Personality of patients with multiple sclerosis and the use of hippotherapy

Comparison of the effects of mechanical hippotherapy and Cawthorne-Cooksey exercises in patients with multiple sclerosis: Randomized trial

BACKGROUND

Patients diagnosed with multiple sclerosis (MS) commonly encounter heightened postural instability and challenges in aligning their eyes, head, and bodily motions while engaging in specific tasks. This study aims to compare the effects of Cawthorne-Cooksey and mechanical hippotherapy exercises on fatigue, balance, gait, dizziness, and life quality in patients with MS.

METHODS

The MS patients were randomly divided into Cawthorne-Cooksey (n:25) and mechanical hippotherapy exercise (n:25) groups. In addition to the traditional physical therapy program, Cawthorne-Cooksey and hippotherapy exercises were applied to the groups 3 days a week, for 8 weeks. The trial's clinical number is NCT06005909. The Fatigue Severity Scale (FSS), Fatigue Impact Scale (FIS), Dizziness Handicap Inventory, Tinetti Balance and Gait Assessment Scale, and Ferrans&Powers Quality-of-Life Index were used for pre-and post-treatment assessment.

RESULTS

Both groups exhibited a significant decrease in FSS, FIS, and Dizziness Handicap Inventory scores, as well as an increase in Tinetti Balance and Gait Assessment Scale and Ferrans&Powers Quality-of-Life Index scores following treatment. In the inter-group comparison, the Tinetti balance and gait assessment and the Ferrans&Powers quality of life index scores were higher in the hippotherapy group compared to the Cooksey group.

CONCLUSIONS

Although both forms of physical activity have demonstrated effectiveness in reducing fatigue among individuals with MS, hippotherapy shows superior efficacy in enhancing balance, gait, and overall quality of life.

Effectiveness of equine-assisted therapies for improving health outcomes in people with multiple sclerosis: A systematic review and meta-analysis

BACKGROUND

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 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.

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.

CONCLUSION

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.