Effects of Hippotherapy and Mechanical Horse Riding Simulators in People with Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Stroke is a neurological disease caused by a sudden, localized vascular lesion in the central nervous system. The objective of this systematic review (SR) was to analyze the effects of complementary interventions such as hippotherapy (HPT) and mechanical horse riding simulators (MHRSs) compared to conventional physiotherapy, no treatment, or other therapies in individuals with this condition. A literature search was conducted in six databases from January to November 2025. The PICOS research strategy was used to establish the study eligibility criteria. The Cochrane RoB 2 tool was used to assess the risk of bias, and the PEDro scale was used to evaluate the methodological quality of the studies. Meta-analyses, including calculating mean differences (MDs) and 95% confidence intervals (CIs), were performed using Cochrane Review Manager (RevMan). Ten articles were included in the SR, and seven in the meta-analysis. Meta-analyses revealed significant differences in dynamic balance with the Berg Balance Scale in HPT (MD = 1.62; 95% CI = 0.72–2.51; p < 0.01) and MHRSs (MD = 1.21; 95% CI = 0.06–2.36; p = 0.04). In conclusion, HPT and MHRSs may provide potential benefits for functional mobility in people with stroke. However, the limited number of studies makes it difficult to draw definitive conclusions.