Protocol for a systematic review and meta-analysis on the effect of hippotherapy and related equine-assisted therapies on motor capabilities in children with cerebral palsy

BACKGROUND: Equine-assisted treatments of the motor system appear to have an effect on the neuromuscular system and aim to improve the pathological condition of children with cerebral palsy. Hippotherapy is a distinct form of equine-assisted therapy where certified physiotherapists use the horse as a dynamic tool in a medical treatment setting. The objective of the proposed review is to summarize and critically appraise the evidence on the effect of equine-assisted treatments on motor capabilities of children with cerebral palsy. METHODS: We will identify trials through systematic searches of PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL). Quality assessment of retrieved articles will be conducted using the criteria outlined in the revised tool to assess risk of bias in randomized trials (RoB 2.0) or the ROBINS-I tool (Risk Of Bias In Non-randomized Studies - of interventions), respectively. Quantitative data synthesis will be performed if treatments, participants, and the underlying clinical question are homogenous and provide adequate outcome data for meta-analysis. Otherwise, data will be synthesized, using the narrative synthesis approach. CONCLUSION: This review will provide a critical summary of the evidence regarding the impact of equine-assisted treatments on motor capabilities of children with cerebral palsy. The result from this review will help to inform healthcare practitioners and policymakers on the additional effect of equine-assisted treatments on reducing the burden of cerebral palsy among children. SYSTEMATIC REVIEW REGISTRATION: This systematic review protocol is registered with the International Prospective Register of Systematic Reviews (PROSPERO). Registration number: CRD42018096403. This protocol was prepared using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols checklist (PRISMA-P).