Effectiveness of Hippotherapy Simulator in Ankylosing Spondylitis
Condition: Ankylosing Spondylitis; Exercise
MeSH terms: Spondylitis; Spondylarthritis; Spondylitis, Ankylosing
Study type: Interventional

Summary: 
      Recent studies and meta-analysis showed that different exercise plans had greater benefits
      than no invention group in improving pain, physical function, and disease activity,
      especially in some studies that involve ankylosing spondylitis patients receiving home-based
      exercise. Different kinds of exercises are efficacious and should be recommended to AS
      patients. But, according to our current knowledge, no clear protocols regarding the
      effectiveness of hippotherapy in AS patients.

      This study aims to investigate the effect of the therapeutic horseback riding therapy via a
      mechanical simulator on disease-specific outcomes and muscle strength of ankylosing
      spondylitis 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 different kinds of disabilities. 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. It is believed that a hippotherapy simulator is a therapeutic exercise option
      for the treatment of thoracolumbar segmental instability and hypo-mobility. Besides
      complications such as fractures caused by falling are greatly reduced using hippotherapy
      simulators under proper supervision. Hippotherapy with a mechanical stimulator simulates the
      motion of a horse as part of a continuous therapy package to provide postural or stability
      training. This exercise develops unified intuitive stimulation plus motor responses. It
      engages movement hits that are produced by the machine which mimicking the animal walks: this
      leads to beneficial consequences.

      This prospective clinical study aims to investigate the effect of therapeutic horseback
      riding therapy via a mechanical simulator on disease-specific outcomes and muscle strength of
      ankylosing spondylitis patients.

      This randomized, single-blind, controlled clinical trial will carry out at the University of
      Usak/ TURKEY.

      This randomized, single-blind, controlled clinical trial will carry out at the University of
      Usak/ TURKEY. The study will include a total of 60 volunteers who had been diagnosed with AS
      according to the modified New York criteria. The subjects will be patients who are referred
      to the outpatient physical therapy center of the Physical Medicine and Rehabilitation
      Department of the Usak University.

      Participants will be allocated to the different treatment groups using the block
      randomization method. All patients in both groups will continue their ongoing medications.
      But also, both groups will plan to complete exercise sessions 3 times a week for 12 weeks,
      each lasting 35 minutes per day.

      For Group 1 (horse-riding simulator group), patients 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 five minutes. For safety, a
      physiotherapist will be accompanied to the exercises for this group.

      For 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.

      During the study, if, any subject making any changes to the drug treatment will withdraw from
      the study.

      Evaluations will make before and after treatment. All evaluations will perform by the same
      experienced physiotherapists who will be blind to the study groups.

      Primer outcomes of the study; The Bath AS Disease Activity Index (BASDAI) and Bath AS Disease
      Functional Index (BASFI) will be used for the activity-related disease, function, and
      baseline measurements of the participants, respectively.

      Quadriceps muscle strength will be measured with the microFET®2 Dynamometer. Bath AS Disease
      Activity Index (BASDAI): This index, which was developed to evaluate disease activity,
      consists of 6 VAS measurements. These are fatigue, spine, and peripheral joint pain,
      sensitivity, and morning stiffness measurements.

      Bath AS Disease Functional Index (BASFI): BASFI measures the functional capacity of the
      patient in the previous week. This index consists of 8 questions about daily activities and 2
      questions evaluating the patient's ability to cope with daily life. The degree of difficulty
      felt by the patient in performing specified tasks is marked on a 10 cm visual analog scale.
      The average of the total score obtained from 10 questions is calculated for use in the
      analysis.

      Quadriceps muscle strength will be measured with the microFET2 Dynamometer. The wireless
      microFET®2 Digital Handheld Dynamometer muscle tester is an accurate, portable Force
      Evaluation and Testing device. It is a modern adaptation of the time-tested art of hands-on
      manual muscle testing. Measurement Range 0-300 lbs force.
    

Intervention name(s): Therapeutic exercise program via hippotherapy mechanical stimulator; Therapeutic home exercise program
Intervention type(s): Other; Other
Intervention description(s): Patients were planned to complete hippotherapy exercises sessions 3 times a week for 12 weeks, each lasting 35 minutes per sessions.; Patients were planned to complete home exercises sessions 3 times a week for 12 weeks, each lasting 35 minutes per sessions.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: randomized, single-blind, controlled clinical trial
Masking: Single (Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: Hippotherapy; occupational therapy; horse; Exercise therapy