Feature Article: Interest in Service Dogs by Veterans with Spinal Cord Injuries: A Pilot Study
Tiffanie A. Brashear, PA, and Diana H. Rintala, PhD
Abstract
Background/Objective: Service dogs are trained to help individuals with disabilities maximize function and enhance social participation. This pilot study obtained an estimate of the proportion of veterans with spinal cord injuries (SCI) receiving care from a Veterans Affairs Medical Center who were interested in information about, or obtaining, a service dog.
Method: Fifty randomly selected veterans with SCI were interviewed by telephone.
Demographic and injury-related factors were examined for associations with interest in a service dog. Tasks the veterans would expect a service dog to do were identified.
Results: Nearly one-third reported no prior knowledge of service dogs. Thirty percent reported at least some interest in obtaining a service dog and 42 percent desired information concerning service dogs. The Satisfaction with Life Scale score, estimated change in the number of hours of unpaid assistance after obtaining a dog, and estimated change in the number of days per week the person would leave their home after obtaining a dog were the only variables that significantly predicted interest in service dogs. Less satisfied persons, persons who predicted they would need fewer hours of unpaid assistance, and those who predicted they would get away from their homes more frequently were more likely to be interested in information or in obtaining a service dog.
Conclusions: Among veterans with SCI there is a substantial interest in service dogs. Health care providers have a responsibility for educating individuals with SCI about the potential benefits and drawbacks of service dogs and for facilitating the process of obtaining information from service dog training organizations.
Key words: assistance animals, assistance dogs, service animals, service dogs, spinal cord injuries, veterans
Introduction
The use of service dogs, one of several types of assistance dogs, is one approach to helping persons with mobility impairments achieve an optimal level of functional independence in activities of daily living and enhance their social participation. Through intense training, service dogs are able to perform a variety of tasks such as pulling wheelchairs, opening doors, retrieving items from store shelves, turning on light switches and electronics, retrieving the telephone, and picking up objects such as clothing and keys. In 2002, Public Law 107-135 (Title II, Section 201(c)(2)) was enacted, authorizing service dogs to be provided by the Department of Veterans Affairs to veterans with spinal cord injuries or dysfunction, other diseases causing physical immobility, or other types of disabilities susceptible to improvement or enhanced functioning in activities of daily living through employment of a service dog. Although there have been several published studies (Allen & Blascovich, 1996; Eddy, Hart, & Boltz, 1988; Fairman & Huebner, 2001; Lane, McNicholas, & Collis, 1998; Mader, Hart, & Bergin, 1989; Marks, 1993; Rintala, Sachs-Ericsson, & Hart, 2002; Roth, 1994; Valentine, Kiddoo, & LaFleur, 1993) and other studies are under way to assess the outcome of obtaining a service dog, to our knowledge, no information exists regarding the extent to which veterans with mobility impairments desire or consider themselves in need of a service dog. In view of the time and money invested in training service dogs, it seems important to determine the extent of desire and need for a service dog among veterans with mobility impairments.
Most studies have found a positive relationship between obtaining a service dog and various outcome measures; however, there are some inconsistencies. Two studies of individuals who had obtained service dogs found respondents reporting that their service dog assisted them with health-related behaviors and that their general health improved as a result (Fairman et al., 2001; Lane et al., 1998), whereas another study found no differences in perceived health functioning when comparing individuals who had obtained a service dog to those still on the waiting list for one (Marks, 1993). Individuals partnered with service dogs have reported functional improvements in tasks of daily living. In Roth’s (1994) retrospective study, respondents reported their service dog assisted them with eating (22%), dressing (20%), retrieving the phone (20%), and grooming (17%). In a study by Fairman et al. (2001), individuals partnered with service dogs have reported, “it is easier to leave home” (77%), and “easier to use community resources” (73%).
Many of the early scientific studies of the effects of service dogs focused on social aspects of living. Individuals partnered with service dogs were found to receive more social acknowledgement from strangers than individuals not partnered with service dogs. In a study of adults who used wheelchairs, bystanders were significantly more likely to smile and begin a conversation with persons accompanied by a service dog than with those not accompanied by one (Eddy et al., 1988). A similar study of children who used wheelchairs found that children with service dogs received more social acknowledgement than children who did not have service dogs (Mader et al., 1989). In a retrospective study of individuals who obtained a service dog, Valentine and colleagues (1993) found that participants reported feeling more independent (90%), having higher self-esteem (80%), being more content (80%), and being more assertive (80%) than they were prior to having a service dog. Rintala and associates (2002) found that self-esteem was significantly enhanced from pre-to post-placement of a service dog in a group of 16 adults with mobility impairments.
Participants reported that the dogs had a positive effect on going out in public, feeling needed, feeling independent, and safety. Allen and Blascovich (1996) reported significant differences in a number of life areas between a group of persons who received a service dog and a wait-list control group. The group who received a service dog had significantly more self-esteem, more internal locus of control, better psychological well-being, and better community integration. They were more likely to attend school, work part time, or both, and they had significantly fewer hours of paid and unpaid personal assistance per week.
The aims of this pilot study were to ascertain what proportion of veterans with spinal cord injuries (SCI) want or believe themselves in need of a service dog, the expectations veterans have regarding the potential effects of having a service dog, and what factors, if any, are related to interest in and a desire for a service dog. The local Institutional Review Board approved the study.
Methods
Participants
In an earlier study, 348 of 509 veterans with SCI who had received care at a Veterans Affairs Medical Center during fiscal years 1999-2001 participated in a telephone survey regarding pain and other aspects of life (Rintala, Holmes, Fiess, Courtade, & Loubser, 2005). The remaining 161 former patients were unable to be contacted, did not wish to participate, or were unable to participate for various reasons. Of the 348 study participants in the earlier study, 327 (94%) agreed that they could be contacted regarding future research studies. Of these 327 veterans, 75 (23%) were randomly selected to be sent a letter recruiting them into the present study using the SPSS (SPSS Inc., 2005) “random sample of cases” function. Of the 75 veterans who were sent letters, 50 completed a telephone survey. Of the remaining 25 veterans who were sent letters, 24 could not be contacted and one was deceased. Fifty interviews was the target sample size given that this was an unfunded, individual student project, that required reasonably lengthy telephone interviews with each participant. A larger sample was not feasible given the available resources and time.
Procedure
The recruitment letter, distributed with the IRB-approved questionnaire, explained the purpose of the study, the risks and benefits, and confidentiality issues. Each potential participant was given two weeks to think about the questions and study prior to receiving a telephone call from the investigators. If the person wished to participate, oral informed consent was obtained via telephone, and the interview was either conducted at that time or scheduled for a later time.
Measures
Demographic and Injury-Related Information: Information was obtained regarding age, race and ethnicity, educational status, current occupational status, marital status, level of SCI (upper and lower body affected or only lower body affected), and time since SCI. Participants were asked if they had ever heard of an assistance or service dog. If they had not heard of a service dog, the interviewer referred to assistance dogs for persons with visual impairments (i.e., Seeing Eye dogs), of which most persons are aware, and then indicated that service dogs are trained to do tasks for persons who have mobility impairments. In some cases, the interviewer mentioned a few examples of tasks a service dog might do. All participants were asked if they had an interest in information about service dogs, and if they had an interest in obtaining a service dog. For each of these two questions, the response options were “no interest,” “some interest,” or “great interest.”
Self-assessed Health Status was evaluated using one item from the Medical Outcome Study Health Status Survey SF-36 (Ware, Jr. & Sherbourne, 1992). The veterans were asked to indicate whether their health was excellent, very good, good, fair, or poor.
Independence and Mobility: Selected questions from the Physical Independence and Mobility subscales of the Craig Handicap Assessment and Reporting Technique Short Form (CHART-SF) were used to evaluate the perceived levels of independence and mobility (Whiteneck, Charlifue, Gerhart, Overholser, & Richardson, 1992). Participants were asked how many hours in a typical 24-hour day they had (a) paid and (b) unpaid physical assistance with personal care activities such as eating, bathing, dressing, toileting, and mobility. They were then asked how many hours of paid and unpaid assistance in a typical 24-hour day they would expect to have if they had a service dog. They also reported on the number of days per week they were able to leave their homes and what they expected that number would be if they had a service dog.
The Satisfaction with Life Scale (SWLS) was used to measure subjective quality of life (Pavot, Diener, Colvin, & Sandvik, 1991). The five-item scale asks the respondent to indicate the degree to which he or she agrees or disagrees with each statement on a seven-point scale ranging from strongly disagree to strongly agree. The five item scores are summed to obtain a total score which can range from 5 to 35. Higher scores reflect greater satisfaction with life.
Tasks for Service Dogs: Participants were asked to indicate which of 36 tasks they would expect a service dog to do if they had one. The task list was derived from a longer list developed by a work group established by the Veterans Health Administration Prosthetic and Sensory Aids Service Strategic Health Care Group (VHA PSAS SHCG). The mission of the work group was to recommend a policy regarding prescription of service dogs for the aid of veterans with mobility deficits due to spinal cord dysfunction or other chronic diseases that impact physical functioning. In the present study, participants could also indicate any additional tasks they would expect a service dog to do that were not among the 36 tasks on the checklist.
Data Analysis
The data were analyzed with SPSS Version 14.0 for Windows (2005) and StatXact Version 6.0 statistical software (Cytel Software Corp., 2003). Descriptive statistics were obtained for all study variables. These included means and standard deviations for normally distributed continuous variables (i.e., age and the SWLS score), medians and ranges for skewed continuous variables (i.e., time since SCI, hours of paid and unpaid assistance and outings per week), and percentages for categorical variables (gender, race and ethnicity, education, occupation, marital status, level of SCI, knowledge of, and interest in, service dogs, health status, and types of tasks a dog would be expected to do). One 70 year-old participant described his SCI as due to a birth defect, thus his time since SCI was 70 years and, therefore, an extreme outlier. The birth defect, however, had not caused him problems until about five years prior to participating in the survey, which explains how he was able to serve in the military in spite of the birth defect. The differences between current hours of paid and unpaid assistance and days out of the home, and the participant’s estimates of those hours and days if a service dog was available for use, were calculated. The sample in the current study and the previous sample of 348 from which it was selected were compared for age, time since SCI, gender, race and ethnicity, and educational level with t-tests and Pearson chi square analyses.
Univariate analyses were conducted to identify relationships between interest in information about, and desire for, a service dog with other study variables, specifically: demographic and injury-related data, self-assessed health status, functional independence, mobility, and life satisfaction. Analyses of variance and non-parametric Kruskal-Wallace analyses were conducted for continuous variables as appropriate, depending on whether the distribution of the variable was relatively normal: age and SWLS score; or was skewed: time since SCI, hours per day of paid and unpaid assistance, days out of the home per week both currently and expected with a service dog, and the calculated expected change in hours of assistance and days out of the home. Pearson chi square analyses were performed for all categorical variables. To avoid small cell sizes, race and ethnicity was collapsed into two categories: non-Hispanic white and other; education was collapsed into three categories: high school or less, some college, and college degree; occupational status was collapsed into two categories: unemployed due to disability and other; marital status was collapsed into two categories: married and not married; and self-assessed health was collapsed into three categories: excellent/very good, good, and fair/poor. Because some cells still were quite small even after collapsing the data, StatXact was used to determine the exact probability rather than the asymptotic probability. Finally, to determine whether those who had previously heard of a service dog had different expectations about what tasks the dogs could do than those who had never heard of the dogs, the two groups were compared with regard to the proportion of participants who expected a service dog to perform each task.
Information for Participants
The participants who expressed interest in information about service dogs were sent a packet with contact and application information for several organizations across the United States that train and provide assistance dogs.
Results
Characteristics of the sample are displayed in the columns labeled “Overall” in Tables 1 through 3. Compared with the 348 veterans in the earlier study from which this sample was selected, the participants in this study were approximately two years older (56.7 ± 9.5 vs. 54.8 ± 11.6 years, t = 1.11, p = .270), had been injured about one year longer (18.6 vs. 17.5 years, t = 0.60, p= .547), were more likely to be female (4% vs. 1%, Chi square = 1.40, p = .121), were more likely to be non-Hispanic Caucasian (68% vs. 60%, Chi square = 0.78, p = .353), and were more likely to have an Associates degree or higher (32% vs. 20%, Chi square = 1.36, p = .217), but none of these differences was statistically significant. Over two-thirds (68%; Confidence Interval [CI] = 54% - 82%) of the sample had heard of assistance or service dogs. Of the 50 veterans, none currently had a formally trained service dog although one previously had a dog that he trained to assist him, and one currently had two dogs that were able to perform minimal tasks for him but were not formally trained as service dogs.
Twenty-one of the 50 veterans (42%, CI = 30% - 54%) had some or great interest in information concerning service dogs and 15 veterans (30%, CI = 16% - 44%) expressed some or great interest in obtaining a service dog. Only 25 percent of those who had never heard of service dogs were interested in information about them, whereas 50 percent of those who had heard of service dogs were interested in information. In general, interest in information about service dogs reflected interest in actually obtaining one (Chi square = 47.69, p < .0001). None of the 29 (58%) persons who did not want information about service dogs was interested in obtaining a dog. Six (12%) persons indicated interest in information but not in obtaining a dog, and 15 (30%) persons were interested in both information and obtaining a dog. Everyone who had great interest in obtaining a dog (n = 7) expressed great interest in information as well.
Displayed in Table 4 are the number of persons interested in information about service dogs as related to their interest in obtaining a dog, separately within the groups designating whether the veteran had previously heard of service dogs or not. One veteran said he wanted information to share with others but could not have a dog because his wife is allergic to dogs. Another veteran reported no interest in information about service dogs or obtaining one because he feared that his current level of functioning would deteriorate and he would lose his current abilities if he became dependent on the dog. One veteran was interested in information but was not allowed to have a dog in his apartment while another was not interested in information or a dog because he didn’t have anyone who would help take care of the dog.
Expectations varied with regard to the effect that having a service dog would have on the amount of paid and unpaid assistance needed. One veteran who currently received around-the-clock paid assistance expected the number of hours to decrease to zero if he got a dog and another thought the number of hours would decrease from 24 to 10 per day. Another veteran, however, expected paid assistance to increase from 8 to 10 hours daily, because he believed that he would need someone to assist with taking care of the dog in addition to assisting him, while another veteran thought it would change from zero hours of assistance daily to 1.5 hours for the same reason. Ninety percent of the participants believed that having a service dog would make no difference in the amount of paid assistance needed.
With respect to unpaid hours of assistance, five veterans (10%) believed they would need one-half to 14 fewer hours of unpaid assistance daily if they had a service dog and four respondents (8%) said they would need one additional hour of unpaid assistance daily to provide care for the dog. Eighty percent believed that a service dog would not change the number of hours of unpaid assistance needed. Twenty percent (n=10) of the respondents thought they would get out of their home 1 to 5.5 more days per week with a service dog, while one respondent thought he would get out one-half day less per week with a dog. Seventy-six percent believed a service dog would not affect the number of days they got out of the home. However, of the 15 veterans who reported an interest in obtaining a service dog, eight expected an increase in the number of days they would leave their home in a week if they had a service dog.
There was no significant difference in age with regard to interest in either information or obtaining a service dog (Table 1). Life satisfaction, however, was related to the degree of interest in information and obtaining a dog. On average, persons with great interest in information, obtaining a dog, or both, had lower scores on the SWLS (Table 1; higher scores = greater life satisfaction). In post-hoc pair-wise comparisons with Bonferroni adjustments for multiple comparisons, persons who had great interest in information had significantly lower scores on the SWLS than did those with some interest in information (p = .037). With regard to interest in obtaining a service dog, persons with great interest had significantly lower SWLS scores than persons who had no interest in obtaining a dog (p = .020).
There was no relationship between interest in either information or obtaining a dog with current or estimated hours of paid assistance or change in those hours (Table 2). There was also no relation with current or estimated hours of unpaid assistance. However, the calculated estimated change in hours of unpaid assistance was significantly related to interest in information (K-W Chi square = 6.07, p = .048) and obtaining a dog (K-W Chi square = 7.68, p = .022). Persons with no interest in information or obtaining a dog believed that the hours of unpaid assistance would increase, whereas persons with some or great interest believed the hours of unpaid assistance would decrease if they obtained a service dog. Similarly for number of days out of the home per week, there was no significant relationship between interest in information or obtaining a dog with either current or estimated outings per week; however, calculated expected change in number of days out of the home per week was significantly related to interest in both information (K-W Chi square = 9.29, p = .010) and obtaining a dog (K-W Chi square = 11.40, p = .003). Persons who were interested in information, a dog, or both, believed they would get out of the home more days per week than they currently did if they had a service dog.
Although the small number of women (n = 2) in the sample precluded statistical analysis of gender differences, it is notable that neither of the two females was interested in information or obtaining a service dog (Table 3). There was no significant association between interest in information or obtaining a service dog and race and ethnicity, education, occupational status, marital status, level of SCI, subjective health, and prior knowledge of service dogs.
Displayed in Table 5 is the percentage of participants who expected that a service dog would do each of the 36 tasks on the checklist. The tasks most frequently selected were taking action in an emergency situation such as pushing an emergency call button, barking, or getting another person to help. Other frequently selected tasks were carrying items, retrieving items, and opening and closing doors. The least frequently selected tasks were helping to make and unmake beds and transferring credit cards or cash to a clerk. In addition to the tasks listed in Table 5, one veteran expected the dog to specifically provide assistance whenever his power chair became caught in a hole while outside in his yard. Two veterans expected the dog to provide companionship and be their friend in addition to other, more physical, tasks. Participants who had previously heard of service dogs were significantly more likely than those who had not heard of them to expect a service dog to open and close cabinets and drawers, transfer credit cards or cash to clerks, put items on a checkout counter, retrieve items, activate emergency devices, and bark in an emergency (Table 5). Participants who had not previously heard of service dogs were significantly more likely to endorse assistance with dressing.
Discussion
Although a law has been passed authorizing the Department of Veterans Affairs to provide service dogs to veterans with mobility impairments, little is known about the number of veterans with SCI who are interested in service dogs. In the present study, 30% of veterans with SCI had at least some interest in obtaining a service dog. This was nearly twice the proportion of veterans interested in obtaining a service dog found in a previous study (Rintala, 2001). In that study, a telephone survey conducted with 590 community-dwelling individuals with SCI (80% non-veterans, 20% veterans), 17.3 percent of the respondents (non-veterans – 17.6%, veterans – 15.1%) wanted a service dog and only 0.4 percent had one. Despite more veterans reporting interest in service dogs in the current study than in the previous study, a large percentage of veterans in the current study (32%, CI = 18% - 46%) reported they had no prior knowledge about service dogs. Since veterans who had never heard of service dogs were less likely to be interested in information or obtaining a dog, there is a need to educate veterans with mobility impairments about service dogs and their potential benefits. As more veterans are informed about service dogs and their potential effects on daily life, perhaps there will be more veterans interested in obtaining a dog, which, in turn, may help them become even more independent and active with increased satisfaction with life.
It is surprising that in spite of many veterans’ interest in service dogs, none of the 50 participants had a formally trained service dog and only one had owned a service dog in the past. It would have been interesting to ask those who had great interest in obtaining a dog why they had not yet gotten one. There are a number of possible reasons, some of which were mentioned by respondents, such as a family member having an allergy to dogs, living in an apartment where dogs are prohibited, and having no one to help take care of the dog. Other reasons might include not knowing where or how to apply for a dog, not knowing what the requirements are to receive a service dog, fearing that it might be too expensive to obtain and maintain one, and having heard that there are long waiting lists. One of the reasons some persons may express no interest in service dogs is that they or their family members do not like dogs in general, or at least do not like having a dog inside their homes.
A strong association was found between the veterans’ subjective satisfaction with life and their interest or lack of interest in service dogs. Veterans who were less satisfied were more likely than those who were more satisfied to be interested in information about service dogs and in obtaining one. We are aware of no other studies that reported a significant association between life satisfaction and interest in service dogs. As noted in the introduction, in previous studies, participants have reported that their service dogs have had a positive effect on their health and health-promoting behaviors, self-esteem, performing activities of daily living, going out in public, interactions with other persons in public, feeling needed, feeling independent, and their safety. In retrospect, it would have been interesting to ask the participants to complete the SWLS a second time, adopting the perspective of how they believed they would answer if they already owned a service dog.
Strong associations were also found between interest in service dogs with the expected change in number of hours of unpaid assistance and expected change in number of days the person would get away from home per week. It is reasonable that persons who are less satisfied with their lives who perhaps believe they will be more satisfied if they had a service dog would be the most interested in obtaining a service dog. It is also reasonable that persons who expect a decrease in the amount of unpaid assistance they need or an increase in the number of times they leave their homes per week would have an interest in service dogs. It is somewhat surprising, however. that neither age nor any of the categorical variables (Tables 1 and 3) were related to interest in service dogs. In particular, one might have expected that persons with upper body impairments would be more likely to be interested in obtaining a dog than persons with only lower body impairments.
The tasks the participants most frequently indicated they would expect a service dog to perform are realistic. For example, the most commonly endorsed tasks in the present study involved summoning help in an emergency. In the study by Rintala et al. (2002), six months after receiving a dog, participants rated the frequency with which the dog helped them with safety issues as a 4.0 on a scale of 1 (no help) to 5 (a great deal of help).
This pilot study has several limitations. The number of persons interviewed (n = 50) is relatively small, thus estimates of the proportions of people with (a) prior knowledge, (b) interest in information about service dogs, and (c) interest in obtaining a service dog, are not very precise, thus yielding relatively wide confidence intervals. Similarly, because of the small sample size, the statistically significant findings regarding life satisfaction, change in unpaid assistance, and change in days out of the house may not generalize to other veterans with SCI. With regard to the estimated change variables, it is important to note that the participants were not asked to estimate the change directly, but were asked to estimate the values if they had a dog. The differences between the current and estimated values were calculated later. Nevertheless, these values were based on self-reported estimates, which may not accurately reflect what actual changes would occur if service dogs were placed with the participants.
The extent to which the fact that one-third of the randomly selected sample of 75 former survey participants could not be contacted has an impact on the findings is unknown. The sample may not accurately represent the population of veterans with SCI, although it was similar to the larger sample from which it was selected with respect to available demographic information. Furthermore, the results may not generalize to the SCI population as a whole since all of the participants were veterans who had received health care at a Veterans Affairs facility within a three-year period. As noted above, other interesting questions might have been included in the study. Because it was based on the task list developed by the VHA PSAS SHCG work group, the checklist of 36 tasks the dogs might be expected to do was limited to physical activities and did not include other aspects such as improved social and psychological well-being which have been shown to be major areas affected by service dogs.
Conclusion
Training of service dogs is expensive and time consuming. Extensive training of the person-dog team is necessary and there are often long waiting lists. Most of the available evidence, however, suggests that the time and money spent on training the dog and the teams are worthwhile. Veterans with lower satisfaction with life were found to be more interested in information about, and possibly obtaining, a service dog. One can hypothesize that persons interested in obtaining a service dog expect that they will get more satisfaction from life as a result. This association between satisfaction with life and interest in service dogs needs to be cross-validated with a larger study. If the finding is supported, then satisfaction with life may be important to include in studies assessing the actual effectiveness of service dogs on the lives of the recipients to determine whether receiving a dog does, in fact, promote greater life satisfaction.
Remarkably, nearly one-third of the veterans reported having no prior knowledge of service dogs or of the benefits a dog could provide. Half of the persons who had heard of service dogs were interested in information about them whereas only one-fourth of those who had not heard about them wanted information. The Department of Veterans Affairs, being committed to helping veterans with disabilities become as independent and active as possible, should strive to provide education about service dogs and the benefits they can provide to veterans with impaired mobility. Discussions of possible drawbacks and limitations, such as costs, necessary care, and unwelcome attention in public, should also be included so that expectations about obtaining a service dog are realistic. One method of achieving this would be to educate the clinical teams that treat these veterans about the benefits and drawbacks of service dogs and the process of obtaining one. These team members could then educate their patients about service dogs and facilitate the process of obtaining a service dog for those veterans who are interested. The teams might also consider using and further developing an instrument to aid in identifying candidates, and matching individuals with disabilities with appropriate service dogs such as the Service Animal Adaptive Intervention Assessment (SAAIA) developed by Zapf and Rough (2002). Financial support of the dog training organizations is the most limiting factor in terms of the number of trained service dogs available. The VA could help support these organizations financially or establish training centers of its own to increase the availability of trained dogs in order to accomplish what Public Law 107-135 intended.
References
Allen, K. & Blascovich, J. (1996). The value of service dogs for people with severe ambulatory disabilities. A randomized controlled trial. JAMA, 275, 1001-1006.
Cytel Software Corp. (2003). StatXact 6.0 [Computer software]. Cambridge, MA: Cytel Software Corp.
Eddy, J., Hart, L. A., & Boltz, R. P. (1988). The effects of service dogs on social acknowledgments of people in wheelchairs. The Journal of Psychology, 122, 39-45.
Fairman, S. & Huebner, R. (2001). Service dogs: A compensatory resource to improve function. Occupational Therapy in Health Care, 13, 41-52.
Lane, DR, McNicholas, J., & Collis, GM (1998). Dogs for the disabled: Benefits to recipients and welfare of the dog. Applied Animal Behaviour Science, 59, 49-60.
Mader, B., Hart, L. A., & Bergin, B. (1989). Social acknowledgements for children with disabilities: Effects of service dogs. Child Development, 60, 1529-1534.
Marks, L. (1993). The effect of service dogs on the self-concept of the physically disabled. Unpublished Master’s Thesis, Florida International University, Miami, FL.
Pavot, W., Diener, E., Colvin, C. R., & Sandvik, E. (1991). Further validation of the Satisfaction with Life Scale: Evidence for the cross-method convergence of well-being measures. Journal of Personality Assessment, 57, 149-161.
Rintala, D. H. (2001). Service dogs: Effects on the community integration of persons with spinal cord injury. In D. H. Rintala & K. A. Hart (Eds.), Final Report: NIDRR Research and Training Center in Community Integration for Individuals with Spinal Cord Injury. (pp. 86-95). Houston, TX: Baylor College of Medicine and The Institute for Rehabilitation and Research.
Rintala, D. H., Holmes, S. A., Fiess, R. N., Courtade, D., & Loubser, P. G. (2005). Prevalence and characteristics of chronic pain in veterans with spinal cord injury. Journal of Rehabilitation Research and Development, 42, 573-584.
Rintala, D. H., Sachs-Ericsson, N., & Hart, K. A. (2002). The effect of service dogs on the lives of persons with mobility impairments: A pre-post study design. SCI Psychosocial Process, 15, 65, 70-82.
Roth, S. (1994). The effects of service dogs on the occupational performance and life satisfaction of individuals with spinal cord injuries. Unpublished Master’s Thesis, Rush University, Department of Occupational Therapy, Chicago, IL.
SPSS Inc. (2005). SPSS 14.0 [Computer software]. Chicago, IL: SPSS, Inc.
Valentine, D. P., Kiddoo, M., & LaFleur, B. (1993). Psychosocial implications of service dog ownership for people who have mobility or hearing impairments. Social Work in Health Care, 19, 109-125.
Ware, J. E., Jr. & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care, 30, 473-483.
Whiteneck, G. G., Charlifue, S. W., Gerhart, K. A., Overholser, J. D., & Richardson, G. N. (1992). Quantifying handicap: A new measure of long-term rehabilitation outcomes. Archives of Physical Medicine and Rehabilitation, 73, 519-526.
Zapf, S. A. & Rough, R. B. (2002). The development of an instrument to match individuals with disabilities and service animals. Disability and Rehabilitation, 24, 47-58.
Tiffanie A. Brashear, PA, is in the Physician Assistant Program at Baylor College of Medicine, Houston, TX
Diana H. Rintala, PhD,Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, Baylor College of Medicine, Department of Physical Medicine and Rehabilitation, Houston, TX