Regarding interventions with real horses, it was not possible to conduct a meta-analysis due to the low number of studies. However, the p-value in the meta-analysis with the postintervention measures was 0.06. Results: Horse-riding simulators significantly reduced the pain levels of patients with low back pain ( p = 0.03, with a SMD of -1.14 and a 95% CI from -2.16 to -0.11) using change-from-baseline measures. Due to some risk of bias concerns, two meta-analyses (using postintervention or change-from-baseline measures) were conducted utilizing Review Manager Software (RevMan 5.3). Eleven articles (seven randomized controlled trials) were selected to be included in the review. Materials and methods: A systematic literature search was carried out in accordance with PRISMA guidelines in Web of Science (WOS) and PubMed (Medline) electronic databases. Therefore, this systematic review and meta-analysis aimed to evaluate the effects of horse riding (with real or simulated horses) on chronic pain. Riding a horse may lead to some benefits in chronic pain patients through the improvement of postural control and other biopsychosocial processes. Background and objectives: Chronic pain is a complex global public health problem that affects the health status, quality of life, activities of daily living, and different work-related variables.
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