Development of an ICF-based assessment tool for equine-assisted therapy: model structure and reliability.

ABSTRACT

BACKGROUND: Scientific investigation and documentation of equine-assisted therapy has increased over the past several years. Yet there are no standardized and validated tools for evidence-based measurement of processes and outcomes to assess equine-assisted interventions. AIM: The objective of this cross-sectional survey study was to develop a standardized assessment tool for the effective measurement of equine-assisted therapy based on the common language of the International Classification of Functioning, Disability and Health (ICF) framework of the World Health Organization (WHO). DESIGN: Cross-sectional study. SETTING: Six equine-assisted therapy rehabilitation centers in Germany. POPULATION Persons with indications for equine-assisted therapy. METHODS: In a qualitative conceptual portion of the study, four semi-structured focus group interviews were conducted and analyzed with a total of 17 experts and therapists according to the aims, content, and sphere of influence of equine-assisted therapy via structured content analysis. Based on these findings and a linkage to the classification system of ICF, a standardized assessment tool (a general module and three specialized submodules) for equine-assisted therapy was developed. It was field-tested with 116 participants at six locations in a multicenter practical field approach and statistically analyzed via explorative factor analyses and reliability tests. RESULTS: Explorative factor analysis provided support for a three-factor structure for the general module, including psychosocial, motor, and mental functioning scales. For both submodules, i.e., the individual and group settings, a two-factor structure was indicated. Reliability was in the good to excellent range for all modules. CONCLUSIONS: A global 80-item assessment tool, divided into a general and three submodules, provides a first step toward a standardized ICF-based assessment of the effects of equine-assisted therapy. A common language in measuring therapy outcomes could increase synchronization and integration of equine-assisted therapy interventions into the international healthcare system. By applying the ICF in multidisciplinary services in rehabilitation management, improved coordination and networking of all necessary services can be provided. CLINICAL REHABILITATION IMPACT The developed assessment tool contributes to evidence-based outcome-measurement and therapy monitoring of equine-assisted interventions. Prospectively, it could enable cost-effectiveness analyses and comparability with other health system interventions.