Effect of Service Dog Ownership and Other Parameters on the Number of Hours of Paid Assistance for Individuals with Spinal Cord Injuries

Fuhrman, Susan I., BS, Fitzgerald, Shirley G., PhD, Collins, Diane M., MA,OTR/L, Martin, Stephanie, BS

Abstract :

A cross-sectional study was conducted of 103 individuals with spinal cord injuries who use wheelchairs for at least 80% of their mobility. Data were collected on level of injury, time since the injury, age, ethnicity, gender, personal and household income, and service dog ownership, to see the effect of each of these factors on the number of hours of paid assistance. Subjects who owned service dogs were surveyed and reported high levels of satisfaction with their service dogs. After the analyses, only injury level and service dog ownership affected the hours of paid assistance. Higher spinal cord injuries correlated with higher levels of paid assistance. Surprisingly, those individuals partnered with service dogs used more hours of paid assistance than those without service dogs.

Keywords :

Disability, hours of paid assistance, service dog, spinal cord injury, wheelchairs

Background :

The number of hours of paid assistance is of interest as a measure of assessing the cost effectiveness (1) of a given intervention, in this case the partnering of individuals with service dogs. A major question affecting insurance coverage for service dogs is whether it is more cost effective to pay for a service dog or to pay for human paid assistance. The interest is in evaluating the direct costs and fiscal benefits of service dog ownership (i.e., by providing a service dog, how much money/ paid care hours will be saved).

Anecdotal evidence (2) suggests that service dogs improve the quality of life and independence for individuals with disabilities. Extremely positive reports (3) indicate that service dogs increase the integration into the community of their partners. Another study (4) stated clearly that all of the participants in their study demonstrated a dramatic decrease in the number of both paid and unpaid assistance hours. Yet, not all researchers have shown these results. Preliminary findings by the research team of this paper report no reduction in the number of hours of paid assistance in the group of subjects that use service dogs.

This difference in study outcomes may be caused by failure to control for the impact of other metrics such as years since injury, the variability in the functionality of individuals with progressive diseases and pathologies, personal demographics, and other socioeconomic factors. The effect of these other factors on the number of hours of paid assistance may be larger than the effect of owning a service dog.

Studies by the research team of this paper that are evaluating the efficacy of using service dogs are using the number of hours of paid assistance per month to indicate efficacy. The initial results of this team show that even highly satisfied service dog owners are demonstrating no effect on the number of hours of paid assistance. This may be a result of other factors having a stronger effect on this cost than the use or non-use of service dogs.

Research questions :

Which of these variables: injury related parameters (number of years since the injury, level of SCI), demographic parameters (gender, age, ethnicity), socio-economic parameters (personal income, household income), and service dog ownership demonstrates a statistically significant relationship to the number of hours of paid assistance?
Is a reduction in the number of hours of paid assistance a primary benefit of service dog ownership?

Methods :

Informed consent was obtained from 103 subjects with spinal cord injuries. The subjects then completed surveys to collect data on their personal demographics, socioeconomic factors, injury related information, and service dog ownership. They were evaluated for the effect of different factors on the number of hours of paid assistance. Only subjects with spinal cord injuries were considered since the level of injury directly affects the level of disability. In this way, the level of injury could be correlated with the number of paid assistance hours per month.

In addition, the subjects who owned service dogs were asked to indicate their percent satisfaction with their service dogs. Responses were recorded on a 10-cm visual analog scale (VAS). Subjects were then asked to anecdotally describe how their service dog had affected their lives. Responses were recorded and entered into the subject data record.

The dependent variable, number of hours of paid assistance, was skewed (mean=55.3, std. dev=96.4) so non-parametric analyses were used. The number of years since injury, level of spinal cord injury, and age were each analyzed using a Spearman-Rho correlation. Service dog ownership and gender were each analyzed with a Mann-Whitney test. Personal income, household income and ethnicity were each analyzed using a Kruskal-Wallis test.

Results :

Of 103 subjects, the average subject was a Caucasian (91%) male (58% male), aged 44.6 years ( + 11.8 years). Half (49.5%) of the subjects had cervical injuries and the remaining subjects had injuries below the T1 level. The injuries were sustained, on average, 17 ( + 12 years) years ago. Personal income ranged from <$10K to >$70K, with 59.8% reporting personal incomes of less than $20K. Household income ranged from <$10K to >$70K, with 58.4% reporting household income of less than $40K.

Of 35 service dog owners surveyed, 94.3% of these owners reported a satisfaction rating of greater than 80%, and 82.9% reported satisfaction ratings in excess of 90%. Anecdotal responses included many statements indicating that the quality of life of the partners was directly related to their service dog ownership.

Of all the factors measured, two showed a significant relationship to the number of hours of paid assistance. The level of injury was significantly correlated (p = 0.00) in that higher levels of injury were associated with greater numbers of hours of paid assistance. Conversely, service dog ownership was significantly (p=0.02) associated with those individuals who used more hours of paid assistance.

Table 1 provides details of the different factors and the number of hours of paid assistance:

**Table 1: descriptive statistics and the significance in relation to the hours of paid assistance**
Parameter	N	Hours of paid assistance / month Mean + SD	p-value
Gender
Male	49	62.9	p-value = 0.39
Female	33	44.1
Owns a service dog
Yes	44	66.4	p-value = 0.02*
No	38	42.5
Ethnicity
African-American	1	0.0	p-value = 0.62
American Indian	2	0.0 + 0.0
Asian-American	1	56.0
Caucasian	75	58.1 + 99.5
Hispanic	3	40.0 + 69.3
Personal income / year
< $10K	18	60.9 + 82.1	p-value = 0.40
$10 – 20K	19	41.6 + 84.3
$20 – 30K	5	27.2 + 54.2
$30 – 40K	4	75.0 + 150.0
$40 – 50K	5	12.5 + 17.1
$50 – 60K	1	180
$60 – 70K	5	19.2 + 42.9
> $70K	5	93.6 + 117.1
Household income / year
< $10K	8	141.0 + 157	p-value = 0.06
$10 – 20K	13	8.31 + 22.9
$20 – 30K	9	50.7 + 95.4
$30 – 40K	10	54.2 + 81.1
$40 – 50K	4	92.0 + 117.0
$50 – 60K	8	67.5 + 111.7
$60 – 70K	6	0.1 + 0.1
> $70K	10	32.0 + 41.4
* statistically significant

Discussion :

Service dog owners report extremely high levels of satisfaction with their service dogs, both on the quantitative VAS measure and on the qualitative anecdotal response section. Yet, unexpectedly, in this study, service dog ownership was associated with those individuals who used more of hours of paid assistance than with those individuals who used wheelchairs and do not own service dogs. This may be due to the fact that individuals who are more limited in their activity may be more inclined to use service dogs to assist them.

Of additional interest, only the level of the spinal cord injury affected the number of hours of paid assistance. Neither age, gender, ethnicity, personal or household income, nor the number of years since the injury affected the number of hours of paid assistance. Since reports from service dog partners indicated that the service dogs positively affected the quality of life of their partners, and the number of hours of paid assistance was greater for service dog partners, then the number of hours of paid assistance may be a poor measure of service dog benefits. Future studies should look for decreases in depression, fewer doctors visits, and increased level of integration into the community as measured by number of days outside the home, and number of hours of spent in outside activities. Additionally, the quality of life of the other household members, as measured by the number of unpaid hours of assistance, could also be examined to determine the effect of service dog ownership on other household members.

References :

Drummond, M. F., O'Brien, B., Stoddart, G. L., Torrance, G. W., Methods for the Economic Evaluation of Health Care Programmes , Oxford University Press, 2000.
Camp, M.M., (2001) “The use of service dogs as an adaptive strategy: a qualitative study”, The American Journal of Occupational Therapy, vol. 55, no 5, 509-517.
Fairman, S. K., and Huebner, R. A., "Service Dogs: A Compensatory Resource to Improve Function", Occuptional Therapy in Health Care , 2000 p. 41-52.
Allen, K., and Blascovitch, J., (1996) “The value of service dogs for people with severe ambulatory disabilities: a randomized controlled trial”, Journal of the American Medical Association , vol.275(13), 3April1996, 1001-1006.

Acknowledgements:

Funding for this research was provided by the VA Merit Review Grant D3078R, also by the VA Stars and Stripes Funding, and the RRND Pre-doctoral Grant AHRRFP.

Author:

Susan I. Fuhrman, BS,
University of Pittsburgh,
Rehabilitation Science and Technology,
Human Engineering Research Laboratories,
VA Pittsburgh Healthcare System,
7180 Highland Dr., Bldg. 4, 151R-1,
Pittsburgh, PA 15206.
sif3@pitt.edu