Summary of findings for the main comparison. Animal‐assisted therapy (AAT) compared to no AAT for dementia.
| AAT compared to no AAT for dementia | ||||||
| Patient or population: dementia Setting: nursing home or assisted‐living facilities Intervention: AAT Comparison: no AAT (standard care, reminiscing activities, cooking, or exercise therapy) | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with no AAT | Risk with AAT | |||||
| Affect and emotional well‐being: depression measured using CSDD (0–19, higher score indicates more severe depressive symptoms) | The mean score for the control group ranged from 8.76 to 9.58 | MD 2.87 lower (5.24 lower to 0.50 lower) | — | 83 (2 RCTs) | ⊕⊕⊝⊝ Lowa,b | — |
| Social functioning measured using MOSES, Withdrawn Behaviour subscale (8‐ 32, higher score indicates more severe withdrawn behaviour) | The mean score MOSES, Withdrawn Behaviour subscale was 20 | MD 0.4 lower (3.41 lower to 2.61 higher) | — | 58 (1 RCT) | ⊕⊕⊝⊝ Lowa,c | — |
| Behaviour measured using NHBPS (0–116, higher score indicates more severe behaviour problem), NPI (0–144, higher score indicates more severe neuropsychiatric symptoms) or MOSES Disoriented Behaviour subscale (8–32, higher score indicates more severe disoriented behaviour) | The mean scores for the control group, expressed using different instruments, were: NHBPS: 3.75; NPI: 28.66; MOSES Disoriented Behaviour subscale: 15.4 | SMD 0.34 lower (0.98 lower to 0.30 higher) | — | 142 (3 RCTs) | ⊕⊝⊝⊝ Very lowa,c,d | As each of the 3 studies used different instrument to measure the outcome, the pooled estimates were expressed using SMD. |
| Agitation or irritability measured using CMAI (14–70, higher score indicates more severe agitation or irritability), BARS (10–70, higher score indicates more severe agitation or irritability) or MOSES Irritability subscale (9–36, higher score indicates more severe irritability) | The mean scores for the control group, expressed using different instruments, were: CMAI: 20; BARS: 24; MOSES Irritability subscale: 13.7 | SMD 0.39 lower (0.89 lower to 0.1 higher) | — | 143 (3 RCTs) | ⊕⊝⊝⊝ Very lowa,b,c | As each of the 3 studies used different instrument to measure the outcome, the pooled estimates were expressed using SMD. |
| Health‐related quality of life measured using QUALID (12–45, higher score indicates poorer quality of life) | The mean quality of life (QUALID) was 15.23 to 26.48 | MD 0.45 higher (1.28 lower to 2.18 higher) | — | 164 (3 RCTs) | ⊕⊕⊕⊝ Moderatea | 2/3 included studies were conducted by the same principal author over a similar period. However, the participants differed (home dwelling people in 1 and nursing home residents in 1) and the studies were registered as separate studies under ClinicalTrials.gov. Although they appeared to be 2 separate studies, we could not exclude the possibility of overlapping participants, hence double‐counting in the outcome data, as we have not heard back from the authors. However, we considered the possibility of double‐counting to be small. |
| Adverse events | — | — | — | — | — | No studies assessed this outcome. |
| Physical functioning, measured using Barthel Index for ADL (0–100, higher score indicates better abilities) | The mean score from Barthel Index for ADL was 71.83 | MD 4.65 higher (16.05 lower to 25.35 higher) | — | 37 (1 RCT) | ⊕⊕⊝⊝ Lowa,c | — |
| Physical functioning: self‐care ability measured using MOSES Self‐Care Functioning subscale (8–32, higher score indicates poorer function) | The mean score on self‐care ability measured using MOSES Self‐Care Functioning subscale was 14.1. | MD 2.2 higher (1.23 lower to 5.63 higher) | — | 58 (1 RCT) | ⊕⊕⊝⊝ Lowa,e | — |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). The assumed risk in the comparison group is taken from the total event rate (dichotomous outcome) or the range of mean scores (continuous outcome) in the comparison group of the included studies. AAT: animal‐assisted therapy; ADL: activities of daily living; BARS: Brief Agitation Rating Scale; CI: confidence interval; CMAI: Cohen‐Mansfield Agitation Inventory; CSDD: Cornell Scale for Depression in Dementia; MD: mean difference; MOSES: Multidimensional Observation Scale for Elderly Subjects; NHBPS: Nursing Home Behaviour Problem Scale; NPI: Neuropsychiatric Inventory; QUALID: Quality of Life in Dementia; RCT: randomised controlled trial; SMD: standardised mean difference. | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||||
aDowngraded one level. The included studies had unclear risk of selection bias and high risk of performance bias. bDowngraded one level. The 95% CI ranged from a moderate reduction in depressive symptoms to virtually no difference with a small sample size from a single study, which is likely to translate into different decisions if either was the true effect. cDowngraded one level. The 95% CI ranged from substantially lower (reflecting meaningful benefit) to substantially higher (reflecting meaningful harm) scores, which is likely to translate into different decisions if either was the true effect. dDowngraded one level. Substantial degree of heterogeneity present as suggested by an I2 greater than 50%. eDowngraded one level. The 95% CI ranged from a moderately lower (reflecting meaningful benefit) to substantially higher (reflecting meaningful harm) score, which is likely to translate into different decisions if either was the true effect.