Introduction: multiple sclerosis (MS) is a chronic autoimmune inflammatory disease that leads to demyelination of the white matter in the central nervous system, including the brain and spinal cord. Among the most debilitating symptoms of MS are balance problems and fatigue. These symptoms often emerge early in the disease, even before other symptoms become pronounced, and significantly affect the patient’s ability to engage in daily activities and social participation. Hippotherapy is one of the complementary interventions that has shown potential in alleviating MS symptoms. Objective: the aim of this literature review was to evaluate research findings on the effectiveness of hippotherapy in improving balance and reducing fatigue in patients with multiple sclerosis. Methods: a review of studies published between 2013 and 2024 was conducted using the PEDro, PubMed, and CINAHL databases. A combination of the following keywords was used in the search: "hippotherapy" OR "equine-assisted therapy," "multiple sclerosis" AND "balance" AND/OR "fatigue. Results: total of six studies were included in the review, comprising four randomized controlled trials (RCTs), one non-randomized clinical trial, and one case study. Two RCTs were rated 6 out of 10 on the PEDro scale, one was rated 8 out of 10, and one was self-rated at 7 out of 10. In total, 182 patients participated in the studies. Five studies utilized hippotherapy with horses, while one employed a simulator. The duration of the therapeutic programs ranged from 6 to 16 weeks. Functional test results from all studies consistently showed that hippotherapy had a positive effect on balance and fatigue. Statistically significant differences were found primarily between the experimental groups, which received hippotherapy, and the control groups, which did not receive any additional therapy. Discussion and conclusion: the findings of the reviewed studies suggest that hippotherapy has a beneficial impact on improving balance and reducing fatigue in individuals with MS. This is supported by better results in functional balance tests and improved scores on fatigue questionnaires following hippotherapy interventions. Statistically significant improvements were mainly observed in comparison to control groups that received no additional therapy. The effects of hippotherapy appear to be comparable to those of other complementary interventions. Future research should focus on additional randomized controlled trials with double-blind designs and explore the impact of hippotherapy in MS patients with varying degrees of disability.
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