Development and pilot of equine facilitated physical therapy outcome measure tool for chronic low back pain patients.

Overview

• This research developed and tested an outcome measurement tool specifically for evaluating the effects of Equine Facilitated Physical Therapy (EFPT) on patients with chronic low back pain (LBP).
• The study aimed to create a reliable online evaluation tool to assess functional movements relevant to sitting on a horse and walking, and to validate its reliability among different raters and within the same raters over time.

Background and Purpose

• Equine Facilitated Physical Therapy (EFPT) is an unconventional treatment method for chronic LBP that involves interaction with horses.
• EFPT lacks standardized documentation and validated outcome measurement tools tailored to its unique rehabilitation setting, especially for patients maintaining posture on horses or moving in this environment.
• The purpose of this research was to develop an online evaluation tool to objectively measure movement-related outcomes in LBP patients receiving EFPT.
• Another key aim was to establish the tool’s inter-rater (between different evaluators) and intra-rater (same evaluator at different times) reliability to ensure consistent and trustworthy scoring.

Development of the Evaluation Tool

• The researchers derived 48 movement-related functions to be included in the tool based on the International Classification of Functioning, Disability and Health (ICF) framework.
• These functions were focused on tasks relevant to EFPT, particularly maintaining sitting position on a horse and walking short distances.
• The functions were organized into an online format to facilitate evaluation and scoring using video recordings.

Methodology

• Video material of 22 patients was recorded during a 12-week EFPT intervention.
• Depending on the validation phase, between two to six raters scored randomized video samples using the developed online tool.
• Raters included experts likely familiar with EFPT, as well as evaluations of healthy adults to benchmark reliability levels.

Reliability Testing and Results

• Inter-rater reliability (agreement between different raters):
  • Among experts, scoring of items reached good reliability (Cronbach’s alpha α = 0.87).
  • When agreement was calculated per patient, inter-rater reliability was excellent (α = 1.00), indicating very high consistency.
  • For healthy adults, inter-rater reliability was acceptable (α = 0.72), but per individual rated, it was excellent (α = 1.00).
• Intra-rater reliability (consistency of the same raters over time):
  • Reached good repeatability (α = 0.87) overall.
  • When calculated per patient, intra-rater reliability remained good (α = 0.80).

Conclusions and Practical Applications

• The developed evaluation tool meets reliability standards necessary for use in therapeutic practice focused on EFPT for chronic LBP patients.
• Physical therapists can use the tool to identify postural improvements and changes resulting from EFPT during treatment.
• The tool supports capturing consistent outcome reports which can aid clinicians in tracking treatment progress objectively.
• It may also assist in designing personalized home exercise programs tailored to the patient’s observed functional status.
• Beyond individual care, the tool allows for standardized data collection across the EFPT industry, facilitating validation and wider acceptance of EFPT as a treatment modality for chronic LBP.