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Equine-assisted therapy

Recreational riding has been used for patients with different physical disabilities since the 1950: s and it has developed into being applied to several different psychological conditions and psychosocial problems [1]. Equine-Assisted Therapy (EAT) is also called hippotherapy and therapeutic horse riding.

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SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

Published: Report no: ut201911 Registration no: SBU 2019/162


Is there any scientific evidence for an effect of equine-assisted therapy on patients' physical, psychological and social functioning?

Table with identified studies

Table 1 Systematic reviews with low/medium risk of bias.
Included studies Population/Intervention Outcome
Stern et al (2018) [2]
13 systematic reviews that covered 79 individual studies of equine‐assisted interventions, including primarily hippotherapy and therapeutic horse riding. Number of participants (relevant to this review):3030.

Population: 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.

Intervention: Animal-assisted interventions, and specifically, hippotherapy and other interventions involving horses
Improvement of biological, physical, psychological and social functioning, and outcomes in humans.
Authors' conclusion:
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
Tzrmiel et al (2019) [3]
15 studies Population: 390 participants (aged: 3–16 years). The subjects were predominantly male (Male: 308 (79%), Female: 72 (21%)). All participants were diagnosed with ASD.
Intervention: Equine-Assisted Activities and Therapies (EAAT)
Stereotyped behaviours, establishing contact, verbal and non-verbal communications, creating and understanding interpersonal relations after EAAT
Authors' conclusion:
The overwhelming majority of the available reports demonstrated high effectiveness of EAAT, especially with regard to improved social functioning. Also, EAAT has been proven to significantly reduce aggressive behaviors and improve trunk stability. Nevertheless, it is impossible to draw universal conclusions due to the considerable discrepancies in therapeutic protocols and measurement instruments of the abovementioned studies.


  2. Stern C, Chur-Hansen A. An umbrella review of the evidence for equineassisted interventions. Aust J Psychol. 2019;1–14.
  3. Trzmiel T, Purandare B, Michalak M, Zasadzka E, Pawlaczyk M. Equine assisted activities and therapies in children with autism spectrum disorder: A systematic review and a meta-analysis. Complement Ther Med. 2019;42:104-13.

Literature search

Project group

Alexandra Snellman, Ann-Kristine Jonsson and Sara Fundell at SBU.

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