Background: Equine-assisted activities and therapies (EAAT) is a rapidly growing practice that is described as therapeutic and entertaining. Complementary therapies such as EAAT are gaining acceptance as the health care needs of the population are changing.

Method: This systematic review draws from four databases. The final review included 52 articles.

Purpose: To explain what is known about EAAT and identify literature gaps. Nursing and rural perspectives are included in the analysis and recommendations.

Findings: There are more than eight types of EAAT and different organizations around the world are providing certification for EAAT. Rural communities and organizations may benefit from the availability of EAAT programs. Although hippotherapy research tends to have stronger study designs, most of the reviewed studies were descriptive, not randomized- control trials. Lack of evidence regarding the effect of EAAT prevents some health care providers from refer-ring their clients to EAAT and allows insurance companies to avoid reimbursing for this alternative therapy.

Recommendations: More research is needed. Although sociologists, psychotherapists, and physiotherapists are using this complementary therapy and publishing in this field, nurses have made minimal contributions to date. As an avenue for improving health, nurses should consider conducting EAAT research.