Effectiveness of equine-assisted therapies for improving health outcomes in people with multiple sclerosis: A systematic review and meta-analysis.
Abstract: Scientific evidence has shown that equine-assisted therapies (EAT) lead to improvements in the physical function and the quality of life (QoL) of people with disabilities through the practice of hippotherapy or therapeutic riding (TR). There is a need to confirm whether people with multiple sclerosis (PwMS) can also benefit from its practice. This review aimed to systematically evaluate and meta-analyze the available data on the potential health benefits of EAT in PwMS. Methods: 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 I statistic. Fixed-effect or random-effects models were applied to obtain the pooled results in the case of low (I 30%) heterogeneity values, respectively. Standardized mean differences (SMD) and 95% confidence intervals (CIs) were calculated to assess the change in each outcome. Results: 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. Totally, 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. Conclusions: 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.
Copyright © 2021. Published by Elsevier B.V.
Publication Date: 2021-07-23 PubMed ID: 34329873DOI: 10.1016/j.msard.2021.103161Google Scholar: Lookup
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- Journal Article
- Meta-Analysis
- Review
- Systematic Review
Summary
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The research article reviews and analyzes data about the benefits of equine-assisted therapy on health outcomes for people with Multiple Sclerosis. It suggests that this therapy improves static balance and quality of life, and reduces fatigue.
Methodology
- The researchers conducted a systematic review and meta-analysis of data from various studies that focused on the effects of equine-assisted therapies (EAT) in patients with Multiple Sclerosis (PwMS).
- Four major databases – MEDLINE/PubMed, Web of Science, SPORTDiscus, and Scopus were consulted for relevant studies from their start to June 2021.
- They specifically targeted randomized controlled trials and comparative studies for the review.
- The methodologies used in these studies were assessed via PEDro and MINORS scales.
- In case of heterogeneity across studies, they applied fixed-effect or random-effects models.
- Finally, they calculated the standardized mean differences (SMD) and 95% confidence intervals (CIs) to evaluate the change in each of the health outcomes studied.
Results
- 234 studies were initially identified, but only 9 of these were selected based on pre-set inclusion criteria.
- The selected studies comprised of a total of 225 PwMS patients.
- The meta-analysis showed that EAT significantly improved static balance (SMD = 0.42; 95% CI: 0.05, 0.78) and quality of life (SMD = 0.37; 95% CI: 0.00, 0.73) in PwMS patients.
- Moreover, there was a notable reduction in self-perceived fatigue with hippotherapy (SMD = 0.70; 95% CI: 0.33, 1.07).
- The results regarding the effect on dynamic balance, however, were mixed (SMD = 0.51; 95% CI: -0.04, 1.06).
Conclusions
- According to the analysis, the evidence regarding the positive impact of EAT on people with multiple sclerosis is primarily related to hippotherapy.
- These results suggest that hippotherapy can increase static balance and improve the quality of life for patients, and can also lessen fatigue.
- Gait and dynamic balance, however, did not show any significant improvements.
- Based on these results, the researchers concluded that hippotherapy could be a useful additional therapy to incorporate in comprehensive care plans for Multiple Sclerosis patients.
Cite This Article
APA
Suárez-Iglesias D, Bidaurrazaga-Letona I, Sanchez-Lastra MA, Gil SM, Ayán C.
(2021).
Effectiveness of equine-assisted therapies for improving health outcomes in people with multiple sclerosis: A systematic review and meta-analysis.
Mult Scler Relat Disord, 55, 103161.
https://doi.org/10.1016/j.msard.2021.103161 Publication
Researcher Affiliations
- VALFIS Research Group, Institute of Biomedicine (IBIOMED), Faculty of Physical Activity and Sports Sciences, University of León, Campus de Vegazana, s/n, León 24071, Spain.
- AgeingOn Research Group, Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Barrio Sarriena s/n, Leioa, Bizkaia E-48940, Spain. Electronic address: iraia.bidaurrazaga@ehu.eus.
- Universidade de Vigo, Departamento de Didácticas Especiais, Facultade de Ciencias da Educación e do Deporte, Pontevedra 36005, Spain. Electronic address: misanchez@uvigo.es.
- AgeingOn Research Group, Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Barrio Sarriena s/n, Leioa, Bizkaia E-48940, Spain. Electronic address: susana.gil@ehu.eus.
- Universidade de Vigo, Departamento de Didácticas Especiais, Facultade de Ciencias da Educación e do Deporte, Pontevedra 36005, Spain; WellMove Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Spain. Electronic address: cayan@uvigo.es.
MeSH Terms
- Animals
- Equine-Assisted Therapy
- Fatigue
- Horses
- Humans
- Multiple Sclerosis / therapy
- Outcome Assessment, Health Care
- Quality of Life
Citations
This article has been cited 3 times.- Stolz I, Braunsmann L, Rosiny F, Poehlau D, Abel T, Anneken V, Drache M, Knaepen K. Effectiveness of hippotherapy on balance performance, neurophysiological parameters and clinical symptoms of multiple sclerosis: Study protocol of a randomized controlled multicenter study (MS-HIPPO II - Movement in Balance). Contemp Clin Trials Commun 2026 Feb;49:101583.
- Stergiou AN, Ploumis A, Kamtsios S, Markozannes G, Christodoulou P, Varvarousis DN. Effects of Equine-Assisted Therapy: A Systematic Review and Meta-Analysis. J Clin Med 2025 May 26;14(11).
- Sortino M, Petrigna L, Trovato B, Amato A, Castorina A, D'Agata V, Maugeri G, Musumeci G. An Overview of Physical Exercise Program Protocols and Effects on the Physical Function in Multiple Sclerosis: An Umbrella Review. J Funct Morphol Kinesiol 2023 Nov 4;8(4).
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