MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

Equine-assisted therapies (EAT) are sometimes used for improving the physical function and the quality of life (QoL) of people (often children) with disabilities through the practice of hippotherapy or therapeutic riding (TR). Yet, the effectiveness for or against these approaches has so far not been well documented.

This review aimed to systematically evaluate and meta-analyze the available data on the potential health benefits of EAT in patients with multiple sclerosis (PwMS).

Four electronic databases (MEDLINE/PubMed, Web of Science, SPORTDiscus, and Scopus) were searched systematically from their inception until June 2021 for randomized controlled trials (RCTs) and comparative studies that provided information regarding the effects of EAT on PwMS. The studies’ methodological quality assessment was performed using the PEDro and the MINORS scales. For the meta-analysis, heterogeneity across studies was quantified using the I2 statistic. Fixed-effect or random-effects models were applied to obtain the pooled results in the case of low (I2 < 30%) or high (I2 > 30%) heterogeneity values, respectively. Standardized mean differences (SMD) and 95% confidence intervals (CIs) were calculated to assess the change in each outcome.

After removing duplicated studies, 234 results were retrieved by the literature search and 11 were eligible for full text search. Finally, 9 studies with a methodological quality ranging from good to low quality met the inclusion criteria. Six of them focused on hippotherapy and 4 of them were included in the quantitative analysis.

In them, a total of 225 PwMS patients were evaluated. Findings from the meta-analysis indicated that this therapy improved static (SMD = 0.42; 95% CI: 0.05, 0.78) but not dynamic balance (SMD = 0.51; 95% CI: -0.04, 1.06), while significant benefits were observed on the patients’ QoL (SMD = 0.37; 95% CI: 0.00, 0.73). Hippotherapy showed effectiveness for reducing self-perceived fatigue (SMD = 0.70; 95% CI: 0.33, 1.07), while TR showed mixed effects on balance and QoL.

The authors concluded that the actual evidence on the effectiveness of EAT in PwMS is mainly limited to hippotherapy. This rehabilitation approach seems to have beneficial effects on static balance, QoL and fatigue, but not directly on gait and dynamic balance. Altogether, the findings suggest that hippotherapy could be incorporated as a complementary therapy when developing comprehensive care plans for PwMS.

These results are further supported by a new study concluding that Hippotherapy improved postural balance, functional mobility, fatigue, and quality of life in people with relapsing-remitting MS. This suggests that hippotherapy may be a useful approach for complementary treatment among people with MS.

EAT is, of course, one of those modalities which are difficult to research. What, for instance, is a good control intervention? And how can one blind the patient? Moreover, EAT is expensive and required lots of resources that are rarely available. Considering these issues, one should perhaps ask whether EAT is sufficiently better than other therapeutic options to justify the cost.

12 Responses to Promising results for equine-assisted therapies

  • Interesting topic. My daughter can’t walk so when we do TR we see more of an emotional change. I can’t say we have seen much of a physical improvement but we haven’t done a long term program. Yes it’s expensive but it is worth it to see the joy it brings her and it’s a good form of exercise.

  • Have fallen off enough horses in the day to confirm it is good for developing rhythm and balance, as well as a giant hole in the purse. So I think the only question still to be asked is “Surely there must be a hobby that can offer equivalent benefits without extracting the GDP of a small island nation?”

    • but you can always eat the horse!
      [I love horses, once had my own, and always insisted I would never touch a horse steak. then, one day, at my father-in-law’s house, he served a steak dinner, I ate with appetite and noted they were all watching me. when I had finished eating, he asked: AND HOW DID YOU LIKE THE HORSE STEAK?]

      • “but you can always eat the horse!”

        There may have been occasions when that crossed my mind, yes. (Like when I broke my ribs…)

        (Tho’ I’m guessing FIL weren’t British, or he’d have been eaten next. Horsey People, amirite?:)

      • @Edzard

        AND HOW DID YOU LIKE THE HORSE STEAK?

        Your answer of course: “Not bad at all, but your rat au vin last week was better.”

        [and your first course of action the next morning was to turn your back on mainland Europe and become British – although …. https://www.youtube.com/watch?v=0q66NuZrB2E ]

        • as long as there is lots of garlic in it!
          btw: I was told once [after dining out in Isabbul] that I had eaten rats – not bad at all, but the wine was off.

        • It is well proven that horse meat is easier to digest than many or even most other red meats. The fat gets rancid easily so it needs to be kept well refigerated. Traditionallly it was salted to keep it for winter. Many people with gastrointestinal problems have told me that they can tolerate horse meat when they cannot tolerate beef. (I am a GI-surgeon so I did encounter such problems often in my carreer).

          I put a well marinated horse steak on the grill every so often – delicious. The horses are specially bred for meat production. Riding horses are not so good for that.
          I also try to get a good cut of minkey whale meat when in season, but that is another matter 🙂 A real delicacy. Marinated with Teriyaki and just seared on each side for a minute – Japanese style. Melts in the mouth.

          Please spare us the indignated lecture about “save the whales” and all that. Minkey whale is NOT endangered and is legally harvested in moderate amounts where I live.

  • On subject of accessibility, BBC had a puff piece the other week on surfing therapy, which may work out cheaper than riding on pones:

    https://www.bbc.co.uk/news/uk-scotland-58994935

    (Not dissing the practice itself, mind; just the Beeb’s frequent standard of science reporting.)

    Heck, even t’GP when I see them tells me to eat sensibly and exercise regularly. (Something Alties like to advocate too… then spoil it by insisting you must also shove coffee up your butt for it to really truly work, or whatever their kink is that particular week.)

    TBH, “scheduled frequent physical activity involving learning and skill, and plenty interaction with other people” sounds like an eminently reasonable baseline for helping to manage a range of mental conditions and some motor ones too. Obviously not something that can be blinded, and doesn’t really lend to randomization either, but the sort of stuff where comparative observational cohort studies could yield practical data on what works best for a given price point and ability. One lives in hope.

  • Upsetting as it is to hear people relishing the thought of eating various types of muscle from non-humans (the very same animals, curiously enough, nearly idolised by the AAT community), we must keep our eye on the ball: at the end of the day, it is the three dimensional movements of the horse which, if anything, brings relief to physical symptoms. These could surely be easily simulated? That humans are incapable of looking after their own without enlisting the “help” of sentient others, regarded one day as therapy tools and another as edible detritus, throws a lurid light on our sorry species. Although being used in these modalities may actually be a better route through life for some horses, the very limited benefits and the large economic costs to humans (the picture illustrates one of the problems: at least three qualified (human) therapists/handlers are needed for this type of therapy), makes the enterprise a doubtful one, even in ideal circumstances. Research (https://www.thedonkeysanctuary.org.uk/research/taxonomy/term/131) shows that equine assisted therapy can be stressful for the equines and their quality of life leaves much to be desired in many cases. Can we really do no better than this? AAT is huge business now and ever growing. It is a welcome sight to see some serious attention being given to its real value, which, unsurprisingly, does not seem to include extravagant claims of “cures” for autism, anxiety and delinquent behaviour, but offers a very modest hope of physical therapy. We should also bear in mind in the former cases that parents and caregivers may be bitterly disappointed by results after seeing apparent miracles performed in sentimental TV programmes.

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