Effectiveness of Hippotherapy Simulator in PwMS
Condition: Multiple Sclerosis; Exercise
MeSH terms: Multiple Sclerosis; Sclerosis
Study type: Interventional

Summary: 
      A mechanical horse-riding simulator (MHRS) is a robotic device with a dynamic saddle that
      mimics the movement of a horse for purpose of hippotherapy. By simulating the rhythmic
      movements of the horse MHRS aims to increase the patient's balance, flexibility and
      adaptation and to provide postural adjustment. MHRS is supposed to produce walking patterns
      of a horse in a three-dimensional aspect. Movements in rhythmic repetitions improve postural
      coordination, allow to produce a reciprocal pattern. By simulating the rhythmic movements of
      a horse, MHRS aims to increase the patient's balance, flexibility and adaptation and to
      provide postural adjustment. This study aims to research the potential benefits of the
      mechanical horseback riding simulator on the postural balance and symptoms of multiple
      sclerosis patients.
    

Detailed description: 
      Hippotherapy or therapeutic horseback riding therapy is a form of animal-assisted therapy
      that uses the horse as a modality that aims to improve postural control, balance and
      mobility. With hippotherapy, it is aimed to change the center of gravity by using the
      movements of the horse and to ensure the adaptation of the trunk and pelvis by developing
      righting and balance reactions against this new position. Current studies suggest that
      hippotherapy may be a useful complementary treatment approach for improving balance, fatigue,
      spasticity, walking and quality of life in MS patients. However, horseback riding therapy
      itself has some limitations as a treatment due to costs, location and risks. By its nature
      horse-riding is too dynamic for patients and requires a large outdoor space.

      This prospective clinical study aims to show potential benefits of horse riding in people
      with Multiple Sclerosis (PwMS) via a mechanical simulator.

      Primer outcomes of the study are postural balance and muscle strength. Sample size
      calculation was performed and forty patients (inclusion and exclusion criteria will listed
      separately) were planned to be included in the study.

      Participants will be allocated to the different treatment groups using the block
      randomization method.

      All patients in both groups will planned to complete exercise sessions 3 times a week for 12
      weeks, each lasting 35 minutes per day.

      For the Group 1 (horse-riding simulator group), patients will will perform a horse riding
      simulation exercise at speeds of 15km/h, 18km/h, 20km/h, 22km/h, 25km/h, each lasting 5
      minutes after warm-up for 5 minutes in each session. Then they will rest for 5 minutes.For
      the safety, a physiotherapist will be accompanied to the exercises for this group.

      For the Group 2 (home exercise group) patients will perform home exercises. Home exercises
      will be consist of a warm-up, stretching, balance, back walking, fingertip walking exercises,
      the first of which is shown by the physiatrist or physiotherapist to the patients. These
      patients will be called twice a month to ask whether they have done the exercises, and the
      patients whose participation rate is below 80% will be excluded from the study by following
      the exercise schedule when they come to the physician's control monthly.

      All participants will be filled with My Multiple Sclerosis (MMMS) scale, Berg Balance Scale
      (BBS), Timed Up and Go Test, before treatment and at the end of the 12th week. Quadriceps
      muscle strength will be measured with the microFET®2 Dynamometer before treatment and at the
      end of the 12th week.
    

Intervention name(s): Exercises
Intervention type(s): Other
Intervention description(s): Patients were planned to complete exercise sessions 3 times a week for 12 weeks, each lasting 35 minutes per day.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: randomized pretest-posttest control group design
Masking: Single (Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: hippotherapy; multiple sclerosis; balance; strength; exercise