“Straight from the Horse’s Mouth”: Equine-Assisted Services Curriculum Development Using Industry-Based Survey Assessment of Horse Welfare and Healthcare Management Practices

Abstract

Equine-assisted services (EAS) is a relatively new area of study within higher education requiring the development of a curriculum that best prepares the undergraduate student for the demands of the industry. Further, coursework targeting the specific management challenges for ensuring the welfare of horses utilized within EAS is limited. Therefore, the objective of this study was to apply an industry-based survey assessment utilizing EAS professionals within the United States to document management practices associated with healthcare and pain management challenges in the EAS horse. Suggested curriculum for undergraduate students targeting a career in EAS is given, utilizing data collected from the survey. Participant responses (n = 30) indicated that all of the surveyed facilities cared for more than three geriatric horses within their program, with the majority (60% responding “definitely yes”) utilizing regularly functionally lame horses, although the prevalence of lameness was not correlated with number of geriatric horses within a program (0.20, p = 0.22). While lameness is a common healthcare challenge within EAS, gastrointestinal conditions (73%) were one of the other leading health concerns for these facilities. The most common equine pain detection method for EAS facilities was behavior assessment (93%), in which this method was positively correlated with years of horse experience (0.51, p = 0.01). Horse pain was primarily managed through annual alternative therapeutic interventions (76%), daily prescriptions (73%), and nutritional supplements (73%). As such, the curriculum for undergraduate EAS degree programs should cover healthcare practices targeting geriatric horse management and associated health issues such as gastrointestinal conditions and lameness, including early detection and pharmaceutical, nutritional, and alternative therapeutic treatments.

1. Introduction

Within the last few decades, programs facilitating equine interaction have been established throughout the United States utilizing horses to therapeutically address a variety of physical, behavioral, and cognitive disorders through practices that fall under what is referred to as equine-assisted services (EAS) [1,2]. Because of the diversity within the types of programs available and the disorders addressed through these programs, the activities performed with a horse during EAS can range immensely and can include both mounted and unmounted activities [1,2,3,4,5]. Unmounted activities can include leading, grooming, and even saddling the horse, and mounted activities can include pattern work, obstacles, and even trail riding. Horses within these programs may be utilized for driving and vaulting activities. Along with the diversity found within the activities performed by the EAS horse, the length of the curriculum of an EAS program can vary vastly from a short-term, one-day equine interaction session to a long-term, multi-week program [6,7]. With the rapid growth in EAS programs and the complexity found within the industry, universities are challenged to develop an effective curriculum that facilitates knowledgeable graduates who can successfully step into the diverse field of EAS.

Industry growth translates not only into potential growth in job opportunities for these undergraduate students but also growth in the number of horses to be utilized within EAS. As such, this brings forth a need for knowledgeable individuals within the EAS industry who understand the health concerns specific to these animals and ways one can properly manage these concerns [8]. Nonetheless, while research often facilitates the establishment of educational opportunities within higher education, the number of studies available concerning the welfare of the EAS horse is limited [9,10,11]. Despite this limitation, the recent growth in public concern related to animal welfare has emphasized the importance of coursework within higher education focused on welfare issues [12]. This coursework can be of particular value not only for the welfare of the EAS horse but also for the potential prevention of economic loss for EAS programs. For example, the United States Department of Agriculture (USDA) estimates that lameness costs the equine industry USD 678 million in combined veterinary care, death loss, and loss of use [13]. Colic and equine protozoal myeloencephalitis (EPM) follow lameness, with the annual costs associated with these health issues equaling USD 115 million and USD 28 million, respectively. These losses can be devastating for an EAS program, and thus, undergraduate students specializing in the field of EAS need to be aware of ways to mitigate these losses.

The current curriculum for undergraduate students focusing on EAS often depends on general studies of basic horse management. To date, no collegiate-based curriculum is available targeting the management specific to the EAS horse. However, there is a current trend in research targeting welfare concerns specific to horses utilized in EAS [14]. This trend may be due to earlier studies suggesting the potential of emotional transfer between horses and humans [15,16]. However, research seems to suggest that therapy horses in general do not encounter undue stress within the therapeutic environment [14]. Nonetheless, there are studies that indicate that specific populations and activities may lead to heightened stress responses within the EAS horse [17,18,19,20,21]. Although further research is warranted, chronic stress for the horse can potentially lead to weakened immune responses and vulnerability to various health-related conditions [22]. Fry [23] goes on to recommend that science-based management practices are necessary to ensure the welfare of the therapy animal. As such, an understanding of heightened management requirements for animals experiencing chronic stress will aid future EAS professionals in the prevention of potential healthcare concerns. Through proper management practices including regular assessment of the horse [24,25], the loss of use of the animal within the EAS setting can be minimized. Rankins et al. [26], for example, utilized a survey methodology to better understand EAS horse selection, longevity, and retirement practices; they found that EAS facilities reported health issues, and soundness had a prevailing effect on horse retirement. The survey, nevertheless, lacked specific management activities associated with these issues. As such, further understanding of the management practices associated with these health concerns can assist in the development of management strategies that delay the retirement of the EAS horse.

The success of an EAS program is dependent on the horse; this requires managers of these programs to have proficient knowledge of both management and early detection of equine health concerns [23,26]. Early pain detection and treatment can potentially prevent the early retirement of a horse from the program and can reduce recovery time. Deviation from normal daily functions such as eating, drinking, resting, and physical activity along with stress-related facial expressions can be indicative of pain [27,28]. The skills utilized for pain detection and treatment within an EAS program can be a valuable tool for future EAS professionals. While research concerning the health and welfare of the EAS horse is limited, professionals within the industry can provide valuable insight into the development of a curriculum that can best prepare an undergraduate student with these needed skills. Evans et al. [29], for example, reported that community engagement undertaken by undergraduate students working with EAS community partners significantly improved equine knowledge and skills by the end of a semester-long service-learning course targeting EAS programs. Through the service-learning activities, community partners were able to educate the students, providing firsthand insight into the needed skills for working with the EAS horse. These findings suggest the utilization of industry professionals for EAS curriculum development can be of value for the EAS undergraduate student, as this relationship will provide workplace skills that will not only make the student more employable within the industry but also make the industry more sustainable with the growth in knowledgeable professionals. Therefore, utilizing industry-based survey assessment, the objective of this study was to evaluate current EAS horse healthcare management practices to better understand needs when developing an undergraduate curriculum that targets the welfare of the EAS horse.

2. Materials and Methods

The study protocol was assessed and approved prior to the onset of this study by the Mississippi State University (MSU) Institutional Review Board (IRB) to ensure the survey and methods concerning the distribution and use of the survey data followed IRB guidelines (Protocol #IRB-20-119). All study participants provided informed consent that followed IRB guidelines.

2.1. Survey Participants

A survey instrument was set up through Qualtrics, and a link to the survey was sent via email to 100 EAS facilities found throughout the United States. The email list for survey participants was developed from the Professional Association of Therapeutic Horsemanship (PATH) International Member Center Directory [30]. The Extension faculty and staff of MSU that currently work with EAS programs reviewed the list and assisted in narrowing the list to 100 EAS facilities within the United States, including verifying those currently active in EAS activities. The first email with the survey link was sent out in April 2020, with a follow-up email sent out in January 2021 to remind potential participants that the survey would be closing on 28 February 2021. Since the initiation of the survey took place at the onset of the COVID-19 pandemic, the survey link was left open for an extended period. Within the email, facilities were asked to refer the survey to the individual responsible for the horse care management decisions and practices carried out within their respective facilities.

2.2. Survey Instrument

The survey questions were developed with guidance from MSU faculty and staff including Extension agents and MSU College of Veterinary Medicine clinicians working with the University EAS program. Revisions to the survey were made according to feedback from these University representatives. The focus of their review was to make survey questions clearer and assist in defining answers that could be measured quantitatively. The review went through four rounds of revisions from the University representatives. Further, to determine the reliability of the revised survey, University representatives assisted in determining the test–retest reliability using the Pearson Correlation Coefficient. University representatives completed the survey twice, and the Pearson Correlation Coefficient between the scores of the surveys was 0.82. According to Kishore et al. [31], this suggests that the survey had good test–retest reliability.

Table 1. Survey questions concerning demographics of the horse caregivers within equine-assisted services (EAS) and their care and management of their horses.

Question Number	Survey Question
1	What is your age?
2	How many years have you worked with horses?
3	How many years have you been involved in EAS?
4	How many horses are currently at your EAS facility?
5	How many geriatric horses (>15 years old) are at your EAS facility?
6	At your EAS facility, are there any functionally lame horses (ie. Horses that have lameness that can be managed so that it doesn’t prevent regular use in your program)?
7	Has any horse at your EAS facility ever experienced noticeable pain caused by an acute lameness such as a horse with navicular disease, laminitis, or degenerative joint disease?
8	When attempting to assess lameness at your EAS facility, do you use the American Association of Equine Practitioners (AAEP) lameness scale of 0–5 to score the extent of lameness the horse has?
9	Has any horse at your EAS facility ever experienced noticeable pain caused by gastrointestinal distress such as a horse experiencing colic or gastric ulcers?
10	Has any horse at your EAS facility ever experienced noticeable pain caused by health issues not associated with lameness-related conditions or gastrointestinal distress such as influenza, strangles, heaves, or roaring?
11	For pain detection of your horses at your EAS facility, do you check for changes in the horse’s vital signs such as an elevated pulse, increased temperature, or increased respiration rate?
12	For pain detection of your horses at your EAS facility, do you look for facial expression changes such as strained jaw and neck muscles, flared nostrils, angled eyes, and/or ear position changes?
13	For pain detection of your horses at your EAS facility, do you check for behavioral changes besides body language such as restlessness, sleeping extensively, not eating/drinking, unusual defecation/urination, or irregular passiveness or aggressiveness?
14	For treatment of chronic lameness, does your EAS facility utilize any of the following management practices on a daily basis?
15	For treatment of chronic lameness, does your EAS facility utilize any of the following management practices at least once a year?

encompasses the 15 questions that made up the final version of the survey. Answers were set in a forced-choice format with a selection of five options. Six of the fifteen questions offered a fill-in option if the participant selected “other” for their answer. For eight of the questions, an option was given for “NA”, not applicable. For questions six through thirteen, the following coding was utilized for the five answer options provided: “definitely yes” = 1, “somewhat yes” = 2, “somewhat no” = 3, “definitely no” = 4, and “NA” = 0. Options that included the terms “definitely” or “somewhat” were utilized to differentiate the intensity of agreement for an answer of “yes” or “no”. As such, a selection of “definitely” was interpreted as a stronger agreement (“yes”) or disagreement (“no”) with the question being asked compared with that of a selection of “somewhat”. A non-response was omitted from statistical analysis but was documented by the research team. Details concerning answer options are given within the Supplementary Materials. At the end of the survey, a final section for “comments” was given for participants to provide feedback freely concerning the survey and/or suggestions related to EAS curriculum development.

2.3. Data Analysis

Descriptive statistics were utilized for each question, with the number of responses totaled into the respective answer selected and percentages generated per answer response. Correlations were considered using the Spearman function of the CORR procedure to compare the number of geriatric horses and the prominence of health-related issues along with comparing years working with horses and pain assessment practices. Statistical analyses were completed using SAS version 9.4. Significance was determined as a p-value of less than 0.05.

3. Results

While 33 surveys of the 100 distributed were submitted digitally, 3 surveys were omitted from this total as these submissions did not include any responses nor any additional information. As such, these submissions were interpreted by the researchers to be a result of a technical issue rather than a survey submission. Once the surveys associated with technical issues were omitted, the response rate was calculated as 30% (n = 30). The survey was made available for 11 months because of the fact that the survey was initiated during the onset of the COVID-19 pandemic, which may have potentially limited survey participation. During the 11-month period that the survey link was made available, two to three surveys per month were submitted. As such, each month observed survey participation, so survey participation occurred throughout the entire duration that the survey was made available. None of the submitted survey responses included the use of “NA” for those questions that offered that option. In addition, all questions were answered by all participants including feedback within the comment section at the end of the survey.

3.1. Demographics

Regarding those that participated (n = 30), half were older adults, with 50% answering that they were 46 years old or older. Most respondents had over a decade of EAS experience, with 63% answering that they had 11 years or more working within the field, and 70% had more than 15 years of experience handling horses. Regarding the size of the EAS programs that these respondents (n = 30) were responsible for, the most popular answer for the number of horses in their EAS programs was 11–15 horses (57%), and none had 5 or fewer horses within their program. While all programs managed more than three geriatric horses (15 years or older), the majority (53%) of the respondents answered they had more than seven geriatric horses within their EAS herds. The age of 15 was selected as the starting point for categorizing a horse as “geriatric” as this followed findings by McGowan [32] that “a horse has aged beyond its physiological peak at 15 years of age”.

3.2. Horse Health Issues

Concerning the health of the EAS horse, according to the respondents (n = 30), most answered “definitely yes” to having functionally lame horses used regularly in their programs (60%), and none of the respondents answered “definitely no” (

Table 2. Results of survey questions (Questions 6–13) concerning pain, lameness, and management of the equine-assisted services (EAS) horse. For each question, a four-point scale for responses was utilized with a neutral option recorded as zero.

Questions	Score Range	Median Score	Mean Score	Standard Deviation
Q6: At your EAS facility, are there any functionally lame horses (i.e., Horses that have lameness that can be managed so that it doesn’t prevent regular use in your program)?	1–4	1.0	1.63	0.96
Q7: Has any horse at your EAS facility ever experienced noticeable pain caused by an acute lameness such as a horse with navicular disease, laminitis, or degenerative joint disease?	1–4	1.0	1.83	1.18
Q8: When attempting to assess lameness at your EAS facility, do you use the American Association of Equine Practitioners (AAEP) lameness scale of 0–5 to score the extent of lameness the horse has? 2.0	1–4	2.0	2.27	1.11
Q9: Has any horse at your EAS facility ever experienced noticeable pain caused by gastrointestinal distress such as a horse experiencing colic or gastric ulcers?	1–4	1.0	1.43	0.86
Q10: Has any horse at your EAS facility ever experienced noticeable pain caused by health issues not associated with lameness-related conditions or gastrointestinal distress such as influenza, strangles, heaves, or roaring?	1–4	2.0	2.13	1.22
Q11: For pain detection of your horses at your EAS facility, do you check for changes vital signs such as an elevated pulse, increased temperature, or increased respiration rate?	1–4	1.0	1.37	0.72
Q12: For pain detection of your horses at your EAS facility, do you look for facial expression changes such as strained jaw and neck muscles, flared nostrils, angled eyes, and/or ear position changes?	1–2	1.0	1.20	0.41
Q13: For pain detection of your horses at your EAS facility, do you check for behavioral changes besides body language such as restlessness, sleeping extensively, not eating/drinking, unusual defecation/urination, or irregular passiveness or aggressiveness?	1–2	1.0	1.07	0.25

Participants were asked to give an assigned answer when given four choices plus a neutral option (1 = definitely yes, 2 = somewhat yes, 3 = somewhat no, 4 = definitely no). Not applicable (NA) was the neutral option and was assigned a zero score.

). It is important to note that information was not collected on whether these functionally lame horses were used in mounted or unmounted activities. Regarding detecting lameness, 57% utilized the AAEP scale for objectively determining lameness [33]. Years of working with horses did not correlate with the use of the AAEP scale (0.24, p = 0.18). In addition to regularly addressing lameness issues, most respondents also had experience within their EAS program implementing pain management practices associated with orthopedic (57%) and gastrointestinal (73%) conditions, along with the majority (60%) working with other health-related issues outside of these two areas of equine health.

No correlation was found between the number of geriatric horses within an EAS facility and the prevalence of lameness (0.20, p = 0.22), orthopedic conditions (0.24, p = 0.16), gastrointestinal conditions (0.03, p = 0.39), and other health-related issues (0.07, p = 0.37). As it relates to monitoring these conditions and other health-related problems potentially found within the EAS horse, most of the programs utilized vital sign measurements (73%), facial expressions (80%), and behavioral changes (93%) to detect equine pain. While years working with horses did not correlate with the use of vital signs (0.29, p = 0.13), significant positive correlations were found between the years of working with horses and the use of facial expressions (0.43, p = 0.03) and behavioral changes (0.51, p = 0.01).

3.3. Horse Pain Management

To manage pain associated with lameness on a daily basis (Figure 1), most respondents utilized prescription pain medications (73%) and nutritional supplements (73%). To not limit the potential options for participants to select from, internal and external “OTC” options were defined as those medications not requiring a prescription from a veterinarian. Examples of “OTC” treatment options for both internal and external uses are available in the Supplementary Materials. Despite the potential options available, the “OTC” internal medications option was the least utilized option (13%).

The topic of nutrition appeared to be an area of interest to survey participants as the responses within the comment section at the end of the survey primarily (81%) focused on students needing a curriculum targeting nutritional-based subject matter. One respondent commented, “nutrition is the one course that is mandatory for any student pursuing jobs in equine therapy”. Finally, for individuals who selected “other” and wrote in answers concerning daily pain management for lameness issues, the responses included fitted boot products to protect the hoof along with various forms of wraps including ice and magnetic wraps.

According to the respondents (n = 30), treatment options employed by managers for chronic lameness mostly (76%) focused on alternative therapies including massage therapy, chiropractor manipulation, and acupuncture (Figure 2). While these alternative therapies required additional medical professionals and potentially added costs, it was more regularly utilized than physical therapy (20%). Physical therapy was defined as an exercise-based therapeutic intervention with or without veterinary supervision. Individuals who selected “other” and wrote in answers associated with annual management for pain included therapeutic farrier care such as specialized shoeing.

4. Discussion

The horse is a fundamental component of an EAS program, and yet, research concerning the welfare of the EAS horse has been limited [9,10,11]. Despite this narrow offering of research in the field of EAS horse welfare, the understanding of healthcare and the detection of health concerns is critical for the performance of the horse and, in turn, the success of their respective programs [34]. As stated by Fry [23], “a greater focus on appropriate management practices and the equine living environment are needed to improve welfare for horses in this area of work.” As such, the curriculum for the undergraduate student going into the field of EAS should include equine healthcare and management practices specific to those encountered within EAS. While such a collegiate-based curriculum is currently unavailable, the development of a curriculum targeting the healthcare management of the EAS horse can be facilitated by the input of EAS industry professionals [26]. Thus, an industry-based survey assessment was utilized to evaluate the prevalence of health concerns within the EAS horse population and determine common practices in horse management and pain detection. Survey questions exploring common management practices associated with healthcare issues in EAS can bring insight into management approaches that can improve EAS horse welfare and, in turn, give insight into potential coursework that would benefit future EAS professionals.

4.1. Horses within EAS

The horses utilized within the surveyed EAS programs fell within the geriatric classification. Anecdotal evidence based on follow-up queries by members of the research team post-survey participation found that the survey participants had a preference for this age group based primarily on behavioral attributes, citing that the “calmness” of the horse was preferred for their respective programs. Horses bred specifically for EAS programs may result in a younger population of horses; however, currently, breeding programs targeting this aspect of the horse industry within the United States are lacking. As such, EAS horses within the surveyed facilities were commonly those retired from another activity, as noted from the follow-up queries with the survey participants. Nonetheless, although aging commonly leads to a higher prevalence of health-related issues within the sport horse industry [34], this was not observed within the EAS facilities participating in this study. This may be attributed to the lower impact of the activities associated with EAS, in contrast to higher-impact sports. According to Menarium et al. [35], most higher-performing barrel racers with years of experience compete with some degree of lameness, particularly within the forelimbs. In fact, 70% of barrel racing horses exhibited inflammation of the sesamoid bones. Bradley [36] documented lameness conditions impacting both the fore and hind limbs of cutting and reining horses. The study concluded that while these conditions can present early in sports horses, without proper treatment, the extent of concussion associated with these sports can lead to a poor prognosis later in life. Further, among multiple factors evaluated, Murray et al. [37] found that age was a contributing factor to lameness in dressage horses. Interestingly, the lack of correlation found within the current study between the number of geriatric horses within an EAS program and incidences of health-related issues such as lameness may suggest that other factors within the EAS environment influence the prevalence of health-related concerns for the EAS horse besides age. This conclusion is supported by previous research [8,26]. Thus, current management practices employed through these programs appear to be effective in maintaining the functional use of the geriatric horse within EAS. This is apparent by the fact that the majority of these facilities are able to utilize functionally lame horses during EAS sessions. This practice may need to be cautioned, however, as it may be not only costly for managers because of the intensity of management needed for these horses but also could potentially limit the longevity of the horse within these programs [26]. Thus, when taking into consideration the poor prognosis of sport horses concerning career longevity, general coursework associated with sport horse exercise physiology may need to be adapted specifically to the unique management concerns of the EAS horse, including safe and effective practices in exercising functionally lame horses.

4.2. Pain Detection Methods within EAS

Since the age of the horse is often considered an underlying factor for the health conditions documented within this study, the lack of correlation between the number of geriatric horses and the prevalence of these health conditions may point to the years of experience associated with the managers who care for these animals. The majority of the respondents had over a decade of experience within the industry. Knowledgeable management can result in the early detection of health concerns found within EAS programs. Likewise, Applebaum et al. [38] reported that animal care by new owners may be a limiting factor in promoting animal welfare. In fact, in veterinary student populations, experienced students had a more consistent and accurate assessment of equine lameness than inexperienced students [39]. Interestingly, within the current survey study, this ability of EAS professionals to utilize certain pain detection methods correlated with years working within the industry, particularly as it relates to assessments applying facial expressions and behavioral changes within the horse. Facial expressions have been documented to be reliable assessment methods for detecting health-related concerns [40]. These expressions can be subtle or difficult to pick up for someone inexperienced with horses; thus, this may be a factor influencing the relationship between the use of facial expressions and the experience of the individual within the current study. Nevertheless, vital sign measurements can give a more objective assessment of animal health. Previous studies have noted increases in heart [18] and respiratory [19] rates during EAS. However, vital signs measurements were not the most common practice implemented within surveyed EAS programs, and a correlation with years of experience was not found as an explanatory factor. The reasoning for why certain assessment methods were more preferred was not tracked within the current study. This information may give insight into whether limiting factors were associated with convenience, time constraints, and/or a lack of knowledge concerning vital signs measurements. As such, a lack of knowledge may suggest coursework providing educational opportunities concerning health assessment, including vital sign measurements, would be of value to future EAS professionals. Further, new technologies utilizing mobile digital heart rate monitoring, as described by Friend et al. [18], may provide future EAS professionals with opportunities for utilizing this health assessment method. Thus, coursework that includes training in such technologies would be of value to students within EAS degree programs.

4.3. Pain Management within EAS

The relationship between veterinarians and EAS professionals is essential to the success of these programs and specifically to the welfare of the EAS horse. While those surveyed within this study appeared to be knowledgeable on a diverse array of healthcare concerns and management needs, the prevalent use of pain management practices beyond those dependent on veterinary intervention such as the use of OTC medications may suggest finances are a limiting factor. Over-the-counter medicines may be as effective as prescription medications, but the utilization of these options is valuable to note. Orsini et al. [41] point out that economic factors associated with managing the lameness of chronically laminitic athletic horses are the driving force behind a large percentage of euthanasia within the population of racehorses with laminitis. Cost factors were not investigated within the current survey study, but this would be of value to veterinarians working with these EAS programs as it can help determine ways to educate EAS professionals on avenues for affordable and effective therapeutic interventions for various healthcare concerns that are common within the EAS horse population. Further, for future EAS professionals, coursework concerning business management and financing would be of value to budget for such veterinary costs more effectively as those highlighted within survey responses. In addition, it is important to note that the treatment practices, both daily and annual practices, employed by those surveyed facilities varied immensely. This may reflect an openness to treatment options or may be an indication that guidelines are needed on treatment strategies specific to the EAS horse. Of course, individual animal variation in how they respond to different types of treatment strategies needs to be considered. Nonetheless, standardization of management strategies for horses within EAS programs is unavailable at this time but could be a valuable tool offered through coursework designed specifically for educating the EAS professional.

4.4. Study Limitations

With most of the survey participants having over a decade of experience not only within horses but also within EAS, it is no surprise that various approaches to healthcare assessment and management practices were reported. This diversification in management strategies, as discussed earlier, could be viewed as either a positive or negative point concerning horse management within the EAS industry. Nonetheless, without further information, it is hard to draw such conclusions. As such, it would be beneficial to recruit a more diverse array of survey participants, including those with less experience. The response rate for the current study, however, was considered comparable to other EAS survey studies [40]. Nevertheless, participant recruitment may have been a limitation that could be addressed in future studies [42]. Recruitment could be improved through the utilization of multiple survey formats (paper, digital, and/or in-person) [43], participation incentives [44], and a reduced survey length [45]. Nonetheless, this diversification of management strategies offered through survey respondents found within the current study suggests that a curriculum based on traditional management practices of horses may not be enough to prepare undergraduate students for a career in EAS. As such, future course development should include a wide range of strategies for addressing the treatment of healthcare concerns observed within EAS programs.

Along with limitations associated with survey recruitment, it is important to note that the current survey questions were limited in scope because of the novelty of this study. Thus, before the future development of the curriculum, additional survey research would be of value with questions targeting more specific areas of managing horses within EAS. For the current study, the research team utilized personal experience and feedback from various EAS professionals in the development of the survey instrument. This may introduce more biased questioning; however, much of the current work concerning EAS horse management and welfare was published after the onset of data collection within the current study [14,16,17,21,26,46,47]. These studies along with the current study, nevertheless, can be of value for the development of questions for future survey instruments targeting EAS horse management and welfare. More so, with geriatric horses being regularly utilized within these programs, current studies on geriatric horses published after the onset of this study can be of value when developing future surveys that target more specific management practices of the EAS geriatric horse [48,49,50].

5. Conclusions

The horses used in EAS programs are commonly geriatric and often are functionally lame. These factors, especially when combined, make them more at risk for further health issues and pain experiences. As such, professionals within the industry who are knowledgeable of these management challenges are required. The information collected through this industry-based survey assessment provides educators within university EAS degree programs insight concerning the EAS horse population, health issues managed, and evaluation parameters utilized by professionals within the industry. Further, since EAS horses appear to commonly need healthcare practices for pain management, coursework focused on horse welfare concerns that require precision medicine is necessary for undergraduate students within these degree programs. Uncovering these concerns and management needs promotes the value of a working relationship between educators within higher education and EAS professionals so that a curriculum is developed that encompasses effective management practices for these healthcare concerns for undergraduate students going into the field of EAS.