The study represents a sound effort to perform a randomized clinical trial (RCT) to explore a popular issue in the treatment of children and youth with cerebral palsy (CP), namely the use of hippotherapy. Hippotherapy refers to the presumed therapeutic benefit of horseback riding under controlled and appropriate circumstances with trained horses and human interveners. A number of perspectives on the putative benefits (functional and personal perspectives) of such therapy are offered. Like any good piece of research the study raises a number of important issues that are worthy of comment.
The first point to consider relates to the huge challenges inherent in trying to carry out effective RCTs in our complex field of developmental disability. Some of stories about the difficulties in recruitment, with 155 of 256 families deemed eligible for the study declining to participate.
The second interesting point concerns the findings of the trial. There will certainly be proponents of hippotherapy who will be disappointed at the lack of statistically significant findings from the trial. However, just because there are no apparent measured benefits from hippotherapy doesn’t mean people should not do it! There was no evidence that the intervention caused any harm, and there are suggestions from the unstructured parental observations that the experience was of value to at least some of the children.
Third, the authors rightly identify the challenges of measuring changes in complex constructs like quality of life, which may in fact be a relatively stable phenomenon, as has been recently reported by this article.
The investigators have undertaken a worthwhile exploration of an intervention for children with CP and have reported findings that should provide a stimulus for further discussion and research in our ever-evolving field of developmental disability.