Effect of Animal-Assisted Therapy on Patients in the Department of Long-Term Care: A Pilot Study

1. A main study   variable was patient mood or ‘sense of satisfaction’ (line 76) but with the   current wording it is unclear exactly how this was measured. First, with the   current wording “A mood was evaluated by the Likert   scale to assess the sense of satisfaction of the patient” (line 76) it   is unclear if the authors were trying to asses patients’ general moods or   their sense of satisfaction - or if these are considered the same construct   or different. The rest of the sentence (lines   76-77)…”which made it possible to ascertain their current attitude and   the approximate degree of the same” is one example of wording whose meaning   is impossible to decipher. Most importantly, it is unclear how exactly   patients’ sense of satisfaction was actually evaluated – if they rated their satisfaction on a scale of 1-10,   or if this rating was judged based on a more general answer, and if so by   whom? The authors do write on line 80: “Their answers were judged on a scale   of one to ten”. But again, how were these judgments made and who made them? Was   it the health-care provider for the control group and the experimenter for   the experimental group? What was the specific   question asked to patients, was it standardized, and why was a 10-point   (as opposed to, for example 5-point) scale used: These are examples from the   Measurements section that need to be discussed more clearly and in more   detail.

1)         We change the terminology at general   mood of patients, which is proper term

2)         A mood was evaluated by a Likert scale   that allowed patients to evaluate their general mood on a scale of 1 to 10.   [10-11] on every day of therapy. The people in the experimental and control   groups were asked by the same therapist to evaluate how they felt.

3)         They were asked to rate by themself   their mood from 1 to 10

4)         They instruction was: Rate your mood you   have right now on a scale of 1 to 10, with 1 being the worst mood and 10   being the best mood. The 10-point   scale was chosen for better understanding reported by patients compared to a   5-point scale, that patients confused with grading at school, where 1 is the   best classification.

  There should be   some discussion as to why it was hypothesized that   blood pressure and heart-rate would not be influenced by the therapy dog   (lines 48-49) but the Barthel index would be? Indeed, other studies,   and several mentioned in the Discussion section (line 223) have found an   effect of AAT on heart-rate and blood-pressure. Also, in the discussion of   the studies that found a positive association (lines 223-228) it would be helpful to briefly explain in what   settings/contexts and with what populations such findings were seen.

5)         Because their levels of blood pressure   and heart rate weren´t at the beginning pathological.

·           To this end, the hypothesis was that a   positive influence would be exerted, pertaining to the general mood and   Barthel index of the patient, thanks to their activation and mediating   pleasant experiences

·           We expect the blood pressure and heart   rate to be the same in both groups. The value will remain at the   physiological level. Therapy will not lead to any pathological increase or   decrease.

6)         All the studies were working with patients   or participants with pathological levels of blood pressure, cardiovascular   disease or under acute stress

  In the Results   section all t-test values should be included (e.g. t-value, df value), not   just the p-values (e.g. lines 169,170, 185, etc.). The vertical axis labels   of the figures seem more appropriate as figure titles; it would be helpful to   instead have labels related to the dependent variables shown. Clarification   is needed for the description of Figure 2 in lines 190-192. It is especially unclear   because the text in lines 185-188 is also ambiguous – perhaps restate the   analysis done, the exact question in focus, or explicitly which results are   meant by “a comparison of results for the experimental group…”(line 185).

7)         The experimental group demonstrated a   statistically significant difference in shift in mood prior to and following   a therapy session with the dog (the value of the Wilcoxon pair test criterion   W = 22; df = 22; p < 0,001). However, variance between satisfaction in the   morning and the second measurement was also seen in the control group (the   value of the Wilcoxon pair test criterion W = 47,5; df = 24; p<0,005).   Complete results are shown in Figure 1.

8)         Figures were corrected

  It is confusing   to have all the citations placed at the end of a sentence when the sentence   contains multiple statements that need citations. For example: lines 20 &   21 include the two separate statements, 1) that “a large number of   hospitalization patients have pets” and 2) that contact with an animal might   beneficially remind them of home – is the Fine (2006) citation related to   both of these points? If not, a second citation would be needed. If so, the   sentence could be re-worded to be more clear. Another example are the   findings and citations reported on lines 35-37. And, a final illustrative   example can be found on lines 266-268. Which studies link to the findings   that an animal can distract from attention to pain, and which for reflection?   It is also unclear from the current wording what is meant here by “reflection   on the participants”. Also, the studies mentioned on line 28 need citations,   as do the claims on lines 32 and 33-34.

9)          corrected

  A thorough edit   for wording and clarity will improve this paper. For example, “the older   people” (line 5) would read more clearly as “elderly” and “this strategy”   (line 19) should be “these strategies”. Line 204 should say “paired-samples   t-test” instead of “Pair T-Test”. Particularly confusing wording includes   lines 63, 212, 213, 325 (what is meant by “optional frequency”?), and 245   (what is meant by “better oriented”?). Also, the capitalization of journal   titles is inconsistent in the references.

10)     corrected

Referencing   seems quite sparse in this section - generally just one per paragraph. Given   that this is the section that places the study in context and provides   rationale and underpinning insights, I think this needs to be addressed.   There is a wide body of literature on many of these issues that could be   engaged with to provide better support for the claims made and to direct   readers to further relevant studies.

1)         We have improved the more detailed   layout of the studies to better refer to the information. We have tried to   reduce references a little, so that the list of literature is not too   extensive because some journals prefer sparse references. However, if you find   it more appropriate to extend the list after making your changes, we will add   appropriate references.

What   kind of illnesses did the patients have? Were they all physical, or also some   cognitive? Did many participants have dementia? I think this is important to   know, and if there are any differences between groups in terms of how they   reacted to the dog

2)         The disease that affected patients was   stroke, mild dementia or mild cognitive disease, or cancer.

Writing   - the paper would benefit from a proof reading by a native speaker for the   first part. Whilst it is fine, there are some places where the structure or   phrasing is unclear and the flow of the argument.

3)         The article was checked by native   speaker.