An umbrella review of the evidence for equine-assisted interventions

Objective To establish the evidence base for animal-assisted interventions, and specifically, hippotherapy and other interventions involving horses, in the context of improving biological, physical, psychological and social functioning, and outcomes in humans. Method A review of systematic reviews (an umbrella review) was carried out using a modified Joanna Briggs Institute methodology and following PRISMA guidelines. Inclusion criteria were any interventions that included a live horse, for humans of any age and for any therapeutic purpose. Service and assistance horses and people who were incarcerated were excluded. Systematic reviews with a clearly articulated and comprehensive search strategy, with evidence of critical appraisal, both qualitative and quantitative and mixed methods, and in English were considered. Results Of 19 systematic reviews considered eligible for inclusion, 13 were included in this umbrella review. These 13 systematic reviews covered 79 individual studies of equine-assisted interventions, including primarily hippotherapy and therapeutic horse riding. Participants included children with cerebral palsy, children and adolescents with autism spectrum disorder, adults with multiple sclerosis, elderly people, adults post-stroke, people with spinal cord injury, adults with serious mental illness, adults with balance problems, people with brain disorders, breast cancer survivors, and obese women. Conclusions The evidence for equine-assisted interventions for adults and children across a range of conditions and presentations is equivocal. The current evidence base is marred by multiple methodological weaknesses and thus, therapeutic interventions that include a horse cannot be asserted as best practice at this time. Rigorous research is indicated to determine the utility of equine-assisted interventions.