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

Lindsay A Gaudet; Sarah A Elliott; Samina Ali; Elise Kammerer; Brandy Stauffer; Bailey Felkar; Shannon D Scott; Liz Dennett; Lisa Hartling

doi:10.1111/acem.14421

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

Acad Emerg Med. 2022 Aug;29(8):1008-1023. doi: 10.1111/acem.14421. Epub 2021 Dec 13.

Authors

Lindsay A Gaudet¹, Sarah A Elliott¹, Samina Ali^{1

2}, Elise Kammerer¹, Brandy Stauffer^{1

3}, Bailey Felkar⁴, Shannon D Scott⁵, Liz Dennett⁶, Lisa Hartling¹

Affiliations

¹ Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
² Faculty of Medicine and Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada.
³ Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
⁴ Children's Hospital at London Health Sciences Centre, London, Ontario, Canada.
⁵ Faculty of Nursing, University of Alberta Edmonton, Edmonton, Alberta, Canada.
⁶ Scott Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada.

PMID: 34817908
DOI: 10.1111/acem.14421

Abstract

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.

Publication types

Meta-Analysis
Review
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Ambulatory Care
Animal Assisted Therapy*
Caregivers*
Emergency Service, Hospital
Humans
Pain