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Physical therapy with hippotherapy compared to physical therapy alone in children with cerebral palsy: systematic
Gustavo Santos de Assis1, Tatiane Schlichting1, Beatriz Rodrigues Mateus1
1Department of Health Sciences, Federal University of Santa Catarina, Araranguá, Brazil.
Insights
Physical therapy incorporating hippotherapy showed similar gross motor function outcomes to physical therapy alone in children with cerebral palsy (CP). Further research with larger, lower-bias studies is recommended for definitive conclusions.
Area of Science:
- Rehabilitation Medicine
- Pediatric Physical Therapy
- Neurology
Background:
- Cerebral palsy (CP) significantly impacts gross motor function in children and adolescents.
- Physical therapy is a cornerstone of CP management, with emerging interest in adjunct therapies like hippotherapy.
- Comparing the efficacy of combined physical therapy and hippotherapy versus traditional physical therapy alone is crucial for optimizing treatment strategies.
Purpose of the Study:
- To compare the effects of physical therapy combined with hippotherapy against physical therapy alone on the gross motor function of pediatric patients with cerebral palsy (CP).
Main Methods:
- A systematic literature search was conducted in January 2021, including controlled trials of children and adolescents (2-18 years) with CP.
- Data on gross motor function, including means, standard deviations, and changes from baseline, were extracted.
- Methodological quality was assessed using the Cochrane Collaboration's EPOC tool, and evidence synthesis employed the GRADE method, with meta-analysis performed using Revman 5.3.
Main Results:
- Six studies involving 315 participants were analyzed. Both groups received comprehensive physical therapy, including strength, aerobic, stretch, mobility exercises, and neurodevelopmental treatment.
- No significant differences were observed between physical therapy with hippotherapy and physical therapy alone in Gross Motor Function Measure scores, cadence, stride length, or gait speed.
- While the physical therapy with hippotherapy group showed slightly greater improvement, it did not reach the minimal clinically important difference, and the overall evidence level was very low due to high risk of bias in the included studies.
Conclusions:
- Physical therapy combined with hippotherapy demonstrates comparable effects to physical therapy alone for improving gross motor function in children and adolescents with cerebral palsy (CP).
- The current evidence is limited by a high risk of bias and small sample sizes across studies.
- Future research should prioritize larger sample sizes and rigorous methodologies with a low risk of bias to establish definitive treatment guidelines.
Aim:
To compare the effects of physical therapy with hippotherapy versus physical therapy alone on the gross motor function of children and adolescents with cerebral palsy (CP).
Method:
Electronic searches were conducted in January 2021. We included controlled trials of the gross motor function of children and adolescents with CP, aged 2 to 18 years. We extracted means, standard deviations, and changes from the baseline to the end of the intervention. We used the Cochrane Collaboration's tool modified by Effective Practice and Organization of Care (EPOC) to assess the methodological quality and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method to verify evidence synthesis. We conducted the meta-analysis using Revman 5.3.
Results:
A total of 315 individuals from six studies were included. Both groups received physical therapy including strength, aerobic, stretch, and mobility exercises, and neurodevelopmental treatment. Studies presented high risk of bias. Both therapies presented similar effects for Gross Motor Function Measure scores, cadence, stride length, and speed during gait. The level of evidence was very low. The change was greater for the physical therapy with hippotherapy group, but inferior to the smallest real difference or the minimal detectable change.
Interpretation:
Physical therapy with hippotherapy presented similar effects to physical therapy alone on the gross motor function of children and adolescents with CP. Future studies should include larger sample sizes and studies with low risk of bias.
