FREE SHIPPING over $40
OVER 9000 FIVE-STAR REVIEWS
5% OFF ALL SUBSCRIPTIONS
100% HAPPINESS GUARANTEE
Analyze Diet
0
Home / Equine Research Bank / Equine Vet J / Efficacy and welfare effects of different forms of physical ...
Equine veterinary journal2025; doi: 10.1111/evj.70081

Efficacy and welfare effects of different forms of physical restraint for upper airway endoscopy of horses.

Abstract: Physical restraint of horses for veterinary procedures is necessary to allow completion of tasks effectively and without injury to patient or personnel. Objective: To compare physiological effects and behavioural responses to four commonly used restraint techniques for upper respiratory tract (URT) endoscopy in unsedated horses. Methods: Blocked and randomised interventional study. Methods: Twelve university owned teaching horses were blocked into groups of four and randomly allocated to one of four restraint methods (nose twitch, ear hold, Stableizer® and nil restraint) for URT endoscopy. Horse response to restraint and endoscopy was evaluated subjectively and by objective measures of procedural efficacy (duration and head movement), time domain indices of heart rate variability (HRV), saliva cortisol and plasma β-endorphin concentrations. Results: Horses demonstrated strong individual differences for procedure tolerance and preferred method of restraint, but there were no differences observed in outcome measures related to procedural efficacy or neuroendocrine response associated with restraint type. Repetition of experimental procedures was associated with a progressive decrease in mean (95% CI) minimum heart rate from 34.2 (31.7-36.7) to 30.1 (28.0-32.2) bpm (p < 0.001), and increased HRV measures related to parasympathetic dominance. Cortisol was greatest on Day 2 (1.5, 1.1-2.5 nmol/L; median, 95% CI), compared with Day 1 (0.8, 0.5-1.6 nmol/L; p = 0.02). Conclusions: Convenience sample of horses familiar with most study interventions; intervention was minimally invasive and of short duration. Conclusions: Study findings did not support current recommendations to prioritise one type of restraint over other available techniques. Unassigned: A contenção física de cavalos durante procedimentos veterinários é necessária para permitir a realização eficaz das tarefas, sem causar lesões ao paciente ou à equipe. Objective: Comparar os efeitos fisiológicos e as respostas comportamentais a quatro técnicas de contenção comumente utilizadas para endoscopia das vias aéreas superiores (VAS) em cavalos não sedados. Unassigned: Estudo intervencional randomizado em blocos. MÉTODOS: Doze cavalos pertencentes à universidade foram agrupados em blocos de quatro e aleatoriamente designados para um dos quatro métodos de contenção (torção do lábio, contenção da orelha, Stableizer® e sem contenção) durante a endoscopia das VAS. A resposta dos cavalos à contenção e ao procedimento endoscópico foi avaliada subjetivamente e por meio de medidas objetivas de eficácia do procedimento (duração e movimento da cabeça), índices de variabilidade da frequência cardíaca (VFC) no domínio do tempo, concentração de cortisol salivar e β‐endorfina plasmática. Results: Os cavalos demonstraram diferenças individuais marcantes em relação à tolerância ao procedimento e ao método de contenção preferido, mas não foram observadas diferenças na eficácia dos procedimentos ou à resposta neuroendócrina associada ao tipo de contenção. A repetição dos procedimentos experimentais foi associada a uma redução progressiva na frequência cardíaca mínima média (IC 95%) de 34,2 (31,7–36,7) para 30,1 (28,0–32,2) bpm (P < 0,001), além de um aumento nos índices de VFC relacionados à dominância parassimpática. Os níveis de cortisol foram mais elevados no segundo dia (1,5; 1,1–2,5 nmol/L; mediana, IC 95%), em comparação com o primeiro dia (0,8; 0,5–1,6 nmol/L; P = 0,016). PRINCIPAIS LIMITAÇÕES: Amostra de conveniência composta por cavalos familiarizados com a maioria das intervenções estudadas; intervenção minimamente invasiva e de curta duração. CONCLUSÕES: Os achados do estudo não apoiam as recomendações atuais de priorizar um tipo específico de contenção em detrimento de outras técnicas disponíveis.
© 2025 The Author(s). Equine Veterinary Journal published by John Wiley & Sons Ltd on behalf of EVJ Ltd.
Get Full Text
Publication Date: 2025-09-08 PubMed ID: 40922053DOI: 10.1111/evj.70081Google Scholar: Lookup
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
LinkedInCopy
  • Journal Article

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

Overview

  • This study compared the physiological and behavioral effects of four physical restraint methods used during upper airway endoscopy in unsedated horses.
  • The research aimed to determine whether any one restraint method was superior in terms of procedure efficacy, stress response, and horse welfare.

Background and Objective

  • Physical restraint is necessary in veterinary procedures to safely handle horses and allow completion of diagnostic tasks like upper respiratory tract (URT) endoscopy.
  • Common restraint techniques include nose twitch, ear hold, a commercial device called Stableizer®, and no restraint.
  • The study sought to objectively compare these four methods, specifically looking at physiological stress markers, behavioral responses, and procedural success in unsedated horses.

Methods

  • Twelve university-owned horses were used, blocking into groups of four to randomize restraint assignment.
  • Each horse underwent URT endoscopy using one of the restraint methods:
    • Nose twitch: twirling or twisting the upper lip
    • Ear hold: physically holding the horse’s ear
    • Stableizer®: a commercial physical restraint device
    • No restraint
  • Evaluations included:
    • Subjective behavioral responses to restraint and procedure
    • Objective measures such as procedure duration and head movement (indicative of tolerance and safety)
    • Physiological measures including heart rate variability (HRV), saliva cortisol (stress hormone), and plasma β-endorphin (pain/stress-related peptide) levels
  • The study was blocked and randomized to reduce bias.

Results

  • Strong individual differences were found in horses’ tolerance and preferred restraint method, indicating variability in how horses respond to restraint.
  • No significant differences were found between the four restraint methods regarding:
    • Procedural efficacy (e.g., procedure duration, head stability)
    • Neuroendocrine stress responses (cortisol and β-endorphin levels)
  • Repeated procedures led to physiological adaptations:
    • Minimum heart rate progressively decreased from ~34.2 bpm to ~30.1 bpm.
    • HRV measures indicated increased parasympathetic nervous system dominance, suggesting reduced stress or habituation over time.
    • Cortisol levels were highest on the second day relative to the first, perhaps reflecting an acute stress response to initial handling or procedure novelty.

Conclusions

  • The study suggests that no single restraint method is clearly superior to others in terms of horse welfare or procedural success during URT endoscopy.
  • Given the individual variation, restraint choice might be better tailored to the horse rather than following a strict protocol favoring one method.
  • Habituation or repeated exposure to the procedure appeared to reduce stress indicators, which may have implications for clinical practice.
  • Research limitations include the small convenient sample size and the fact that horses were already familiar with most interventions, possibly limiting generalizability.

Implications for Veterinary Practice

  • Veterinarians can consider multiple restraint options depending on the horse’s preferences and temperament without concerns that one method is markedly less effective or more stressful.
  • Repeated handling and procedures may reduce stress responses, emphasizing the value of acclimatization for diagnostic interventions.
  • Decision making on restraint should prioritize animal welfare, safety, and practical considerations rather than strict adherence to a “best” restraint technique.

Cite This Article

APA
O'Brien C, Simon O, Franklin SH, Ferlini Agne G, Weaver S, Raidal SL. (2025). Efficacy and welfare effects of different forms of physical restraint for upper airway endoscopy of horses. Equine Vet J. https://doi.org/10.1111/evj.70081

Publication

Equine veterinary journal
ISSN: 2042-3306
NlmUniqueID: 0173320
Country: United States
Language: English

Researcher Affiliations

O'Brien, Claire
  • School of Animal and Veterinary Sciences, The University of Adelaide, Adelaide, Australia.
Simon, Olivier
  • School of Animal and Veterinary Sciences, The University of Adelaide, Adelaide, Australia.
Franklin, Samantha H
  • School of Animal and Veterinary Sciences, The University of Adelaide, Adelaide, Australia.
Ferlini Agne, Gustavo
  • School of Animal and Veterinary Sciences, The University of Adelaide, Adelaide, Australia.
Weaver, Sarah
  • School of Animal and Veterinary Sciences, The University of Adelaide, Adelaide, Australia.
Raidal, Sharanne L
  • Melbourne Veterinary School, The University of Melbourne, Melbourne, Australia.

References

This article includes 40 references
  1. Mirza MH, Costa LRR. Physical restraint of the horse for clinical procedures. Manual of clinical procedures in the horse. Hoboken, NJ: Wiley‐Blackwell; 2017. p. 5–26.
  2. Carroll SL, Sykes BW, Mills PC. Moving toward fear‐free husbandry and veterinary care for horses. Animals 2022;12:2907.
    doi: 10.3390/ani12212907google scholar: lookup
  3. Doherty O, McGreevy PD, Pearson G. The importance of learning theory and equitation science to the veterinarian. Appl Anim Behav Sci 2017;190:111–122.
    doi: 10.1016/j.applanim.2017.02.012google scholar: lookup
  4. Pearson G, Waran N, Reardon RJM, Keen J, Dwyer C. A Delphi study to determine expert consensus on the behavioural indicators of stress in horses undergoing veterinary care. Appl Animal Behav Sci 2021;237:105291.
    doi: 10.1016/j.applanim.2021.105291google scholar: lookup
  5. McGreevy P, Berger J, de Brauwere N, Doherty O, Harrison A, Fiedler J. Using the five domains model to assess the adverse impacts of husbandry, veterinary, and equitation interventions on horse welfare. Animals 2018;8(3):41.
    doi: 10.3390/ani8030041google scholar: lookup
  6. Flakoll B, Ali AB, Saab CY. Twitching in veterinary procedures: how does this technique subdue horses?. J Vet Behav 2017;18:23–28.
    doi: 10.1016/j.jveb.2016.12.004google scholar: lookup
  7. Ali ABA, Gutwein KL, Heleski CR. Assessing the influence of upper lip twitching in naive horses during an aversive husbandry procedure (ear clipping). J Vet Behav 2017;21:20–25.
    doi: 10.1016/j.jveb.2017.07.001google scholar: lookup
  8. Blum S, Gisler J, Dalla Costa E, Montavon S, Spadovecchia C. Investigating conditioned pain modulation in horses: can the lip‐twitch be used as a conditioning stimulus?. Front Pain Res 2024;5:1463688.
    doi: 10.3389/fpain.2024.1463688google scholar: lookup
  9. Watson JC, McDonnell SM. Effects of three non‐confrontational handling techniques on the behavior of horses during a simulated mildly aversive veterinary procedure. Appl Anim Behav Sci 2018;203:19–23.
    doi: 10.1016/j.applanim.2018.02.007google scholar: lookup
  10. Ducharme NG, Hackett RP, Fubini SL, Erb HN. The reliability of endoscopic examination in assessment of arytenoid cartilage movement in horses. Part II. Influence of side of examination, reexamination, and sedation. Vet Surg 1991;20:180–184.
    doi: 10.1111/j.1532-950x.1991.tb00332.xgoogle scholar: lookup
  11. WheelerEnterprises. The stableizer equine restraint & training system, EZAnimal products. 2024 [cited 2025 Sep 5]. Available from: https://udderlyez.com/wp‐content/uploads/2022/04/The‐Stableizer‐Brochure‐May‐2022.pdf
  12. Cock G, Blakeney Z, Hernandez JA, DeNotta S. Opioid‐free sedation for atlantoaxial cerebrospinal fluid collection in adult horses. J Vet Intern Med 2022;36:1812–1819.
    doi: 10.1111/jvim.16450google scholar: lookup
  13. Tarvainen M, Lipponen J, Niskanen J‐P, Ranta‐aho P. Kubios HRV software user's guide. 2021 [cited 2024 Jun 14]. Available from: https://www.kubios.com/downloads/Kubios_HRV_Users_Guide.pdf
  14. Houben R, Vedrnooij J, Sloet van Oldruitenborgh‐Oosterbaan M. Effect of recording length and posture on the reliability of heart rate variability in horses. Pferdeheilkunde 2021;2021(37):577–587.
  15. Shaffer F, Ginsberg JP. An overview of heart rate variability metrics and norms. Front Public Health 2017;5:258.
    doi: 10.3389/fpubh.2017.00258google scholar: lookup
  16. Lagerweij E, Nelis PC, Wiegant VM, Ree JM. The twitch in horses: a variant of acupuncture. Science 1984;225:1172–1174.
  17. Reid K, Rogers C, Gronqvist G, Gee E, Bolwell C. Anxiety and pain in horses measured by heart rate variability and behavior. J Vet Behav 2017;22:1–6.
    doi: 10.1016/j.jveb.2017.09.002google scholar: lookup
  18. Baevsky RM, Chernikova AG. Heart rate variability analysis: physiological foundations and main methods. Cardiometry 2017;10:66–76.
  19. Villas-Boas JD, Dias DPM, Trigo PI, Almeida NAS, Almeida FQ, Medeiros MA. Behavioural, endocrine and cardiac autonomic responses to a model of startle in horses. Appl Anim Behav Sci 2016;174:76–82.
    doi: 10.1016/j.applanim.2015.10.005google scholar: lookup
  20. Evans L, Cameron-Whytock H, Ijichi C. Eye understand: physiological measures as novel predictors of adaptive learning in horses. Appl Anim Behav Sci 2024;271:106152.
    doi: 10.1016/j.applanim.2023.106152google scholar: lookup
  21. Castaldo R, Montesinos L, Melillo P, James C, Pecchia L. Ultra-short term HRV features as surrogates of short term HRV: a case study on mental stress detection in real life. BMC Med Inform Decis Mak 2019;19:12.
    doi: 10.1186/s12911-019-0742-ygoogle scholar: lookup
  22. Liu K, Jiao Y, Du C, Zhang X, Chen X, Xu F. Driver stress detection using ultra-short-term HRV analysis under real world driving conditions. Entropy 2023;25(2):194.
    doi: 10.3390/e25020194google scholar: lookup
  23. Visser EK, van der Reenen CG, Werf JT, Schilder MB, Knaap JH, Barneveld A. Heart rate and heart rate variability during a novel object test and a handling test in young horses. Physiol Behav 2002;76:289–296.
  24. Bohák Z, Szabó F, Beckers JF, Melo de Sousa N, Kutasi O, Nagy K. Monitoring the circadian rhythm of serum and salivary cortisol concentrations in the horse. Domest Anim Endocrinol 2013;45:38–42.
    doi: 10.1016/j.domaniend.2013.04.001google scholar: lookup
  25. Larsson M, Edqvist LE, Ekman L, Persson S. Plasma cortisol in the horse, diurnal rhythm and effects of exogenous ACTH. Acta Vet Scand 1979;20:16–24.
  26. Peeters M, Closson C, Beckers J-F, Vandenheede M. Rider and horse salivary cortisol levels during competition and impact on performance. J Equine Vet Sci 2013;33:155–160.
    doi: 10.1016/j.jevs.2012.05.073google scholar: lookup
  27. Peeters M, Sulon J, Beckers JF, Ledoux D, Vandenheede M. Comparison between blood serum and salivary cortisol concentrations in horses using an adrenocorticotropic hormone challenge. Equine Vet J 2011;43:487–493.
    doi: 10.1111/j.2042-3306.2010.00294.xgoogle scholar: lookup
  28. Raidal SL, Freccero F, Carstens A, Weaver S, Padalino B. Raod transportation is associated with decreased intestinal motilty in horses. Front Vet Sci 2025; 12:1647236.
    doi: 10.3389/fvets.2025.1647236google scholar: lookup
  29. Brubaker L, Schroeder K, Sherwood D, Stroud D, Udell MAR. Horse behavior towards familiar and unfamiliar humans: implications for equine‐assisted services. Animals 2021;11:2369.
    doi: 10.3390/ani11082369google scholar: lookup
  30. Marsbøll AF, Christensen JW. Effects of handling on fear reactions in young Icelandic horses. Equine Vet J 2015;47:615–619.
    doi: 10.1111/evj.12338google scholar: lookup
  31. Ferlazzo A, Fazio E, Cravana C, Medica P. The role of circulating β‐endorphin in different stress models in equines: a review. J Equine Vet Sci 2018;71:98–104.
    doi: 10.1016/j.jevs.2018.10.012google scholar: lookup
  32. Pilozzi A, Carro C, Huang X. Roles of β‐endorphin in stress, behavior, neuroinflammation, and brain energy metabolism. Int J Mol Sci 2020;22(1):338.
    doi: 10.3390/ijms22010338google scholar: lookup
  33. McCarthy RN, Jeffcott LB, Clarke IJ. Preliminary studies on the use of plasma β‐endorphin in horses as an indicator of stress and pain. J Equine Vet Sci 1993;13:216–219.
    doi: 10.1016/s0737-0806(06)81015-4google scholar: lookup
  34. Mehl ML, Sarkar DK, Schott HC, Brown JA, Sampson SN, Bayly WM. Equine plasma beta‐endorphin concentrations are affected by exercise intensity and time of day. Equine Vet J Suppl 1999;31(30):567–569.
    doi: 10.1111/j.2042-3306.1999.tb05285.xgoogle scholar: lookup
  35. Mehl ML, Schott HC, Sarkar DK, Bayly WM. Effects of exercise intensity and duration on plasma beta‐endorphin concentrations in horses. Am J Vet Res 2000;61(8):969–973.
    doi: 10.2460/ajvr.2000.61.969google scholar: lookup
  36. Malinowski K, Shock EJ, Rochelle P, Kearns CF, Guirnalda PD, McKeever KH. Plasma beta‐endorphin, cortisol and immune responses to acute exercise are altered by age and exercise training in horses. Equine Vet J 2006;38:267–273.
    doi: 10.1111/j.2042-3306.2006.tb05551.xgoogle scholar: lookup
  37. Cravana C, Medica P, Ragonese G, Fazio E. Influence of training and competitive sessions on peripheral β‐endorphin levels in training show jumping horses. Vet World 2017;10:67–73.
    doi: 10.14202/vetworld.2017.67-73google scholar: lookup
  38. Guinnefollau L, Bolwell CF, Gee EK, Norman EJ, Rogers CW. Horses' physiological and behavioural responses during undergraduate veterinary practical teaching classes. Appl Anim Behav Sci 2021;241:105371.
    doi: 10.1016/j.applanim.2021.105371google scholar: lookup
  39. Pearson G. Stress in equids undergoing veterinary care and the development of interventions that positively influence the horses' experience. [PhD thesis]. Edinburgh: The University of Edinburgh; 2022.
  40. Pearson G, Reardon R, Keen J, Waran N. Difficult horses—prevalence, approaches to management of and understanding of how they develop by equine veterinarians. Equine Vet Educ 2021;33:522–530.
    doi: 10.1111/eve.13354google scholar: lookup

Citations

This article has been cited 0 times.
Subscribe to our newsletter
Join 99,005 horse owners like you who receive our email updates on horse health and nutrition.