Effect of hippotherapy on walking performance and gait parameters in people with multiple sclerosis

Andréa Gomes Moraes; Silvia Gonçalves Ricci Neri; Robert W Motl; Carlos Bernardo Tauil; Felipe von Glehn; Éber Castro Corrêa; Ana Cristina de David

doi:10.1016/j.msard.2020.102203

Effect of hippotherapy on walking performance and gait parameters in people with multiple sclerosis

Mult Scler Relat Disord. 2020 Aug:43:102203. doi: 10.1016/j.msard.2020.102203. Epub 2020 May 26.

Authors

Andréa Gomes Moraes¹, Silvia Gonçalves Ricci Neri², Robert W Motl³, Carlos Bernardo Tauil⁴, Felipe von Glehn⁵, Éber Castro Corrêa⁶, Ana Cristina de David²

Affiliations

¹ Laboratory of Human Motion Analysis, Faculty of Physical Education, University of Brasilia, Brasilia, DF, Brazil. Electronic address: deyafisio9@hotmail.com.
² Laboratory of Human Motion Analysis, Faculty of Physical Education, University of Brasilia, Brasilia, DF, Brazil.
³ Department of Physical Therapy, University of Alabama at Birmingham,Birmingham, AL, United States.
⁴ Faculty of Medicine, University of Brasília, DF, Brazil.
⁵ Department of Medical Clinic, Faculty of Medicine, University of Brasilia, Brasilia, DF and Department of Immunology, University of Unicamp, SP, Brazil.
⁶ Clinen, Neurology and Endocrinology Clinic, Brasília, DF, Bazil.

PMID: 32485633
DOI: 10.1016/j.msard.2020.102203

Abstract

Background: Walking dysfunction is one of the most common symptoms of multiple sclerosis (MS).

Objective: To evaluate the effects of an 8-week hippotherapy intervention on walking performance and spatiotemporal gait parameters in people with relapsing-remitting MS; and to examine whether the effects of hippotherapy on walking performance are mediated by changes in spatiotemporal gait parameters.

Methods: Participants were assigned into a hippotherapy intervention group (n = 17) or a control group (n = 16). The intervention included 16 sessions of 30-minutes of hippotherapy conducted twice a week. Participants underwent the 25-foot walk test (T25FW) and 6-minute walk test (6MWT), as primary outcomes, and spatiotemporal gait evaluation using GaitRite system, as secondary outcomes, before and after intervention. The data were examined using mixed model ANOVA with Bonferroni post hoc. Mediation analysis was conducted as per Baron and Kenny's criteria.

Results: Compared with control, the intervention group significantly increased 6MWT distance (+9.70%, p<0.001) and decreased T25FW time (-15.86%, p<0.001).Regarding spatiotemporal gait parameters, the intervention group exhibited significantly greater improvements in most variables (Δ% from 3.66 and 41.43%; all p<0.005) than control. Only balance time (p = 0.043), stance time (p = 0.031), and absolute (p = 0.004) and relative (p = 0.017) double support time were identified as significant mediators of the effects of hippotherapy on walking performance evaluated by T25FW. There was no significant mediator for 6MWT (all p>0.05).

Conclusion: Hippotherapy improved walking performance and spatiotemporal gait parameters in people with relapsing-remitting MS, and changes in walking performance, evaluated by T25FW, were partially driven by reduction in stance time and double support time and increase in balance time. Hippotherapy may be a useful complimentary treatment approach for improving walking in people with MS.

Keywords: Hippotherapy; Multiple sclerosis; Spatiotemporal Gait; Walking performance.

MeSH terms

Equine-Assisted Therapy*
Gait
Humans
Multiple Sclerosis* / therapy
Multiple Sclerosis, Relapsing-Remitting*
Walking