Effectiveness and efficiency of aquatic therapy on independence in activities of daily living and mobility in post-acute spinal cord injury: A matched case-control study.

BACKGROUND AND PURPOSE: Aquatic therapy (AT), though potentially effective, lacks studies on clinical efficacy in patients with spinal cord injury (SCI). A recent study analyzing interviews with rehabilitation professionals on its clinical application reported that the scarce evidence of AT benefits was one of the actual barriers to its successful integration into clinical practice. We seek to provide evidence by comparing independence in activities of daily living (ADLs) and functional ambulation capacity in patients following rehabilitation which included AT and matched controls who followed rehabilitation without AT (non-AT). METHODS: Functional Independence Measure (FIM), Spinal Cord Independence Measure (SCIM-III), Walking Index for Spinal Cord Injury (WISCI-II) and its minimal clinically important difference (WISCI-II/MCID) were assessed. The AT group followed the Halliwick concept. We performed nonparametric nearest-neighbor k:1 matching for age, time since injury to admission, FIM at admission, level of injury (paraplegia/tetraplegia), completeness and cause of injury (traumatic, non-traumatic). The rehabilitation program comprised four daily hours of intensive treatment from the multidisciplinary team. Both groups received the same total number of rehabilitation hours at the same specialized clinical center and were admitted to follow inpatient rehabilitation within 2 months after injury. RESULTS: A total of 29 patients with SCI who followed AT (admitted between 2017 and 2023) were compared to historical matches selected from 551 inpatients with SCI (admitted between 2014 and 2023). For k = 1, the groups showed no significant differences in gains, efficiency, or effectiveness in FIM and SCIM-III; significant differences were observed in WISCI-II gain (p = 0.018) and WISCI-II efficiency (p = 0.046) in favor of the AT group; the proportion of patients achieving WISCI-II/MCID was significantly higher for the AT group (75.9% vs. 48.3%) (p = 0.030). These results were confirmed for k = 2. CONCLUSION: The AT group performed similarly in independence for performing ADLs and significantly better in ambulation than the matched historical controls.

Supporting Infants' Motor Development through Water Activities: A Preliminary Case-Control Study.

The first twelve months of an infant's life are the most dynamic time in the development of motor activities. Water activities can positively stimulate the motor skills, visual perception, and cognitive abilities of infants. The purpose of this study was to evaluate the motor development of infants aged 3-12 months participating in water activities. Participants in the study included 43 infants aged 3-12 months who attended water activities classes at Warsaw City swimming pools (n = 21) and infants not attending any classes (n = 22). Two methods of assessing motor development were used in the study: the Alberta Infant Motor Scale (AIMS) and the Early Motor Development Questionnaire (EMQ). The raw scores of the AIMS test and the EMQ questionnaire were statistically significantly different (p < 0.05) in both groups between the first and second examinations. In contrast, there was a statistically significant improvement in motor development measured by AIMS and expressed in percentiles (p = 0.002) and in percentiles for Polish children (p = 0.030) in the water group. The age-independent total score of the EMQ before and after the intervention did not change significantly (p = 0.149). The water environment has the potential to support the motor development of infants aged 3-12 months.

A Controlled Clinical Trial on the Effects of Aquatic Exercise on Cognitive Functions in Community-Dwelling Older Adults.

Several therapies have been developed to reduce cognitive decline associated with aging. Aquatic exercises, which are widely used to enhance functional capacity, may play a role in stimulating cognitive functions. This study investigated the effects of a 3-month aquatic exercise program on cognitive functions in community-dwelling older adults. In this prospective, single-blinded, controlled clinical trial, 31 participants were allocated to either the experimental (aquatic exercises) or control (no-exercise) group. The intervention program consisted of exercises conducted twice a week in a 1.2 m deep indoor pool. The main outcome measures were cognitive functions, assessed using Raven's Progressive Matrices test and the Wisconsin Card Sorting Test. A repeated-measures analysis of variance was used to assess the impact of the exercise program. The effect sizes (η2p) were reported when a level of significance was achieved (p < 0.05). Compared with the control group, the participants who underwent aquatic exercises showed positive outcomes in Raven's Progressive Matrices test (p = 0.046; η2p = 0.131) and the Wisconsin Card Sorting Test (p = 0.001, η2p = 0.589). Complementary analyses of the Wisconsin Card Sorting Test indicated that the benefits of the aquatic exercise were observed in terms of the number of trials (p = 0.001, η2p = 0.478), number of errors (p = 0.001, η2p = 0.458), and number of non-perseverative errors (p = 0.001, η2p = 0.302). The results indicate that a period of three months of aquatic exercise was beneficial for stimulating specific aspects of the cognitive function of community-dwelling older individuals. Aquatic exercise should be prescribed to this population.

Percepción de los principios bioéticos aplicados en las prácticas hidroterapéuticas: ecos de los terapeutas

El artículo informa de una investigación acerca de la aplicación de los principios bioéticos del personalismo en la práctica hidroterapéutica a nivel internacional. Se usó una metodología cualitativa, de tipo fenomenológica, con un muestreo intencional y opinático. La muestra estuvo constituida por 12 terapeutas acuáticos seniors internacionales, quienes participaron en entrevistas semiestructuradas en modalidad online. Se realizó análisis de contenido categorial temático, con apoyo del software Atlas Ti, versión 9. Como resultado se levantaron cuatro principios del personalismo y tres categorías emergentes: valores, principio de vulnerabilidad y el principio costo-beneficio. Se concluye que la práctica hidroterapéutica es consistente con la corriente personalista. Emerge un principio del utilitarismo y de la Declaración de Barcelona, y valores tales como la honestidad, el respeto y la humildad. Se plantea la necesidad de profundizar en torno a los principios bioéticos del personalismo en la práctica acuática generalizada, como asimismo en los procesos formativos y en las competencias bioéticas adquiridas por los terapeutas.

Article reports an investigation into the application of the bioethical principles of personalism in hydrotherapeutic practice internationally. A qualitative, phenomenological, purposive and opinionated sampling methodology was used. The sample consisted of 12 international senior aquatic therapists, who participated in semi-structured online interviews. Thematic categorical content analysis was carried out with the support of Atlas Ti software, version 9. As a result, four principles of personalism and three emerging categories were identified: values, principle of vulnerability and the cost-benefit principle. It is concluded that hydrotherapeutic practice is consistent with the personalist current. A principle of utilitarianism and the Barcelona Declaration emerges, as well as values such as honesty, respect and humility. The need to deepen the bioethical principles of personalism in general aquatic practice, as well as in the training processes and bioethical competences acquired by therapists, is raised.

O artigo informa sobre uma investigação acerca da aplicação dos princípios bioéticos do personalismo na prática hidroterápica a nível internacional. Se utilizou uma metodologia qualitativa, de tipo fenomenológica, com uma amostra intencional e opinático. A amostra foi constituída por 12 terapeutas aquáticos seniors internacionais, que participaram em entrevistas semi-estruturadas na modalidade online. Realizou-se análise de conteúdo categorial temático, com apoio do software Atlas Ti, versão 9. Como resultado identificaram-se quatro princípios do personalismo e três categorias emergentes: valores, princípio de vulnerabilidade e o princípio custo-benefício. Concluiu-se que a prática hidroterápica é consistente com a corrente personalista. Emerge um princípio do utilitarismo e da Declaração de Barcelona, e valores tais como a honestidade, respeito e humildade. Se propõe a necessidade de aprofundar os princípios bioéticos do personalismo na prática aquática generalizada, bem como nos processos formativos e nas competências bioéticas adquiridas pelos terapeutas.

Aquatic therapy in congenital malformation during the use of external fixator for bone lengthening: It is possible?

OBJECTIVES: The objective of this study is to describe the rehabilitation of individuals with Congenital Malformations (CMF) during the use of an External Fixator (EF) in Aquatic Therapy (AT) and to analyze the association between diagnosis, EF type and location with rehabilitation process outcomes, surgical intervention, and adverse effects. METHODS: This retrospective study included 29 medical records from which the personal and rehabilitation data of the patient were collected. The AT used was described and the outcome variables were associated. The medical records were selected by screening the database of the CMF clinic at the AACD. The inclusion criteria were participants with CMF who used EF treated between 2011 and 2019 of both genders and without age restriction. The exclusion criteria were incomplete medical record data or not undergoing AT while using EF. The extracted data included diagnosis, gender, age, EF type and location, objective of the surgery, adverse events, surgical interventions, time of rehabilitation in AT, physiotherapeutic objectives, and rehabilitation process outcomes in AT. RESULTS: The mean age of the participants was 12.1 ± 3.99 years, with male predominance (55 %) and hemimelia cases (37 %). The most used EF was circular (51 %), located in the femur (37 %), and the main objective of surgery was bone lengthening (52 %). The most recurrent adverse effect was infection (62 %) and 76 % completed AT. There was no association between the variables analyzed. CONCLUSIONS: It was possible to describe CMF rehabilitation with EF in AT. There was no association between the variables analyzed.

Comparison of water- vs. land-based exercise for improving functional capacity and quality of life in patients living with and beyond breast cancer (the AQUA-FiT study): a randomized controlled trial.

BACKGROUND: Patients living with and beyond breast cancer frequently exhibit several side effects that can impact quality of life and physical functioning way beyond diagnosis and cancer therapies. Traditional on-land exercise has shown to be effective in reducing several symptoms of BC but little is known about the role of water-based exercise in improving physical and psychological well-being. OBJECTIVES: To compare land- vs. water-based exercise training for BC survivors to improve Health-Related Quality of Life (HRQoL), cancer-related fatigue (CRF), physical functioning, body composition and physical activity in patients with BC. METHODS: A randomised, parallel group (1:1) controlled trial was conducted between 2020 and 2022. Patients were randomly allocated to complete a similar exercise training twice weekly during 12 weeks either on land (LG) using traditional gym equipment or in a swimming pool (WG) using body-weight exercises and water-suitable accessories. Both groups were supervised and monitored by an experienced physiotherapist. Main outcome was HRQoL (EORTC QLQ C30 and B23 module) and CRF measured with the Piper Scale. Secondary variables included functional capacity with the 6 Minutes Walking Test (6MWT), upper and lower body strength (handgrip strength and 30″ Sit-to-Stand (STS) test), body composition and objectively measured physical activity. RESULTS: 28 patients were assessed and randomised during the study period. One patient did not receive the allocated intervention due to skin issues and one patient was dropped out during the intervention. A significant effect of time was found for both symptom severity (F(2,52) = 6.46, p = 0.003) and overall functioning (F1.67,43.45 = 5.215, p =0 .013) but no interaction was found between group and time. No effects were reported for CRF. Similar findings were reported for functional capacity (time effect F1.231,32.019 = 16.818, p < 0.001) and lower body strength (time effect F2,52 = 15.120, p < 0.001) as well as fat mass (time effect F2,52 = 4.38, p = 0.017). Notably, a significant time per group interaction was reported for physical activity (F2,52 = 6.349, p =0.003) with patients in the WG significantly improving PA levels over time while patients in the LG exhibited a marked decreased. CONCLUSIONS: Exercise training either in water or on land can decrease symptom severity and improve functionality and body composition. Water-based training seems more effecting than land-based exercise to improve physical activity patterns over time.

Physiotherapeutic Intervention Techniques for Knee Osteoarthritis: A Systematic Review.

Globally, knee osteoarthritis (KOA) is the leading cause of disability. The most prevalent complaints associated with KOA are knee pain, joint stiffness, and weakness in the muscles of the lower limbs. These symptoms impede movement and result in functional limitations. As a result, people with KOA have a lower quality of life. For all patient groups with knee OA, an effective rehabilitation program focuses on improving knee range of motion, isometric quadriceps strength, and productivity level while reducing discomfort. The American College of Rheumatology (ACR) categorization criteria for KOA, research on KOA physiotherapy, and reviews covering various physical therapy interventions, including exercise, physical modalities, and patient education, were used to narrow down the pool of 180 systematic reviews to 15 articles. Google Scholar, PubMed, the Cochrane Library, and EMBASE were the databases that were used. The following keyword combinations were included in our search: KOA and physiotherapy or interventions or exercises, strengthening and stretching, concentric and eccentric training. Through our analysis, we identified a few methods that, in addition to standard therapy, could be used in clinical settings for people with osteoarthritis in the knee. It has been shown that Mulligan, Pilates, Kinesiotaping, Aquatic Therapy, and other current therapies are effective. The study employed a broad range of results. This review concludes that rather than relying solely on conventional therapy, it is preferable to combine a number of the most current physiotherapy techniques with it.

Impacto da fisioterapia aquática em UTIN sobre a mobilidade diafragmática avaliada por ultrassonografia cinesiológica: ensaio clínico / Impact of Aquatic Therapy in the NICU on diaphragmatic mobility assessed by ultrasound: clinical trial

INTRODUÇÃO: A fisioterapia aquática é uma modalidade de hidroterapia realizada em recém-nascidos (RN) nas Unidades de Terapia Intensiva Neonatal (UTIN). Os efeitos sobre nível de dor, estado comportamental e função respiratória já são conhecidos, porém pouco se refere aos efeitos sobre a função diafragmática na população recém-nascida a termo prematura. OBJETIVO: Avaliar o efeito da fisioterapia aquática sobre a amplitude diafragmática por meio da ultrassonografia cinesiológica diafragmática (USCD) em RNs internados em UTIN, bem como a segurança de sua realização quanto a estabilidade clínica dos RNs, estado comportamental, dor e desconforto respiratório. MÉTODOS: Ensaio clínico tipo antes e depois, de caráter transversal. Os RNs participantes do estudo receberam uma única intervenção com fisioterapia aquática durante 10 minutos. Foi realizada a avaliação utilizando a USCD antes e depois da sessão, e anotado as frequências cardíaca e respiratória, estado comportamental, dor e desconforto respiratório. RESULTADOS: Participaram 26 RNs. Observou-se aumento significativo da amplitude diafragmática (p= 0,02) e da saturação periférica de oxigênio (p= 0,05); os parâmetros fisiológicos permaneceram nos limites da normalidade e a intervenção não provocou desorganização comportamental, dor ou desconforto respiratório aos RNs. CONCLUSÃO: A fisioterapia aquática promoveu aumento da amplitude diafragmática, sugerindo que esta técnica pode ser utilizada como forma de estimular a contração da musculatura respiratória em RN, além de se mostrar uma técnica segura, pois não gerou instabilidade clínica, desorganização comportamental, dor ou desconforto respiratório aos participantes.

INTRODUCTION: Aquatic physiotherapy is a modality of hydrotherapy performed on newborn babies (NB) in the Neonatal Intensive Care Unit (NICU). The effects on pain levels, behavior, and respiratory function are already known; however, little has been said about the effects on diaphragmatic function in the preterm newborn population. OBJECTIVE: To evaluate the effect of aquatic physiotherapy on diaphragmatic amplitude using diaphragmatic kinesiologic ultrasound (DKUS) in NBs admitted to a NICU, as well as the safety regarding the clinical stability of the NBs, behavioral state, pain, and respiratory distress. METHODS: Crosssectional before-and-after clinical trial. The NBs participating in the study received a single intervention with aquatic physiotherapy for 10 minutes. An assessment was performed using the USCD before and after the session, and heart and respiratory rates, behavioral state, pain, and respiratory discomfort were recorded. RESULTS: Twenty-six NBs participated. There was a significant increase in diaphragmatic amplitude (p= 0.02) and peripheral oxygen saturation (p= 0.05); physiological parameters remained within normal limits, and the intervention did not cause behavioral disorganization, pain, or respiratory discomfort in NBs. CONCLUSION: Aquatic physiotherapy promoted an increase in diaphragmatic amplitude, suggesting that this technique can be used as a way to stimulate the contraction of the respiratory muscles in NB, in addition to being a safe technique, as it did not generate clinical instability, behavioral disorganization, pain, or respiratory discomfort to the participants.

Efectividad de la Terapia Acuática en la Función Motora Gruesa en Población Infantojuvenil con Parálisis Cerebral. Una Revisión Narrativa / Effectiveness of Aquatic Therapy on Gross Motor Function in Children and Young People with Cerebral Palsy. A Narrative Review

Introducción. La parálisis cerebral (PC) es una de las principales causas de discapacidad en la población infantil, afectando diversas áreas del desarrollo como la función motora gruesa; equilibrio y marcha. Hay evidencia de los beneficios de la terapia acuática y de cómo puede complementar la rehabilitación. Objetivo. Describir la efectividad de las intervenciones acuáticas en personas con PC, determinar mejoras en la función motora gruesa uso de métodos, protocolos y dosificación. Métodos. Se analizaron 9 estudios aleatorizados controlados desde el 2012 a la fecha, seleccionados por un experto y cuyos sujetos tenían PC espástica, Gross Motor Function Classification System (GMFCS) I a IV, entre los 2 y 20 años. Post intervención acuática se reportan mejoras significativas en el promedio de los ítems medidos por Gross motor function measure (GMFM). De los métodos que contribuyeron a mejoras se encuentra Halliwick y ejercicios acuáticos sin un programa específico. Resultados. Se obtuvieron mejoras de 35 a 100 minutos, y de 12 a 30 sesiones en total. No se logra concluir el tipo de terapia más efectiva, ya que las medidas de resultado y las características de los sujetos eran diversas. Conclusión. Una dosificación mínima de 2 veces por semana, 35 minutos de intervención en un total de 16 sesiones (9,3 horas en total) pareciera mejorar la función motora gruesa, cuyos resultados son transferibles a las actividades en tierra inmediatamente, sin embargo, no se obtiene información si se mantienen a mediano o largo plazo.

Background. Cerebral palsy (CP) is one of the main causes of disability in the child population, affecting various areas of development such as gross motor function; balance and gait. There is evidence of the benefits of aquatic therapy and how it can complement rehabilitation. Objective. to describe the effectiveness of aquatic interventions in people with CP, to determine improvements in gross motor function using methods, protocols, and dosage. Methods. Nine randomized controlled studies were analyzed from 2012 to date, selected by an expert and whose subjects had spastic CP, Gross Motor Function Classification System (GMFCS) I to IV, between 2 and 20 years of age. Results. After the aquatic intervention, significant improvements were reported in the average of the Gross motor function measure (GMFM) items measured. Of the methods that contributed to improvements, there is Halliwick and aquatic exercises without a specific program. Results. Improvements were obtained from 35 to 100 minutes, and from 12 to 30 sessions in total. It is not possible to conclude the most effective type of therapy, since the outcome measures and the characteristics of the subjects were diverse. Conclusion. A minimum dosage of 2 times per week, 35 minutes of intervention in a total of 16 sessions (9.3 hours in total) seems to improve gross motor function, the results of which are immediately transferable to activities on land, however, it is not obtains information if they are maintained in the medium or long term.

Efficacy of aquatic vs land-based therapy for pain management in women with fibromyalgia: a randomised controlled trial.

OBJECTIVE: To determine the efficacy of two physiotherapeutic interventions - aquatic therapy (AT) and land-based therapy (LBT) - for reducing pain in women with fibromyalgia. DESIGN: Single-blind, randomised controlled, equivalence trial. SETTING: Fibromyalgia, Chronic Fatigue Syndrome and Multiple Chemical Sensitivity Association in A Coruña, Spain. PARTICIPANTS: Forty women with fibromyalgia were assigned at random in a 1:1 manner to two groups: AT (n = 20) and LBT (n = 20). INTERVENTIONS: Two therapeutic exercise programmes, with 60-min sessions, were undertaken three times per week for 12 weeks. Sessions were carried out in groups by a trained physiotherapist. OUTCOME: The primary outcome was pain intensity (visual analogue scale). The secondary outcomes were pressure pain threshold (algometer), quality of life (Revised Fibromyalgia Impact Questionnaire), sleep quality (Pittsburgh Sleep Quality Index), fatigue (Multidimensional Fatigue Inventory) and physical ability (6-Minute Walk Test). Patients were evaluated at baseline, 12 weeks (post-treatment) and 18 weeks (follow-up). The statistical analysis was per-protocol. P < 0.05 was considered to indicate significance. Effect size was calculated. RESULTS: The mean age was 50 [standard deviation (SD) 9] years, with median body mass index of 27 [interquartile range (IQR) 25-30] kg/m2 and median symptom duration of 11 (IQR 6-15) years. No differences were observed between the groups post-treatment, but differences in favour of AT were found in pain intensity [2.7 (IQR 1.5-4.9) vs 5.5 (IQR 3.3-7.6); p= 0.023; large effect, Cohen's d= 0.8; 95% confidence interval (CI) 0.1-1.5] and sleep quality [12.0 (IQR 7.3-15.3) vs 15.0 (IQR 13.0-17.0); p= 0.030; large effect, Cohen's d= 0.8; 95% CI 0.1-1.5] at follow-up. CONCLUSIONS: The results suggest that AT is better than LBT for reducing pain intensity and improving sleep quality after 6 weeks of follow-up. AT may be a good treatment option for women with fibromyalgia. CLINICAL TRIALS REGISTRATION NUMBER: ClinicalTrials.gov NCT02695875 CONTRIBUTION OF THE PAPER.

Comparison of energy expenditure of individuals with Duchenne muscular dystrophy in the sitting posture on the ground and in water.

Duchenne Muscular Dystrophy (DMD) is one of the most frequent childhood dystrophies, affecting cardiopulmonary functions and walking ability. One of the main symptoms is fatigue, which is caused by altered muscle metabolism related to energy expenditure (EE). Aquatic physiotherapy is a therapeutic modality that facilitates the maintenance of this posture because of immersion on the body. This cross-sectional observational study aimed to compare the EE on the ground and water of individuals with DMD through oxygen consumption in the maintenance of sitting posture. The individuals were in a sitting position on the ground and in the water for 20 min for the assessments. The variables peripheral oxygen saturation, heart rate, maximum expiratory pressure, maximum inspiratory pressure, forced vital capacity, respiratory quotient (RQ), and oxygen consumption per kilogram of body weight (VO2 /kg) were compared, adopting a significance of 5 %. No difference was found between medians and quartiles of RQ when comparing the two environments. The same was observed for VO2 /Kg values on the ground and in water. The data from this study demonstrate that the EE of individuals with DMD did not change when maintaining a sitting posture on the ground and in water.

Effects of aquatic exercise program versus on-land exercise program on cancer-related fatigue, neuropathy, activity and participation, quality of life, and return to work for cancer patients: study protocol for a randomized controlled trial.

BACKGROUND: Exercise has shown positive effects on fatigue, exhaustion, neuropathy, and quality of life in cancer patients. While on-land exercises have been studied, the aquatic environment offers unique advantages. Water's density and viscosity provide resistance, enhancing muscle strength, while hydrostatic pressure improves venous return. This trial aims to investigate the effect of aquatic exercises on time to return to work, work hours, work-related difficulties, daily life activity and participation, quality of life, exhaustion, fatigue, and neuropathy among cancer patients, compared to on-land exercise intervention group and a non-exercise group. METHODS: This randomized controlled trial will include 150 cancer patients aged 18-65 years with stage III colon cancer or breast cancer patients with lymph node involvement. Participants in the aquatic exercise intervention group will undergo an 8-week, twice-weekly group-based Ai-Chi program, while the on-land exercise group will perform identical exercise. The control group will not engage in any exercise. The primary outcome will be assessed using an employment barriers questionnaire, capturing return to work date and working hours and daily life participation and activity and quality of life. Secondary outcomes include exhaustion, fatigue, and neuropathy. Data will be collected at baseline, post-intervention (8 weeks), and at 3,12, and 24 months. Mixed variance analyses will explore relationships among groups and over time for independent variables, with separate analyses for each dependent variable. DISCUSSION: The potential benefits include an earlier return to work for patients, reducing their need for social and economic support. The study's implications on socio-economic policies are noteworthy, as a successful intervention could offer a cost-effective and non-invasive solution, improving patients' quality of life and increasing their participation in daily activities. This, in turn, could lead to a faster return to work, contributing to both personal well-being and broader societal interests by reducing reliance on social services. TRIAL REGISTRATION: The trial is registered at ClinicalTrials.gov NCT05427344 (22 June 2022).

Effectiveness of aquatic training based on aerobic and strengthening exercises in patients with fibromyalgia: systematic review with meta-analysis.

BACKGROUND AND PURPOSE: fibromyalgia is a chronic condition causing widespread pain, fatigue, limited physical function, and reduced quality of life. Aquatic training is recommended as a first-line non-pharmacological treatment. This study aims to evaluate the effectiveness of aquatic training based on aerobic and strengthening exercises in improving symptoms in women with fibromyalgia. MATERIAL AND METHODS: a systematic review with meta-analysis was conducted by searching the PubMed, Scopus, Cochrane Library and Web of Science databases. Randomized clinical trials that compared aquatic therapy with either a control group or a land-based exercise group were included. Study quality was assessed using the PEDro scale, the risk of bias was evaluated using the Cochrane Risk of Bias Tool, and the certainty of the evidence was assessed the GRADE guidelines. RESULTS: six randomized clinical trials comprising 9 publications showed that aquatic therapy had statistically significant benefits compared to no intervention, including pain, fatigue, fibromyalgia impact, depression, physical function, and mental health in the short term. In the medium term, improvements were observed in fibromyalgia impact, physical function, and mental health. However, aquatic therapy was not found to be superior to land-based exercise. CONCLUSION: low to very low certainty of evidence suggested that aquatic training may reduce pain, fibromyalgia impact, fatigue and depression and improve physical function and mental health in patients with fibromyalgia. Further studies should investigate the medium and long-term effects of aquatic training using larger sample sizes.

The effectiveness of hydrotherapy on return to play in sports following hip arthroscopic surgery: a comparative study.

BACKGROUND: The postoperative management of femoroacetabular impingement (FAI) is variable with favourable surgical outcomes. Yet there is no evidence on the efficacy of hydrotherapy in athletes undergoing hip arthroscopy for FAI. The purpose of this study was to evaluate the role and the impact of hydrotherapy on return to sports following hip arthroscopy for symptomatic FAI. METHODS: 2 cohorts of mixed level of athletes from various sports: a hydrotherapy group that followed land-based exercises in combination with hydrotherapy exercises and a control group that followed solely the same land-based exercises. Pre- and postoperative pain and hip-specific outcome scores were completed, and patient satisfaction was rated. RESULTS: A total of 88 hip arthroscopies were included with a minimum of 2 years follow-up; the hydrotherapy group comprised of 36 hips and the control group, 52 hips. There was a significant improvement in time to return to previous performance (HR 1.91, 95% CI, 1.21-3.01; p = 0.005) in the hydrotherapy group compared with the control. The hip-specific scores and patient satisfaction were considerably improved in the hydrotherapy group. CONCLUSIONS: The analysis of our data indicates that the incorporation of hydrotherapy into postoperative rehabilitation for hip arthroscopy for FAI accelerates the return of athletes to their pre-injury performance, since recovery time decreased significantly.

A qualitative pilot study exploring clients' and health-care professionals' experiences with aquatic therapy post-stroke in Ontario, Canada.

BACKGROUND: Aquatic therapy is beneficial for people post-stroke, as it improves their physical function, well-being, and quality of life. There is a lack of description of users' experiences and perspectives toward aquatic therapy that could elucidate contextual factors for aquatic therapy implementation. OBJECTIVES: To explore participants' experiences with aquatic therapy post-stroke as part of a participatory design project to develop an education tool-kit to address the users' needs for aquatic therapy post-stroke. METHODS: A qualitative descriptive study was employed using a purposive sampling. Letters were sent to stroke and aquatic therapy organizations. Individual interviews were conducted either by phone or Zoom with nine participants in the chronic phase of stroke and 14 health-care professionals. All transcripts were coded and analyzed independently by two researchers. Inductive thematic analysis was used to identify the main themes. RESULTS: Health-care professionals practiced aquatic therapy in rehabilitation hospitals (N = 7), community centers (N = 8) and private clinics (N = 3). From the interviews, two organizing themes were identified: (1) Importance of aquatic therapy (e.g. experiences, benefits, and program approaches); and (2) Aquatic therapy education (e.g. knowledge gaps, sources of learning and communication). CONCLUSIONS: Health-care professionals and clients reported numerous benefits of aquatic therapy post-stroke including, but not limited to, improvements in mobility, balance, wellbeing, and socialization. Lack of formal and informal education and communication as participants' transition from rehab to community were viewed as barriers to aquatic therapy use post-stroke. Developing education material and communication strategies may improve the uptake of aquatic therapy post-stroke.

Aquatic therapy in congenital malformation during the use of external fixator for bone lengthening: It is possible?

Abstract Objectives: The objective of this study is to describe the rehabilitation of individuals with Congenital Malformations (CMF) during the use of an External Fixator (EF) in Aquatic Therapy (AT) and to analyze the association between diagnosis, EF type and location with rehabilitation process outcomes, surgical intervention, and adverse effects. Methods: This retrospective study included 29 medical records from which the personal and rehabilitation data of the patient were collected. The AT used was described and the outcome variables were associated. The medical records were selected by screening the database of the CMF clinic at the AACD. The inclusion criteria were participants with CMF who used EF treated between 2011 and 2019 of both genders and without age restriction. The exclusion criteria were incomplete medical record data or not undergoing AT while using EF. The extracted data included diagnosis, gender, age, EF type and location, objective of the surgery, adverse events, surgical interventions, time of rehabilitation in AT, physiotherapeutic objectives, and rehabilitation process outcomes in AT. Results: The mean age of the participants was 12.1 ± 3.99 years, with male predominance (55 %) and hemimelia cases (37 %). The most used EF was circular (51 %), located in the femur (37 %), and the main objective of surgery was bone lengthening (52 %). The most recurrent adverse effect was infection (62 %) and 76 % completed AT. There was no association between the variables analyzed. Conclusions: It was possible to describe CMF rehabilitation with EF in AT. There was no association between the variables analyzed.

Effect of aquatic exercise versus standard care on paraspinal and gluteal muscles morphology in individuals with chronic low back pain: a randomized controlled trial protocol.

BACKGROUND: Low back pain (LBP) is one of the most disabling diseases and a major health issue. Despite the evidence of a link between paraspinal and gluteal muscle dysfunction and LBP, it is unknown whether aquatic exercises can lead to improvements in paraspinal and gluteal muscle morphology and function, and whether improvements in overall muscle health are associated with improvements in patients' outcomes. The unique properties of water allow a water-based exercise program to be tailored to the needs of those suffering from LBP. This study uses magnetic resonance imaging (MRI) to investigate the effect of an aquatic exercise program versus standard exercise on 1) paraspinal and gluteal muscle size, quality and strength and 2) pain, disability, and psychological factors (pain related fear, depression, anxiety, sleep quality) in chronic LBP. METHODS: This study will include 34 participants with chronic non-specific LBP and moderate to severe disability, aged between 18 and 65, who will be randomly assigned (1:1) to the aquatic exercise group or land-based standard care exercise group. Both groups will receive 20 supervised sessions, twice per week over 10 weeks. MRIs will be obtained along the lumbosacral spine (L1-L5) and pelvis at the start and end of the intervention to assess the effect of each exercise intervention on paraspinal and gluteal muscle size and quality. Pre- to post-intervention changes in all outcomes between each group will be assessed, and the association between the changes in back muscle quality and clinical outcomes will be examined. Between-subjects repeated measure analysis of variance will be used to examine the changes in paraspinal muscle morphology over the different time points. Linear mixed models will be used to assess whether baseline scores can modify the response to the exercise therapy treatment. DISCUSSION: This study will determine if water-based exercises targeting the lower back and gluteal muscles can lead to important changes in muscle quality and function, and their possible relation with patients' pain and functional improvements. Our findings will have strong clinical implications and provide preliminary data to design a community program to better support individuals with chronic LBP. TRIAL REGISTRATION: NCT05823857, registered prospectively on April 27th, 2023.

Efectividad de la fisioterapia multimodal acuática mediante ejercicio terapéutico, autodrenaje manual y medidas de autocuidado en el linfedema de miembro superior en mujeres supervivientes de cáncer de mama. Ensayo clínico aleatorizado / Effectiveness of aquatic multimodal physiotherapy through therapeutic exercise, manual self-drainage and self-care measures in upper limb lymphedema in female breast cancer survivors. Randomized clinical trial

Introducción El linfedema secundario al cáncer de mama es una patología crónica. La fisioterapia descongestiva compleja (FDC) es el tratamiento conservador de elección, consta de una fase intensiva para disminuir el volumen de la extremidad, y una fase de mantenimiento para fomentar el autocontrol de la patología. El objetivo es evaluar si la fisioterapia multimodal acuática (FMA) compuesta por ejercicio terapéutico, auto drenaje manual y medidas de autocuidado de miembro superior mantiene o reduce el volumen del linfedema en fase de mantenimiento y si esta es más efectiva que la fisioterapia multimodal de miembro superior en sala. Metodología Se ha realizado un ensayo clínico aleatorizado comparando dos grupos, experimental n:43 que realizó una pauta de ejercicios en el medio acuático y control n:47 que realizó la misma pauta de ejercicios en sala. Ambos grupos efectuaron 20 sesiones de 45 min, dos o tres días por semana. Se evaluaron como variables principales los cambios en el volumen del linfedema, mediante circometría y la calidad de vida de las participantes, mediante la escala FACT-B + 4. Resultados No se encontraron diferencias estadísticamente significativas entre las intervenciones realizadas, ambas mejoran el volumen a las 20 sesiones (p = 0,7855), pero si entre la frecuencia del tratamiento y el tiempo postintervención (p<0,01). Se encontraron mejoras en las variables de calidad de vida; «estado físico general del paciente», «ambiente familiar y social», «estado emocional», «capacidad de funcionamiento personal» y «preocupaciones de las pacientes» (p < 0,01). Conclusión La FMA de miembro superior parece mejorar la calidad de vida de las mujeres supervivientes con linfedema de miembro superior en fase de mantenimiento. La FMA no muestra un beneficio añadido a la fisioterapia multimodal en sala (AU)

Introduction Lymphedema secondary to breast cancer is a chronic pathology. Complex decongestive physiotherapy is the conservative treatment of choice, it consists of an intensive phase to minimize the volume of the limb, and a maintenance phase to promote self-control of the pathology. The objective is to evaluate if aquatic multimodal physiotherapy (AMP) composed of therapeutic exercise, manual self-drainage and upper limb self-care measures maintains or reduces the volume of lymphedema in the maintenance phase and if it is more effective than upper limb multimodal physiotherapy in-room. Methodology A randomized clinical trial has been carried out comparing two groups, experimental N:43 that performed a pattern of exercises in an aquatic environment and control N:47 that performed the same pattern of exercises in-room. Both groups carried out 20 sessions of 45min, 2 or 3 days per week. The main variables were the changes in the volume of the lymphedema, by means of circometry, and the quality of life of the participants, by means of the FACT-B + 4 scale. Results No statistically significant differences were found between the interventions carried out, both improve the volume at 20 sessions (p = 0.7855), the interaction between the frequency of treatment and the time after intervention was (p-value: < 0.01). Improvements were found in quality of life variables; «general physical state of the patient», «family and social environment», «emotional state», «personal functioning capacity» and «patient concerns» (p-value: < 0.01). Conclusion Upper limb AMP seems to improve the quality of life of surviving women with upper limb lymphedema in the maintenance phase. AMP does not show an added benefit to room multimodal physiotherapy (AU)

Effects of Exposure to Formal Aquatic Activities on Babies Younger Than 36 Months: A Systematic Review.

This systematic review investigated the possible effects of exposing infants to formal activities in aquatic environments. A literature search of eight databases was concluded on 12 December 2022. Studies were eligible if they: (i) focused on 0-36 months of age infants, (ii) addressed the exposure of infants to formal aquatic activities, and (iii) compared the 'same condition of aquatic exposure with the control' or 'before and after exposure'. The PRISMA protocol was used. Articles considered for inclusion (n = 18) were clustered in the health, development, and physiological outcome domains. The results show that research is focused on indoor activities, mainly in baby swimming programs and baby aquatic therapy interventions. Swimming and aquatic therapy practices are generally safe for babies' health, and there are benefits to preterm and newborns exposed to aquatic therapy once the physiological parameters are maintained in normal and safe patterns. A positive effect is also suggested in general gross and fine motor skills, visual motion perception, cognitive flexibility, and response selection accuracy for infants who participated in aquatic programs. Further investigation with high-quality experimental designs is required to establish the effect of exposure of infants to formal aquatic activities (Systematic Review Registration: CRD42021248054).

Aquatic therapy following arthroscopic rotator cuff repair enables faster improvement of Constant score than land-based therapy or self-rehabilitation therapy.

PURPOSE: To compare the clinical and functional outcomes of arthroscopic rotator cuff repair over a period of 2 years using three postoperative rehabilitation modalities: aquatic therapy, land-based therapy, and self-rehabilitation therapy. The null hypothesis was that aquatic therapy would provide no difference in Constant score compared to land-based therapy and self-rehabilitation therapy. METHODS: A prospective study was performed on subjects scheduled for arthroscopic rotator cuff repair between 2012 and 2017 that complied with the following criteria: (i) small to medium sized symptomatic supraspinatus and/or infraspinatus tendon tears, (ii) low to moderate tendon retraction according to Patte, and (iii) fatty infiltration stage ≤2. Patients were allocated to perform either aquatic therapy, land-based therapy, or self-rehabilitation therapy for 2-4 months. Independent observers blinded to the study design collected Constant score, SSV, and patient satisfaction at 2 months, 3 months, 6 months, 1 year and 2 years. STUDY DESIGN: Level III, cohort study RESULTS: At 2 months follow-up, patients performing aquatic therapy had significantly higher Constant scores (p < 0.001) and SSV (p < 0.001) compared to those performing land-based therapy or self-rehabilitation therapy. At 3 months follow-up, patients performing aquatic therapy had significantly higher Constant scores (p < 0.001), and SSV (p < 0.001), both of which exceeded the respective minimal clinically important differences (MCIDs) of 10.4 and 12. Patients performing aquatic therapy continued to have significantly higher Constant scores and SSV at 6 months, 1 year, and 2 years. CONCLUSION: Aquatic therapy has a very limited positive effect on clinical outcomes at 3 months after surgery, but yields no relevant improvements on function or satisfaction at 1 to 2 years follow-up.