Mechanisms of Change for Children Participating in Therapeutic Horse Riding: A Grounded Theory

ABSTRACT

Aim: To develop a model for understanding mechanisms of change in health outcomes for riders with disabilities participating in therapeutic horse riding (THR). Methods: Using grounded theory methods we collected and analyzed data from interviews with 16 child riders and 18 caregivers, teachers and primary therapists, and from participant-observation during THR sessions. Results: The central concept underpinning the model illustrating mechanisms of change was “gaining the tools to go on.” Riders' experiences suggested the THR landscape (i.e., “where the tools are gathered”) allowed for an expanded range of experiences in which riders could participate. Riders experienced an expansion of self-concept by learning to move, succeed, connect, and adapt (i.e., “the tools gathered”) within the THR landscape. Riders then iteratively translated an expanded view of self into other environments, reflecting “how and where the tools are used.” Conclusion: Findings suggest that positive changes in health arise from riders' experiences of learning and agency within the THR therapeutic landscape, and from the influence of these experiences on a child's developing self-concept. This article considers the wider impact of THR on children's health, beyond a focus on changes in physical outcomes.

KEYWORDS:

• Children
• grounded theory
• learning
• mechanisms
• outcomes
• rehabilitation
• self-concept
• therapeutic horse riding

Acknowledgments

The authors acknowledge the individuals who kindly gave their time to participate in this study and the data collection collaboration with the New Zealand Riding for the Disabled Association Inc. (NZRDA).

Declaration of Interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Funding

This study was funded by a New Zealand Riding for the Disabled Association Inc. (NZRDA). Scholarship administered through the University of Otago. NZRDA did not influence the results of the study or preparation of this manuscript.

Additional information

Notes on contributors

R. A. Martin

Rachelle Martin, Dip.Phys, MHSc(Rehabilitation), is a doctoral candidate at the Wellington School of Medicine, University of Otago. She has worked as a physiotherapist in acquired brain injury rehabilitation services in both acute and community settings. Her research interests are focused on outcomes that are important to people who access rehabilitation services, evaluating complex health and rehabilitation interventions, and social identity for people living with the experience of disability.

F. P. Graham

Fiona Graham, B. Occ Ther, PhD, is a Senior Lecturer in interprofessional rehabilitation at the Rehabilitation Teaching and Research Unit of the University of Otago, Wellington, New Zealand. Her research interests include participation of children with neurodisability, and exploration of autonomy supportive communication between health professionals and people impacted by disability.

W. J. Taylor

William Taylor, PhD, MBChB, FRACP, FAFRM, is Associate Professor at the University of Otago Wellington, Department of Medicine and consultant rheumatologist and rehabilitation physician at the Hutt Valley District Health Board. His main research interests relate to rheumatic diseases, rehabilitation process, classification criteria and the measurement of outcome. He is currently involved with the Australasian Musculoskeletal Clinical Trials Networks in a project to determine transparent criteria for research prioritisation.

W. M. M. Levack

William Levack, PT, PhD, MHealSc(Rehabilitation), BPhty is an Associate Professor of Rehabilitation at the University of Otago, New Zealand. He works at the Associate Dean Research for the Wellington campus of the University of Otago and as the Academic Head of the Rehabilitation Teaching & Research Unit – an interprofessional, distant-teaching and research unit. His research interests include interprofessional practice, person-centeredness and patient engagement in rehabilitation, with a particular focus on respiratory and neurological conditions.