found in most of the items that evaluate the frequency of child-dog social relationships (look at the dog, touch it, talk to it and get involved in an activity with the animal) and child-therapist relationships (look at the therapist and talk to him/her); the effect sizes ranged from medium to large. In conclusion, the early application of an AAI is feasible and seems to improve communication and social interaction skills, both essential elements for social participation. The results suggest that this intervention may be a beneficial non-pharmacological therapy as a complementary approach within community care for children with ASD in the early years of their life.

Dog-assisted interventions and outcomes for older adults in residential long-term care facilities: A systematic review and meta-analysis

OBJECTIVE

To comprehensively review studies on dog-assisted interventions (DAIs) among older people in residential long-term care facilities (RLTCFs) and to provide an overview of their interventions, outcomes and methodological quality.

METHOD

We searched 18 electronic databases to identify English articles (published January 2000-December 2019) reporting on well-defined DAIs targeting older adults (≥65 years) in RLTCF. Data were extracted by two independent reviewers. Descriptive statistics were produced for quantitative studies, with key themes identified among qualitative studies. Where possible, estimates were pooled from randomised controlled trials using random effects meta-analyses.

RESULTS

Forty-three relevant studies (39 quantitative; 4 qualitative) were identified. The majority of quantitative studies were assessed as low-quality according to the MMAT criteria (n = 26, 67%). Almost half of the quantitative studies (n = 18, 46%) found no significant changes over time or between groups across outcomes measured. The most salient intervention effects included improved social functioning (n = 10), reduced depressive symptoms (n = 6) and loneliness (n = 5). A random-effects meta-analysis revealed a medium effect in favour of DAT on reducing depressive or loneliness symptoms (pooled SMD: 0.66, 95%CI 0.21-1.11; I²  = 50.5; five trials), relative to treatment as usual. However, compared to treatment as usual, no overall effect of DAI on activities of daily living was detected (p = .737). Key themes from qualitative studies included (a) animals as effective transitional objects, (b) the therapeutic value of pets and (c) the significance of the care environment and stakeholders in facilitating DAI.

IMPLICATIONS FOR PRACTICE

The findings of this review indicate that while DAI has value for older people in RLTCF, challenges remain in accurately measuring its impact to provide a stronger evidence-base. Standardisation of DAI service design, delivery and evaluation is required for future research and practice in providing holistic care for older adults.

Systematic Review and Meta-Analysis of the Occurrence of ESKAPE Bacteria Group in Dogs, and the Related Zoonotic Risk in Animal-Assisted Therapy, and in Animal-Assisted Activity in the Health Context

Animal-assisted interventions are widely implemented in different contexts worldwide. Particularly, animal-assisted therapies and animal-assisted activities are often implemented in hospitals, rehabilitation centers, and other health facilities. These interventions bring several benefits to patients but can also expose them to the risk of infection with potentially zoonotic agents. The dog is the main animal species involved used in these interventions. Therefore, we aimed at collecting data regarding the occurrence of the pathogens ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp.) in dogs, in order to draft guidelines concerning the possible monitoring of dogs involved in animal-assisted therapies and animal-assisted activities in healthcare facilities. We performed a literature search using the PRISMA guidelines to examine three databases: PubMed, Web of Science, and Scopus. Out of 2604 records found, 52 papers were identified as eligible for inclusion in the review/meta-analysis. Sixteen papers reported data on E. faecium; 16 on S. aureus; nine on K. pneumoniae; four on A. baumannii; eight on P. aeruginosa; and six on Enterobacter spp. This work will contribute to increased awareness to the potential zoonotic risks posed by the involvement of dogs in animal-assisted therapies, and animal-assisted activities in healthcare facilities.

Managing emotional support animal letters in clinical practice

ABSTRACT

The purpose of this brief report is to inform clinical practice and decision making in addressing the increased number of individuals requesting and receiving emotional support animal (ESA) waivers. It is important for providers including nurse practitioners to carefully consider the diagnostic and legal implications of endorsing ESAs. Nurse practitioners should be aware of the legal implications of writing ESA letters before providing them to their patients, understanding that a letter constitutes a determination of a disability. The literature on this topic is sparse, making it difficult to support the evidence-based practice of writing ESA letters. The therapeutic effects and benefits from human-animal interactions warrant further study in the case of ESAs to further support their use. Ultimately, it is up to the individual provider's clinical judgment supported by due diligence on a case-by-case basis should they decide to provide an ESA letter to their patient.

Risks associated with animal-assisted intervention programs: A literature review

The benefits of animal-assisted interventions (AAI), to utilize companion animals as an adjunctive treatment modality, is well-established and a burgeoning research field. However, few studies have evaluated the potential hazards of these programs, such as the potential for therapy animals to transfer hospital-associated pathogens between individuals and the hospital environment. Here we review the current literature on the possible risks of hospital-based AAI programs, including zoonotic pathogen transmission. We identified twenty-nine articles encompassing reviews of infection control guidelines and epidemiological studies on zoonotic pathogen prevalence in AAI. We observed substantial heterogeneity in infection control practices among hospital AAI programs. Few data confirmed pathogen transmission between therapy animals and patients. Given AAI's known benefits, we recommend that future research utilize a One Health framework to evaluate microbial dynamics among therapy animals, patients, and hospital environments. This framework may best promote safe practices to ensure the sustainability of these valuable AAI programs.

Randomized Trial of Therapy Dogs Versus Deliberative Coloring (Art Therapy) to Reduce Stress in Emergency Medicine Providers

OBJECTIVE

Cognitive stress during shift work contributes to burnout in emergency department (ED) workers. We hypothesize that if physicians and nurses interact with a therapy dog for 5 minutes while on ED shift, both their perceived and their manifested stress levels will decrease.

METHODS

In this single-center, prospective, randomized controlled clinical trial (NCT03628820), we tested the effectiveness of therapy dogs versus coloring a mandala and versus no intervention (control) on provider stress. Consenting emergency medicine physicians and nurses provided three self-reported assessments of stress and saliva samples at the start (T1), at the middle (T2), and near the end (T3) of shift. Thirty minutes prior to T2, participants were randomized to either interacting with a therapy dog or coloring for 5 minutes; controls had neither. Stress was assessed on visual analog scale (VAS, 0-100 mm) and with salivary cortisol (Salimetrics) and the modified Perceived Stress Scale (mPSS-10). To assess potential change in participant behavior, patients of providers in either group were asked to complete an internally derived survey of empathic behaviors displayed by providers at T1 and T3.

RESULTS

We enrolled 122 providers (n = 39 control, n = 40 coloring, n = 43 dog); 48% were residents, and 60% enrolled on an evening shift. At T1, mean (±SD) VAS score was not different between groups (18.2 [±17.8] mm). At T3, VAS tended to increase with coloring (24.5 mm), remain unchanged in controls (20 mm), and decreased slightly with dogs (13.6 mm, p = 0.018 vs. coloring, Tukey's post hoc). Salivary cortisol levels were consistently highest at the beginning of each providers' shift and were significantly decreased versus control in both the dog and the coloring groups (p < 0.05, Tukey's). We observed no difference between groups for the mPSS-10 nor in patient reported survey of empathic behaviors.

CONCLUSION

This randomized controlled clinical trial demonstrates preliminary evidence that a 5-minute therapy dog interaction while on shift can reduce provider stress in ED physicians and nurses.

Dog-assisted therapy in the dental clinic: Part A-Hazards and assessment of potential risks to the health and safety of humans

Background

Dog-assisted therapy in the dental clinic may be an attractive alternative to sedation for anxious patients. Including a dental therapy dog in a clinical setting introduces new hazards and potential risks to health and safety for both humans and animal.

Objectives

The study aims to describe potential hazards associated with risks to humans by having a therapy dog present in the dental clinic and to provide guidance on best practices to minimise and control risks for the patients, the dentist, and the dental clinic staff.

Materials and Methods

Literature searches in Medline, http://Clinicaltrials.gov, and Google Scholar for qualitative and quantitative assessments of hazards and risks associated with the use of therapy dogs in health care settings, in combination with a review of the reference list of the included studies. Identified hazards and risks were analysed with respect for the health and welfare of humans in a dental clinic setting that involves the presence of a therapy dog.

Results

Potential risks to health and safety for humans in dental clinics that offer dog-assisted therapy can be categorised within four general categories of hazards: the dog as a source of zoonotic pathogens and human diseases, exposure to canine allergens, adverse animal behaviour, and dangers associated with high activity in a congested dental clinic operatory. Risks to humans are reduced by maintaining awareness amongst the dental clinic staff and the dog handler of all potential hazards in the dental clinic, and on how to reduce these hazards as well as adverse events that may scare the dental therapy dog.

Conclusions

Risks to the health and safety of humans in the presence of therapy dog in the clinics are present but are low if the dental clinical staff and dog handlers comply with best practices.

Effectiveness of the dog therapy for patients with dementia - a systematic review

BACKGROUND

Dementia represents a mental and economic burden for both patients and their caregivers. Therefore, the aim of this study is to explore the effectiveness of animal assisted therapy (AAT) with special focus on canis therapy among people with dementia, specifically Alzheimer's disease.

METHODS

The key method of this review study is a systematic review of the research studies detected in the Web of Science, Scopus and PubMed. The search was conducted for the studies dating from 2016 till 31 August 2018 because several review studies were published before. Eventually, only six studies were involved into the final analysis.

RESULTS

The findings of this review, based on significant effect sizes, reveal that AAT may work as a beneficial and effective complementary treatment, especially in the area of behavioral and psychological symptoms, for patients with different degree of dementia severity if AAT is targeted at their specific needs and interests.

CONCLUSIONS

More research in the area of methodology for the implementation of AAT is necessary, and more research should be conducted with respect to the use of AAT for the improvement of cognitive functions in people with dementia.