Risks and benefits of animal-assisted interventions for critically ill patients admitted to intensive care units

BACKGROUND

Pets offer significant health benefits, from decreased cardiovascular risks to anxiety and post-traumatic stress improvements. Animal-assisted interventions (AAI) are not frequently practiced in the intensive care unit (ICU) for fear of health risk for critical patients because there is a hypothetical risk of zoonoses.

OBJECTIVES

This systematic review aimed to collect and summarize available evidence about AAI in the ICU. The Review questions were "Do AAI improve the clinical outcome of Critically Ill Patients admitted to ICUs?" and "Are the zoonotic infections the cause of negative prognosis?".

METHODS

The following databases were searched on 5 January 2023: Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, and PubMed. All controlled studies (randomized controlled, quasi-experimental, and observational studies) were included. The systematic review protocol has been registered on the International Prospective Register of Systematic Review (CRD42022344539).

RESULTS

A total of 1302 papers were retrieved, 1262 after the duplicate remotion. Of these, only 34 were assessed for eligibility and only 6 were included in the qualitative synthesis. In all the studies included the dog was the animal used for the AAI with a total of 118 cases and 128 controls. Studies have high variability, and no one has used increased survival or zoonotic risk as outcomes.

CONCLUSIONS

The evidence on the effectiveness of AAIs in ICU settings is scarce and no data are available on their safety. AAIs use in the ICU must be considered experimental and follow the related regulation until further data will be available. Given the potential positive impact on patient-centered outcomes, a research effort for high-quality studies seems to be justified.

Robotic animal-assisted therapy as a complementary therapy in clinical practice: Exploring animal-assisted intervention professional perspectives

BACKGROUND

and Purpose: Animal-Assisted Therapy (AAT) is a therapy that incorporates animals to improve the motor, social, behavioral, and/or cognitive functioning of participants. AAT has been shown to be a beneficial intervention for a wide range of populations. Although, researchers have suggested concerns in implementing AAT. The purpose of this study is to gain insight into the perspectives of therapists who incorporate AAT into their programs and to explore benefits and ethical considerations within the field of AAT. This study also aims to seek possible implications for robotic animal-assisted therapy (RAAT).

MATERIALS AND METHODS

Professionals from the Association of Animal-Assisted Intervention Professionals (AAAIP) were recruited, along with members from multiple AAT private and public Facebook groups. Participants completed an anonymous online semi-structured survey, exploring their experience with and perspectives on both AAT and RAAT. Fourteen participants' responses were analyzed using Dedoose software to identify common themes in the responses.

RESULTS

The results of this study provide various perspectives from professionals in different settings on the benefits of AAT, concerns about AAT, and the implication for the utilization of RAAT. The data indicated that most of the participants have not incorporated RAAT into practice. However, many of the participants believed that RAAT can be an alternative or preparatory intervention when interaction with live animals is not possible. The data collected further contributes to an emerging niche setting.

The effects of goldfish on anxiety, fear, psychological and emotional well-being of hospitalized children: A randomized controlled study

AIM

This study aimed to determine the effect of goldfish intervention on anxiety, fear, psychological and emotional well-being of hospitalized children.

MATERIALS AND METHODS

Between November 2020 and August 2021, an open-label, single-center randomized controlled experimental study was conducted in Türkiye's Eastern Anatolia region. The study included 112 children aged 8 to 10 years old (56 in the study group and 56 in the control group). The study and control groups were randomly assigned to strata using a table of random numbers. The children in the study group observed after goldfish intervention for three days. As data collection tools, the State-Trait Anxiety Inventory for Children, Child Fear Scale, and the Stirling Children's Well-being Scale were used.

RESULTS

The mean state anxiety scores of the children in the study group who looked after goldfish intervention decreased significantly compared to the control group. When the two groups were compared, the difference between the post-test measurements were significant (p < 0.05). The mean score of the fear scale in the post-test measurements of the study group children was significantly lower than the control group (p < 0.05). Finally, the emotional, and psychological well-being post-test scale mean scores of the study group children were higher than the control group (p < 0.01).

CONCLUSION

Goldfish intervention was found to be effective in decreasing the state anxiety and fear levels and increasing the psychological and emotional well-being levels of the children in the study group.

Are children and dogs best friends? A scoping review to explore the positive and negative effects of child-dog interactions

Personal wellbeing is greatly influenced by our childhood and adolescence, and the relationships formed during those phases of our development. The human-dog bond represents a significant relationship that started thousands of years ago. There is a higher prevalence of dog ownership around the world, especially in households including children. This has resulted in a growing number of researchers studying our interactions with dogs and an expanding evidence base from the exploration of child-dog interactions. We review the potential effects of child-dog interactions on the physical, mental, and social wellbeing of both species. A search of the SCOPUS database identified documents published between January 1980 and April 2022. Filtering for key inclusion criteria, duplicate removals, and inspecting the references of these documents for additional sources, we reviewed a total of 393 documents, 88% of which were scientific articles. We were able to define the numerous ways in which children and dogs interact, be it neutral (e.g., sharing a common area), positive (e.g., petting), or negative (e.g., biting). Then, we found evidence for an association between childhood interaction with dogs and an array of benefits such as increased physical activities, a reduction of stress, and the development of empathy. Nonetheless, several detrimental outcomes have also been identified for both humans and dogs. Children are the most at-risk population regarding dog bites and dog-borne zoonoses, which may lead to injuries/illness, a subsequent fear of dogs, or even death. Moreover, pet bereavement is generally inevitable when living with a canine companion and should not be trivialized. With a canine focus, children sometimes take part in caretaking behaviors toward them, such as feeding or going for walks. These represent opportunities for dogs to relieve themselves outside, but also to exercise and socialize. By contrast, a lack of physical activity can lead to the onset of obesity in both dogs and children. Dogs may present greater levels of stress when in the presence of children. Finally, the welfare of assistance, therapy, and free-roaming dogs who may interact with children remains underexplored. Overall, it appears that the benefits of child-dog interactions outweigh the risks for children but not for dogs; determination of the effects on both species, positive as well as negative, still requires further development. We call for longitudinal studies and cross-cultural research in the future to better understand the impact of child-dog interactions. Our review is important for people in and outside of the scientific community, to pediatricians, veterinarians, and current or future dog owners seeking to extend their knowledge, and to inform future research of scientists studying dogs and human-animal interactions.

Perceptions and Practices of Key Worker Stakeholder Groups in Hospital Animal-Assisted Intervention Programs on Occupational Benefits and Perceived Risks

BACKGROUND

Animal-assisted intervention (AAI) programs, used widely for patient benefit, have increasingly been used for healthcare workers (HCW) to reduce occupational stress. However, there are barriers to these programs which limit their utilization, for both patients and HCW, specifically infectious disease concerns. The aim of the research project is to identify barriers and facilitators to AAI program use for healthcare worker benefit, and determine knowledge, beliefs, and practices regarding infectious disease risk and control policies, in order to understand the contextual parameters of program implementation.

METHODS

We collected perceptions of key stakeholders involved with hospital AAI programs (HCW and AAI workers) through semi-structured in-depth interviews. We used framework analysis to guide thematic coding, completed independently by three researchers.

RESULTS

We interviewed 37 participants in this study. We divided our themes into two topic areas: program use for HCW and perceived infectious disease risk. Use for healthcare workers included perspectives on the benefits for HCW and program barriers and facilitators (specifically collaboration and leadership). Perceived risk included opinions on infection concerns with AAI, thoughts on control measures to reduce this risk, and responsibility for safety during these programs.

CONCLUSIONS

While significant benefits were reported for HCW, they were limited by administrative barriers and hazard concerns. Facilitators to surmount these barriers are best implemented with collaboration across the hospital and appropriate leadership roles to direct safe program implementation. By addressing these barriers through targeted facilitators in the form of evidence-backed guidelines, AAI programs can be used to benefit both patients and HCW.

Use of animal-assisted interventions in relieving pain in healthcare settings: A systematic review

BACKGROUND AND OBJECTIVE

Therapeutic interaction with animals for patients coping with physical and mental health conditions is a growing interest among healthcare providers and researchers. We aimed to comprehensively summarize and evaluate the current state of evidence examining the use of animal-assisted interventions [AAI] for pain relief in healthcare settings.

DESIGN

Systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement.

METHODS

Two researchers independently assessed publications dated before February 5, 2021 in OVID Medline, CINAHL, and PsychINFO databases, and used the Delphi list to evaluate the quality of the evidence.

RESULTS

Of the 109 studies screened, a total of 24 studies totaling 1,950 participants were ultimately included. Studies varied in design, including single group trials (8), controlled trials with at least two groups (6), and randomized controlled trials (10). The most common form of pain measurement was the visual or numeric rating scale. For the 18 studies that reported data on changes in pain severity from pre-to-post-test, 13 reported a significant reduction; using the converted common metric we created, these reductions ranged from 0.20 to 3.33 points on a 10-point numeric rating scale.

CONCLUSIONS

AAI may be considered a promising approach in need of further, more rigorous research. Available evidence supporting AAI remains weak due to issues of study quality and design, thereby impeding our ability to draw reliable conclusions on the utility of AAI in relieving pain. Given the rapidly increasing availability of these interventions in hospitals, it is important to better understand its effectiveness.

Effects of animal-assisted interventions for people with dementia: A systematic review and meta-analysis

Animal-assisted interventions (AAIs) are non-pharmacological, cost-effective interventions developed to improve outcomes in patients with dementia; however, the effects remain inconclusive. The purpose of this study was to analyze the efficacy of AAIs for people with dementia. A systematic review and meta-analysis was performed of English-language literature published from January 1, 2001, to July 3,2021, and indexed in the following databases: CINAHL, EMBASE, MEDLINE, PubMed, Web of Science, Cochrane, and PsycINFO. Intervention groups were people with dementia who received AAIs. Study quality was assessed using the Joanna Briggs Institute tool. Among 10 included studies, significant differences in depression levels were identified between the intervention and control groups (p < 0.001). No significant differences in cognitive function, neuropsychiatric syndrome, or independence in activities of daily living were observed between groups. Future research remains necessary to examine the effects of AAIs on depression during different stages of dementia. AAIs therapists may collaborate with healthcare workers to improve AAIs benefits.

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.

Animal-Assisted Interventions for School-Aged Children with Autism Spectrum Disorder: A Meta-Analysis

Research has indicated beneficial effects of Animal-Assisted Interventions (AAIs) for children with Autism. However, there is a dearth of meta-analyses and findings are often contradictory. The current meta-analysis assesses the effectiveness of AAIs on social interaction, communication and global Autism symptoms. A total of 1447 studies were returned, of which 16 (n = 489) met the inclusion criteria. The meta-analyses indicated small effect sizes related to improvements in social interaction and communication and reduction in Autism Spectrum Disorder symptoms. Additionally, there was little evidence for a relationship between dosage and effect size. In conclusion, AAIs appear to offer small improvements in social interaction and communication for children with Autism, which may be comparable to activities used in active control conditions.

Human-animal-environment interactions as a context for youth social-emotional health and wellbeing: Practitioners' perspectives on processes of change, implementation, and challenges

BACKGROUND

Human-animal-environment interactions (HAEIs) are increasingly used in interventions for youth with psychosocial challenges, yet research is limited. Staff from an exemplary program that use HAEIs have unique perspectives on the processes involved in youth outcomes. The aim of this study was to elucidate processes of change that may underly HAEIs and key implementation considerations.

MATERIALS AND METHODS

A phenomenological approach was used to ascertain HAEI staff perspectives of how they have seen HAEIs impact youth. Semi-structured interviews were completed with 24 staff at a mental health treatment program that utilizes HAEIs.

RESULTS

Six themes were identified, including views that HAEIs had challenges, afforded youth with valuable opportunities, improved mood, facilitated relationships and self-regulation, and strengthened self-conception.

CONCLUSION

Findings will inform program development; and future research to assess mediating variables and best practices in implementation of HAEIs.

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.

Donkey Therapy and Hippotherapy: Two Faces of the Same Coin?

Animal-assisted interventions are considered an innovative rehabilitation approach to improve social, emotional, and physical domains in several diseases. Among such treatments, the equine-assisted activities and therapies have been developed to support the conventional approaches. There is growing evidence on the beneficial effects of hippotherapy, whereas few data are available regarding donkey therapy. Herein, we compare such treatments, hypothesizing their best application field to reach the proper therapeutic outcomes.

Gazing as a help requesting behavior: a comparison of dogs participating in animal-assisted interventions and pet dogs

Dogs tend to gaze at humans when they are confronted with inaccessible food during an unsolvable task, which is often interpreted as a help requesting behavior. Dogs who participate in animal-assisted interventions (AAI) interact with many people during their lives and prior studies have emphasized the importance of gazing in their communication. We compared the behavior of AAI (n = 15) and pet (n = 16) dogs during an unsolvable task, using a container fixed to a wooden board with inaccessible food inside, while the owner and an unfamiliar woman stood facing each other at the sides of the board ignoring the dog. Results showed that AAI dogs spent significantly more time gazing and alternated their gaze more frequently between the container and the people than pet dogs. In addition, they spent more time in contact with the unfamiliar person. However, no significant differences were found in the time dogs of either group gazed towards the owner compared to the unfamiliar person, in the frequency of gaze alternation or in the time spent interacting with the apparatus. In line with prior studies, these results suggest that gazing may be a significant communicative response in AAI dogs, which could probably contribute to having a better coordination with their handler. A greater understanding of the characteristics of this population may aid the selection and training of AAI dogs, which is particularly relevant given the increased popularity of AAI nowadays.

"We need them as much as they need us": A systematic review of the qualitative evidence for possible mechanisms of effectiveness of animal-assisted intervention (AAI)

OBJECTIVE

Although Animal-Assisted Interventions (AAI) are effective treatments for a variety of psychological problems, the mechanism of treatment effectiveness remains unclear. Qualitative studies of AAI may reveal possible mechanisms. This review aims to synthesize qualitative research and identify factors that might contribute to the effectiveness of AAI.

METHODS

A literature search of qualitative evidence published before August 8^th, 2018 was conducted using the following databases: PubMed, ERIC, PsycARTICLES, PsycINFO, and HABRI, with the aim of identifying qualitative research conducted with individuals undergoing AAI. Quality assessment was undertaken by CASP and the certainty of the evidence was evaluated using CERQual.

RESULTS

A total of 1866 articles were reviewed, and seven were included in the final analysis. A total of six themes were identified as factors relating to the effectiveness of AAI: 1. Fostering feelings of normalcy, 2. Improving behavioral activation, 3. Self-esteem enhancement, 4. Physical contact, belonging, and companionship, 5. Calming and comforting, and 6. Distraction. Barriers to AAI effectiveness were also identified.

CONCLUSION

The results of these studies suggest that AAI was viewed as a positive and highly accepted intervention across populations and settings. AAI might be a useful intervention among people who suffer from a variety of mental disorders. All themes consistently demonstrated that contact with a live animal is more important than the appearance of the animal. Additional investigations of AAI treatment mechanisms are needed.

The role of therapy and service animals in the lives of persons with disabilities

Over the past 20 years, a great deal of attention has been paid to the psychological and physiological impact that animals have on the lives of people with disabilities. The focus of this paper is to demystify the mechanisms that are affected as a consequence of these interactions as well as to describe the value of various types of therapeutic working animals. For human-animal interactions to become more legitimised, more rigorous empirical research needs to be undertaken to demonstrate the value of such interactions as well as the need for changes in the public policy impacting them.

Effectiveness of a Standardized Equine-Assisted Therapy Program for Children with Autism Spectrum Disorder

In this study the effectiveness of an equine-assisted therapy (EAT) in improving adaptive and executive functioning in children with autism spectrum disorder (ASD) was examined (children attending EAT, n = 15, control group n = 13; inclusion criteria: IQ > 70). Therapeutic sessions consisted in structured activities involving horses and included both work on the ground and riding. Results indicate an improvement in social functioning in the group attending EAT (compared to the control group) and a milder effect on motor abilities. Improved executive functioning was also observed (i.e. reduced planning time in a problem-solving task) at the end of the EAT program. Our findings provide further support for the use of animal-assisted intervention programs as complementary intervention strategies for children with ASD.

Animal-Assisted Interventions in Dutch Nursing Homes: A Survey

OBJECTIVES

Animal-assisted interventions (AAI) have become more and more popular in nursing homes in the past decade. Various initiatives for using animals in nursing homes have been developed over the years (eg, animal visiting programs, residential companion animals, petting zoos) and, on the whole, the number of nursing homes that refuse animals on their premises has declined. In this survey, we aimed to determine how many Dutch nursing homes offer AAIs, what type of interventions are used, and with what aim. We also focus on the use of underlying health, hygiene, and (animal) safety protocols.

METHODS

Using an online Dutch nursing home database, we invited all listed (457) nursing home organizations in the Netherlands (encompassing a total of 804 nursing home locations) to participate in our digital survey, powered by SurveyMonkey. The survey consisted of a total of 45 questions, divided into general questions about the use of animals in interventions; the targeted client population(s); and specific questions about goals, guidelines, and protocols. The results were analyzed with SPSS Statistics.

RESULTS

In the end, 244 surveys, representing 165 organizations, were returned: 125 nursing homes used AAI in one way or another, 40 did not. Nursing homes that did not offer AAI cited allergy and hygiene concerns as the most important reasons. Most nursing homes offering AAI used visiting animals, mostly dogs (108) or rabbits (76). A smaller number of nursing homes had resident animals, either living on the ward or in a meadow outside. Almost all programs involved animal-assisted activities with a recreational purpose; none of the participating nursing homes provided animal assisted therapy with therapeutic goals. Psychogeriatric patients were most frequently invited to participate. A total of 88 nursing homes used alternatives when animals were not an option or not available. The most popular alternative was the use of stuffed animals (83) followed by FurReal Friends robotic toys (14). The sophisticated robot seal Paro was used in 7 nursing homes. A large percentage (80%) of nursing homes that worked with animals did not have AAI-specific health protocols or animal welfare and safety protocols underlying the animal activities or specific selection criteria for the selection of suitable animals.

CONCLUSION

Most of the participating Dutch nursing homes offer AAI in recreational programs (animal-assisted activities) for psychogeriatric clients (using visiting animals, especially dogs). Most nursing homes do not have specific AAI protocols for animal welfare, hygiene, and safety during animal activities, nor do they employ specific selection criteria for participating animals and their handlers.

Mental health rehabilitation in a care farm context: A descriptive review of Norwegian intervention studies

BACKGROUND

C are farming is a service developed at farms for promoting mental and physical health and is increasingly used in mental health rehabilitation in Norway.

OBJECTIVE

This article aims to present a descriptive review of Norwegian intervention research on care farms that provide rehabilitation for people with mental health disorders.

METHODS

This literature review applied a non-systematic search strategy: all articles in the field known to the authors were selected for inclusion. The selected studies were intervention studies that were conducted on farms in Norway, that used adult participants with mental health problems/disorders, and that reported outcome measures related to mental health. The studies and articles presented quantitative and/or qualitative data.

RESULTS

The findings from the published articles report improvements to mental health problems, such as depression, anxiety, perceived stress, positive affect, rumination, and self-efficacy. Qualitative data describe a variety of positive experiences, such as improved coping ability, increased social support, and appreciation of the care farm activity.

CONCLUSION

Participating in interventions on care farms positively influences mental health. Care farming may therefore be used as a supplementary approach in mental health rehabilitation, as it offers meaningful and engaging occupations and social inclusion.