Safety practices and incidents during occupational, physical, and speech language therapies that use hippotherapy in the US: A 5-year survey study

Hippotherapy is the use of equine movement as a treatment tool within occupational, physical, or speech-language therapy sessions to achieve functional outcomes. While effective, its implementation presents unique safety concerns. The purpose of this study is to describe safety incidents and safety practices in occupational, physical, and speech-language therapy incorporating hippotherapy in the U.S. across five years, 2019–2023. The five-year survey study gathered data from therapists or therapy assistants integrating hippotherapy into occupational therapy, physical therapy, or speech-language therapy. The survey asked questions regarding respondents’ clinical background and experience, safety practices, and safety incidents that occurred in their therapy sessions using hippotherapy in the previous 12 months. Across the 455 responses, descriptive statistics were calculated, and negative binomial regression was used to identify predictors of safety incidents. Out of 188,267 reported therapy sessions, client safety occurrences requiring basic first aid were reported in 0.03 % of sessions, and client injuries occurred in 0.004 % of sessions. While uncommon, client injuries included fractures, soft-tissue injuries, and concussions. Safety predictors included PATH, Intl affiliation, helmet use during ground activities, and emergency dismounts performed. Wearing helmets during ground activities reduced incidents, while frequent emergency dismounts were associated with more safety occurrences. Overall, this study suggests that industry-recommended safety protocols are widely implemented, likely contributing to the rarity of safety incidents during therapy sessions that integrate horses. Findings highlight the importance of helmet use during ground activities and proactive risk management. This research can support informed risk/benefit analyses concerning the use of hippotherapy within therapy sessions.