The Short-term Effects of Hippotherapy and Therapeutic Horseback Riding on Spasticity in Children With Cerebral Palsy: A Meta-analysis.

Each included study had a small sample (individual groups ranged from 5 to 22 participants), limiting generalisability. The children varied in CP severity and type, so the pooled result does not apply equally to all presentations. The modified Ashworth scale, used in most studies, has been questioned as an accurate measure of spasticity; the Tardieu scale has been recommended as an alternative. Most studies combined hippotherapy or THR with conventional physical therapy, and the therapy programmes were often insufficiently described, so the effect of the horse alone cannot be isolated. No study used blinding or allocation concealment, which is difficult to achieve with a horseback intervention but still limits certainty. Only short-term effects were measured; whether spasticity changes over longer periods remains unknown. Heterogeneity in scoring methods across studies required conversion of medians to means, which may introduce error.

Do not read this as evidence that hippotherapy or THR provides a lasting or cumulative reduction in spasticity. The meta-analysis found no difference between a single session and multiple sessions, and most included studies combined horseback riding with conventional rehabilitation, so the contribution of the horse alone cannot be separated from the other therapy the child was receiving.