Benefits of Equine-Assisted Therapies in People with Multiple Sclerosis: A Systematic Review
Table 3
Effects of equine-assisted therapy intervention on the assessed instrument.
Study
Tool
Groups
Before intervention
After intervention
Effect size [CI 95%]
Differences ( value)
Between-group
Mean (SD)
Mean (SD)
Within-group
HEALTH-RELATED QUALITY OF LIFE
Moraes (2021)
FAMS (total)
EATG
133.4 (35.2)
151.4 (38.3)
0.11 [−0.57, 0.80]SMD
ICG
143.2 (27.2)
138.7 (27.2)
Muñoz-Lasa (2019)
KHQ
EATG
34.83 (16.15)
17.7 (6.95)
1.38 [ 0.1, 2.6]d
NSD
ICG
32.36 (19.99)
34 (21.73)
−0.08 [−1.5, 1.3]d
NR
MSQOL-54 (2,3)
EATG
2.85 (0.9)
3.55 (0.61)
−0.85 [−2.0, 0.3]d
NSD
ICG
2.63 (1.3)
2.61 (1.05)
0.02 [−1.4, 1.4]d
NR
Vermöhlen (2017)
MSQOL-54 (physical health)
EATG
46.0 (14.2)
57.0 (15.1)
0.36 [−0.12, 0.85]SMD
NR
ICG
53.7 (14.6)
51.3 (15.9)
NR
MSQOL-54 (mental health)
EATG
62.6 (18.0)
75.7 (15)
0.64 [0.14, 1.13]SMD
NR
ICG
67.1 (17.2)
64.2 (19.9)
NR
Frevel (2015)
HAQUAMS total
EATG
13.6 (2.3)
14.5 (2.1)
0.38 [−0.62, 1.37]SMD
NSD
NSD
ACG
11.5 (4.1)
13.0 (4.9)
NSD
Hammer (2005)
SF-36 (general health)
EATG
54.5 (25.82)
53.8 (19.26)
NA
NA
NA
SF-36 (mental health)
EATG
70 (19.74)
69.6 (30.53)
NA
NA
NA
SF-36 (physical functioning)
EATG
40 (24.30)
37 (20.38)
NA
NA
NA
FATIGUE
Moraes (2021)
FSS
EATG
5.0 (1.6)
4.0 (1.7)
−0.17 [−0.86, 0.51]SMD
ICG
4.5 (1.7)
4.3 (1.7)
MFIS Total
EATG
44.2 (19.0)
32.3 (18.5)
−0.86 [−1.57, −0.14]SMD
ICG
48.1 (10.3)
45.9 (11.5)
Muñoz-Lasa (2019)
FIS
EATG
5.52 (0.67)
1.93 (0.83)
4.76 [2.5, 7.0]d
NSD
ICG
2.85 (0.48)
2.87 (0.74)
−0.03 [−1.4, 1.4]d
NR
Vermöhlen (2017)
FSS (sum score of FSS)
EATG
51.80 (10.5)
42.6 (11.4)
−0.38 [−0.86, 0.11]SMD
NR
ICG
47.8 (11.9)
46.8 (10.6)
NR
Frevel (2015)
FSS
EATG
5.40 (0.80)
4.4 (1)
0.24 [−0.75, 1.22]SMD
NSD
ACG
4.50 (1.90)
4.00 (2.00)
NSD
MFIS
EATG
44.7 (18.3)
22.9 (11.8)
−0.31 [−1.30, 0.67]SMD
NSD
ACG
34.6 (22.6)
28.5 (20.8)
NSD
BALANCE
Vermöhlen (2017)
BBS
EATG
40.60 (11.50)
47.0 (8.7)
0.19 [−0.29, 0.67]SMD
NR
ICG
42.10 (10.90)
45.10 (10.90)
NR
Frevel (2015)
BBS
EATG
40.30 (9.80)
45.8 (8.3)
−0.08 [−1.06, 0.90]SMD
NSD
ACG
43.50 (9.90)
46.50 (9.00)
DGI
EATG
12.8 (6.4)
15.8 (6.6)
0.07 [−0.91, 1.05]SMD
NSD
ACG
13.3 (6.6)
15.3 (6.5)
Silkwood-Sherer (2007)
BBS
EATG
39.38 (16.87)
56 (15.11)
1.31 [0.04, 2.58]†
NR
ICG
41.00 (9.19)
40.20 (7.91)
NR
Lindroth (2015)
BBS
EATG
42 (1.73)
46 (0)
NA
NA
NA
Hammer (2005)
BBS
EATG
40.5 (24.57)
31 (26.06)
NA
NA
NA
MOBILITY
Moraes (2021)
Timed up and go test
EATG
9.9 (3.1)
7.5 (2.2)
−0.27 [−0.95, 0.42]SMD
ICG
8.7 (2.5)
8.09 (2.13)
Muñoz-Lasa (2011)
POMA
EATG
16 (6.1)
19.3 (3.6)
1.23 [0.38, 2.08]†
NSD
ACG
17.3 (6.8)
17.1 (6.7)
NSD
Silkwood-Sherer (2007)
POMA
EATG
18.44 (6.45)
22.11 (4.82)
−2.05 [−3.51, −0.59]†
NR
ICG
19.33 (3.9)
18.83 (3.98)
NR
Hammer (2005)
Timed up and go test
EATG
14.85 (7.52)
14.82 (7.75)
NA
NA
NA
SPASTICITY
Muñoz-Lasa (2019)
Modified Ashworth Scale
EATG
1.25 (0.25)
0.5 (0.55)
3.40 [1.11, 5.69]†
ICG
1.12 (0.58)
0.82 (0.48)
NSD
Vermöhlen (2017)
NRS
EATG
4.6 (2.1)
3.2 (2.4)
−0.25 [−0.74, 0.23]SMD
NR
ICG
4.4 (2.2)
3.8 (2.3)
NR
WALKING PERFORMANCE
Moraes (2020)
Walking endurance (6-minute WT (m))
EATG
459.06 (118.34)
503.59 (126.38)
0.06 [−0.63, 0.74]SMD
ICG
513.00 (101.97)
497.13 (88.88)
Frevel (2015)
2-minute WT
EATG
130.3 (22.5)
141.3 (28.8)
0.24 [−0.75, 1.22]SMD
NSD
NSD
ACG
128.6 (50.7)
130.0 (57.1)
NSD
GAIT SPEED
Moraes (2020)
Speed (cm/s)
EATG
97.84 (25.94)
114.93 (31.20)
0.29 [−0.39, 0.98]SMD
ICG
110.95 (33.35)
105.95 (28.61)
Muñoz-Lasa (2011)
Speed (m/s)
EATG
0.44 (0.11)
0.48 (0.10)
−0.38 [−1.2, 0.4]d
NSD
Lindroth (2015)
FGA
EATG
14 (4.36)
18 (6.24)
NA
NA
NA
DISABILITY
Muñoz-Lasa (2011)
EDSS
EATG
5.2 (1.2)
5.2 (1.1)
0 [−0.8 , 0.8]d
NSD
NSD
ACG
4.9 (1.3)
5 (1.3)
−0.08 [−0.8, 0.6]d
NSD
PAIN
Vermöhlen (2017)
VAS
EATG
32.2 (29.9)
24.9 (27.6)
0.05 [−0.43, 0.54]SMD
NSD
ICG
24.7 (29.3)
23.4 (27.0)
PHYSICAL FUNCTIONING INDEPENDENCE LEVEL
Muñoz-Lasa (2011)
Barthel Index
EATG
89.6 (10.5)
90.4 (8.9)
−0.08 [−0.9, 0.7]d
NSD
ACG
90.3 (10.9)
90.7 (11.3)
−0.02 [−0.8, 0.7]d
NSD
POSTURAL CONTROL
Moraes (2021)
CoP Speed (cm/s), stable surface, and eyes open
EATG
1.2 (0.4)
0.7 (0.4)
−1.21 [−1.96, −0.46]SMD
ICG
1.4 (0.7)
1.4 (0.7)
CoP Speed (cm/s), stable surface, and eyes closed
EATG
1.6 (0.6)
1.1 (0.6)
−0.98 [−1.70, −0.25]SMD
ICG
2.0 (1.1)
1.7 (0.6)
CoP Speed (cm/s), foam surface, and eyes open
EATG
2.7 (0.9)
1.6 (0.9)
−0.80 [−1.51, −0.09]SMD
ICG
2.8 (1.1)
2.3 (0.8)
CoP Speed (cm/s), foam surface, and eyes closed
EATG
5.9 (2.2)
2.6 (1.6)
−1.14 [−1.88, −0.40]SMD
ICG
6.4 (2.7)
5.10 (2.6)
Menezes (2013)
AMPap (cm), eyes open
EATG
2.85 (0.93)
2.28 (0.68)
0.70 [−0.4, 1.8]d
ICG
1.58 (0.35)
1.89 (0.99)
−0.42 [−1.8 , 1.0]d
AMPap (cm), eyes closed
EATG
3.91 (1.70)
3.02 (0.84)
0.66 [−0.4, 1.7]d
ICG
2.39 (1.71)
2.61 (1.37)
−0.14 [−1, 5, 1.2]d
AMPml (cm), eyes open
EATG
2.2 (1.19)
1.66 (0.76)
0.54 [−0.5, 1.6]d
NSD
ICG
0.96 (0.43)
0.96 (0.63)
0 [−1.4, 1.4]d
AMPml (cm), eyes closed
EATG
3.28 (2.21)
2.17 (0.99)
0.65 [−0.4, 1.7]d
NSD
ICG
1.41 (0.67)
1.08 (0.67)
0.49 [−0.9, 1.9]d
Msap (cm/s), eyes open
EATG
1.44 (0.56)
1.48 (0.46)
−0.08 [−1.1, 1.0]d
NSD
ICG
0.83 (0.19)
0.97 (0.28)
−0.59 [−2.0, 0.8] d
Msap (cm/s), eyes closed
EATG
1.91 (0.79)
1.85 (0.70)
0.08 [−1.0, 1.1]d
NSD
ICG
0.99 (0.27)
1.33 (0.35)
−1.09 [−2.6, 0.4]d
MSml (cm/s), eyes open
EATG
1.30 (0.75)
1.19 (0.59)
0.16 [−0.9, 1.2]d
ICG
0.62 (0.30)
0.72 (0.28)
−0.34 [−1.7, 1.1]d
MSml (cm/s), eyes closed
EATG
1.70 (0.99)
1.19 (0.41)
0.67 [−0.4, 1.8]d
ICG
0.69 (0.26)
0.84 (0.15)
−0.71 [−2.1, 0.7]d
Lindroth (2015)
SOT
EATG
67.33 (9.29)
73 (12.49)
NA
NA
NA
SD: standard deviation; EATG: equine-assisted therapy group; ICG: inactive control group; NR: not reported; ACG: active control group; NSD: not significant differences; dwithin group Cohen’s d value with an interval confidence of 95%; SMDStandardized Mean Difference results of randomized trials (calculated with after intervention data); †Standardized Mean Difference results of nonrandomized trials (calculated with change from baseline data); NA: not applied; MSQOL-54: Multiple Sclerosis Quality of Life-54; HAQUAMS: Hamburg Quality of Life Questionnaire in Multiple Sclerosis; FAMS: Functional Assessment of Multiple Sclerosis Quality of Life; SF-36: Short Form 36; KHQ: general health perception of King’s Health Questionnaire; FSS: Fatigue Severity Scale; MFIS: Modified Fatigue Impact Scale; VAS: Visual Analogue Scale; BBS: Berg Balance Scale; POMA: Performance Oriented Mobility Assessment; NRS: Numeric Rating Scale; WT: walking test; FGA: Functional Gait Assessment; EDSS: Extended Disability Status Scale; CoP: center of pressure; AMPap: amplitude of center of pressure displacement in the antero-posterior directions; AMPml: amplitude of center of pressure displacement in the medial-lateral directions; Msap: mean speed of the center of pressure displacement in the antero-posterior directions; MSml: mean speed of the center of pressure displacement in the medial-lateral directions; SOT: Sensory Organization Test.
