Complementary medicine framework for horses in Sweden could be improved – study

In the Swedish study, there was majority support among horse owners for the protection of professional titles for CAVM therapists, and a belief that they should receive basic training in animal medicine.
In the Swedish study, there was majority support among horse owners for the protection of professional titles for CAVM therapists, and a belief that they should receive basic training in animal medicine.

The framework under which complementary or alternative veterinary medicine is used to treat horses in Sweden could be improved, the findings of a fresh study suggest.

Researchers Karin Gilberg, Anna Bergh and Susanna Sternberg-Lewerin, writing in the journal Animals, set out in their study to explore the use of complementary or alternative veterinary medicine (CAVM) in Swedish horses.

CAVM, they said, is an umbrella term covering a wide range of methods, from those that could almost be considered conventional medicine to those where animal studies are lacking, or that have even suggested no effect in animals.

Electronic questionnaires were distributed to horse owners, equine veterinarians and CAVM therapists.

Of the 204 responding horse owners, 83% contacted a veterinarian first in cases of lameness, while 15% contacted a CAVM therapist. For back pain, 52% used a CAVM therapist as their first contact and 45% a veterinarian.

Only 10 to 15% of the respondents did not use any CAVM method for prevention or after injury.

Of the 100 veterinarians who responded, more than half did not use CAVM themselves but 55% did refer to people who offer this service.

Of the 124 responding CAVM therapists, 72% recommended their clients seek veterinary advice when needed, and 50% reported receiving referrals from a veterinarian, while 25% said they did not collaborate with a veterinarian.

The two most common methods used on horses were stretching and massage.

All three groups were asked if the use of CAVM in animals should be regulated to improve animal welfare and avoid mistreatments.

Among horse owners, there was majority support for the protection of professional titles for CAVM therapists, and a belief that they should receive basic training in animal medicine. A majority also felt that CAVM therapists should be obliged to refer to a veterinarian when warranted, and that there should requirements around record-keeping. A majority of the veterinarians and therapists who took part also supported such requirements.

“Many veterinarians wrote that they want better control of the methods used and more research on what methods really work,” the study team reported. “Some veterinarians want more opportunities for postgraduate training in CAVM and some quality assured titles for such education.

“Many therapists wrote that they want more collaboration between veterinarians and therapists, and many wrote that they already keep records.”

The authors noted that a large proportion of Swedish horses are insured, and most policies cover not only veterinary treatments but also CAVM treatments if performed after a veterinary referral.

“This prerequisite presumes that veterinarians have sufficient knowledge of relevant CAVM methods and CAVM therapists to be able to refer to an appropriate person and method.

“As veterinarians are legally obliged to base their treatments and recommendations on science or well-documented experience, and most CAVM methods are not well-documented in animals (if at all), this presents a dilemma.

“On the other hand, some methods classified as CAVM are well studied in humans and may even be regarded as conventional human medicine, although animal studies are lacking. Hence, it may not be entirely obvious what methods may be regarded as evidence-based and applying the veterinary legislation is not always straightforward.”

Discussing their findings, the authors noted that international studies indicate many horse owners use CAVM for locomotion-related problems and the results from the Swedish horse owner questionnaire revealed a similar trend.

The responses indicated that CAVM is frequently used by horse owners as a complement to veterinary treatments and for the prevention of health problems.

The findings, they said, emphasize the need for well-designed research studies to ensure evidence-based information on the use of CAVM.

“The fact that there are withdrawal periods for many CAVM treatments before a competition, not just for pharmaceuticals, may lead horse owners to believe they are indeed effective, whereas the main objective of the withdrawal periods is to discourage competing with horses in need of any treatment, i.e., any horse that is not entirely sound.

“Nevertheless, many therapists also stated that they collaborate with a veterinarian and that they receive referrals from veterinarians, which should ensure that their animal patients had received the necessary veterinary treatment.

“However, it is not clear how the referring veterinarian can take responsibility for the CAVM treatment of the animal. Some CAVM therapists work in veterinary clinics, which means that the veterinarian is responsible for the treatment, while others operate autonomously.

“In the latter case, it is important that the therapists understand when a veterinary consultation is needed.”

The researchers said there is some collaboration between veterinarians and CAVM therapists, but the horse owners in this study wanted more of it. “Closer collaborations might lead to better opportunities for proper diagnoses by veterinarians before CAVM therapy,” they said.

Gilberg is with the veterinary service Distriktsveterinärerna Gävle; Bergh and Sternberg-Lewerin are with the Swedish University of Agricultural Sciences.

Gilberg, K.; Bergh, A.; Sternberg-Lewerin, S. A Questionnaire Study on the Use of Complementary and Alternative Veterinary Medicine for Horses in Sweden. Animals 2021, 11, 3113.

The study, published under a Creative Commons License, can be read here

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