Evidence-Based Aquatic Therapy Guidelines for Parkinson's Disease: An International Consensus Study

Aquatic aerobic exercise prescription in Parkinson's disease: A scoping review

CONTEXT AND PURPOSE

Parkinson's disease (PD) is characterized by degeneration of dopaminergic neurons causing motor and non-motor changes that lead to reduced quality of life and functionality. Among the therapeutic strategies used, aquatic aerobic exercise has shown potential effects in stabilizing symptoms and disease progression. However, the development of exercise-based therapies requires an accurate prescription, and, in this regard, there are gaps in the literature. The purpose of this study was to examine the scientific literature on the prescription of aquatic aerobic exercises for individuals with PD, duration, types of exercises intervention, forms of intensity control and main outcomes analyzed assessed.

METHODS

This review was conducted based on PRISMA-ScR and was registered in the Open Science Framework. Studies published in the last 10 years were selected from the following databases: PubMed, PEDro, Sciencedirect and Web of Science. As inclusion criteria, studies that described aquatic aerobic exercise programs were selected. The study selection was conducted using the StArt platform, and data related to the types of exercises intervention, duration, intensity control and outcomes were extracted and analyzed.

RESULTS

In total, 1642 studies were identified and following the eligibility criteria, 9 studies were selected. The sample included 215 people with PD between stages 1-4 of the Hoehn Yahr scale.

CONCLUSION

There is currently no standardized prescription for aerobic training, therefore further studies are required.

Implementation considerations of aquatic therapy post-stroke: A qualitative study from Ontario, Canada

BACKGROUND AND PURPOSE

Aquatic therapy is an effective alternative approach to therapy on land in facilitating mobility and independence after a stroke. Despite the evidence reporting on the effectiveness of many aquatic interventions, there is a lack of studies elucidating essential implementation factors for aquatic therapy post-stroke.

MATERIALS AND METHODS

A purposive sample of people with lived experience of stroke and healthcare providers participated in semi-structured interviews about their experiences with aquatic therapy. A deductive content analysis approach using the Consolidated Framework for Implementation Research (CFIR) was used to identify the essential aspects of aquatic therapy implementation post-stroke.

RESULTS

Twenty-three participants (9 people with stroke experience and 14 healthcare providers) participated in the study, from across the province of Ontario in Canada. The interview data were all relevant to the five main CFIR constructs and to some of the sub-constructs. Although participants were highly favorable to aquatic therapy, several implementation considerations in terms of costs, program structure, provider qualifications, and pool access were identified at the patient, provider, and system level.

CONCLUSION

The CFIR proved valuable in identifying contextual factors relevant to implementing aquatic therapy with the stroke population. These factors included the importance of education, barriers to accessing aquatic therapy in rehabilitation and community settings, and internal and external factors influencing the application of aquatic therapy post-stroke.

Factors influencing physiotherapy decisions between restorative and compensatory gait rehabilitation: an Italian multicenter study

Background and purpose

This study aimed to investigate the factors that influence physiotherapists' decision in choosing restorative or compensatory rehabilitation during gait training in people with neurological disorders (PwNDs) and the different treatments used in the approaches.

Methods

This cross-sectional analysis used the baseline data from an observational cohort study. We analyzed data from 83 PwNDs (65 people after stroke, 5 with multiple sclerosis, and 13 with Parkinson's disease) who underwent at least 10 sessions of physiotherapy (PT) focusing on gait function. Performance was quantified using the modified Dynamic Gait Index (MDGI), three impairment domains of Fugl-Meyer Assessment for lower extremity (mFM-LL), Activities-specific Balance Confidence (ABC), modified Barthel Index (mBI), Mini-Mental State Examination (MMSE), and Motivational Index (MI). Forty-three physiotherapists completed a treatment report form categorizing the rehabilitation approach and specifying treatments used (e.g., resistance training and proprioceptive exercises).

Results

Fifty-six subjects underwent restorative rehabilitation approach. The univariate predictors of restorative approach were being in the subacute phase with a disease onset of less than 180 days, (odds ratio [95%CI]; 3.27[1.19-9.24]), mFM-LL (1.25[1.11-1.44]), MMSE (0.85[0.67-1.00]), and number of sessions (1.03[1-1.01]). The backward stepwise analysis revealed an association between restorative and subacute phase (36.32[4.11-545.50]), mFM-LL (3.11[1.55-9.73]), mBI (1.79[1.08-3.77]), MMSE (0.46[0.25-0.71]), and the interaction between mFM-LL and mBI (0.99[0.98-1.00]). No statistically significant association between treatments used and approach was found (p = 0.46).

Discussion and conclusion

The restorative approach was more commonly used to improve gait. The main variables associated with this approach were: being in the subacute phase of the disease, a low level of impairment, and a high level of functional independence at baseline. However, few differences were found between the treatments used for the restorative or compensatory approaches, as similar PT treatments were used for both.

Clair KA, Toledo S, York MK, Todaro R, Yarab N, Wallock K. Delivering Multidisciplinary Rehabilitation Care in Parkinson's Disease: An International Consensus Statement

BACKGROUND

Parkinson's disease (PD) is a complex neurodegenerative disorder impacting everyday function and quality of life. Rehabilitation plays a crucial role in improving symptoms, function, and quality of life and reducing disability, particularly given the lack of disease-modifying agents and limitations of medications and surgical therapies. However, rehabilitative care is under-recognized and under-utilized in PD and often only utilized in later disease stages, despite research and guidelines demonstrating its positive effects. Currently, there is a lack of consensus regarding fundamental topics related to rehabilitative services in PD.

OBJECTIVE

The goal of the international Parkinson's Foundation Rehabilitation Medicine Task Force was to develop a consensus statement regarding the incorporation of rehabilitation in PD care.

METHODS

The Task Force, comprised of international multidisciplinary experts in PD and rehabilitation and people directly affected by PD, met virtually to discuss topics such as rehabilitative services, existing therapy guidelines and rehabilitation literature in PD, and gaps and needs. A systematic, interactive, and iterative process was used to develop consensus-based statements on core components of PD rehabilitation and discipline-specific interventions.

RESULTS

The expert-based consensus statement outlines key tenets of rehabilitative care including its multidisciplinary approach and discipline-specific guidance for occupational therapy, physical therapy, speech language pathology/therapy, and psychology/neuropsychology across all PD stages.

CONCLUSIONS

Rehabilitative interventions should be an essential component in the comprehensive treatment of PD, from diagnosis to advanced disease. Greater education and awareness of the benefits of rehabilitative services for people with PD and their care partners, and further evidence-based and scientific study are encouraged.

Long-term efficacy of hydrotherapy on balance function in patients with Parkinson's disease: a systematic review and meta-analysis

BACKGROUND

Hydrotherapy can improve the motor and non-motor symptoms of Parkinson's disease (PD), but the long-term effects of hydrotherapy on PD are still unclear.

OBJECTIVE

The purpose of this systematic evaluation and meta-analysis was to explore the long-term effects of hydrotherapy on balance function in PD patients.

METHODS

A systematic search of five databases was conducted to identify appropriate randomized controlled trials (RCTs) according to the established inclusion and exclusion criteria. The general characteristics and outcome data (balance, exercise, mobility, quality of life, etc.) of the included studies were extracted, and the quality of the included studies was evaluated using the Cochrane risk of bias assessment tool. Finally, the outcome data were integrated for meta-analysis.

RESULTS

A total of 149 articles were screened, and 5 high-quality RCTs involving 135 PD patients were included. The results of the meta-analysis showed positive long-term effects of hydrotherapy on balance function compared to the control group (SMD = 0.69; 95% CI = 0.21, 1.17; p = 0.005; I2 = 44%), However, there were no significant long-term effects of hydrotherapy on motor function (SMD = 0.06; 95% CI = -0.33, 0.44; p = 0.77; I2 = 0%), mobility and quality of life (SMD = -0.21; 95% CI = -0.98, 0.57; p = 0.6; I2 = 71%). Interestingly, the results of the sensitivity analysis performed on mobility showed a clear continuation effect of hydrotherapy on mobility compared to the control group (SMD = -0.80; 95% CI = -1.23, -0.37; p < 0.001; I2 = 0%).

CONCLUSION

The long-term effects of hydrotherapy on PD patients mainly focus on balance function, and the continuous effects on motor function, mobility, and quality of life are not obvious.

The mediating role of psychological capital between post-traumatic growth and uncertainty in illness among patients with Parkinson's disease

With the application of positive psychology in health management, many studies have confirmed the close relationship between post-traumatic growth, psychological capital and uncertainty in illness. However, there is still a lack of attention to the positive psychology of patients with Parkinson's disease, and previous studies have not clarify the specific relationship. Therefore, the present study sought to explore the multiple mediating roles of psychological capital between post-traumatic growth and uncertainty in illness among patients with Parkinson's disease. We conducted a cross-sectional survey, a total of 268 patients with Parkinson's disease were investigated by the Post-Traumatic Growth Inventory, the Positive Psychological Capital Questionnaire and the Mishel Uncertainty in Illness Scale - Adults from November 2021 to June 2022 in the Parkinson's specialist outpatient department of three 3a-grade hospitals in Tianjin, China. The results showed that the score of post-traumatic growth was (51.78±17.872), the score of uncertainty in illness was (68.08±17.555), and the score of self-efficacy, resilience, hope, and optimism dimensions of psychological capital were (28.93±10.511), (28.79±11.553), (27.57±8.558) and (25.35±9.768). Post-traumatic growth was negatively correlated with uncertainty in illness and positively correlated with all four dimensions of psychological capital (p < 0.01), and uncertainty in illness was negatively correlated with all four dimensions of psychological capital (p < 0.01). Bootstrap test showed that the direct effect of post-traumatic growth on uncertainty in illness of patients with Parkinson's disease was not significant; the total indirect effect of psychological capital between post-traumatic growth and uncertainty in illness was significant. The mediating effects of resilience and hope were significant, accounting for 53.07% and 19.41% of the total indirect effects, respectively. Based on the research results, psychological capital played a completely mediating role between post-traumatic growth and uncertainty in illness of patients with Parkinson's disease. Post-traumatic growth affected uncertainty in illness through two dimensions: resilience and hope. Healthcare professionals should pay attention to the level of psychological capital of patients with Parkinson's disease and implement targeted positive psychological interventions focusing on the two dimensions of resilience and hope, to enhance post-traumatic growth and reduce the level of uncertainty in illness.

What web-based information is available for people with Parkinson's disease interested in aquatic physiotherapy? A social listening study

Background

Aquatic physiotherapy is becoming a more frequently utilised treatment for people with Parkinson’s Disease (PD). Consumers are increasingly accessing information regarding health choices online, and it is not known what type or quality of information regarding aquatic physiotherapy is available.

Methods

Web-based platforms (Facebook™, Twitter™, YouTube™, Instagram™, blogs and the web) were searched using the Awario© social listening software. Webpages had to be in English, mention PD, aquatic physiotherapy and its effects. Quality of webpages was assessed using a modified DISCERN tool and content analysis summarised reported effects.

Results

Awario© identified 2992 entries, with 133 assessed using the modified DISCERN tool. A small number (n = 31, 24%) described the effects of aquatic physiotherapy for people with PD. Quality of webpages was low, with many lacking information regarding clear sources of information, contraindications to aquatic physiotherapy and descriptions of the therapeutic environment. Content analysis showed several themes; general physical, PD-specific and psychosocial effects. More than a third of webpages indicated that aquatic physiotherapy would improve strength, balance, pain and aid relaxation. A large number (n = 96, 72%) described at least one hydrodynamic or hydrostatic property of water, most commonly buoyancy (n-83, 62%).

Conclusions

Overall quality of information was poor, and it is recommended that webpages list all potential contraindications to aquatic physiotherapy and direct consumers to discuss potential participation with their healthcare professionals. Webpages also should include information regarding the therapeutic environment, disclose sources of information and focus on enablers to exercise to improve engagement of people with PD in aquatic physiotherapy.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12883-022-02669-3.