The impact of service dogs on objective and perceived sleep quality for veterans with PTSD

One in four post-9/11 veterans (Fulton et al., 2015) have been diagnosed with posttraumatic stress disorder (PTSD), facing sleep disruptions as one of their most common symptoms. Service dogs have become an increasingly popular complementary intervention and anecdotes suggest they may impact sleep for veterans with PTSD. There is a need for empirical investigation into these claims through measurement and analysis of sleep quality. The purpose of this study was to longitudinally investigate the impact of service dogs on sleep quality through both objective and subjective measures. Participants in the treatment group (n=92) received a service dog after baseline, while those in the control group (n=76) received usual care alone for the duration of the study. Actigraphy (objective) and survey (subjective) data were collected longitudinally (at 0 and 3 months). Descriptive statistical tests and regression analyses were performed while controlling for baseline and demographic characteristics to compare sleep outcomes for the treatment versus control groups. Results indicated that service dog placement was significantly associated with better perceived sleep quality (overall: B=-0.12, p\u3c0.05; fear of sleep: B=-0.33, p\u3c0.001; sleep disturbance: B=- 0.45, p\u3c0.01). In contrast, no significant differences in objective sleep measures were observed (duration: B=-0.09, p=0.52; regularity: B\u3c0.01, p\u3e0.99; efficiency: B=-0.10, p=0.54). These findings suggest that while service dogs may be associated with better perceived sleep quality for veterans with PTSD, these improvements do not appear to be motion related (Actigraphy). Instead, they may be related to differences in other sleep quality determinants such as nightmares and general fear of falling asleep

Blessing or Burden? The Impact of PTSD Service Dogs on Military Families

While PTSD service dogs are specifically trained to interact with their veterans, emerging evidence suggests that service dogs may also have an impact on other members of veteran households. To our knowledge, only one study quantifies these effects focused on veteran spouses (McCall et al., 2020). Our study aimed to quantitatively measure the impact of PTSD service dogs on military family wellbeing. Data was collected from survey responses of 88 veteran spouses who rated their experiences on standardized outcome measures. Each spouse answered the surveys at two time points: (1) baseline, and (2) three months post-baseline (follow-up). Spouses in the control group (n=40) were on the waitlist for a service dog for both baseline and follow-up, while the service dog group (n=48) received a service dog after baseline. Multiple regression analysis yielded statistically significant differences between the waitlist and service dog groups which suggested that service dogs may increase caregiver burden and decrease caregiver satisfaction, but potentially encourage increased participation in activities for veteran spouses. Small effect sizes suggested service dogs may also foster increased companionship and positive affect in veteran spouses. Analyses indicated no notable impact on veteran children. These findings suggest that the impact of PTSD service dogs may extend to veteran spouses, potentially encouraging interest and investment in this complementary intervention option. Two statistically significant negative effects emphasize the need to inform the military family of practical strategies to minimize possible detrimental effects, which would likely lead to an improved family experience with the service dog

Animal-assisted interventions for military families: a systematic review

IntroductionThe incorporation of animals into interventions focused on military families is a relatively new concept. Though animal-assisted interventions (AAIs) have been studied in the context of military veterans, few studies incorporate members of the military family or focus on the family members’ experiences.MethodsThis systematic review investigates the effects of AAIs on the wellbeing of military family members beyond the veteran themselves through three aims: (1) by describing the characteristics of AAIs for military family members, (2) by evaluating the quality of the methodology present within the current literature, and (3) by identifying key concepts and knowledge gaps within the findings reported to date.ResultsA total of nine articles met the criteria to be included in the review. Though the inclusion criteria and search terms included all types of animal-assisted interventions, the only interventions represented were service dogs (n = 4) and equine-assisted services (n = 5).DiscussionFindings suggest AAIs could be beneficial in areas such as communication, relational bonds, and psychosocial well-being. Though additional research is necessary, AAIs may be an effective complementary intervention for military families

Defining Terms Used for Animals Working in Support Roles for People with Support Needs

The nomenclature used to describe animals working in roles supporting people can be confusing. The same term may be used to describe different roles, or two terms may mean the same thing. This confusion is evident among researchers, practitioners, and end users. Because certain animal roles are provided with legal protections and/or government-funding support in some jurisdictions, it is necessary to clearly define the existing terms to avoid confusion. The aim of this paper is to provide operationalized definitions for nine terms, which would be useful in many world regions: “assistance animal”, “companion animal”, “educational/school support animal”, “emotional support animal”, “facility animal”, “service animal”, “skilled companion animal”, “therapy animal”, and “visiting/visitation animal”. At the International Society for Anthrozoology (ISAZ) conferences in 2018 and 2020, over 100 delegates participated in workshops to define these terms, many of whom co-authored this paper. Through an iterative process, we have defined the nine terms and explained how they differ from each other. We recommend phasing out two terms (i.e., “skilled companion animal” and “service animal”) due to overlap with other terms that could potentially exacerbate confusion. The implications for several regions of the world are discussed

Defining Terms Used for Animals Working in Support Roles for People with Support Needs

The nomenclature used to describe animals working in roles supporting people can be confusing. The same term may be used to describe different roles, or two terms may mean the same thing. This confusion is evident among researchers, practitioners, and end users. Because certain animal roles are provided with legal protections and/or government-funding support in some jurisdictions, it is necessary to clearly define the existing terms to avoid confusion. The aim of this paper is to provide operationalized definitions for nine terms, which would be useful in many world regions: “assistance animal”, “companion animal”, “educational/school support animal”, “emotional support animal”, “facility animal”, “service animal”, “skilled companion animal”, “therapy animal”, and “visiting/visitation animal”. At the International Society for Anthrozoology (ISAZ) conferences in 2018 and 2020, over 100 delegates participated in workshops to define these terms, many of whom co-authored this paper. Through an iterative process, we have defined the nine terms and explained how they differ from each other. We recommend phasing out two terms (i.e., “skilled companion animal” and “service animal”) due to overlap with other terms that could potentially exacerbate confusion. The implications for several regions of the world are discussed

Adding 6 months of androgen deprivation therapy to postoperative radiotherapy for prostate cancer: a comparison of short-course versus no androgen deprivation therapy in the RADICALS-HD randomised controlled trial

Background Previous evidence indicates that adjuvant, short-course androgen deprivation therapy (ADT) improves metastasis-free survival when given with primary radiotherapy for intermediate-risk and high-risk localised prostate cancer. However, the value of ADT with postoperative radiotherapy after radical prostatectomy is unclear. Methods RADICALS-HD was an international randomised controlled trial to test the efficacy of ADT used in combination with postoperative radiotherapy for prostate cancer. Key eligibility criteria were indication for radiotherapy after radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to radiotherapy alone (no ADT) or radiotherapy with 6 months of ADT (short-course ADT), using monthly subcutaneous gonadotropin-releasing hormone analogue injections, daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as distant metastasis arising from prostate cancer or death from any cause. Standard survival analysis methods were used, accounting for randomisation stratification factors. The trial had 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 80% to 86% (hazard ratio [HR] 0·67). Analyses followed the intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov, NCT00541047. Findings Between Nov 22, 2007, and June 29, 2015, 1480 patients (median age 66 years [IQR 61–69]) were randomly assigned to receive no ADT (n=737) or short-course ADT (n=743) in addition to postoperative radiotherapy at 121 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 9·0 years (IQR 7·1–10·1), metastasis-free survival events were reported for 268 participants (142 in the no ADT group and 126 in the short-course ADT group; HR 0·886 [95% CI 0·688–1·140], p=0·35). 10-year metastasis-free survival was 79·2% (95% CI 75·4–82·5) in the no ADT group and 80·4% (76·6–83·6) in the short-course ADT group. Toxicity of grade 3 or higher was reported for 121 (17%) of 737 participants in the no ADT group and 100 (14%) of 743 in the short-course ADT group (p=0·15), with no treatment-related deaths. Interpretation Metastatic disease is uncommon following postoperative bed radiotherapy after radical prostatectomy. Adding 6 months of ADT to this radiotherapy did not improve metastasis-free survival compared with no ADT. These findings do not support the use of short-course ADT with postoperative radiotherapy in this patient population

Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial

Background Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain. Methods RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov , NCT00541047 . Findings Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths. Interpretation Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy. Funding Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society

Animal Assisted Interventions for Autism Spectrum Disorder: A Systematic Review of the Literature from 2017-2020

The purpose of this project is to perform a systematic review, following PRISMA guidelines, of the literature regarding animal assisted interventions for autism spectrum disorder from January 2016- August 2020

The Influence of Service Dogs on Recipients, Families, and Caregivers

Though literature on the influence and efficacy of service dogs as a complementary and integrative health intervention option for a variety of needs (e.g., medical, mobility, psychiatric) continues to emerge, a focus on how service dogs are integrated into the everyday lives of their handlers remains understudied. This dissertation offers new insights to this previously understudied area by first comparing the expectations versus lived experiences of veteran service dog handlers with posttraumatic stress disorder (PTSD) and then focusing in on the influence of service dogs beyond the handler, looking at the influence of service dogs on spouses, family members and caregivers. Using a rigorous multi-modal approach, both qualitative and quantitative insights emerge regarding the integration of a service dog for the handler and their families. Findings suggest that understanding the similarities and differences between expectations and experiences may help to inform practitioners and interested recipients about the service dog intervention and help to set realistic expectations about the integration process. Additionally, in populations of psychiatric assistance dogs for posttraumatic stress disorder (PTSD) and in populations of mobility and medical alert assistance dogs, findings suggest that the benefits and challenges of the intervention reach beyond the service dog recipient and handler, extending to affect the wellbeing of their families and caregivers. Researchers and practitioners should work together to develop programs that integrate these findings to provide family-focused educational interventions where both positive and negative experiences are shared alongside strategies to overcome the challenges associated with integrating a service dog into a home prior to pairing. Providing this opportunity enables setting realistic expectations for this complementary and integrative intervention option which in turn may affect its efficacy and success throughout and beyond the integration process