Evidence-Based Medicine (EBM) in horses involves the systematic use of current, peer-reviewed research and clinical expertise to make informed decisions about equine healthcare. EBM aims to integrate the best available scientific data with practical knowledge to optimize treatment outcomes for horses. This approach includes the assessment and application of research findings to guide clinical practices, diagnostic procedures, and therapeutic interventions. By utilizing evidence-based methodologies, veterinarians and equine health professionals can improve the accuracy of diagnoses and the effectiveness of treatments. This page compiles a collection of peer-reviewed research studies and scholarly articles that explore the principles, application, and impact of Evidence-Based Medicine in the field of equine health.
Selby A, Smith-Osborne A.This systematic review examines the empirical literature in an emerging body of evidence for the effectiveness of biopsychosocial interventions involving equines across populations with chronic illness or health challenges. Methods: Selected quantitative studies published in peer-reviewed journals were reviewed for inclusion; the gray literature and white papers were also explored. Population, Intervention, Comparison, and Outcome (PICO) criteria and Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) were applied to all studies. Fourteen full reports meeting a priori inc...
Vandeweerd JM, Coisnon C, Clegg P, Cambier C, Pierson A, Hontoir F, Saegerman C, Gustin P, Buczinski S.Various treatments of osteoarthritis (OA) have been described, including use of nutraceuticals. Objective: To review systematically the literature about the effects of nutraceuticals on clinical signs of pain or abnormal locomotion in horses, dogs, and cats, and to discuss methodological aspects of trials and systematic reviews. Methods: A systematic search of controlled trials evaluating the impact of nutraceuticals on OA in horses, dogs, and cats was performed, using Medline, CAB Abstracts, and Google Scholar. Scientific evidence was evaluated by means of criteria proposed by the Food and Dr...
Clegg PD, Pinchbeck GL.Evidence-based medicine (EBM) refers to the conscientious, explicit, and judicious use of current best evidence from research for the care of an individual patient. Central to the adoption of EBM is both producing and identifying the best possible evidence for a particular intervention or therapy. This article identifies and reviews the approaches to producing and identifying the best possible evidence that is necessary for the full acceptance of stem cell therapies in the horse and reviews the approaches that will allow future clinical studies in stem cell therapies to provide the best eviden...
Shmalberg J, Xie H.Acupuncture exerts diffuse analgesic effects through the release of endogenous opioids and other locally and centrally acting mediators. Successful therapeutic interventions for various musculoskeletal conditions in horses are well documented, and acupuncture may significantly enhance performance. The use of acupuncture is specifically supported in treating nonsurgical gastrointestinal disorders, in which specific techniques can alter motility and contribute to visceral analgesia. This article describes the use of acupuncture and Chinese herbal medicine for equine reproductive management and f...
Stiller L, Depczynski J, Fragar L, Franklin R.Child injury on farms is a significant public health problem. This article describes the evidence and consultation base for development of a national strategy for child safety on farms in Australia. Methods: A data profile describing farm child injury was compiled, with evidence for the effectiveness of solutions being defined and the strength of recommendations determined. Representative working groups played a key role in assessing the evidence and advising on the best ways to communicate prevention messages within the farming community. Results: The main risks identified were drowning; farm...
Bedenice D.One of the fundamental skills required for practicing evidence-based medicine is the development of a well-built clinical question, which specifies the patient group or problem, intervention, and outcome of interest. For this purpose, various "levels of evidence" have been developed in the human literature, which rank the validity of evidence. Our established conclusions and advice are thus supported by specific "grades of recommendations," which are intended to give an indication of the "strength" of a clinical recommendation. This article was compiled with these principles in mind.
Nolen-Walston R, Paxson J, Ramey DW.The use of an evidence-based approach allows veterinary clinicians to assess questions that are clinically relevant to the diagnosis and treatment of equine gastrointestinal tract disease. This approach involves formulating a clinical question, searching the literature, and answering the question with the best available evidence, with the results summarized as a clinical "bottom line." This article is organized to reinforce the principle that the cornerstone of evidence-based medicine is the clinical question. Specific questions are further categorized as to topic, with epidemiologic risk fact...
Bertone JJ.The nature of the equine industry and equine veterinary medicine often requires veterinarians to prescribe drugs with little evidence for a drug's formulation safety or efficacy, or even assurance of the chemistry of the drug used. This means that equine veterinarians must remain skeptics and understand the limitations in their ability to attribute safety and efficacy to a particular drug or treatment. An evidence-based approach to pharmacology demands rigorous testing and an unbiased analysis of results.
Mair TS, Smith LJ, Sherlock CE.Colic surgery is now performed at many equine hospitals around the world. Despite the tremendous improvements in survival rates over the past 30 years, the morbidity and mortality rates remain relatively high. This fact, coupled with the high cost of treatment, makes it important to apply evidence-based medicine principles to establish the best possible treatment plans and surgical techniques whereby the outcomes can be optimized. Factors affecting survival rates and rates of major complications (incisional complications and postoperative ileus) are discussed. Preoperative assessment and posto...
Richardson DW, Loinaz R.There is an enormous volume of published material about most of the agents used to treat or prevent arthritis in horses. Unfortunately, most of the claims made by nearly all purveyors of arthritis medications in such media are largely unsubstantiated. In addition, the quality of the available information is highly inconsistent, making evidence-based recommendations difficult. This article concentrates on injectable polysulfated glycosaminoglycan, injectable hyaluronan, and the common oral "nutraceuticals".
Williamson KK, Davis MS.It is clear from a review of the current scientific literature that an evidence-based approach to medical treatment of equine respiratory disease can be applied, at least in the instance of common lower respiratory diseases. In particular, there is clear evidence for efficacious treatments for recurrent airway obstruction and exercise-induced pulmonary hemorrhage, and with the recognition of this evidence, these treatments should be the first to be considered by a practitioner when treating these conditions. The purpose of this article is not only to identify the existence of relevant high-qua...
Attia J, Page J.Students of evidence-based medicine often try unsuccessfully to commit to memory a particular critical appraisal framework (often lengthy), or they have to depend on pocket cards and are lost without them. We have described a pedagogic aid: a flow diagram of an RCT, which has been developed over years of teaching residents. This diagram focuses on the steps in an RCT, and by drawing arrows, it highlights the biases possible at each step. This diagram serves as a framework on which the list of critical appraisal questions can be hung and is easy to remember.
Ramey DW.Learning to critically evaluate therapeutic claims is vital to the success of the practicing veterinarian and the veterinary profession as a whole. Until such time as good scientific data in support of therapies are obtained, veterinarians should be careful in their advocacy and employment of new and unproved practices. They should also be aware of the many reasons why therapeutic "success" may be the result of a variety of factors unrelated to the treatment modality itself. Only by relying on rigorous standards of evidence can equine veterinarians prevent a return to the sincere but misguided...
Taylor PM, Pascoe PJ, Mama KR.This chapter begins by providing an overview of current philosophies relevant to equine pain management. Objective and subjective techniques for assessing pain and the limitations of these are then described in depth. The conclusion emphasizes the need for an evidence based approach to managing pain in the horse and sets the stage for subsequent chapters in this edition.
Nieforth LO, Schwichtenberg AJ, O'Haire ME.In the last five years, the literature on animal-assisted intervention (AAI) for Autism Spectrum Disorder (ASD) has doubled in size from 42 studies prior to 2015 to 85 studies (cumulative total assessed in 2020). Horses remain the most commonly researched animal for AAI, followed by dogs. The most commonly researched outcome was social interaction, across 21 studies. Though the quantity of studies has increased, issues with methodological rigor remain. Results highlight the need for a continued focus on methodological rigor as well as refining the structure of animal-assisted interventions, ad...
Bedenice D.One of the fundamental skills required for practicing evidence-based medicine is the development of a well-built clinical question, which specifies the patient group or problem, intervention, and outcome of interest. For this purpose, various "levels of evidence" have been developed in the human literature, which rank the validity of evidence. Our established conclusions and advice are thus supported by specific "grades of recommendations," which are intended to give an indication of the "strength" of a clinical recommendation. This article was compiled with these principles in mind.
Stanley SD, Moffitt K, Wiebe V.Equine practitioners should follow these recommendations when using compounded medications: (1) the decision must be veterinary driven, based on a valid veterinarian-client-patient relationship and on evidence-based medicine; (2) compliance with the Animal Medicinal Drug Use Clarification Act of 1994; and (3) use limited to (a) horses for which no other method or route of drug delivery is practical; (b) those drugs for which safety, efficacy, and stability have been demonstrated; or (c) disease conditions for which a quantifiable response to therapy or drug concentration can be monitored.
Adair S.This article serves as an introduction into integrative case management as it applies to the horse's mental health, pain management, and tissue healing. The integrative philosophy pertains to the combination of conventional Western medicine and complementary and alternative therapies to provide the best patient care possible using currently available evidence. The goal is to improve the health of the patient in a more holistic manner.
Bertone JJ.The nature of the equine industry and equine veterinary medicine often requires veterinarians to prescribe drugs with little evidence for a drug's formulation safety or efficacy, or even assurance of the chemistry of the drug used. This means that equine veterinarians must remain skeptics and understand the limitations in their ability to attribute safety and efficacy to a particular drug or treatment. An evidence-based approach to pharmacology demands rigorous testing and an unbiased analysis of results.
Ramey DW.Learning to critically evaluate therapeutic claims is vital to the success of the practicing veterinarian and the veterinary profession as a whole. Until such time as good scientific data in support of therapies are obtained, veterinarians should be careful in their advocacy and employment of new and unproved practices. They should also be aware of the many reasons why therapeutic "success" may be the result of a variety of factors unrelated to the treatment modality itself. Only by relying on rigorous standards of evidence can equine veterinarians prevent a return to the sincere but misguided...
Richardson DW, Loinaz R.There is an enormous volume of published material about most of the agents used to treat or prevent arthritis in horses. Unfortunately, most of the claims made by nearly all purveyors of arthritis medications in such media are largely unsubstantiated. In addition, the quality of the available information is highly inconsistent, making evidence-based recommendations difficult. This article concentrates on injectable polysulfated glycosaminoglycan, injectable hyaluronan, and the common oral "nutraceuticals".
Attia J, Page J.Students of evidence-based medicine often try unsuccessfully to commit to memory a particular critical appraisal framework (often lengthy), or they have to depend on pocket cards and are lost without them. We have described a pedagogic aid: a flow diagram of an RCT, which has been developed over years of teaching residents. This diagram focuses on the steps in an RCT, and by drawing arrows, it highlights the biases possible at each step. This diagram serves as a framework on which the list of critical appraisal questions can be hung and is easy to remember.
Barton CK, Goodrich LR.The use of radiofrequency energy (RFE) has become increasingly popular in equine orthopedic surgery in recent years, particularly for the debridement of cartilage lesions and soft tissue resection. However, despite considerable advancements in the technology, the safety and efficacy of RFE have continued to be questioned. While studies investigating the use of RFE for chondroplasty in the equine population are lacking, there is an abundance of research studies in the human literature assessing its effect on healthy chondrocytes, and researchers are seeking to develop guidelines to minimize col...
Menzies R.The oral examination is performed in equids to assess and monitor oral health status, provide diagnoses, and determine efficacy of treatments. While there is currently insufficient scientific material of adequate quality to enable evidence-based medicine in equine dentistry, this by no means negates the clinician's responsibility to provide oral health care in a scientific and ethical manner. To do so requires that the clinician be knowledgable and skilled in dentistry and general medicine, that each case upholds the principles of scientific method, and that data is gathered and appraised in a...
Cantatore F, Pagliara E, Marcatili M, Bertuglia A.Obtaining a healthy wound environment that is conductive to healing in horses can be challenging. Negative-pressure wound therapy (NPWT) has been employed in humans to enhance wound healing for decades. The existing evidence for the effectiveness of NPWT remains uncertain in equine medicine. The aim of this review is to investigate NPWT applications and benefits in horses. A scoping review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines for scoping reviews on three databases (PubMed, Web of Science-Thompson Reuters, and Wiley...
Lawson A, Pinchbeck G.When planning to conduct research, thorough consideration of the study design is essential to enable valid results and purposeful conclusions. A good study design will provide a strong basis for robust conclusions that can contribute to the evidence base. Conversely, a poor study design may unintentionally lead to invalid conclusions with inappropriate claims of the clinical importance. The purpose of this article is to review important aspects of observational study design, with an emphasis on observational clinical research. The value of an observational study can be manifold and the benefit...
Williamson KK, Davis MS.It is clear from a review of the current scientific literature that an evidence-based approach to medical treatment of equine respiratory disease can be applied, at least in the instance of common lower respiratory diseases. In particular, there is clear evidence for efficacious treatments for recurrent airway obstruction and exercise-induced pulmonary hemorrhage, and with the recognition of this evidence, these treatments should be the first to be considered by a practitioner when treating these conditions. The purpose of this article is not only to identify the existence of relevant high-qua...
Citarella G, Heitzmann V, Ranninger E, Bettschart-Wolfensberger R.This systematic review aimed to identify the evidence concerning the analgesic efficacy of non-steroidal anti-inflammatory drugs to treat abdominal pain in horses, and to establish whether one non-steroidal anti-inflammatory drug could provide better analgesia compared to others. This systematic review was conducted following the "Systematic Review Protocol for Animal Intervention Studies". Research published between 1985 and the end of May 2023 was searched, using three databases, namely, PubMed, Embase, and Scopus, using the words equine OR horse AND colic OR abdominal pain AND non-steroidal...
