Author(s): STOLZ, I., BRAUNSMANN, L.1, ROSINY, F.2, POEHLAU, D.3, ABEL, T.2, KNAEPEN, K.1, Institution: GERMAN SPORT UNIVERSITY COLOGNE, Country: GERMANY, Abstract-ID: 2203

INTRODUCTION:
Multiple sclerosis (MS) is commonly associated with persistent deficits in postural control, substantially limiting functional independence. Aligned with the “Exercise is Medicine” paradigm, movement-based interventions are increasingly regarded as integral to disease management, driving growing interest in evidence-based, non-pharmacological approaches to improve mobility. Hippotherapy has been proposed as a multimodal physiotherapeutic intervention targeting sensorimotor integration and postural regulation. However, biomechanical evidence based on objective outcome measures remains scarce.
METHODS:
Effects of hippotherapy on static balance control were examined in 61 individuals with MS (m = 5, f = 56, age ⌀ 55 ± 9.02 years, EDSS = 5 ± 0.7) after participating in a 12-week RCT (T1) with a 6-week follow up (T2) compared to before (T0), (Intervention group (IG) = 34, Control group (CG) = 27). IG received hippotherapy (DKThR)® additional to treatment as usual, CG received treatment as usual only. Center of pressure (CoP) analysis was applied during three standing conditions on a force plate: Quiet stance (eyes open and eyes closed) and narrow stance (eyes open) for 3 × 20 seconds each. CoP trajectories were quantified using the 95% confidence ellipse area of the CoP (area95), path length, sway amplitudes and mean CoP velocity.
RESULTS:
Linear mixed-effects models (LMMs) demonstrated intervention-related improvements across multiple postural sway parameters, characterized by significant time × group interactions and moderate to large effect sizes. For stance with eyes open, area95 LMMs revealed a significant time × group interaction (F(2, 116.89) = 4.32, p = .016). Estimated marginal means (EMMs) indicated a pronounced reduction in the IG from T0 to T1 (EMMs: 12.548 to 5.479) and sustained improvement at T2 (EMM: 6.730), whereas the CG showed no consistent changes. Holm-adjusted post-hoc contrasts confirmed improvements from T0 to T1 (Δ = 7.069, z = 3.37, p = .006, d = .83) and from T0 to T2 (Δ = 5.818, z = 2.70, p = .049, d = .68) in the IG only. For path length during the same condition, LMMs revealed a significant time × group interaction (F(2, 111.71) = 3.92, p = .023). EMMs indicated a pronounced reduction in the IG from T0 to T1 (EMMs: 45.450 to 33.937), which was maintained at T2 (EMM: 34.373), whereas the CG showed no consistent changes. Holm-adjusted post-hoc contrasts confirmed significant reductions in the IG from T0 to T1 (Δ=11.513, z = 2.95, p = .026, d = .73) and from T0 to T2 (Δ = 11.078, z = 2.76, p = .041, d = .70).
CONCLUSION:
The findings demonstrate statistically significant and sizable improvements in static balance control characterized by reductions in sway area, path length, and directional amplitudes, with partial maintenance at follow-up. These improvements may be functionally relevant, highlighting the potential of CoP-based measures for translating movement-based interventions into evidence-informed rehabilitation strategies for individuals with MS.