Can therapy dogs improve pain and satisfaction after total joint arthroplasty? A randomized controlled trial

Abstract

Background: The use of animals to augment traditional medical therapies was reported as early as the 9th century but to our knowledge has not been studied in an orthopaedic patient population. The purpose of this study was to evaluate the role of animal-assisted therapy using therapy dogs in the postoperative recovery of patients after THA and TKA.

Questions/purposes: We asked: (1) Do therapy dogs have an effect on patients' perception of pain after total joint arthroplasty as measured by the VAS? (3) Do therapy dogs have an effect on patients' satisfaction with their hospital stay after total joint arthroplasty as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)?

Methods: A randomized controlled trial of 72 patients undergoing primary unilateral THA or TKA was conducted. Patients were randomized to a 15-minute visitation with a therapy dog before physical therapy or standard postoperative physical therapy regimens. Both groups had similar demographic characteristics. Reduction in pain was assessed using the VAS after each physical therapy session, beginning on postoperative Day 1 and continuing for three consecutive sessions. To ascertain patient satisfaction, the proportion of patients selecting top-category ratings in each subsection of the HCAHPS was compared.

Results: Patients in the treatment group had lower VAS scores after each physical therapy session with a final VAS score difference of 2.4 units (animal-assisted therapy VAS, 1.7; SD, 0.97 [95% CI, 1.4-2.0] versus control VAS, 4.1; SD, 0.97 [95% CI, 3.8-4.4], p<0.001) after the third physical therapy session. Patients in the treatment group had a higher proportion of top-box HCAHPS scores in the following fields: nursing communication (33 of 36, 92% [95% CI, 78%-98%] versus 69%, 25 of 36 [95% CI, 52%-84%], p=0.035; risk ratio, 1.3 [95% CI of risk ratio, 1.0-1.7]; risk difference, 23% [95% CI of risk difference, 5%-40%]), pain management (34 of 36, 94% [95% CI, 81%-99%], versus 26 of 36, 72% [95% CI, 55%-86%], p=0.024; risk ratio, 1.3 [95% CI of risk ratio, 1.1-1.6]; risk difference, 18% [95% CI of risk difference, 5%-39%]). The overall hospital rating also was greater in the treatment group (0-10 scale) (9.6; SD, 0.7 [95% CI, 9.3-9.8] versus 8.6, SD, 0.9 [95% CI, 8.3-8.9], p<0.001).

Conclusions: The use of therapy dogs has a positive effect on patients' pain level and satisfaction with hospital stay after total joint replacement. Surgeons are encouraged to inquire about the status of volunteer-based animal-assisted therapy programs in their hospital as this may provide a means to improve the immediate postoperative recovery for a select group of patients having total joint arthroplasty.

Level of evidence: Level II, randomized controlled study. See Instructions for Authors for a complete description of levels of evidence.

Fig. 1

Eighty-five percent of eligible patients elected to enroll in the study. There was no crossover or loss to followup. MRSA = methicillin-resistant Staphylococcus aureus.

Fig. 2

The therapy dog in our study, a 5-year-old curly-coated retriever named Holden, is shown.

Fig. 3

The VAS for the animal-assisted therapy group after physical therapy was significantly lower than that of the control group at three times *Session 1: 5.2 ± 1.5 versus 7.1 ± 1.3, p < 0.001; *Session 2: 3.05 ± 1.3 versus 5.8 ± 0.74, p < 0.001; *Session 3: 1.71 ± 0.88 versus 4.07 ± 1.05, p < 0.001.The bars indicate standard error. AAT = animal-assisted therapy.

Fig. 4

The Hospital Consumer Assessment of Healthcare Providers and Systems survey (HCAHPS) showed the treatment group had a greater proportion of top box scores for *Nursing Communication (33 of 36 [92%] versus 25 of 36 [69%], p = 0.03) and *Pain Management (34 of 36 [94%] versus 26 of 36 [72%], p = 0.02) compared with the control group. The bars indicated 95% CI. AAT = animal-assisted therapy.