A SYSTEMATIC REVIEW OF THE EFFECTS OF PSYCHOTHERAPY ...

CHAPTER 4
DISCUSSION
To date, there have been no systematic reviews undertaken to examine the psychosocial
effects of equine-assisted/facilitated interventions on participants without physical disabilities.
Best practice dictates that the decision-making process and data synthesis be designed to reduce
the gaps between clinical practice and the empirical evidence base (Gambrill, 2006). There is a
fine line between the honest brokering of knowledge and adherence to ethical principles and what
is practical and realistic. Interventions involving equines in the therapeutic process are widely
appealing and have captured the imaginations of the public at large and in particular members of
the professional community, but the empirical evidence supporting the use of this treatment
approach remains scant. This purpose of this review is to address the knowledge gap and to
instill a level of confidence in the consideration of the practicality and feasibility of the application
of this approach.
4.1 Effectiveness: Does it work?
This systematic review is an effort to answer several fundamental questions, not the least
of which is whether interventions involving equines are effective. Of the studies reviewed, six
provide relatively strong support for the effectiveness of this approach (Graham, 2007; Kaiser et
al, 2004; Klontz et al, 2007; Russell-Martin, 2006; Schultz et al, 2007; Trotter et al, 2008); of
these six, two (Graham; Trotter) were the most methodologically rigorous of all the studies
reviewed, and were determined to fit the criteria for a moderate level of evidence according to
GRADE recommended guidelines (GRADE Working Group, 2007), which is the highest rating
that an observational study can receive according to this system. The remaining four studies
(Kaiser et al; Klontz et al; Russel-Martin; Schultz et al) met GRADE criteria for a low level of
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