Hall SS, MacMichael J, Turner A, Mills DS. A survey of the impact of owning a service dog on quality of life for individuals with physical and hearing disability: a pilot study. Health Qual Life Outcomes. 2017 Mar 29;15(1):59.
BACKGROUND: Quality of life refers to a person’s experienced standard of health, comfort and happiness and is typically measured using subjective self-report scales. Despite increasing scientific interest in the value of dogs to human health and the growing demand for trained service dogs, to date no research has reported how service dogs may affect client perceptions of quality of life. METHOD: We compared quality of life scores on the 16 item Flanagan quality of life scale from individuals who owned a trained service dog with those who were eligible to receive a dog, but did not yet have one (waiting list control). Data were analysed separately from two groups; those with a service dog trained for individuals with physical disabilities (with physical service dog: n = 72; waiting for a service dog: n = 24; recruited from Dogs for Good database) and those with a hearing service dog (with hearing service dog = 111; waiting for a service dog = 30; recruited from Hearing Dogs for Deaf People database). RESULTS: When controlling for age and gender individuals scored higher on total quality of life scores if they owned a service dog or a hearing service dog, but this was only statistically significant for those with a service dog. Both groups (physical service dog and hearing service dog) scored significantly higher on items relating to health, working, learning and independence if they owned a service dog, in comparison to those on the waiting list. Those with a physical service dog also scored significantly higher on items relating to recreational activities (including items relating to reading/listening to music, socialising, creative expression), and those involving social interactions (including items relating to participating in organisations, socialising, relationship with relatives). Additionally, those with a physical service dog scored higher on understanding yourself and material comforts than those on the waiting list control. In contrast, those with a hearing service dog appeared to receive fewer benefits on items relating to social activities. CONCLUSIONS: Owning a service dog can bring significant specific and potentially general benefits to the quality of life of individuals with physical disabilities and hearing impairments. These benefits may have considerable implications for individuals with disabilities, society and the economy by promoting independence, learning and working abilities.
Physical and medical consequences of an intervention are relatively easy to assess, but what about the consequences like happiness, energy level, and satisfaction with life? These “quality of life” issues are important, but not always very easy to measure. To help assess changes in quality of life (QOL) issues, several “assessment tools” (questionnaires) have been studied. Using these QOL assessment tools, it is now possible to get a better understanding about how interventions can affect a subject’s QOL.
For individuals with physical disabilities, their QOL is often impacted, especially in specific areas (i.e., social interactions, sense of independence, etc). Service animals improve the functioning of such individuals, but do they improve the individual’s QOL? In the words of the authors, this study was undertaken to “to assess the impact that owning a service dog (for physical assistance or hearing assistance) may have on a client’s perceived quality of life in comparison to the quality of life scores obtained from individuals who need a service dog but do not yet own one.” Their starting hypothesis was that “that there would be a significant difference in quality of life scores between those ‘with service dogs’ in comparison to those ‘waiting for a service dog’.”
This investigation was designed as a case-control study of surveys collected from individuals who currently owned a service dog or were waiting to receive one. Participants were self-recruited from databases held by either of two UK charitable organizations: Dogs for Good and Hearing Dogs for Deaf People. The only stipulation for participating in the study was that the individual must be over 18 years of age and meet the criteria for receiving a service dog, set by the organization to which they belonged (either Dogs for Good or Hearing Dogs for Deaf People).
Once enrolled, questionnaires were distributed to contacts by way of postal or electronic mail. Participants were also allowed to elect to read their responses over the telephone, which one participant chose to do. Subjects were given 4 weeks to return the questionnaire. A reminder notice was sent to all participants who did not return their questionnaires within the first 2 weeks.
The questionnaire consisted of demographics questions: age, gender and service dog status, along with a question asking subjects to describe their disability. The second section of the questionnaire consisted of the Flanagan Quality of Life Scale (QOLS) assessment tool, with one additional question, previously tested and validated, to assess independence. As the authors describe it, “Independence was thought to be important in this study because service dogs are often applied for in the belief that they increase their owner’s independence and ability to do more without assistance from others.” Subjects were asked to answer each of the 16 questions with a response on a 7-point scale: (1 = Terrible, 4 = Mixed, 7 = Delighted). The total quality of life score was obtained by summing the individual scores from each of the 16 items.
The authors evaluated the physically impaired groups and the hearing impaired groups separately, figuring that the difference between physical and hearing disability itself might impact on subjects’ quality of life, as because the capacity to impact that QOL might differ between a physical service dog and a hearing assistance dog.
A total of 208 contacts were made through Dogs for Good; 96 (46%) returned the forms: 72 participants had been trained to work with and currently lived with a service dog (53% response rate); 24 had qualified for and were waiting for their service dog, or they had contacted the charity in order to be assessed to see if they qualified for a service dog. Subjects’ underlying medical problems included arthritis (n = 7 with dog; n = 2 waiting for dog); wheelchair user due to spinal injury or infection (n = 21 with dog; n = 8 waiting for dog), multiple sclerosis (n = 18 with dog; n = 5 waiting for dog), “impairment from disease/virus such as polio (n = 6 with dog; n = 1 waiting for dog), stroke (n = 3 with dog; n = 2 waiting for dog) and Ehlers danlos syndrome (n = 2 with dog; n = 2 waiting for dog). Impairments mentioned only by the ‘with dog’ group included muscular injury/wastage (n = 4), spondyloptosis (n = 1), neurological/brain disorders (n = 3), arthrogryposis (n = `), cerebral palsy (n = 1) and spina bifida (n = 1). Impairments mentioned only by those in the waiting list “control” group included seizures (n = 1), dystonia (n = 1), and scleroderma (n = 1). Four subjects in the “with dog” group and 1 in the control group chose not to disclose their disability. There was a significantly larger portion of older subjects in the “have dog” group compared to the “waiting for dog” group. There was no significant difference in the proportion of men and women between the two groups, however.
A total of 667 clients from the Hearing Service Dog agency were similarly contacted. The response rate was 39% (260 individuals), but only 21% (141) actually completed and returned the questionnaire: 111 currently living with a hearing service dog and 30 waiting to receive a dog. There was no significant age or gender difference between these two “have dog” and “waiting for dog” groups.
Analysis of the physical disability subjects’ questionnaires revealed a significant effect of Service Dog status on total Quality of Life Scores, when controlling for age and gender; F(1, 95) = 23.11, p = .000. Those with a service dog had a significantly higher total Quality of Life score than those waiting for a service dog. For individual items, subjects with service dogs scored significantly higher than those waiting for a service dog on the questions of material comforts, general health, relationship with relatives, helping or volunteering, participating in organizations, learning, understanding self, working, creative expression, socializing, active reaction, reading or music, and independence. There was no significant effect on having or rearing children, close relationship with spouse or others, or the question on relationships with close friends. Interestingly, the size of the effects (or the size of the difference between the “have dog” and “waiting for dog” groups) was often greater in men than in women.
Analysis of the questionnaires from the hearing disabled subjects revealed a trend towards an improved total QOL score with ownership of a dog, but this trend could not be considered statistically significant (p = 0.15). The only individual QOL questions where there was a significantly higher score among dog owners were: health, learning, working, and independence. There was a trend towards improved QOL score for understanding self (F = 3.41, p = .06) and active recreation (F = 3.31, p = .06). Again, effect sizes were generally greater in men than in women.
It has long been known that service animals can improve the functioning of many patients with disabilities. It has been demonstrated also that service and companion animals can improve the mental status and emotional state of their owners. In this study, the authors demonstrated an improvement in overall sense of well-being of patients with physical disabilities who own service dogs, as measured by the Quality of Life Score. Most of the individual areas of QOL that the test measures were also significantly improved, with the exception of feelings about having or rearing children or social relationships.
For subjects with hearing impairments, the trend towards improved total QOL score seen in subjects who owned hearing assistance dogs was not statistically significant, but individually, the sense of better health, active learning, working, and independence were all higher in the dog-owning group.
The authors present a thorough discussion of possible explanations, which I will not repeat here. I will offer an example, however, just to give the flavor of the speculation that surrounds these findings:
“Improved perceptions of physical health with service dog owners may be related to improved perceptions on items relating to personal fulfilment (e.g. independence, learning, engaging in recreational activities) and active interactions with others (e.g. socializing). By leading a fulfilling life, it is possible that participants believe that their health is not holding them back, and hence they report greater health satisfaction. In other words, the person feels able to cope . . . and feelings of coping are directly related to reported health and quality of life. Another possible explanation is that those with service dogs are more likely to go outdoors, which has been shown to improve health, as well as meet others through dog walking; another factor shown to improve wellbeing. However, it is possible that those who are awaiting a service dog report poorer quality of life because they are anticipating the improvement that they believe a service dog will bring. This may result in a negative contrast in their self-perceived quality of life (i.e. they are lacking something which they might soon have which they anticipate will improve their life) or they may be holding off engaging in new health promoting activities until they receive a dog. Therefore, it is plausible that those who are on a waiting list to get a service dog may score lower on quality of life to those who are similarly living with disability who are not awaiting a dog. Nonetheless, it may also be that individuals are holding off taking up activities because without the dog they lack the psychological (e.g. confidence) or physical ability to do so.”
While the entire discussion is worth pondering – and definitely worth studying by those who research this field – the fact is that it is all speculation. The authors note as much. They conclude that further research is needed, and that such research should differ in design. For one thing, they propose that subsequent research might use a “three-participant cohort group:” subjects with a service dog, subjects on a waiting list for a service dog, and subjects qualified to receive a service dog but not wishing to do so. Subsequent research also should explore the details behind these general feelings of satisfaction. Why are subjects more satisfied with their work? Are they performing better, or faster, or more independently? Are they having more social interaction at work, which might be contributing to their overall satisfaction and/or performance at work? These are the sorts of questions that a brief assessment tool cannot answer, but that an in-depth interview might.
For me, the major fault of the study was simply the inability to sort out the control group of subjects who were approved and waiting to receive a physical service dog, from those who were registered but not yet assessed. Clearly, not all of the unassessed subjects would be good case-control matches for the dog-owning group. Though small (especially the hearing-impaired groups), this study was a reasonable way to test the original hypothesis that service dog ownership would improve the owner’s sense of well-being, and it points us now in the direction of new questions with new hypotheses, begging to be studied.
-Reviewed by Ronald Sherman, MD