Physical therapy with hippotherapy compared to physical therapy alone in children with cerebral palsy: systematic review and meta-analysis.

Hippotherapy, which involves using the movement of a horse as part of therapy, is sometimes added to standard physical therapy for children with cerebral palsy in the hope of improving gross motor function, the ability to sit, walk, and move. This systematic review and meta-analysis pooled data from six controlled trials involving 315 children and adolescents to see whether physical therapy plus hippotherapy produced different results than physical therapy alone on measures like Gross Motor Function Measure scores and gait characteristics such as cadence, stride length, and speed. Both groups improved, and the abstract describes the two approaches as having similar effects on these outcomes. The change was numerically larger in the group that received hippotherapy, but this difference was smaller than what would count as a real or clinically detectable change, so it cannot be treated as meaningful.

The certainty of this evidence was rated very low, and the included studies carried a high risk of bias, meaning these findings should be read as provisional rather than conclusive.

If you're a parent looking into hippotherapy, or horse-riding-based therapy, for a child with cerebral palsy, this review looked at whether adding it to regular physical therapy makes a bigger difference to gross motor skills like sitting, standing, and walking compared to physical therapy alone. Researchers combined results from six studies involving 315 children and teenagers. Both groups, those doing physical therapy alone and those combining it with hippotherapy, showed improvement, and the review found the two approaches had similar effects overall.

The hippotherapy group showed a slightly larger numerical change, but this difference was too small to be considered a real or meaningful improvement based on established thresholds. It's important to know that the studies behind this review were rated as having a high risk of bias, and the overall quality of the evidence was very low. This means the findings are uncertain, and larger, more rigorously designed studies are needed before firmer conclusions can be drawn about whether hippotherapy adds any benefit beyond standard therapy.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This systematic review and meta-analysis pooled six controlled trials (n=315) comparing physical therapy combined with hippotherapy against physical therapy alone in children and adolescents with cerebral palsy, aged 2 to 18 years. Both intervention arms received comparable core physical therapy components, including strength, aerobic, stretching, and mobility exercises, plus neurodevelopmental treatment, with hippotherapy as the added variable of interest. Pooled results showed similar effects between groups for Gross Motor Function Measure scores and gait parameters, including cadence, stride length, and speed.

The abstract reports that the change was numerically greater in the hippotherapy group, but this difference fell below the smallest real difference or minimal detectable change threshold, indicating it does not represent a distinguishable or reliable treatment effect based on current measurement standards. The abstract does not report a statistically significant between-group difference favoring either arm. Methodological quality was assessed as high risk of bias using the Cochrane Collaboration's tool modified by EPOC, and GRADE-rated certainty of evidence was very low across outcomes.

These limitations, combined with small sample sizes across the six pooled studies, substantially constrain confidence in any conclusion, and the authors explicitly call for larger, lower-bias trials before firmer clinical inferences can be drawn.