Investigation of the effectiveness of the hippotherapy simulator added to respiratory physiotherapy in children and adolescents with cystic fibrosis

Objective: The aim of this study is to investigate the effect of hippotherapy simulator (HS) add to chest physiotherapy on children and adolescents with cystic fibrosis (CF) in terms of the amount of sputum, ease of expectoration, sense of chest congestion, pulmonary functions, functional capacity, postural stability, dynamic balance, peripheral muscle strength, core muscle endurance, flexibility, physical activity and quality of life. Methods: Thirty-two patients with clinically stable CF, aged between 8-14 years were randomly assigned to experimental group or control group. Both groups received a home-based comprehensive chest physiotherapy for 30 minutes, twice a day, every day of the week for 8 weeks. In addition, the experimental group received 30-minute HS sessions 2 days a week for 8 weeks. All patients were evaluated twice, at the beginning and at the end of the 8-week treatment program. In the assessment, spirometer for respiratory functions, 6-minute walk test for functional capacity, Biodex Balance System® device for postural stability and dynamic balance, Mcgill Trunk Endurance Tests for core muscle endurance, digital hand-held dynamometer for peripheral muscle strength, sit and reach test for flexibility, Physical Activity Questionnaire for physical activity, Cystic Fibrosis Questionnaire-Revised (CFQ-R) for quality of life, visual analog scale for ease of expectoration and sense of chest congestion were used. To determine the amount of sputum, the weight of the wet sputum produced by the patients for 24 hours was weighed on the day when the patients did not receive the treatment interventions. Results: Only the experimental group showed improvement in terms of the amount of sputum, pulmonary functions, functional capacity, postural stability, core muscle endurance, peripheral muscle strength, physical activity and emotional functioning and body image scores in CFQ-R. The experimental group achieved a greater increase than the control group in terms of extensor and lateral group core muscles and dynamic balance. Both groups showed similar increases in ease of expectoration. No group showed significant changes in terms of sense of chest congestion and flexibility. Conclusion: HS is an effective method that can be applied selectively to children and adolescents with CF who have weak core muscle endurance and dynamic balance impairment. Additionally, when the HS is added to the comprehensive chest physiotherapy, it can improve pulmonary functions, functional capacity, postural stability, peripheral muscle strength, physical activity and quality of life.