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Aquatic Physical Therapy

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Stephanie Fisher

on 11 July 2014

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Transcript of Aquatic Physical Therapy

By Stephanie Fisher, Student Physical Therapist
University of the Pacific, Class of 2014
Does hydrotherapy improve strength and physical function in patients with osteoarthritis- a randomized controlled trial comparing a gym based and a hydrotherapy based strength programme.
Land-Based Versus Pool-Based Exercise for People Awaiting Joint Replacement Surgery of the Hip or Knee: Results of a Randomized Controlled Trial.
A Specific Inpatient Aquatic Physiotherapy Program Improves Strength After Total Hip or Knee Replacement Surgery: A Randomized Control Trial.
Land-Based Versus Water-Based Rehabiliation Following Total Knee Replacement: A Randomized, Single-Blind Trial.
N= 102 (land-based n49, water-based n53), 81% of patients attended > 8/12 visits
1hours sessions 2x / week for 6 weeks

Outcome Measures: assessed at 8 & 26 weeks postsurgery.
6-Minute Walk, Stair climbing power (SCP), WOMAC osteoarthritis index, VAS, PROM, Edema circumference

Results:
No inbetween difference in 6-Minute Walk (overall significant improvement at 26 weeks)
Greater water-based vs. land-based improvements in SCP at 26 weeks
WOMAC pain decreased with no significants between groups, however, < stiffness in the land-based group
No significant difference in VAS scores
Edema slightly greater reduction in water-based between 8-26 weeks
Aquatic Physical Therapy
Principles of Aquatic Therapy
1. Buoyancy
2. Hydrostatic Pressure
3. Viscosity

Pascal's Law:
the pressure of a fluid is exerted on an object equally at a given depth.

The pressure increase with density and depth of the fluid.
The resistance of fluid to its adjacent fluid layers sliding freely by one another.

The friction causes a resistance to flow when moving through
a liquid
Indications
Facilitate range of motion (ROM) exercise
Initiate resistance training
Facilitate weight-bearing activities
Enhance delivery of manual techniques
Provide three-dimensional access to the patient
Facilitate cardiovascular exercise
Initiate functional activity replication
Minimize risk of injury or re-injury during rehabilitation
Enhance patient relaxation
Archimedes' Principle:
An immersed object at rest has an upward thrust equal to the same volume of the fluid volume it displaces.

Individuals in water experience an upward force related to the water depth and specific gravity



Buoyancy can be used to progress therapeutic exercise

4 Main Manipulable Variables
Position or direction of movement in water
Water depth
Lever arm length
Flotation or weighted equipment use

The depths and corresponding forces through the body are as follows:
water at waist level = 50% of your body weight, chest level = 75% of body weight, and neck level = 90% of body weight.
Precautions/Contraindications
Evidence Based Practice
Land-Based Versus Pool-Based Exercise for People Awaiting Joint Replacement Surgery of the Hip or Knee: Results of a Randomized Controlled Trial.
Does the research support aquatic therapy for knee & hip OA treatment?
Any Questions
How do you gain a certificate in Aquatic Therapy?
Hydrostatic pressure is greatest at the bottom of a pool due to the weight of the water overhead.
Turbulent flow: produced when the speed of movement reaches critical velocity

Resistance is proportional to velocity squared.
the speed of movement, significantly the resistance.
References

Foley A, Halbert J, Hewitt T, Crotty M. Does hydrotherapy improve strength and physical function in patients with osteoarthritis--a randomised controlled trial comparing a gym based and hydrotherapy based strengthening programme. Ann Rheum Dis. 2003;62(12):1162-7.
Gill SD, McBurney H, Schulz DL. Physio. Land-based versus pool-based exercise for people awaiting joint replacement surgery of the hip or knee: results of a randomized controlled trial. Arch Phys Med Rehabil. 2009;90(3):388-94.
Harmer, A., Naylor, J., Crosbie, J. & Russell, T. (2009). Land-Based Versus Water-Based Rehabilitation Following Total Knee Replacement: A Randomized, Single-Blind Trial. Arthritis & Rheumatism, 61 (2), 184-191.
Rahmann, A., Brauer, S. & Nitz, J. (2009). A Specific Inpatient Aquatic Physiotherapy Program Improves Strength After Total Hip or Knee Replacement Surgery: A Randomized Controlled Trial. American Concress of Rehabilitation Medicine, 90, 745-755.
(2014, ). Aquatic Physical Therapy Section 800/999-2782 ext. 8512 - APTA. Certificate in Aquatic Physical Therapy Clinical Competency (CAPTCC) -Aquatic Physical Therapy Section 800/999-2782 ext. 8512 - APTA. Retrieved July 2014, from http://www.aquaticpt.org/captcc/
Available for PT/PTA authorized by the APTA

Certificate in Aquatic Physical Therapy Clinical Competency
(CAPTCC)

There are 6 online learning
modules and a 3 day pool course to complete the entire certificate series

http://www.aquaticpt.org
Does hydrotherapy improve strength and physical function in patients with osteoarthritis- a randomized controlled trial comparing a gym based and a hydrotherapy based strength programme.
Foley et al.
Aquatic Therapy for Knee/Hip OA
Aquatic Therapy Post TKA/THA
Gill et al.
N= 82 (Land-based: n40, Pool-based n42), Randomized, single blinded

Outcome Measures: WOMAC pain & function, 50-Foot Timed Walk, 30-second Chair Stand Test, SF-36 MCS

Results:
Pool based presented with < pn immediatly following tx session
No significant postintervention difference
Land based HEP was given to both groups which could have impacted the findings
WOMAC Pain significantly improved in both groups in 7 weeks but only land based improved in 15 weeks
A Specific Inpatient Aquatic Physiotherapy Program Improves Strength After Total Hip or Knee Replacement Surgery: A Randomized Control Trial

Rahmann et al.
What about aquatic therapy post TKA or THA?
Conclusion:
Both gym & hydrotherapy resistive programs improved physical function
Hydrotherapy may be beneficial when extended periods of weight bearing exacerbate symptoms
Potential for increased aerobic exercise
Pool based tx results less pain immediately following exercise, however, land base has better long term affect on pain
Short term program of either land-based or water-based rehabilitation improvements were evident in nearly all outcome measures up to 6 months post TKR
Positive effects on early recovery of hip strength with aquatic therapy

N=105 (52 woman, mean age 70.9)
- Randomized into 3 groups
- Hydrotherapy (84% compliance), Gym (75% compliance), & Control

3 visits per week for 6 weeks
Outcome measures: quadriceps strength & 6-Minute Walk test, WOMAC, SF-12, Arthritis Self-Efficacy Questionnaire

Results:
Gym program > muscle strength
No significant difference between groups for walking speed & distance
WOMAC pain score decreased significantly in hydrotherapy group from baseline, no significant difference between groups
Fear of water
Acute infection
unstable epilepsy
Cardiac failure
Renial failure
Open wounds/ulcers
Steroidal joint injection within 24 hours
Recent radiotherapy (<6wks)
Within 6 weeks of CVA
Sensitive skin/eczema
Uncontrolled hyper/hypotension
Uncontrolled thyroid deficiency
Febrile conditions
Infectius skin disorder
Contagious diseases
Land-Based Versus Water-Based Rehabiliation Following Total Knee Replacement: A Randomized, Single-Blind Trial.
Harmer et al.
Treatment
Land Based:

Water Based: wal
N=65 (average age 69, 30 men)
Pragmatic, RCT with measures taken pre-surgical, post surgery 14 days, 90 days, and 180 days
- Randomized into 3 groups
-aquatic physiotherapy, nonspecific water exercise, and additional ward treatment

Outcome Measures: Hip abductor strength, Timed 10 meter walk test, WOMAC, mid-patellar circumference, TUG, quadriceps strength, PSFS

Results
Aquatic therapy showed significant increase in hip abductor strength 14 days post surgery
No other measures were significantly different among the 3 groups
Full transcript