MANAGING BOX REST
impoverishment—as at best we are returning them to a life worth living, not a good life (Langford, personal communication, 2023).
DO NOT FORGET ABOUT HUMAN BEHAVIOUR CHANGE
There is no magic bullet for successfully managing horses on box rest. Instead, treatment should be individually tailored to that horse- owner combination. Try to encompass a suit of interventions that the owner will find easy to implement by employing the COM- B model (Michie et al., 2011 ), for a review of how this can be implanted in equestrianism see (Wolframm et al., 2023 ).
• Capability—Does the owner have psychological and physical capability (i.e. knowledge and physical skills) to implement each suggestion?
• Opportunity—Is each suggestion something that is feasible in the physical environment? And will there be social support or social pressure that will impact on compliance? Suggesting the use of a small electrically fenced pen on a livery yard that does not allow electric tape will not only be unfeasible but may result in a demor- alised owner.
• Motivation—Most human behaviours are habits and so strategies that fit in with an owner ' s normal routine will be easier to imple- ment than those that require reflective processing, that is plan- ning new behaviours.
Engaging owners in the management plan whilst understand-
ing their Capability, Opportunity and Motivation to change their Behaviour compliance.
(COM- B) regarding their horse ' s care will increase
RESTORING THE BALANCE—MINIMISING THE NEGATIVE AND PROVIDING OPPORTUNITIES FOR POSITIVE EXPERIENCES
The aim should be for the horse to return to full physical health while minimising the detrimental impact on their mental health and, just as importantly, keeping horse and owner safe during both confinement and restricted exercise. Possible considerations to achieve this include:
1 . Companionship: In this scenario, the authors ensured another horse was always visible and this is certainly better than being completely socially isolated. Nevertheless, physical contact is important to horses and stress can be offset by social buff- ering (Visser et al., 2008 ). The concept of a social box with full- length vertical bars, allowing a horse to pass its head and neck through to the neighbouring stable, has been shown to improve welfare when compared to visual and olfactory con- tact only (Gmel et al., 2022 ). Even in horses that spend 23
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hours a day in a herd, when stabled for just 1 h those with a half wall between stables used the opportunity to engage in physical contact, spent more time resting and less time stood vigilant compared to those with a full- dividing wall (Borthwick et al., 2023 ). Altering the structure of stables is clearly unfeasi- ble for most. A simpler solution may be tying the horse up to allow grooming over a stable door with a preferred companion, if
it is safe to do so (Figure 1 ). This could be undertaken
whilst mucking out twice a day to improve equine well- being whilst easily fitting into the owner ' s routine. If physical contact with another horse is not possible then encouraging the owner to spend time scratching their favourite areas (those where the horse twitches their upper lip or leans into the pressure) will still lower heart rate and promote relaxation (Feh & de Mazières, 1993 ). Additionally, horses will often stand resting next to a large stable mirror. If physical contact is limited this can be a very effective way to promote resting behaviour and reduce stress (McAfee et al., 2002 ), especially if
the horse
would otherwise lose sight of other horses when it chooses to lay down. In our hospital, horses maintained initially in a sling to manage a fracture are unable to see conspecifics, here the use of a manikin horse outside the stable door is highly beneficial.
2 . Training: Learning new tasks and performing trained ones results in dopamine spikes (McBride et al., 2017 ) and so provides valuable mental stimulation. The authors already suggested physiotherapy exercise as a resource for maintaining physical strength and sup- pleness. Clayton ( 2016 ) provides examples of how to undertake these exercises and has shown their beneficial effects in horses re- turning to work after a period of box rest (Holcombe et al., 2019 ). While commonly performed as carrot stretches, these exercises can also be trained using a target with clicker training. Altering the novelty and complexity of the tasks will keep the horses brain engaged, so mix up exercises that will help physical fitness with others the horse and owner find fun.
FIGURE 1 Horses will choose to engage in social contact and particularly mutual grooming if given the opportunity. Social buffering can be a key component of reducing stress.
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